Preparing for the USMLEs is like running a marathon. The last two weeks are the final sprint. Your preparations may have started months, or even years ago. If test-day is fast approaching, you might be thinking: what’s the point? However, many things can boost your final score and prevent test-day disappointment.
Feb 15, 2017 Forums Medical USMLE Step 2 CK. NBME 6 Questions and Answers. Discussion in 'USMLE Step 2 CK' started by orthopod, May 24, 2015. I'm about 4 days out from my Step 2 and I just took NBME 6 as my last practice test. If you can get the answers up, that would be great. Haloperidol decanoate is the injection form. Cant give this patient any.
But how can you maximize your limited time? With 1-2 weeks to go your goal should be to fine-tune your approach to the actual USMLE. In this article, you’ll learn how to:
To that end, here are seven suggestions:
We all have our goal score. Mine was 260. For others, it might be 240, 200, or a “pass.”
The beauty of the USMLEs is that the only requirement is that you pass. Your goal score will depend on your self-assessment, your temperament, and your career goals.
The best score predictors are the NBME (National Board of Medical Examiners) Self-Assessments. The NBME has correlated each form with students’ final scores. As such, the NBME Self-Assessments are the most accurate predictors of your final USMLE score.
(To read NBME Self Assessments: Ultimate Guide for the USMLEs and Shelf Exams, click here).
Note: I do NOT recommend using the bootlegged copies floating around online. Even though the NBME Self-Assessments are not perfect, the most valuable thing about these exams is their predictive value. Each NBME form has its own unique “curve.” (E.g., eight questions wrong on one test may predict a 250 3-digit score. On another NBME, eight wrong may predict a different score).
To my knowledge, no bootlegged copy has reproduced each NBME form’s unique curve. I have no idea how the bootlegged score predictor works. Use it at your peril.
What if your goal score is 240, but you score a 200? Be realistic and ask yourself three questions:
The answers to these questions are highly personal. I cannot answer them for you.
But how long should you delay? To answer this, consider: will delaying force you to push back your graduation by a year?
(To read Are You Ready to Take Your USMLE or Need More Time?, click here).
For me, I would have taken the test if my predicted score was above 250. I might have pushed back my test date had I scored significantly below that.
At the time of Step 1, I was planning to apply to internal medicine. I didn’t need a killer score. As such, I probably wouldn’t have pushed back my graduation to score a 240.
If I had wanted to match in a super competitive field like dermatology? Different story.
(To read Get Into a Top Residency: 5 Things You Need to Know, click here).
Most people’s scores are not EXACTLY like their most recent NBME. However, most are in the ballpark, particularly for Step 1. It is rare to see someone score substantially higher (or lower) than their most recent NBME. Lightkey ipad. NBMEs within a week or two of the final test are most predictive.
There is no shame in preparing to take the test until you’re ready. More than 1/3 of my Stanford class delayed taking their exam. Some Stanford students even spend several extra months studying. They spent the rest of their extra year doing research/other things to help improve their residency applications.
You only get one shot at this exam. Put your best foot forward.
The USMLE Step 1 has 7 blocks total. Each block is 1 hour. Thus, with 1 hour of break/instruction time, the total test will take 8 hours. (Step 2 CK has 8 question blocks/1 hour of breaks. The total time is 9 hours!).
You likely have never taken such an extended test before. Fatigue can be a significant issue, particularly in the last couple of blocks.
To simulate this 8-hour gruel, I took 2 full-length practice tests. One of these practice tests was back-to-back UWorld Self-Assessments (UWSA). Each UWSA is 4 blocks. Thus, two UWSAs back-to-back is one block extra than the real exam.
Why was my practice test was even longer than the real thing? I wanted to train myself to answer questions beyond 7 blocks. The additional practice block helped me when the fatigue hit on the actual test day.
Want to practice for the real exam AND predict your final score? Then consider taking an NBME right after a UWSA exam.
In the experience of many, UWSAs tend to overestimate your score. But why would you want to take the NBME after the UWSA? Won’t you be so exhausted that your NBME will be artificially low?
Yes! The point is to give you some margin-of-safety. If you take an NBME after a 4-block exam, it is more likely to underestimate your score rather than overestimate it due to fatigue. Tell me: would you rather be pleasantly or unpleasantly surprised by your final score?
Your practice exam(s) may look like this:
Or if you want extra practice:
7 blocks (8 blocks for Step 2 CK) is a lot of questions. It doesn’t help that we’re conditioned to feel like the USMLEs have do-or-die stakes. (Remember: it’s just a test! Take several deep breaths).
Practice a full-length test once or twice before the real exam. That final block on test day will be much more doable.
You (and your classmates) probably feel like this right now:
How most med students feel before their USMLE
Your goal should be to walk into the exam like this:
How you will feel after completing the steps in this article
But how to ensure test-taking nirvana? Re-create as many of the conditions as possible for the real exam.
Things you should practice:
Familiarity breeds calm. Do a complete dry run before your test to work out any last kinks.
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To repeat: familiarity breeds calm. What better way to ensure familiarity than taking a practice exam at the place your real test will be?
You want to know how to:
If you’re like most, you will already be pretty nervous for your exam. Stress from things you didn’t expect can affect your concentration and test-day performance.
Demystifying your test-day experience helps you be calmer when it matters most.
Note: as of this writing, the practice exam at the Prometric test center is only 3 blocks (120 questions) total. You can get the same questions for free. (These are known as the “Free 120” released by the USMLE). Translation: you may NOT be seeing new information. That’s not the point. Instead, use your practice session to get familiar with the test center layout and procedures.
Click here to schedule your practice exam at the Prometric test site.
There is no substitute for practice. Try to do as many questions as possible. (At least 100-150/day). I recommend:
Approach each item as if it were the real thing. I highly recommend using UWorld questions, since they best approximate the real thing.
(Read UWorld: Is Your Strategy Wrong? (I Scored 270 By Ignoring The Dogma), click here).
You have up to 60 minutes of break time on Step 1 and Step 2 CK. Having a plan for your break time will help you feel calmer. You also don’t want to waste precious energy stressing about when/how long to take a break.
First of all, skip the introductory tutorial. (You can take 30 seconds to check that your headset audio is working).
Why skip the instructions? Because if you skip the instructions, you can add the 15 minutes allotted for them to your 45 minutes of break time. Translation: instead of 45 minutes, you’ll have a total of 60 minutes for breaks. (That essentially adds 1/3 to your break time).
Note on breaks: At the end of each block, you can choose to move on to the next section or take a break. Important: you need to click on “Break” if you choose to take a break. If you choose nothing, it will choose to start your break time automatically. (This is to prevent you from missing an entire section because you forgot to click on “Break”).
First, how much break time do you get? Both Step 1 and Step 2 CK give you 45 minutes of break time.
“But wait, I thought I get an hour!”
Yes! That is true. However, it comes because there is a 15-minute computer-based orientation at the beginning of each exam. If you SKIP the orientation (preferably after you’ve spent 30 seconds checking your headphones to make sure there isn’t a problem), you’ll get the 15 minutes added to your break time.
Now, how would I recommend you use your break time on your exam?
Here is my Step 1 break time strategy (note there are 7 blocks of Step 1 questions):
And here is my Step 2 CK break time strategy (note there are 8 blocks of questions):
This is based on the observation from both myself and others that your attention will be much stronger in the beginning, and doing two blocks back-to-back is not much of a challenge. However, as you move on, it becomes increasingly difficult to go over questions without a break in-between.
If you feel like you need a break early on, but don’t have one scheduled, you can give yourself a short, 2-3 minute “sit-down” break, by sitting at your computer and starting a break, but without taking the time to check out and in again.
No test-taker feels 100% on every subject. You will have strengths and weaknesses.
Some people prefer passive learning. (E.g., listening to Goljan, watching Pathoma/Doctors in Training, etc.). These aren’t very useful, period. However, passive learning is even worse in the weeks leading up to your exam.
Why? Because the NBME writes questions that will force you to use knowledge. Cramming and memorizing are next to worthless if you want to improve your score.
(To read How Are USMLE Questions Written? 9 Open Secrets for Impressive Boards Scores, click here).
Instead, focus on active methods for testing yourself. These include:
No matter how well you prepare, something unexpected will happen. You might:
Embrace the unexpected. That’s part of the fun of test day. You’ve done your best to prepare. However, there will always be some little wrinkle that throws you for a loop. There’s even evidence suggesting how we think about stress affects whether it negatively affects our health.
Even if you’re lucky and everything goes according to plan, you will see questions you’ve never seen before. You won’t have seen them from a lecture, your QBanks, or your NBME practice exams.
These “WTF” questions test your ability to reason and apply your knowledge. They do NOT test your ability to memorize.
I have the utmost respect for the NBME question-writers who make the USMLEs. They’re not stupid. They read the same resources we do. The NBME is excellent at making questions that we haven’t seen. They even have ways of identifying when students share answers with their friends.
Remember, 50% of all of the pathology questions are designed to be “General Principle” questions. (According to a USMLE Step 1 question-writer I spoke with). So when you ask yourself, “WHAT?? I DIDN’T KNOW THAT I NEEDED TO KNOW THE CAUSES OF HEART DISEASE IN GAMBIAN RATS!” Remember that you WEREN’T supposed to know the specific knowledge. So take a step back, and figure out what principle they want you to apply.
If you’re wondering what to do 1-2 weeks before your exam, congratulations! You’re 1-2 weeks away from one of the best feelings in medical school: finishing your USMLE!
And if you decide to push back your test, don’t despair! The best anxiety-reliever is knowing you did your best to prepare. If it takes several weeks, or even months to reach that point, it’s worth it.
Either way, getting to this point takes immense work. You deserve a huge congratulations!
Finishing a USMLE is one of the greatest feelings in med school.
What do you think? This list is by no means exhaustive. Please share in the comments section other tips/advice you’ve heard from others/have used yourself!
Photos by: Bernard Goldbach, jessicahtam, Ian Stauffer, Andreas Fidler
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