Improving on a weak subject

As part of your preparation for any USMLE exam, you should have a good strategy to increase your potential by preparing your weaker subjects and making them as strong as your favorite topic. Many students have made the same question how do I make a strong topic from a weak one, this week we will give some helpful tips to increase your strength in difficult or weak areas.

Identify your weaknesses.

Everyone has a topic they don’t know much about or don’t like at all, that’s ok. We all have strengths and weaknesses in our preparation, to identify your own weaknesses there are three ways to know for sure you are not doing as good as you think.

1-Pick the topics you really dislike, surely enough you have a couple subjects you don’t like or even hate, from the list that is relevant to each exam. Take note of those subjects you didn’t like to study most commonly these are the subjects that you are weak in your preparation.

2-Look for the really hard topics, try and think the subjects you find the most complicated or the ones you always keep forgetting, these will be part of your weak spots.

3-Compare the topics included for the exam with your own preparation, some schools make more emphasis in some subjects while leave others in a relative low level, you should select from the list of subjects the ones that your school didn’t cover or did poorly. For IMGs generally medical genetics, behavioral sciences, ethics are different from the U.S. schools. Also EKG and microscopic images are not easy to remember.

Once you have identified your weak subjects, make a list of them and keep it in some of your review books, you will need to take some out after our next steps.

Make sure they are relevant.

Surely we have topics that are not our strong side, like for me its oncology, it keeps changing and it’s hard for me, specially the pharmacology. Once you have a list of your relative weak topics it’s important to find how relevant they are for the exam. If they are not high yield topics you should not include them in your list. Some hard topics include only 2 or 3 questions, if this is the case you should leave them at the end of the list. 

Now you have a list of your weak topics and their priority in order. Next up find out if they really are your weaknesses.

Take focused question banks.

To be sure that you need more effort in some areas you should test them against a set of questions to see how good /bad you’re doing. There’s no point in assuming you are doing bad, you should confirm with a focused set of questions banks, as you go through those questions you will know firsthand if the questions make sense or not if you know what they are about or if it sounds totally new.

Take a 50 question test with a subject you think is one of your weaknesses, a score lower than half before studying should tell you there’s one that needs improving. Also it should be high yield to be important keep that in mind.

 Now your list is more real and priorities are in order, the next step will be to make a schedule taking into account what you know now.

Start from the lowest.

Everyone should make their own schedule and program the order of material to cover accordingly, even when courses, guides and reviews have their own order for the material of any step, you should make your own starting from your weakest topic to the one you can handle more easily, after all for the last part you may be a little exhausted.

If a topic results to be hard but is low yield leave it for the end, you should make the highest yield topics your priority, also in order from the weakest to the strongest, this way you will improve all around in every subject.

Remember to take into account images, charts, formulas, microscopy, diagrams and all sort of imaging that may be used for questions, it’s very important to know them by heart also you may find many questions using images just to confuse or distract from the real question, the only way to improve is by training against question banks.

Finish with a review.

After you finish your studying for each topic you should end it with a quick review. Other than morning reviews which we also advice to take every morning, you should perform at least a half day quick review of all the material for a given topic. Remember that it’s not just about remembering facts but understanding them as well, many questions will play with concepts to try and confuse and only by having clear concepts and not just knowing a list of details will let you answer correctly. So in your reviews you should be able to explain by yourself a given concept or a cycle, physiologic function etc.

We hope that these tips will be helpful to your preparation. If you have any questions or comments leave them below, and don’t forget to check our tutoring guides at www.usmleprepguide.com for a complete and detailed subject by subject guide for your preparation.

Usmle step 1 study tips

The first exam in the series is always the most extensive to prepare, even a marathon needs some strategy so with that in mind here’s a list of tips to make your preparation easier:

1- Pick a date.

Things just got serious, when you pick a date for your exam even if it’s not definitive (but still within your eligibility period, preferably pick your date at the start of your eligibility period) will get you in the “it’s on” attitude, picking a date and sticking to it will make you more focused and will give you an idea of how much you have to cover and the effort it will need.

It’s not masochism, instead think of it as a way to make you aware of the volume of material ahead; psychologically this will give you the right kind of pressure to start working towards your goal. So go ahead and give it a date, try to stick to it for your preparation but remember to be flexible if needed.

2-Make a Schedule.

First thing about making a schedule, be real. Adjust a studying schedule that will work for you, don’t try to imitate other people, some may need more time, others may need less. Only you know how much time and how many effective hours a day you can study. Also remember to think about you own way to prepare, if you use flashcards, music etc. adapt to prepare at your own habits.

Once you have a schedule that works for you, stick to it and be strict about following your own schedule. No one is going to be pushing you to study. You must have your goals clear all the time if needed place a post it somewhere visible to remind you why you are doing all of this.

3-Follow a guide.

Either you make a guide or follow a study guide, having a set course for your studies will make your studies more focused on the important facts and topics, don’t forget to also take into account your strong and weak topics to improve your performance.

Following a study guide or having a personal tutor will help you by taking advantage of others experience, for more on tutoring take a look to our blog USMLE tutoring: http://usmleprepguide.blogspot.com/2014/09/usmle-tutoring.html

 

4-Use question banks.

Question banks are by far one of the best ways to improve your preparation, having a constant test of your retention and developing the kind of logic needed for most questions is as important as memorizing important facts and the only way to develop your answering skills is to keep practicing.

As part of your preparation you should include questioning sessions during your schedule, don’t leave it for last, start as soon as you can, often you will find information in the explanations that will help you understand better a topic. 

You can find more about question banks and USMLE preparation in our blog about question banks, http://usmleprepguide.blogspot.com/2014/11/usmle-question-banks.html

 

5-Make your notes.

Notice I didn’t say take your notes, which means you should take important information and write it down in your own words, preferably as side notes in your review book, but also you can make a full review of a topic with your own words.

When taking quick reviews having information in your own way will make it easier to remember and to keep for the exam. Also don’t forget to relate important information from one topic to the other, in the case of pathologies and metabolic pathways for example.

6-Make morning reviews.

Every morning you should make a quick review of what you studied the day before, this will increase your retention and will let you find the things you miss or have already forgotten, also sometimes helps you understand better a topic.

Your reviews should be quick don’t take more than an hour; having your own notes will make this process quicker. 

7-Take your time.

This is important, take your time, this is not a sprint is a marathon, you should prepare as such. Don’t try to make things faster there is a right amount of time to prepare for each person and only you will know how much is enough, for step 1 people suggest to take 8 months for preparation that is a suggestion, you should take as long as you need, take off the pressure of fitting into someone else´s time frame, less time or more time doesn’t make a difference in your score, the really important part is to make a conscious preparation not to make it faster.

For more on time and your preparation take a look at our blog “when to take a step “ there are some good tips there too, http://usmleprepguide.blogspot.com/2014/10/when-to-take-step.html

 

Hopefully this tips will help you during your preparation, for more about our study guides check out our website at www.usmleprepguide.com , as always if you have more tips or any comments leave them below.

Step 2 CS hints… part 2.

There are lots of anxious candidates when it comes to step 2 clinical skills exam, but in reality it is the easiest of the series it only takes some preparation both in practice as well as knowing what the exam is about, if you’re planning on taking the exam soon take a look at our second part of step 2 cs hints,

Chief complaint.

This is by far the most important part of the doorway information, it will help you make an oriented interview and also to start the conversation, so when you enter each room you can introduce yourself and ask directly about the sp patient chief complaint, from there it’s pretty much downhill asking about different symptoms, finding possible signs and exhausting your questions for a syndromic diagnosis.

The chief complaint will give you the possible differentials; helps you ask oriented questions while you prepare a case in your mind, one thing you have to keep in mind is to keep all information in a coherent chronological order, that means that you should write down information so you don’t forget including their time of appearance, sometimes we find information about the case like appearance of symptoms, rash etc. in disorder, you can put them in order later while writing your patient note.

Ros

During your interviews with an sp (simulated patient), making a quick review of organs and systems may be a way to discover other symptoms not detailed or oriented during the chief complaint or your initial interview, it’s better to make the ROS after you have exhausted your questions about their chief complain, it’s not about detailing all  possible symptoms but to ask for example about headaches in a patient with abdominal pain, the idea is to discover other possible leads that may change your diagnosis.

Even when it doesn’t feel natural to ask about other organs and systems, it’s important to ask a lot and since it’s an evaluation of your questioning skills you should ask all you can about possible signs and symptoms, even if it feels uncomfortable to ask that much remember that is part of the evaluation, your skill to investigate in detail a patient story.

Ask for relevant familiar history.

Familiar history should be asked briefly a couple questions and you should be fine, for what is relevant depends on what you think your patient might have, there is always hereditary predisposition for cancer mainly breast, prostate and colon, heart disease, colon diseases, chronic conditions like diabetes and hypertension should also be asked, as for psychiatric conditions bipolar disorder and schizophrenia have familiar predisposition.

Don’t beat yourself up with knowing all familiar predispositions a couple relevant to your differentials will be good enough. For the patient note you may text 2 or 3 lines of relevant familiar findings, including negative findings.

Hand washing or gloves,

Many students question whether to use gloves or use the sink, for me I think it’s better to wash your hands, the reason being that when you turn yourself away from the patient you have a little time to think about questions that may help your note, details you may have missed or time to think about the physical you are going to make.

Using gloves you must maintain conversation and keep eye contact, hand washing gives you a little more time to think. Try yourself and choose the one that feels more comfortable after all that is more important to make your interviews easier.

Relax!!!

This is really important, you must be comfortable with the situation, feel at home, think of it as another day at the office, after all this is what you will be doing the rest of your productive life, so take it as another day, don’t pressure yourself thinking about anything but the patient behind each door, it’s not really useful to think about your last patient or what cases could be lurking ahead, just focus on one case at a time and relax.

 

Thanks to all for taking time to read our blog, it’s great for us to help in any way we can, for a detailed and complete guide for your clinical skills exam check our guide at www.usmleprepguide.com , if you have any comments leave them at the bottom.

Patients and nutrition.

While preparing for your exams it’s good to keep in mind what your role will be in the not so far future, that being the person in charge of healing and recovery for delicate patients, no matter the specialty or age of your patients this will be your responsibility.

Up to 40 per cent of those admitted to hospital are underweight (Audit Commission, 2001) and many lose weight while in hospital. It is estimated that up to 60 per cent of hospital patients are clinically malnourished (Malnutrition Advisory Group, 2003).

The nutrition part of a patient as part of an integral approach for their recovery is a topic always overlooked while in the rounds, you focus more on treatment, lab results etc. and rarely take the time to think about your patients nutrition, this is something I always thought the best attendants had, a mind on the details, after all there is a good chance that an improved diet can help those in bed to recover faster.

Of course there is personnel attending nutrition for inpatients but as the person in charge of each one of the patients in your guard you should also have a saying in what they should be eating, absolutely no one likes boiled chicken and tasteless gelatin.

Thinking of nutrition as part of an integral therapy, it’s important to remember the requirements to improve granulation, scar formation, boost immune response, blood cell count, collagen formation etc. and use this knowledge to improve the patients nutrition, patients in recovery should have more fresh vegetables, fruits and nuts and in a greater variety to meet those requirements.

This is where you should aim your nutritional advice to increase nutrients available for a fast recovery, to make all possible requirements fulfilled during their treatment; this also means to improve overall nutrition while under your care. Of course nutrition is a topic both complicated and controversial for some institutions but that shouldn’t stop you from using your own logic to improve the patient’s nutrition while under your care, this means using all available information to improve a patient’s condition, using fresh food to meet the requirements without doing controversial practices.

Multivitamins, cold press juices, salads, fruit and nut snacks are all practices that should improve the available nutrients as well as quality proteins when available, use the patients family to help if necessary, the important part of this advice is that as future attendants you should keep in mind that there is a need to improve the nutrition of a patient while under your care that also can be reflected on the recovery process.

Thanks again for taking your time to read our posts, as always we invite you to visit us at www.usmleprepguide.com and check out our tutoring guides for the USMLE series, also if you have any comments please leave them at the bottom,

Patient Education.

One of my old time sayings (both to students and to myself) has always been “an educated patient is the best kind of patient” for my practice this has been a big revelation, when people understand what they have their treatment goes great, they are more compliant with treatment even if it takes a long  time or a really complicated schedule, their time for recovery is less than other patients and they seem to be more aware of their own behavior if that is the cause of their disease (diabetes makes a  good example).

Of course the time in each consultation increases but as I have seen only for first time patients, the follow ups are easy and fast, and at the beginning of this idea I also doubted it because it involved me talking more and taking more time with each patient on an already busy day, with time it balances itself, when you have quick follow ups you recover the time invested and so on, this way I’m having almost the same amount of time in my office as before, the real difference is my relation with patients and a better outcome.

What I also discovered is that by explaining all you can, you develop a different relation with your patients their attitude towards you is better; you find them more open to discuss their behavior and trusting more your opinion. Each day is better and also I find it easier to get along with patients while feeling more satisfied with my work.

When you think about the best way to make a patient compliant with their treatment, a way to make them more involved in their healing process and a way to improve trust issues within a doctor-patient relation one of the best ways to go is patient education and there is something more here, people really want to know what they have so they are really listening when they step into your office.

Explain them in their own words.

One of the first thing to have in mind is that normal people doesn’t really understand medical terms, even if they have an idea of what something means it might be the case that they have some other meaning for it so it’s important to explain what they have in the most simple terms you can find.

Try and use analogies, sometimes people understand better a concept when you use some other concept that helps get the idea more comprehensive, like explaining circulatory problems with faucets or plumbing, the idea is to make a patient more comfortable with a concept and make them understand their disease. Once a patient understands his/her disease explain them their options as well with details of how they work and what you expect as outcome for each line of treatment.

Also important is to explain anatomical parts in a way they can really understand. Again using analogies or models can help them understand pathology.

Check for comprehension.

Something important to keep in mind is to ask your patient about what you just explained them, try and ask them if they understood your explanation and see if they have the proper idea for that concept, sometimes it happens that patients understand things differently and you need to make another explanation or clarify their misunderstandings.

Ask them for doubts, sometimes people don’t ask because of what you might think of them, you have to give patients a level of confidence to make them trust you with their own ideas and opinions, you will be surprised to see how many patients don’t get it and still remain silent, check always for comprehension and any type of doubts, especially for treatment it’s really important to have a clear communication.

Helps them make informed decisions.

A patient that understand better a condition and his/her options for treatment can make a better decision and become more compliant with the treatment he/she decided, this is something that is more common in chronic diseases and long term treatments, and it is quite logical that you make better decisions about something you understand that say ordering in a foreign language.

People need to be informed to understand what you are doing with them, also important to keep a clear idea of what the treatment is going to do, what each medicine does, how do they work, and especially for procedures what you are going to do, how, if it hurts, why is important to make it etc.

Don’t trust me try it yourself.

All in all the strategy can help your patient outcomes if you try it, at first it may be a little hard since you have to think of how to explain each disease and treatment with practice it becomes really natural for you to explain your patients what they have, what you will be doing for them, what the results will be, and how long will it take, using images or models can increase comprehension and save you some time, but as any other part of your practice it doesn’t work if you don’t try it, you will see the results and then decide if you keep it or continue in antoher direction.

Also look for aids to help you teach your patients currently there are a lot of online services for patient education, AMA has some resources you can check http://www.ama-assn.org/ama/pub/physician-resources/patient-education-materials/atlas-of-human-body.page but also there are other companies dedicated to patient education you can check to help you increase your quality of service and reduce the chance of misunderstandings with your patients.

Again let me thank you for reading our blog and don’t forget to check our website www.usmleprepguide.com if you have any comments leave them below.