Tips while using USMLE world

USMLE World, for those of you who are new to the field of USMLE is a MUST HAVE during the preparation of your Steps for United States Medical Licensing Exam (USMLE).

A few tips I thought that might be useful for people who start using it for the first time.

Use the timed mode and NOT the untimed or tutor mode, since you are using the Q bank as a test prep material not for a walk in the park. If you want to be sharp and score well you need to learn to pace yourself well in time. Time management is of paramount importance.

The next tip is not my own, but I had stumbled upon it during my search to learn how to use the Q bank effectively. I felt that since you have a time limit during each test, say for example in my case Step 1. The timer is set at 60.00 mins which thankfully starts counting downwards. This way you know how much time is remaining prior to the ending of the section. Now for those of you who are good with maths, you can ignore this tip, but I felt that if you started from the last question i.e. q no. 46 and worked your way to q no 1, you start to realise whether your time management is good. I mean to say at 60.00 mins I am at q no. 46; by 30 mins I should be at least halfway down the line which makes it roughly at about q no. 23. Not sure whether you agree with me on this but this tip helped me a lot. I didn’t have to worry about how many questions I had left since the number I am currently on, is the number of questions left.

The next one is marking. So for this let me tell you of a strategy. You should train your mind NOT TO PANIC and to read through questions quickly.

Divide your question reading techniques into 3 rounds.

·         In the first round read the entire section and try to answer questions which you sure off (recall types). Skip ones you have no clue about, don’t worry about them now.

·         In the 2nd round finish off those which you feel you know the answer but are not yet sure.

·         Finally in the last round do all the questions, regardless of whether you know them or not, since touch-wood the USMLE currently doesn’t have any negative marks so what have you to lose by selecting an answer.

Now marking is both a boon and a bane. I feel marking can be used when you feel you know the answer but don’t have time currently. I mean it should be left for those questions where you feel that if you could just spend a little more time you will be sure of the answer. Like say for example the capital of Karnataka is Bangalore. Sometimes people may get confused thinking about whether is it Bangalore or Mangalore, since both are similar sounding and that way waste precious time (PS: I know it is Bangalore, I am only giving an example here) So here you mark the question and later when you have finished ALL the questions in the 3 rounds that I mentioned earlier NOW you come back to the marked ones.

The tips till now are purely exam oriented.

Now for revision purposes in U world.

While studying the answer to a question, you feel that you will not remember this question without another look, mark them now while studying. Since there is an option in U world where you can do questions which are ONLY marked, which will be easier for you towards the end when you have a lot of time constraints. This was one thing which I dint do which cost me a lot I guess.

Regarding the studying aspect, have already covered that in the Step 1 experiences post.

Feel free to comment.

Immunization schedule comparison

This Immunization table is based on a comparison of the National Immunization Schedule and the one recommended by the Indian Academy of Pediatrics. This table was done during my final year MBBS course. Feel this should help those students who just need a quick comparison between the two.

Age	National Immunization Schedule (NIS)	Indian Academy of Pediatrics (IAP)
Birth	BCG OPV 0 Hep-B 0	BCG OPV 0 Hep-B 1
6 weeks	DPT 1 OPV 1 Hep-B 1	DPT 1 IPV 1 Hep-B 2
		Hib 1 Rotavirus 1 PCV 1
10 weeks	DPT 2 OPV 2 Hep-B 2	DPT 2 IPV 2
		Hib 2 Rotavirus 2 PCV 2
14 weeks	DPT 3 OPV 3 Hep-B 3	DPT 3 IPV 3
		Hib 3 Rotavirus 3 PCV 3
IAP: 6 months		OPV 1 Hep-B 3
9 completed months to 12 months	Measles + Vitamin A (1 lakh IU)	OPV 2 Measles
12 months		Hep-A 1
15 months		MMR 1
		Varicella 1 PCV booster
NIS: 16 to 24 months IAP: 16 to 18 months	DPT B1 OPV B1	DPT B1 IPV B1
		Hib B1
18 months		Hep-A 2
2 years		Typhoid 1
NIS: 5 to 6 years IAP: 4 ½ to  5 years	DT	DPT B2 OPV 3 MMR 2
		Varicella 2 Typhoid 2
NIS: 10 and at 16 years IAP: 10 to 12 years	TT	Tdap/Td HPV

DPT: DTwP/ DTaP (w= whole cell, a = acellular)

NOTE:

·         Egg allergic: Do not give Influenza and Yellow fever

·         BCG: Saline, Catch up may be given up to 5 years

·         Measles: Distilled Water

·         Hepatitis B - Any of the following schedules

o   Birth, 1, & 6 months

o   Birth, 6 and 14 weeks

·         Rotavirus

o   The maximum age for the first dose in the series is 14 weeks, 6 days; and SHOULD end by 8 months, 0 days for the final dose in the series. 

o   Vaccination should not be initiated for infants aged 15 weeks, 0 days or older.

o   S/E: Intussusception

·         Typhoid - Only Vi-PS (polysaccharide) vaccine is recommended

·         Varicella - The risk of breakthrough is lower if given 15 months onwards.

·         Measles

o   Catch up vaccination beyond 12 months should be MMR

o   Measles vaccine can be administered to infants aged 6 through 11 months during outbreaks.  These children should be revaccinated with 2 doses of Measles containing vaccines,  the first at ages 12 through 15 months at least 4 weeks after the previous dose, the second at ages 4 through 6 years

Link for the Comparison

Immunization comparison

USMLE Step 1 Preparation

This post is on my Step 1 preparation.

Time frame (3 months 10 days) 

Preparation started 1 November 

Exam 10^th February

This is not an ideal plan but this is for those people who like me are forced to cram up in order to face a deadline I feel this experience will be a post worth reading. Due to some problems I had to finish my Step 1 USMLE examination in 4 months time max.

I started my proper preparation for Step 1 in November 1^st week. Initially I was like a rusted machine trying to get back in shape since my internship was like an extended vacation. Coming from a college where the Profs keep shooting bouncer questions at you during clinical rounds in the hospital and where each person is trying to outdo the neighbour, internship is a breeze. The Profs love you more than the P.G.s and the final year students love you as you are their link to the exam cases and clinical skills ;) 

So starting off. I started with Kaplan Lecture notes and videos as was recommended by all, for the initial preparation in order to make the foundation strong. I used to watch the videos at 2x to 3x speed (helps to reduce a 3 hour lecture to 1 hour) and thanks to that in a month's time I was done with at least 3/4^th of ALL subjects. The drill was get up at 6. Start watching the videos @7 till 12. Eat chit chat with friends and then again start @2 till 8 in the night. Watch a bit of TV and if cant do that then continue studying. During this session I didn’t focus on studying, I only heard videos understood concepts, marked or annotated my lecture notes with important information that I found interesting in the lecture. Nothing else.

Regarding Patho I would recommend doing Goljan audios. Really amazing teacher. The jokes and stories from his lecture I will not forget till date. Really informative.

Now in December I met one of my senior’s Ms. X who actually got me into the game zone from my fairy tale story. I owe her my entire score and study plan. She advised me to start Uworld early on and not wait for a month prior to the exam since that was my original plan. So on December 5^th I opted for the 2 months Uworld subscription along with 2 UWSA exams and thank god for that, since it actually gave me a fresh outlook to how bad my studies were. I initially was studying from a POV of byehearting the entire book thinking each and thought that every point was essential, but as I chugged along Uworld I realized what was important and what wasn’t. I could start focussing on parts where I was weak and re-read them. 

Initially I was 2 percent below the average in individual exams (a very helpful feature I feel in Uworld). When I told my seniors this, they said don’t worry about it as initially they were all in the same boat. They told me that as you progress through the q bank you slowly start building your knowledge, and that questions start to form in your head when studying. Towards the end I was somewhere about 10 percent above the average which was what my seniors told to look forward to. 

Few Tips (which I got from seniors) Read EACH and every LINE of uworld. Not only the right answer but wrong ones too. DO NOT think of it as a Q Bank but take it as a book to study and learn from. Use those side indexes from post-its on your First Aid in order to know which section is where. (Label each section in short) 

The labelling of sections that I meant

Next use yellow stick ons from post-its and ADD information to your first aid. In the end when you are only reading First Aid you have to know where what is where. You should be that familiar with it like the back of your hand.

The addition of post-its and information from Uworld

I then took my Uworld self assessment around 2 weeks prior to exam and figure out where I stack up in the long run and I found it decent enough, but decided will study harder since your score determines where you match. 1 week prior took the 2^nd UWSA, scores came along the same lines. Finally did a few NBMEs and they were all on the same lines and then I decided I was ready. I did not want to postpone my exams since seniors had said that it will not be a wise decision. 

An advice that one of my seniors told was to an online NMBE say form 15 along with the 3 hours sample questions which USMLE.org gives in sample study material. So you get a rough idea of what 8hours feels like.

So in all 3 months and 10 days later I finally gave my exam and got a score of 235. Might not look like a great score, but when time is scarce, I would settle with this which is a bit above the average that I needed to match in IM or Peds.

A last word of advice. On the exam day for heaven’s sake DON’T take cetirizine if you have a cold. (worst mistake of my life) will never do that ever again.

EXAM DAY EXPERIENCE

I had my exam in Hyderabad. Half way through the exam thought I had flunked already and was feeling really bad and thought of just walking out. I even slept in the exam as I was that drowsy thanks to the cetrizine I had taken earlier. Furthermore to those who won’t believe me, when I came out from the exam I actually thought will start preparing for Indian PG entrance and stop thinking about USMLE. So hope you can understand how bad the exam went (Now looking back at it feel that everyone goes through a similar experience :D)

However on the day of the result when I saw 235 I actually felt thankful to god since I was expecting just a passing score (200 odd). But then as I always feel God has already planned out my life, I am just fulfilling my destiny.

FAQ's

You dont need to read Kaplan books more than once. 

Do micro and immunology LN with the videos - the professor is amazing

Patho Goljan audios should be sufficient if time constraints there.

Physio Kaplan Notes plus videos nice

Ethics DO THE VIDEOS and notes

Anatomy EmBRYO very good videos

In short if possible do all the videos atleast the for the initial chapters:)

Do mail me if have any doubts:) 

Also checkout firecracker http://med.firecracker.me/ and usmlestat http://usmlestat.com/ . They free for Step1 preparation:)