How to Study for Boards Using Question Banks

Definitions & Key takeaways

There are a few different strategies you can use to study for boards using question banks. One option is to try to answer all the questions in the bank. This approach can be time-consuming and might not be very effective since you might be unable to remember all the answers. A better option is to first focus on understanding the concepts behind the questions and then practice answering as many questions as possible. This way, you'll have a better chance of remembering the answers and applying the concepts in new situations. Finally, make sure to take practice tests so that you can see how well you're doing and identify any areas that need more practice.

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Hey, everyone. Welcome, welcome, welcome.

My name is Pak Joshi. I go by PJ and uh welcome to this webinar on how to study for board using question banks.

So let's kind of go over the agenda of what this talk is gonna be like. Uh We're gonna start off with uh just a little bit about me who I am and what this webinar is, who, who this webinar is designed for.

Um We're gonna talk about question banks in general, you know how they come to be, who are they for? Uh We're gonna be talking about the NBA B question writer guide, which um guides uh the folks who write questions for the national Medical Boards.

We're gonna talk about common mistakes that everybody does when they're using question banks. And then we're gonna contrast that with the best practices that everybody should be using.

And then we're gonna close off with some next steps that you can do after listening to this webinar and we'll go on to some closing thoughts.

OK? So with that, I'm gonna go ahead and start.

So just a little bit about me and what this webinar is about. So I'm an osmosis question writer.

We have a very robust question bank. If you're using osmosis, you probably know that I'm a non practicing physician.

Uh However, I've taken it past all my steps, uh, step one, step two CS and CK along with step three. And right now my career focuses on pharma and medical education.

So about half the time I'm working Pharma here in S and Cambridge and the other half of the time I'm working in medical education with osmosis and a couple of other folks.

So if you're actually interested in what I do as a career or if you're just in Pharma in general, there's a um osmosis webinar happening on September 30th where we're gonna be talking about alternative careers in medicine.

So if that's something that you're uh that uh tickles your fancy, go ahead and tune in uh later this month. So, one of the reasons why I wanted to do this webinar is because I saw a huge jump in my step one and step two score.

Um I didn't score so hot on step one. You know, I really struggled uh during, uh during uh the initial studying that I had for my uh first boards.

And then right afterwards, I had a pretty big jump and I attributed this jump really using question thanks to the right way.

I was really lucky because, you know, after doing so poorly on my first set of boards, I got really stressed out and I really wanted to do things the right way.

And it's not that I did more questions. Uh When I studied for step two, I did questions the right way.

And I learned that using this technique is really what you guys need to be doing in order to see that jump. OK.

So that's why we're doing this webinar. Um This is specific for the USM le um that stands for United States medical licensing examination, but it's really applicable to all medical board examinations.

Um So if you wanna reach out to me, you can do that any, any time I'm very accessible to you. Uh You can just uh email me at Pak Joshi at osmosis.org or you can hit me up on Twitter at Aloha.

Pak. Uh I'm not Hawaiian, by the way, I just really wanna be in Hawaii.

So send me an Aloha. All right.

So let's get started about um talking about using question banks in general. So in 1915, the United States had an organization which was founded called the N BM E, the N BM E stands for the National Board of Medical Examiners.

OK. And the purpose of this organization was to elevate the standard of qualifications and provided means of licensure to practice medicine all across the States.

OK. Now, since the NB created this um exam in 1915, all the way until 1922 it became a more and more clinical exam.

I actually have a snack. A uh screenshot here of what all of the different um uh topics were on the first ever uh medical exam which is created by the N BM E.

And you can see anatomy itself was three hours uh followed by chemistry and physics um for two hours and physiology for two hours.

So plan on being, having a very long exam is something that's in the N BM ES blood and you should get used to it. But you know, jokes decide in 1992 something big happened.

Um Previous to 1992 this was a written exam. You would actually go in a big auditorium like, you know, you did in college or in um in high school or something like that.

And you would actually take this by uh pencil and paper in 1992 that changed to a computer based test. OK.

And what that means is everybody would get a slightly different version of the exam which would test all of the same things.

And as the exam progressed from 1992 onwards, it integrated three main things. Q I quality improvement in medicine in general.

It integrated thoughts on patient safety, meaning that you would have to know things like black box warnings for uh all the new pharmacological drugs that are coming out and it integrated medical ethics.

OK. Um So basically, since this time, the trend seems to be going towards the NBA or sorry, the U Assembly becoming a more and more clinical examination and this kind of reached ahead um late last year when the um NBB announced that it would be a pass fail exam in a couple of years in 2022.

And what this means is um a lot of the medical schools around the States are actually gonna be changing their uh clinical requirements.

You know, traditionally this was the NB step one was taken or sorry. Yos step one was taken after your second year of medical school.

A lot of schools are actually changing that to be the end of your third year. The rationale being that step one will become a less important examination and step two will actually be a more driving force into which residency appointment you get or not.

Ok. So one really important thing to know here is that all of this, all of the different step examinations test different levels of clinical mastery.

OK. The use only step one tests basic science knowledge.

Step two is intended to test your ability to diagnose disease and your ability to uh figure out what is the best initial treatment.

Step three. On the other hand, test provider based differences in disease management.

So at this point, you kinda know the basic science, you know how to diagnose, you know what's the best thing. However, when you give someone a medication or therapeutic, you have to understand that the disease changes over time and symptomatology can change over time.

So, understanding disease, chronicity is really important and you have to know the best step in your particular role in health care.

So for example, if you are an er, doc, you know the way you manage patients is gonna be slightly different than if you are a family medicine physician.

So it tests your ability to understand those different roles. So I just wanted to take a minute and kind of just get a broad overview of what it's like to be a medical student right now in the US, right?

So typically it's divide into year one, year two, year three, year four and then postgraduate training and in between all of these years, you have different exams, right?

So at the end of year two, right now, we typically take step one at the end of year three is when you would take step two, CK and step two CS.

And at the end of or some somewhere in your postgraduate training, typically after your first year, you'd be taking um step three.

So this is actually a pretty recent development. Uh because what's happening is right before you take all of these board exams, students are doing something really unique where we're kind of quarantining on our own.

We're not seeing a human face for a while and all we're doing is sitting down and taking um practice questions in the form of question banks, you know, this is kind of relatively new to the medical education um history.

And the thing is it's bad in one way because you're kind of learning for an exam rather than learning for the sake of learning and being a better clinician.

However, there's a flip side to it and the flip side is, you know, your ability to learn using question banks is a fundamental key to performing well so that you can get the best uh residency appointment that you want and demonstrate that clinical mastery that you've gained over all these years.

And number two, using question banks is gonna help you develop independent learning skills. OK.

So when you're taking these exams, these really important um boards, you know, it's just you and the computer, you know, that you won't have anyone else doing group learning with you or anything like that.

It's really just you at the plate about to take a, a bath, right? So having the, having those skills of independent learning are really gonna serve you well throughout your career as a clinician and developing that during your um time doing question banks is really key.

So one question that I often get is which question bank should I use? You know?

Um Right now I have a uh snippet here from first aid where they kind of have a, you know, an ABCD kind of ranking of what is the quote unquote best question bank to use, you know, probably the one that most, if not all of you are familiar with is G world um followed by a couple of others, you Rx Kaplan and others.

And more recently, there have been a lot of different companies that specialize in creating question banks such as osmosis, obviously uh past test ambos, True Learn Firecracker.

And um all of these have different price points, right? Um In addition to this, you can also find question banks written by writers of the USM le.

Number one, we have N BM E examinations, which you can buy from the N BM E website. I think uh back when I was taking boards, it was something like 50 or 60 bucks a pop and there's something called the free 120.

Now, the free 120 is something that all of you can Google. And I think that, you know, all of you should, since this is a kind of um free questions that they give away just so you get an idea of what it's like.

The free 120 is a PDF document that the NBA A releases to give you an idea of what the questions are like, what, what the, what the question style is like, you know, are there images are there um you know, medical laboratory results, things of that sort just to get you acquainted with it.

But I would use it as a way to kind of assess yourself, you know, are you comfortable taking these types of questions are the strategies which you're learning blah, blah, blah.

The key difference is the free 120 the N BMS are written by writers of the assembly. So if you're trying to gauge your performance, this is the tier none, you know now instead of kind of perseverating over which question bank is best, we should really be thinking about how do I best use the question bank, which is available to me.

So that's why I wanna take a second and talk about the NBE question writer guide. So a little bit about the question writer guide.

So this is a guide that all of you can find. It's II believe it's also called the Quote unquote Gold book.

Um This is a guide that the N BM E gives to their question writers. OK.

Now these question writers are all experts in their respective fields, subspecialties and so forth and they're given this guide.

OK. And it tells them what is a good question?

What is a poor question? OK.

Furthermore, it kind of talks about the process in about, in, in which they make the question, you know, question writers will make a question based on their experience and they will think, oh, this is a really good question based on what I know and what I've learned in the clinic.

However, that may not always translate to a good question. OK.

Now what I wanna really uh emphasize to all of you is that the N BM E is a very data driven organization. OK.

Now, what that means is when a question writer makes a question and they write different answer choices, you know, they might think that every answer choice, um you know, kind of gives away an answer or not.

But the NB B's uh percentile differences that they attribute to each question answer is what really drives if, if this is a good question or a bad question.

Basically, they want every answer to be a quote unquote plausible answer. OK.

I hope that makes sense. Now also II wanted to kind of highlight what is the goal of the N BM E question writing experience, right?

They want, they, they say that a good item is one that discriminates between two test takers who know the material and those who do not.

OK. Furthermore, they say that questions should not focus on a direct assessment of isolated facts.

And then they go on to say that each item should focus on one important concept or testing point. OK.

Now test taker should apply these ethical principles and their decisions related and their direct decisions related to patient care.

OK. So what this means is that they want you to apply the information they want, don't want you to know just trivial facts.

So furthermore, a couple more points, right? They say that they want you to solve clinical problems.

This is kind of more relevant towards step two and step three. And second, the questions are more likely to focus on important information rather than trivia as we know.

And they want to identify test takers who have memorized, right? So what are the takeaways from this?

Each question has a clear specific goal. Number one, number two, they want you to focus on interpretation and application of concepts.

They don't want people who memorize minutia. And number three, the exam is training appropriate and tries hard to avoid ambiguity.

Guys, this exam is really built for students who are in between step two or, or sorry, in between year two and three of medical school in between year three and four of medical school.

And our first year post graduates, this is not as a crazy test, which is supposed to be impossible to solve, you know, you have all of the tools there.

So based on this information, I really urge you guys to number one, not overthink, you know, um oftentimes we might see really advanced patients or, you know, advanced treatment modalities when we're in the clinic, but don't overthink it, you know, uh they want you to work through each problem using stepwise clinical reasoning, you know.

So the way I think about uh this point is that if you were to explain your logic to a friend, would they be able to follow it in a stepwise manner?

Or are you quick to just read a question and then jump to a specific answer choice based on your experience, don't make it experience based, you know, think about why you're picking the answer that you're picking in a very stepwise way.

And then last but not least, try to discern the question objective. Now, as a question writer with osmosis, I don't write a single question that doesn't serve one objective.

OK. There's only one objective and there's only one question for it.

This is the same way that the N BM does it. You know, there's one objective that they're trying to hammer down with this question.

And it's your job to figure it out equally as important as finding the answer is finding out what they're asking. Ok, so please try and keep that in mind.

That's gonna be a really important point as you go through your um practice with question banks. So let's talk about common mistakes that folks use when they go through question.

Thanks. So here's what I've heard as a student all the time.

You know, I've heard just read First Aid. You know, first Aid is a really comprehensive book.

Just read it a couple of times. You'll be fine.

Similarly, I've heard just go through your world one or two times or, you know, my friend John scored a 260 going to this one step, one class.

So that's gotta be the best one or you might be thinking, well, you know, I went to XYZ medical school, so I should be good, you know, they really prepared me.

I'm fine. And then finally, which is one that I love is that step one is pass fail anyway.

Um So this, like I said, came into the news a couple of years ago. Uh that won't take into effect until 2022.

Ok. So keep, keep that in mind as you're studying a couple of other things that people kind of fail to um use correctly.

Number one screenshot answers. OK.

Um I remember when I was uh going through my clinical rotations, I had a friend with me who would, you know, study on her ipad and screenshot every answer.

And what she would do is she would actually print out these images and she treated the textbook out of them. OK?

And then she would, you know, just kind of carry that in her coat pocket all the time highlighting it and just studying it as a textbook.

OK. I'll go over why?

That's a very poor way to study in a second. OK.

But just keep in mind these, these are things that students often do. Um only reading the major takeaways point or ignoring incorrect answer choices.

Um So as a question writer, I spend about two hours for every one question that I write sometimes more. OK?

And the major takeaways portion which is kind of like a little blurb at the end of the answer explanation really just hits a, a very minor thing you know, if, if you only read that as you're blazing through questions, you're gonna miss the majority of what effort that I put into writing that question.

You know, all of that, all of the goodness is in the answer explanations. Ok?

And you're, you're really doing yourself a disservice by ignoring that or conversely ignoring your incorrect answer explanations.

You know, just because you didn't pick an answer right now, doesn't mean that, that same logic can be applied to a different question.

You know, you're paying for these question big. So really try and uh you know, get your money's worth, really read through everything and try to understand it.

OK? Now, finally, and this is the most common thing that folks do is using a non simulated environment.

People often do question banks untimed and in an environment that's not conducive to focusing. OK.

Now, back, uh back when I was studying this really cool thing happened, you know, Netflix just came out with their picture and picture thing so you can start a movie or something and then click the home button and then you'll be able to kinda do work on the side as well, you know, I know this applies to you.

OK? Raise your hands or so, you know, right in and chat if you do this, OK?

Judgment free zone, right? This is a very common thing that folks do.

You know, it's easy to kind of lull yourself into a sense of complacency by, um, having entertainment in the background, you know, or maybe you're just in an environment that's very cozy.

You know, maybe you're doing your questions while sitting on the couch with your dog or watching The Bachelor or, you know, in the park or something like that.

The reason why this is bad is because you're not giving yourself that stress, which is really important in your test, taking experience.

Ok. When you're gonna be taking your boards, it's gonna be you a computer and a dimly dark, dimly lit room.

Ok? And that's stressful.

You're there taking the most, in many cases, the most difficult exam that you're ever gonna be taking, taking, you know, and you really wanna give yourself that sense of impending doom almost, you know, because, you know, it prepares you and for the day that it, you know, you actually have to go in and take this exam, you'll be much better prepared for that.

Ok? So please keep that in mind.

Ok? So now let's transition and talk about some of the best practices that you should be using as some as uh folks that are studying for your boards using question banks.

Ok. Now, this is a chart that I made on my own.

OK. Part of it is data driven and part of it is experiential driven.

Ok. Now, what part of this is data driven?

Number one, we just talked about the writer's guide with the N BM E. Right.

And they clearly said that application is what they're going after. Ok.

So clinical application and reasoning is far more important than wrote facts. Ok.

Now, don't get me wrong. You, you, you're not likely not gonna be able to get away with this with taking these exams if you don't know your basic sciences.

Right? You just have to put the work in, you have to read your text books, you have to know certain facts, right?

But the application is far more important as their words. Now, in my opinion, I feel that test taking skill is equally, if not more important than your clinical reasoning skills.

OK? Now I'll say that again, test taking skill in my opinion is equally if not more important than your clinical reasoning skills in this exam.

OK. Now, the reason for that, uh OK.

So we're just gonna sorry about that. We're just gonna focus a little bit more on test taking skill itself and why I came to this conclusion.

OK. So there was a study done.

OK, of 6000 random people and these 6000 folks were told to take a standardized exam and they stratified all of these people into three groups.

OK? They wanted to test people's risk taking uh motivations, meaning their willingness to guess their motivation, meaning like, OK, they're driven to try and find an answer.

And number three test taking anxiety. OK.

Now, from this large study that they did, they found three clusters of groups, one was called the moderate, OK. Meaning that they had moderate risk taking abilities, moderate motivation and moderate test anxiety.

There was also the calm risk taker. Now, the calm risk taker is someone who has low anxiety and motivation.

Maybe they don't care that much, you know, they're just in the study for whatever purpose, right? But they're high risk taking.

OK. And third the test, anxious risk averse population.

Now, this population of folks is what I kinda wanna harp on a little bit because they're very anxious about the exam. They're kind of terrified of getting the wrong one, the wrong answer choices as they go through each question.

OK. So they're very risk averse and by risk averse, they define it as unwilling to guess.

OK? Now, I kind of just wanted to highlight the results of this study.

They found that the most successful test take taker profile in this study is the calm risk taker. This profile s scored significantly higher on their metrics.

OK? The anxiety or sorry, test anxiety has been shown to be negatively related to achievement and risk taking strategies to be positively related.

So, what am I trying to say here? I'm trying to say that in a standardized exam.

If you don't know an answer, you should try and use your best ability to guess. Ok.

Now, am I talking about guessing just to guess? No, but you should be willing to guess far too often as medical professionals, we feel like we have to know everything.

You know, like I've gone through a year of this, a year of that, some of us might have p hds or master's degrees when we go into medical school.

You know, we have this need to try and know everything and try and reason through everything and that is a huge factor why we fail these exams and why we don't do well.

Ok, because at some point you have to, you have to realize you get about 90 seconds per question. And if you're not using your time correctly, you know that that's time.

That could be used to a different question which you might have gotten, right? Ok.

So keep that in mind. Ok, moving forward, sorry about that, moving forward.

So how do we apply these practices in our question? Bank practice, right?

Number one, realize one thing you're not gonna know every answer. So don't be afraid to guess.

Like I said, time is critical and each question is worth the same. OK.

So focus on the easy questions, focus on the questions that you know, you can get, right? OK.

And motivation and mentality in my uh you know, personally, for me it's critical. OK.

So what are my recommendations? Number one, there are different types of questions on medical boards, right?

Sometimes you have multi page scientific article questions or ones that have, you know, Pharma ads and things like that.

Skip those. OK?

Unless you're scoring uh uh all, unless you're getting almost all of the questions in a 30 or 40 question block, correct.

You should be skipping these questions. Why?

Because you're not using your time economically. OK?

These questions are meant to really parse through your reading comprehension skills. OK?

And if, if you're already struggling with other things or if you know there are other questions that you could be getting right?

Focus on those, don't focus on ones that are gonna bleed your time. OK?

There are also questions that are subsequent answer sets. OK?

And what I mean by that is after you've clicked an answer for one, it takes you to a different question which is related to that clinical scenario.

And after you've answered that you cannot go back and change it. So what that means is the next question is actually going to give away the answer for the previous one.

So for example, you know, if it asks you, OK, what is the best treatment in question one? You select something.

And then in the vignette for question two, it says, oh patient X has been treated with blah, blah, blah, you know, that can really throw you off, right?

Cause you imagine if you're taking an exam and you see that oh I actually didn't put the right, you know, answer choice for the first question.

It makes you stuck, right? You start thinking about it and wondering if, oh, was it the right choice?

Are they just messing with me? Right.

We've all done it. Don't get stuck.

OK. Even if you might find that you're wrong.

Lastly, pathology images. OK.

Now, I did a year of fellowship in pathology and you know, it, sometimes you, you're very tempted to kind of look at an image that they're giving you and try and figure out based on like the periphery of the image.

What is actually going on? Don't do that.

OK. Remember this is designed for students who are in medical school or recent graduates who may not know pathology at all, you know.

So in these images, they're gonna put the money right in the center of the picture. OK?

They're not gonna have some something vague on the side. OK?

It's always gonna be right in the middle, all right, and focus on the image center and think about the clinical context.

Sometimes you won't even need the image. OK?

Sometimes the image is there to throw you off, think about the clinical context. OK?

So a couple more recommendations. Time management.

OK? In my, in my personal opinion, I think time management is the key to doing well on your boards and uh seeing a dramatic difference over time.

OK. Now, uh I think when I took my step one, I did every question in order.

Now um per block you get about 38 to 40 questions. Um give or take some.

Um And I would just start at the beginning, I would, I would do question one, question two, question three and just run along, you know, and I realized that, you know, II wasn't mitigating my time wisely using that strategy.

So I came up with something else during my step two studying. And what I used to do is I used to do questions one through 10 in order.

Then I would jump and do questions 40 to 30 then I would jump again and do questions 20 to 25 and then 30 to 25. OK.

Now part of this is uh seeing a variety of questions. OK?

Um Because you never know if you know you're doing questions. 123, how long each question stem is?

You know, this, this kind of randomizes it a little bit. So you get a good variety and you get to really hit the questions which you will um have a good chance of getting, right?

And also it helps with my own time management. You know, you start to be able to feel what it's like to do 10 questions, right?

So the shorter the time that you're taking per, per 10 questions, you know, the easier it is to feel and get that tactile feel of OK?

I need to be moving on, I need to be moving on, you know, because it's gonna bleed your time. If you constantly just watch the clock, right?

Uh Another thing is know your common reference ranges, you know. Um One thing I did during uh step one is I would search, you know, you, you open up the little sidebar and you would look up, you know, what is the normal value for this or that or the other?

The thing is if you know your common reference ranges, which you, which you use clinically, you're gonna get away with it.

OK? What do I mean by that?

I mean that if you know what's usually presented in a clinical scenario, that is what they're testing you on, you know, don't go up, don't really try and parse through minutia and look at, you know, what, what is some obscure reference range cause that's there to bleed your time.

OK. Next up is better, uh, your reading comprehension skills.

And what I mean by that is read the question first. OK.

As a question, writer, sometimes I will write an essay for you and ask you a question that's completely unrelated. You know, you read the question first, you know, and that'll give you a huge, um, advantage because you'll know what to focus on as well.

Uh One practice which I tried to do, uh, during my, um, uh, step two studying was to actually highlight the, the last question of the vignette just so that I already have in my mind.

What am I hunting for in this vignette? You know what am I trying to look for?

So I can actually look through it really quickly. OK.

Um Use your annotations uh tools, you know, I know a lot of a study on our ipads and mobile devices and things of that sort.

But um you know, you have a tool of a highlighter and I would encourage you to use it because visually it, it gives a little bit of a contrast and it helps you kind of understand what you're trying to um uh emphasize with, with these question.

OK. That, that'll help you out a little bit, give you a little bit of variation too.

So a couple of other things when you're creating a study plan, right? Make sure that that study plan is proportionate to what is being tested.

OK? And number one, if you don't have a study plan, please make one osmosis is a great feature where you can actually make one on your own.

Ok. And what is the logic behind this?

The logic is that normal physiology and organ systems are worth far more on these boards, you know, about more than half of the boards is really testing this.

OK? If you're spending time with my details, like, you know, ethics or occupational disease or, you know, subspecialty stuff, don't focus on that.

Focus on your cardiovascular physiology, focus on your common, common uh things that are tested. OK.

And finally, Biostat now bio stas is something that students often say to the end. They, you know, they, they often say to me, oh, I'm just gonna study for bio stats, you know, uh, two weeks before and I'll be good.

I'll be fine. Um, and for a lot of people that works out because they just kind of cram in the equations and they're good to go.

However, uh, I would encourage you to not do that. Um, because these questions are easy.

OK. Number one, they give you easy enough questions that if you know what you're being tested on, you can actually go through them really quickly.

So you don't actually need to use a calculator. Second of all, um like I said to you early on in this uh presentation, the N BM E really hates people who memorize, right?

You are gonna be dra dramatically rewarded for being able to apply those concepts, right? So if you're given a bio stats question, which doesn't really just, you know, it is not just a plug and jug kind of question, you're gonna be uh penalized, right?

You have to really know what uh these concepts are in order to excel. OK?

And finally learning them really quickly early on and you kind of incorporating it throughout your study process is gonna make you faster.

OK? And that's, that's money on this exam.

OK? So even more recommendations.

No. So this kind of goes into mentality and I wanna say that all of you each and every one of you are exceptional students.

Ok. It takes a certain amount of intestinal fortitude to get to the point where you are at your education.

Ok. I have no doubt that all of you are super smart and you know, you're gonna be fine right now.

Improvements take time, practice, discipline and most of all introspection. Ok.

Now, here's, here's what I mean by that, right? When, when you're using question banks, you're often given a lot of statistics by these Q banks, right?

You're given, ok. What is the proportion numbers a number of students getting this right wrong, et cetera, et cetera.

Number one, it's easy to get demotivated and realize that, oh, you're well, be below the path or conversely, it's easy to give you a sense of complacency or, you know, thinking that, you know, it, you know, just because you're scoring, well, you might be taking this exam again and again, you know what I mean?

Like if you're, if you're doing the same questions over again, you're gonna get this, these questions, right? Not because of your medical knowledge just because you've been familiar with the question.

That's number one, you know, be honest with yourself. Ok?

Um, number two, don't be disheartened by the stats. Ok?

Um, oftentimes if you're an I MG, if you're studying from around the world and you've been a practicing physician, you know, people study for these boards for years, you know, and you're, you know, if, depending on where you are in your education.

You, you could be doing this in a couple of months, um, if not weeks. So be really honest with yourself and don't be disheartened.

Ok. And lastly, I wanna say that everyone needs a coach.

Ok. And this is something that I really, really believe in because, um, you know, we're getting to this time in digital medi medical education where everything is a little bit automated.

Um you know, every company out there is giving you a schedule and this or that or the other. And I really feel like having a personalized experience is really going to help all of you.

Ok. Um There's actually a really great talk by Doctor UL Go one who's um uh used to be, I think he's still a surgeon here at bringing woman's and he said this, he said that cultures are your external eyes and ears, providing a more accurate version of your reality.

They break down your actions and build them up as you as you go again, ok? And even the greatest in the world need the coach, right?

That's what he's saying. And uh he was talking about how he, you know, throughout his career, he kind of got used to used to operating, right?

He's an endocrine surgeon. He got used to it and he wasn't saying seeing a drop in his complication rates and he wanted to get better.

Now, you know, having a coach really showed him that he could get better. He, he noticed little things which he wasn't seeing before and I wanna impress upon you that that's gonna be huge in your um use of Q banks.

Ok? You need to have somebody who you can.

Number one confide in who you can talk to and we'll give you an objective opinion of why you're not seeing the scores that you want.

Oh, sorry. Ok.

So what would coaching actually look like? Right.

So number one, some people need a little bit more help than others. So that can come in the form of one on one tutoring where you would actually go through problems together.

Ok. Um It could be as simple as, as simple as auditing your schedule and uh seeing if you're on, on track with your daily questions.

Um if you need a little bit of help in other areas, uh giving valuable resources that maybe that person used, um giving ad advice on balance, you know, clinical stuff, uh family life, personal matters motivation, you know.

So the thing is, you know, we're, we're in this age where we're, you, we have a lot of things that we're figuring out. You know, we're all young adults, we have relationships at home and sometimes those can get in the way, you know, maybe you come home after your clinical rotations when you're studying for step two and you have a wife and a kid or a dog and you know, maybe your significant other is, uh, uh, has a 95 job and, uh, when, when he or she comes home they expect you to be present with them.

You know, and you have to study all of these things are very difficult to kind of balance. And, um, you know, it's, it's good to have an objective opinion about what you're quote unquote supposed to be doing and what is really best for you and strategies for kind of talking this through with other folks and, uh, uh, figuring out the best plan for you as an individual.

Ok. So there are paid services out there, ok?

You can Google them. There are tons out there and they're expensive.

They're several thousands of dollars. And I think that they're really unnecessary to be, to be frankly honest with you.

I think that the best thing for most of you to do is to make your own coach. Now, what I mean by that is find someone who has the experience in taking the exams that you're taking.

Ok, find someone who's been there, find someone who's maybe had a lot of improvement over the course of their, um, education and taking exams.

Right? Upper classman, you'll be surprised you have all of these students who are with you, you know, who, who have taken the same exams as you and so on and so forth and it, it, it, it's really kind of staggering to me how, how few people network.

You know, these are great resources, you know, and if you just cold call someone, cold text someone and just say, hey, you know, II kind of want help with this.

You'll be surprised at how many folks will actually get back to you and give you objective feedback throughout the course of your education.

You know, this is really something I hope you all take advantage of. Um I kind of said this as a joke but willing attendings if uh if you guys have any stellar sellar attendings out there, who wanna help you with your boards and uh be your friend throughout this process.

I would highly um you know, encourage you you to do so or, you know, if at the very least you're not finding anybody and you really just need a coach and you need someone who's just gonna be there and help you out.

I'd be happy to do that for you. Um So again, you can reach out to me at Pinnock dot Joshi at osmosis.org or just reach out to me on Twitter, like several of you already have at Aloha Pinnock on Twitter.

OK. And I'll be happy to uh make a plan with you.

Ok? So, uh next up, I just wanna close out and uh talk about some other resources which you, which you can uh take advantage of here, osmosis.

So um check out osmosis do work uh there, you know, we have a ton of resources out there to help you prepare for exams. And um there's actually a um resource created by uh Doctor Catherine here with us who is our director of Curriculum.

And um this is a really kind of comprehensive guide to doing well on specific topics, you know, all throughout your medical education.

Uh This uh this video series kind of focuses on step one and how to go through it and what are some high yield facts of all of these different um um topics.

So make sure you check that out. This is money.

OK. Uh Next up, uh Doctor Tackett, um who's our research director.

Um We created this really great class which kind of just talks about learning, you know, um all of you who are involved in medicine will spend the majority of your life um learning and uh being educated and learning to be a good educator.

And yet they actually teach us very few things about how we learn and what are the best things that we can do for ourselves, right?

So, uh if you're curious about that, please go ahead and check out this um this course that he created. And lastly, I wanted to end this qu end uh this uh webinar with this quote from doctor Goon.

OK. Now, I, you know, when I was studying for words, I thought that this test was impossible.

I thought, you know, I cried several times. I was terrified and Um By the way, if, if any of you are having problems with test anxiety, I would highly recommend you check out um a couple of webinars we have on test anxiety uh uh with uh Mirena who's uh our uh question writing manager here, she created some really great resources for you.

But um apart from that, you know, I honestly, I thought this test was impossible. I thought I couldn't get through it.

And um I honestly coming, coming back in retrospect and thinking about it, this test isn't that bad. OK.

I used to think that the NB me writers are out to get me. You know, this is a horrible thing, blah, blah, blah.

But II II just wanna quote doctor goon here. This test is imminently possible.

This test is very well written. This test is not hard.

This test you can ace. OK?

I'm gonna say it again just for emphasis cause I know some of you all wanna hear this, this test is imminently possible.

This test is very well written. This test is not hard.

This test you can ace. OK.

So um with that, I just wanna thank you all for um uh checking out this webinar and uh uh it looks like we have actually went a little bit over time, but uh you know, thank you guys for tuning in.

Uh We're just gonna take a few questions here if that's OK. Um I'm just gonna go ahead and pull up the um questions that I might have.

Does the M BM me write questions for step three? Uh Yes, they do.

Um Let's see. Uh Thank you guys.

Thank you all for being here. Um I'm just trying to find this Q and A.

Thanks. I'd love to visit Costa Rica.

Um Any specific advice for a graduate who scored low on step one. So the thing is number one, the biggest advice I've give for anybody who scored lowly on step one is to not freak out honestly.

You know, that was a huge thing which I, that I felt, I thought my life was over. I can't, you know, um go on to having a residency, you can do it, ok?

No matter if you've even failed step one or, or so on and so forth, the thing that matters now is step two and step three.

Ok? And it really depends on uh your progress and things of things of that sort.

But, um, but the, the key thing I would say is really kick it out of the park in your next steps. Ok?

Um The reason for that is people love the underdog, ok. All the residency directors love improvement.

Think about residency. Residency is a time when you're gonna go through immense change, personally, professionally with your medical knowledge and judgment as a clinician, they love to see improvement and the fact that you can make an improvement even though you might be disheartened is huge.

Ok. So really kick it out of the park and don't think that it's ever gonna um hit you, hit you down.

Ok? Any advice for step two, number one, don't use step one resources.

OK? People love to do this, especially if they score well, do not use step one resources.

The reason why is because step two tests something different. It tests your ability to diagnose, it tests your ability to uh think about the next step in treatment.

OK. That is what's key here.

OK. And number, you know, you really have to get used to this idea of independent study when you're um doing CK because a lot of students are out there doing their clinical rotations during this time and they're not strictly in class and having all that guidance and structure if you need that, create that guidance and structure using osmosis um uh study schedules or, or other resources out there, you know, OK.

What is the most effective way to review the um correlations of the uh qubba taking those reading multiple times? Um Well, the thing is you have to figure out for every question that you're getting wrong.

Why are you getting it wrong? That's something that you really need to take some time and digest.

OK. When I was doing Cubans, I would have a sheet of paper and I would write down for every question I was getting wrong.

Why? OK.

Sometimes it's gonna be study strategy. I just ran out of time.

That happens. OK?

Sometimes it's gonna be that you didn't know a certain fact about something that's OK. But what is the key thing here?

Like we said, don't focus on minutia. Don't just write down, oh, this, this drug has this side effect or some obscure thing.

OK. Understand what is the breakdown in your knowledge and where you had to go to get to that answer?

Ok. That is the key.

OK. Don't keep studying minutia.

OK. How long do you recommend doing first uh past two banks?

Too long? Annotating everything at first aid?

Um Honestly, I would say it, it, it's a really personalized question loz um you know, I would really uh uh it, that kind of depends on your progress in medical school, uh your grades and your comfortable, your, you know, experience through all your different subject matter and things of that sort.

Um I would recommend at least three months to go through a first pass in C banks. Ok.

Um Yeah, don't like you said, don't take too long annotating everything in first. A like I said, this is a, this is an exam that tests your ability to clinically reason, not regurgitate facts.

When do you recommend starting Cubans? This is a great question from Danielle.

Start it as soon as you can. OK.

And the reason why I say this is medical schools are really starting to emphasize the fact that you're taking standardized exams all throughout your career, specifically, ones that are more, more clinically oriented, you know, if you have the means to do so, I would recommend you start studying and starting, starting to get those, um, you know, good question habits down early, preferably and, you know, as soon as you start medical school.

Ok. How about risk factors related to a specific question?

Ok. So here's the thing, risk factors are really important.

Why are they important now? They're important because they guide your clinical decision making, right?

So that question is really important for step two, know your risk factors. That is very important.

OK. So more important than risk factors, however, is knowing what to do with them.

For example, if someone has turned 50 you have to know that. OK, maybe they're due for a colonoscopy.

That's just an example, right? OK.

Is it better to study the theory and test until you feel ready or is it OK to do without it? Um I would say that studying uh you know, the thing is you're never gonna feel completely um ready for it, right?

Whenever you do a question, do you ever feel like you're OK with it? You know what I mean?

I think that's an artifact of where we've come with our education. You know what I mean?

A lot of us have come um you know, uh through several years of our bachelor's and master's of P hds and, and et cetera and we wanna know that we feel ok, taking it, but the thing is you're not gonna feel ok, taking it on your boards.

Ok. So get used to that feeling, ok?

And use these Q banks as a tool. Ok.

Don't think that this is an assessment. Ok.

How many questions is recommended to do per day? Um, honestly, as much as you can.

Uh, I know, I know folks who have studied, you know, using question banks for 8 to 10 hours a day. Um I don't think that's necessary.

I think if you study about six hours a day, it's, it's, it's really significant for uh uh good enough for you. Ok.

Uh When don't I take step one before or after pass, fail update? Um Honestly, scheduling when you take your step exam is pretty irrelevant.

Ok, the, the reason why is, if you take it in 2022 not a whole lot will change based on uh residency selection criteria.

Does that make sense? So basically in the months leading up to it, residency directors are gonna look more and more at step two in the first place, you know what I mean?

So the fact that let's say you take it before 2022 and pass is gonna be less relevant. Ok.

What is the most important area to study? Um, let's see, your test taking skills, I would say is the most important area to study, you know, have that in introspection really uh figure out why you're not getting questions, right?

OK. Apart from that, look through the N BM E and figure out what is the highest percentage there, you know, like organ systems and normal, normal physiology over half the test is that, you know?

OK. How, let's see.

All right. All right.

Thank you guys. I think we're out of uh out of time here.

I wanna thank you all for attending the webinar and um uh tune into the events page on uh osmosis to uh check out so future webinars that we have.

Ok. Thank you all for attending.

Bye bye-bye.