As I sat there, I knew something had to change. While I had done well on my shelf exams, and knew my stuff, my first NBME score was nowhere near the average for internal medicine. Worse yet, when I looked over my exam I realized that the mistakes I made were stupid and not even stuff I didn’t necessarily know. I asked myself howl I could avoid such mistakes. So, I went back to the drawing board and asked, “What exactly makes a good test taker?”
A good test taker has the ability to simply feel out the answer, and unfortunately I was not one of those gifted few (below-average MCAT, slightly above-average SAT). After some self-loathing, I said, “Okay great, how can I teach myself to do the same thing as the GREAT test takers?”
Conventional wisdom says that you do it by doing tons of questions under test conditions, but this doesn’t give you the feedback needed to teach your mind how to process those questions. The learning was simply too indirect, passive, and therefore inefficient.
So I figured if USMLE World was like the exam, then that would be the best way to get that type of training. I gave myself one minute per question (less than the 1 minute 15 seconds on the real thing) and did questions on tutor mode, reviewing after every 12 questions. This allowed me to record my own thought process as I went through a question. I could now see it (Oh, it’s a diagnosis question), analyze it (Oh, it must be Cystic Fibrosis), then get immediate feedback on whether my thought process was correct (Wait, it’s Hirshprung’s? WTF mate?).
Then in a few minutes, I could look back and ask myself the most important question: What could I have known that would have made me get this question correct? (Babies with Hirshprung’s get explosive diarrhea after a DRE, but not with Cystic Fibrosis). You see, unlike reading, you will find that there are details in questions that lead to an answer that really can’t be studied in a book. It goes beyond buzz words but is really a confluence of things, or even lack of things, that directs you more towards one answer than another. After analyzing your own thinking over 2100 times you’ll find that you have now developed the sixth sense “test takers” are born with.
The beautiful thing is that because UWorld tends to ask multiple questions on high-yield topics you, will be able to find mistakes in your thinking and then correct them on subsequent questions within the same section, solidifying that though process. As you continue through, you’ll learn what it “feels” like to know the right answer, be unsure of it, or have no idea (since you get immediate feedback on that feeling through tutor mode), and it will save you tons of time on the test because you’ll know when a question is worth coming back to vs. simply answering it and moving on.
The USMLE loves to take out a few common symptoms and throw in a few weird ones just to mess with you on exam day, but once you’ve developed a sixth sense for this, your mind will be hard to trick. Before you even look at the answers, you’ll “feel” it, even though it’s not exactly how you remember it’s probably this disease/treatment/work-up. You won’t know why, but it’s secretly your subconscious saying, “Hey Buddy, I’ve seen this like five times in the past eight weeks, it’s this answer, now move on!”
This brings me to the next point regarding the practice exams: confidence. A minute and fifteen seconds simply isn’t enough time to be 100% sure of your answers, and therefore, as Obi Wan said to Luke (Star Wars reference), you need to learn to trust your feelings. You see, we all have this dormant super computer lying around in our minds called our subconscious. It knows how to interpret traffic lights and pedestrians while driving at high speeds in less than a second, so that you can drive safely. It can read micro-expressions, vocal tonality, and posture to make split-second decisions about people. It even knows how to initiate complex physical movements like Zumba, all without your conscious mind even realizing it.
Your subconscious knows things you never even thought you knew in the first place. There is a famous story in which a soldier in charge of radar detection once blew an enemy missile out of the sky before it could reach a U.S. ship, even though it looked exactly the same as friendly jets. When asked why, he said he just “felt” like it was wrong. It turned out he had unconsciously learned how to read the difference on radar, even though no one had taught him — no one even knew how to do the same thing. Your subconscious learns though repetition; constantly analyzing the world around you then spitting back what it learned through emotions, gut feelings, that your conscious mind can feel.
What we are doing here is taking that process to the conscious forefront. Instead of going through tens of thousands of questions to develop this sense, we are doing it consciously and cutting down our learning curve. Just like it took our soldier thousands of hours to realize the difference between friendly and enemy vessels on radar subconsciously, it could likely have been taught to him in less than an hour. Learning sub-consciously is simply inefficient.
So how do you test that you are learning correctly? Well, first, by getting more questions correct within the same section in UWorld, but most assuredly by taking NBMEs in nine hour timed conditions. These aren’t for learning, they are for testing. You’ll be going into these assuming you are awesome, everything you “feel” is correct, and that this test is no match for the now well-trained super computer in your head.
The first time I did this, it was literally just as an experiment, and I got the highest NBME score I’d ever gotten and from there rarely decreased. This will also get your brain ready for the grueling nine hours of exam that is ahead of you. You want to do this at least three but even four to five times before the real thing. This is both to track your progress and get you ready for the mental marathon that is the USMLE Step 2 CK.
- Do USMLE World on tutor by section, allowing no more than one minute per question.
- Once done with a question, look at the answer and briefly (like literally half a second) make a mental note of if your thinking was correct or not by seeing if you got the right or wrong answer.
- After 10 – 15 questions, review the question and ask yourself, “What could I have known about this question that would have made me get it correct?” and then make sure to highlight it.
- Take 3 – 5 nine hour exams ending in a full length NBME or UWorld assessment, to build mental stamina and ensure you are developing a correct sixth sense.
- Always go into the exam with the confidence of Khal Drogo (Game of Thrones reference) before a battle — you need to go in KNOWING that your feelings are correct and you are going to conquer this test.
While I joke a lot, this secret improved my score by 40 points and kept it there until the exam. This is the reason why correlation studies say that doing tons of questions improves your score (you’re building a subconscious sixth sense), but here we are doing it consciously which is both more time efficient and effective. Congratulations, you can now be one of those annoying test-taker who just always seems to know the answer. Go forth and annoy the world, or at least do well on your USMLE Step 2 Clinical Knowledge exam.