The triple therapy for Helicobacter pathologi.

If you are just like me in an overseas university that have a completely different curriculum you'd feel what I'm feeling during my prep. I already have 15 weeks for dedicated prep but what to do to strengthen my basics during the last year of basic sciences ?!!

Studying for the boards is like studying pathology and a punch of other small entities along it's side. If my patho foundation is weak the whole exam will turn into a nightmare especially after they announced in the 2014 changes that even normal states will be asked through pathology scenario, so if I can't diagnose it right here goes any of my anatomy or physio knowledge with it.

For a medical school that's not USMLE oriented they can have a really foreign curriculum to what is important and HY in the boards, and trying to parallel both could be really stressing, especially for me.

A year ago, I stumbled on a play list on YouTube where there is a med student explaining how American medical students study. It's really awesome so have a look at it, here is the link for it :

After some trial and error and a lot of modifications here is the plan I study pathology according to:

Resources:

1. Pathoma book and videos
2. Robbins Basic pathology
3. Goljan RR book and audios

How I do it:

1. I'd start every new chapter using pathoma videos on 1.2× speed and go through the whole chapter with pathoma book. That should take an hour or two depending on the chapter, after all pathoma has all of the fundamentals of pathology in 34 hours.
2. Then comes the real studying. I'd start by listening to Goljan audio of the same chapter and then study that chapter at the RR book and take my notes. At first I went at a slow pace like 7 or 8 pages per hour but the speed slightly improved with time.
3. After studying Goljan which is an easier read with a lot of integration and to be honest is more fun than Robbins, comes Robbins turn. I'd dip into Robbins but to understand only with no extensive note taking or a lot of memorization effort.
4. With that done the chapter should be clear by now and to make sure I've covered all the HY items in the chapter I'd go through Pathoma again and repeat the same chapter.
5. Pathoma again fo the 3rd time but now with First Aid, I annotate from all the sources into First Aid but of course Pathoma gets the priority.
6. Dr. Sattar is really fun to listen to and you can listen to him ×1.5 or even ×1.8 if you are familiar with the content. If you have an android phone or tablet, there is that great video player called Dice player that can play the videos with any speed you want and you don't even have to turn on the screen so I can listen to him during walking or running.
7. The chapter is now done, here comes the questions: There are 3 question sources that I'm using during the year: 
• Robbins qbook
• Lippincott's qbook
• Webpath
8. Being done with the questions I'd again return back to First Aid and Pathoma to revise.
9. I still have 3 months till the end of my basic years and I hope that by then I'd have finished all my pathology studying that way to have FA+Pathoma only for the dedicated prep. So here is [Pathoma+Goljan+Robbins] triple therapy for the ulcers you can get from H.pathologi :)

Is prometric practice session worth it ?!

If you're taking your exam soon then you're already considering whether to take the practice test at the prometric center. The test, at least in my country, costs almost 200 $ which is quite expensive, don't you think ?
So let's take a look at it and see the pros and cons:

Pros:

mimic the test day experience exactly.
test the noise canceling headphones.
try layer dressing and the air conditioning.
see the security measures and what they will ask you to do when you're about to enter.

Cons:

$$$

Verdict:

If you're on a tight budget, better use that money to buy 3 or 4 NBME forms that can really predict your score and give you a confidence booster. If you have the money then you'd better take it. Don't worry, if you can't or won't take it you can go to the prometric a couple of days before the exam and see the transportations and ask about whatever you want there. The staff there are really helpful and they will help you.

English skills: Shadowing

Communication skills can be a glowing part in your favor during the USCE and interviews or they can have  detrimental effect on your application. Beside being the no.1 cause of malpractice law suits, mis-communications are really important cause for IMGs to fail CS and reduce their chances greatly.

How can you improve your level, here is a great videos:

Watch it try it out and tell me what do you think about it?
As for me I love to shadow How I met your mother and Novels written by Tess Gerritsen. and you ? 

Practicing USMLE questions

Look at this survey results, No look really close. Even though we have no exact numbers of the correlation can you even doubt that solving as many questions as you possibly can, even if not causing the high score, is associated with a high score. No one who solved more than 7.5 thousand questions during his prep got a score lower than 235. and I mean NO one.

Come to think about it, how many banks should be done to get past this 7500 questions?
The 3 big banks would get you there, but what if you really want to shine and fly? Do you still have others to solve?

Of course you have. You have the NBME forms, USMLE weapon, USMLE consult and Goljan pathology bank. and that's just the on-line materials that are highly recommended.
There are also punch of other highly recommended question books that could dramatically increase your question load and more training that would help you greatly during the exam.

But, how can you manage the time to do all of that. Med school is a time sucker. I can barely get enough sleep, so talking about dedicating time to solve before the dedicated prep time is a dream, or not?

If I managed my time properly I think I'd be able to finish between 15 and 18 K questions in the year before my exam, how is that manageable? That's what I'm about to describe here.

• A 50 question block with feedback should never take you more than 2.15 hours max. If I'm taking more than 2.30 hours in any block I'd really try read faster and try to preserve my comprehension. From the experiences I've read and from advice I got from senior class mates, train yourself for this and you should have no problem finishing exam blocks in 45 mins during the exam. Saving precious time for difficult and more time consuming questions. I'm not suggesting lowering your comprehension for the sake of speed, that would be counterproductive. What I'm merely trying to achieve is train my eye movement patterns to read fast with the same comprehension I achieve when I take my time. Search for speed reading for more info.
• Start with the bank or book you want but leave UW for the end.
• For a start, I use Kaplan + weapon + consult combo. I solve them subject wise and start a subject after I finish a subject in school or after I review it, and solve it simultaneously as I study the next subject.
• Of course add your notes into your FA copy.
• I started out solving a block a day but evolved to handle more over time. but a block a day is a pretty good start, it could take almost 4 hours in the start.

That's what I'm doing for now. I really hope it would pay off .

Who am I ?

Hello there! Well, I'm new to the world of blogs. I'm an international medical student from Egypt. Class of 2018. I'm preparing for USMLE step 1 exam. I mainly started this blog to write what's on my mind about my prep and that long exhaustive journey.

Sorry If i made some English mistakes, it's not my native so bear with me :)

If you are preparing for this exam and you like this blog feel free to re-blog my posts and share them. You can comment or e-mail me and I'd respond as soon as I see it.

With that said, I hope you like my blog and benefit from it.

Question banks

The advice I got from almost all of my seniors was that the no. of questions solved during the USMLE prep time highly correlates with the score.
Searching for the big banks for step 1 I found the banks we all know about and giving each of them a try, I've reached my verdict.

1. UW
Of course this is the number 1 question bank for the usmle, the questions are beautifully written and the answers are long enough to clear the point for you but not too long to waste precious time. The number of 2 and 3 step processing questions are too damn high, with a minority of questions that are either 1 or 4 steps.

2. Kaplan
Why Kaplan is no. 2 and can't make it to the top of the list is their questions quality. The feedback is not as great as that of UW but still good. The real issue here is the questions,  a lot of the questions are 1 step processing, testing really low yield info, concentrating about retrieving some details instead of applying the learned principals. Also a lot of questions are not in a case format or too short compared to the standard 110:140 words per question in the real deal.

3. USMLE weapon
I'm in my full mind and not affiliated with any organizations. For me, weapon tops Rx Qmax.for a variety of reasons actually. Weapon's questions are just as Qmax in terms of practicing FA but the questions are well written, a case format of the appropriate length and the feedback is sufficient yet concise, a trait you'd value greatly when you're preparing and you're short on time, and they throw you the buzzwords, which I think is good in the first run over the materials. The defect was with the low count number of questions, they concentrated on some topics and ignored others almost completely. More than a 20 questions about lysosomal storage diseases with less than 5 about metabolism!!!  While the bank is obviously overpriced, the amount of slides and audio files is the bare minimum. I don't want a description of a murmur, I need to listen to a dummy like the real exam.

4. Rx Qmax
Don't get me wrong, this is still a great source of questions but not number 2 or 3 for me while for others Qmax is no. 2. What really irritates me is how direct the questions are, most of the times they are just a mere recollection of the information. Putting that beside the fact I'm solving it with the course load during the school year!!  The questions are not what I'd call ideal for the step exam.

5. USMLE consult
I didn't really have enough time to try it. The questions were short with short feedback but with extensive references to textbooks. I think if your school offers it for free during the basic years then do it. But if you're thinking about buying it near the exam, you'll be hurting yourself and your score.

6. Goljan pathology bank
Less than 450 questions and since most students have already bought the book then solving them in 3 or 4 days while studying pathology is not a bad idea.

7. usmle easy, score 95 and others
Don't even think about it. You could try them if you want, but when it comes for exam prep in 2014 don't use materials that feels like they've stopped supporting for a decade.

That's my order list of the commercially available questions banks for the usmle. What is yours?

Question resources available for Behavioral.

Ethics:

There are 2 main books for ethics Fisher's and Khan's. Each one of them contains almost 100 high yield questions. So I think Fisher's is a good start, and if you still not confident after finishing it you should give Khan's a try.

Biostatistics:

UWorld has a dedicated bank for Biostatistics for which they require 35$, Those questions are super HY and A++. You must do them and understand not just memorize the way equations are done. The real deal will mutilate the shape severely, that feels terrible huuh!! you bit! It would feel even worse if you're not prepared for this in the pro-metric center, but what the real exams won't do is change the concepts. The same concepts you'll encounter here will be the same in the exam you just have to recognize them and not be thrown away by any new presentation you're giving. That could only be achieved by understanding rather than memorizing. Overall most students reported that those questions were adequate for the step exam.

Behavioral:

There is what is good and what is almost damaging, and those are BRS and Pretest respectively. I've said previously that BRS contains 700 of A+ type of questions, while they are almost exclusively one step thinking, they get the right presentation of the case presented to you clearly. Pretest, at least the copy I've navigated through in the book store and from my peers, really concentrates on obscure details, those that almost no one reported being asked about in the exam, and ignores an enormous amount of other High Yield materials. depending on Pretest would hurt your score rather than help it. My advice do NOT even buy it.

Comprehensive Question Books:   

There are 3 major books and all of them got really good and high yield questions when it comes to behavioral. They are Kaplan, Rx and lange. I intend to do them and I think you also should do the same.

Behavioral science, The silent killer.

Pathology, Pathology, Pathology. All of us concentrate on pathology while studying and give it the lion's share of our study time, and we are correct in that case, and some even subtract the majority of the time that should be dedicated to other subjects to be better at pathology. When you ask yourself what subject you are neglecting the answer will be almost always "Behavioral science".
In my home institution, there is no such course as Behavioral science. I didn't study Biostatistics or psychology or ethics during the basic years, while psychiatry is of course studied during clinical years.
So when it came to studying something I'm not familiar with with no assistance or guidance and with the thought that it's not as important as other subjects, most of my friends, colleges and senior students either consciously or subconsciously neglected in favor of more study hours of other more difficult material. Neglecting Behav has proved itself to be a double edged weapon, as you improve other domain you really go downhill in this particular field and instead of getting a push in your score you find yourself losing even up to 20 precious points.
With that said, how can an IMG handle Behav?!! especially for the first time ever.

• Barbara Fadem Books. This beautiful and brilliant professor has written the 3 most relied upon books concerning Behav for the USMLE, 
• The first one which is called behavioral sciences in medicine is the biggest one of them, with almost 500 pages. In my opinion the book is good but not necessarily for the purposes of the exam. You'll find many lower yield information that is not really crucial in your understanding of the information and would rarely be tested and the book could potentially take more time than you intend to dedicate to the subject. I have the book but I didn't use it much and wouldn't advice you to do so.
• The medium sizes one: BRS behavioral sciences. The pearl for the USMLE. The book is concise with a total of 300 pages. I'd advice every IMG who never took Behav or didn't really grasp it to use this book. The book is written in an easy and fast pace, you'd understand what exactly is she trying to tell you plus tables to contrast similar conditions and materials to really get to the essence of the difference between them. The major plus here is the 700 question that is presented both after each chapter and a comprehensive exam at the end. The chapters are small and numerous so you'd get the feeling that you're achieving a lot by finishing more chapters giving you a positive attitude and motivation to achieve more. Overall I'd advice you to use this brilliant resource.
• The small one: HY Behavioral sciences. This book is essentially the modified BRS book. Some details have been removed and the questions were also treated the same. The tables are still there but a little bit modified. If you are already familiar with Behav, then this is the book for you. If you not, I really think you should stick with BRS.

• Kaplan book: a decent book. A lot of student scoring all over the spectrum have used it and they liked it. But for me I liked BRS more. It's a matter of personal preference after all, use the book that you enjoy to be able to absorb the materials faster and retain it better. So, if you like kaplan more than BRS, It's your choice. Stick with kaplan.

• HY Biostatistics: Both Kaplan and BRS have dedicated chapters concerning Biostatistics. Those are brief but sufficient. If you find a persistent defect while solving then I'd advice to get the HY book and study it. It's highly rated by most students.

• Ethics: Fisher's book of course. The book is simple but clear. Many of what seems complicated situations in the eyes of international students are presented easily and the explanation is clear. Do this. Do NOT do that. Period. The book has like 107 cases and detailed explanations at the end. Those are of an excellent quality. Overall this book shouldn't take you more than 1 day is you are doing it more towards the end of your prep.
• Kaplan Videos made by Dr. Steven Daugherty. I like him, and if I like a professor I really concentrate with every word he says or speaks. You can follow with his lectures along Kaplan, BRS or even First Aid directly. What seems as complicated and non-related materials when read alone starts to make sense when you listen to them from someone who understands what he is talking about. With that said I can only give him A+ rating.