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Dr. David Delnegro MST USMLE Tutor

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  • in reply to: Randomized vs Subject-Specific UWorld Questions #347

    Agree here! Doing them by system especially early lets you see the little nuances in pathology that aren’t apparent if you only see a cardiology question every 10 or so questions. Later on, you shift gears and want to be able to switch between different topics and subjects like the real deal, so mixed makes sense!

    in reply to: What Does Step 1 Being Pass/Fail Mean for Me? #327

    To piggyback off the prior posts, in some ways this is a good thing because some clinically unimportant details (sorry esoterics) will become traded for stuff that will determine your ability to manage patients. If you’re looking for a pass versus an actual number, you’ll focus on what’s truly clinically important because CK will be the end goal, and CK looks more like real life.

    in reply to: What if I'm completely stumped by a question? #309

    Here to echo a little bit of Sana’s thinking. STEP 1 is a longgg exam, with 280 or so questions. Don’t let yourself die on the hill for one question you are likely to not get right in any universe.

    For example, a friend once got a question on how to treat a jellyfish sting. Nowhere in class nor a book did he know that answer. Was it saline? Cold tap water? Hot tap water? Urine?

    He simply tried to narrow it down to the ones he knew it wasn’t (the old wives tail of peeing on a sting is certainly not the right answer and tried to improve his odds from 20% to 33%. Over an exam with 280 questions, saving your time for others while trying to at least improve your odds with a quick ‘process of elimination’ pass can help you pick up a couple of points here and there. More importantly, it will prevent you from falling into a quicksand for a question you just don’t know.

    in reply to: Histology on Step 1 #308

    A great way to look at it. Everyone is always so afraid of histology and pathology because the wide world of things under the microscope are just that, seemingly endless. However, the world of high-yield histology is very small and limited and as you do practice exams and finish uworld and other question bqnks you shall see exactly what is high yield in these subjects.

    If it’s important, it’ll 1) likely be in pathoma and 2) show up multiple times in uworld and nbme exams.

    in reply to: How will COVID-19 affect USMLE testing? #306

    To follow up on that last post, the USMLE has indeed move forward with their plans for medical schools to host regional exams. For example, the State of Florida may take their exam at the University of South Florida in Tampa. There’s also plans for a Midwestern, northeastern, and other regional sites.

    This dynamic is ongoing and changing so check the USMLE website for the latest information about regional testing centers.

    in reply to: Studying for Step III in Residency #302

    Some great points here! Residency invariably has harder and easier rotations. Talk to your upperclassmen and see when they found time to study and to take it.

    For example, during my emergency medicine intern year I found a bunch of time during anesthesia to knock out studying and at the end just took the exam.

    Ditto for not doing back to back. If you passed Step 1 and 2 comfortably (and I mean comfortably as in distance from 192, not “I only got a 235”) then you can do a Friday Monday or something similar to give your brain a rest. If you were borderline passing, then you may actually need to spread the days out a little further in order to study for CCS and Day 2 material.

    in reply to: NBMEs vs. UWSAs #275

    Just to add on to that excellent responses, I normally tell students to schedule nbmes and UWSAs backwards from your test date. Meaning you’ll want to take the gold standard three (UWSA 1/2) and NBME 18 as your last three in the last 2-3 weeks, kinda like Dan mentioned. This will let you get the best data points when you’re the best prepared.

    Further out you can get more creative. If your study plan is longer than the standard 6-7 weeks, I’ll typically say to start with the Kaplan Diagnostic Test so you get some good practice without wasting one of the big gun exams.

    in reply to: How Do I Use UWorld? #266

    I typically tell students to approach studying in an n+1 approach. In the evening, review the notes you made today and the notes from yesterday. What you understand you can leave be moving forward. So, for your first day of GI you would review that material alongside your notes for the last day of endo. What you understand, move on. However, if you still have an unresolved endo weakness, spend a few minutes approaching it and add it to the next days queue as well. Often a new resource or different angle will help it fit a little better this time around.

    Rinse and repeat.

    And reach out to us so that we can help you put together a schedule and help you 🙂

    in reply to: What are good remedies to avoid exam fatigue? #253

    I always say prepare for the worst times in the best times. Awfully hard to make more lifeboats when you are sinking in the middle of the North Atlantic, and whatnot.

    Write your study schedule as if you will be 70% efficient every day. That gives you plenty of wiggles if you get sick or burned out. Falling behind is the worst.

    Also, look at mental health and wellness and set goals for it like you would UWorld Questions. 8 hours of sleep, 30 minutes a day of exercise, natural light in the morning, etc.

    Test-taking is similar to a sport, and you are similar to an athlete. OVertraining can hurt you with Step just like sports. Look at this incredible ESPN expose on Chess Champ Magnus Carlsen and his training routine:

    in reply to: How do I prepare for Step 2 CS? #252

    Don’t leave the encounter before the 5-minute warning either! You don’t need the entire time for the interview, but a friend of mine who was very smart ended up having to retake the exam and he was told that leaving too early were auto-fails for that station.

    CS is weird…

    in reply to: USMLE Step 1 Pass/Fail Decision #245

    The obvious answer is how would schools know that you took that gap year to slide into the new system? You could easily give a number of answers to why you took a gap here, and because it is so common, not a soul blink twice.

    That being said, Step 2 CK is still scored so there’s still an inherent risk involved. One of the best parts about step one being scored is that you had an opportunity on CK to improve on it.

    My best advice to use to gather lots of opinions. However, personally I would say to not use this change as the sole or major reason for taking or not taking a gap year.

    in reply to: How does Step 2 compare with Step 1? #228

    A good question! I will expand on that in a different post, but the short answer is that First Aid takes a diminished role (in my opinion) for Step 2 CK. Every pass through the material means you should be moving from a higher proportion of passive studying to a higher proportion of active studying.

    The first pass (preclinical class) and even the second pass (Step 1) require lots of First Aid typically because so many of the concepts are brand new. The third pass (shelf studying) requires some review to see the algorithms again, but by the fourth pass (CK studying) you should move First Aid from a primary to a secondary resource to look through as needed because you should be cranking through questions at this point.

    in reply to: I just took Step 1, and I think it went horribly…now what? #227

    If there is one that I have learned in years of boards and helping others slay them, it is that your perceived self-efficacy taking board exams have almost no correlation with your actual score.

    I always tell my students to not count questions because you are not going to do anything useful with the information even if it is accurate.

    Enjoy your vacation and eat lots of ice cream!

    in reply to: How can I best practice self-care? #226

    Love all of this! I think Mental Health and Wellness should have goals like everything else. It helps keeps you accountable.

    I usually tell students to try and sleep 8.5 hours per day on dedicated (seriously, you have the time even if it doesn’t feel like it). To try and exercise 30 minutes per day (averaged over 7 days) and to always get yourself out of the bubble of medical school.

    Test-taking is like every other sport. Look at this amazing ESPN expose of the workout routines of Chest Champion Magnus Carlsen for proof.

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