One of the most common questions I hear when advising people preparing for the USMLE is how to memorize and remember all the details required for their exam. The short answer is that if you are at the level of memorizing, you are simply not ready to take any of the Steps of the USMLE. Yes, the USMLE requires you to know essential medical knowledge. But, doing well on the exam comes from being able to apply that knowledge, not from the mastery of rote memorization.
USMLE is all about structure of pyramid to understand:
The examiners assume that you already know the required medical content. Your medical school success certifies that you have the basic knowledge already. The USMLE is not testing you on what you know, but problem-solving, whether you know what to do with what you know.
You do not get to this level of mastery required for medical practice all at once, but by increasing levels of involvement and understanding over time. These levels can be conceptualized as pyramid in which one learning task supports the next. Recognition, being familiar enough with material to know it when you see it, is the bottom level of the pyramid. Next comes Memorization, being able to call content to mind when needed. Problem-solving, the third level, is achieved when you can combine remembered content and apply it to find the best response to presented situations. At the top of the pyramid comes Innovation, being able to create a new knowledge, new understanding, and new responses.
In medical school you are tested primarily on recognition and memorization. The USMLE test you primarily on problem-solving. The amount of problem-solving required increases as you move from Step 1 to Step 3. The Clinical Case Simulations of Step 3 push problem-solving right up to the border of innovative thought.
- You need to do something with the material
- Outlines help
- So does making diagrams
- But, nothing speeds up the process like talking about the material
- Interacting with peers and professors is the quickest way to boost your mastery beyond the level to recall, to being able to use the material you have learned
The bottom line is that there are a lot of good sources of study material out there, but none of it will get you where you need to be unless you use it the right way. Before you take your USMLE, you must move beyond memorization to application and problem-solving. The USMLE does not want to see what you know, but whether you can use that knowledge like a physician.
USMLE in not about Memorization:
Students excel by memorizing information and being able to recall that information in the right circumstance. The best students are the ones who can remember the most facts. On a multiple-choice exam, students make their choices based on what they can remember.
Physicians excel based on their judgment and their capacity to make the right choices in complex situations. Although physicians must have a solid knowledge base, the best physicians are those that can apply that knowledge in appropriate ways and circumstances. On a multiple-choice exam, physicians make their choices based on the application of their best judgment.
If you find your scores on practice questions stuck in the 50% to 60% range, then you are stuck thinking like a student and need to master the art of clinical reasoning. Clinical reasoning begins by recognizing that not everything matters, but some things are critical.
Here are some simple techniques you may find useful to help you in USMLE exam:
- Practice honing your judgment by being clear why something matters. When studying, tell yourself why each fact is relevant and in what circumstances it might be of value. Keep asking yourself, “So what?” or “Why does this matter?” If you can’t answer the question, then the content is likely too esoteric to matter for the USMLE.
- Put together a short lecture on some content with which you are struggling. Nothing organizes your understanding better than having to talk about it.
- Write some questions. Not the simple recall questions, but the longer USMLE clinical case items. By thinking about what to include, or leave out of your questions, you are helping yourself focus on the details that matter.
- After answering a question, go back over the content and tell yourself how you would need to change the question to make every one of the options correct.
Judgment is not the same as memorization. There is a big difference between knowing what a hammer is, and knowing the right occasions for using one. The transition from student to physician is one of the most important moments of your career. Remember, the USMLE is not testing if you are a good student, but if you will be a good physician.
Understand the value of Context and Combination:
The thought processes required on the USMLE are different than those required on most medical school exams. The content you need to know is the same. But the way you need to think about that content, and how you will use that content in your exam, requires some mental reprogramming.
- Context is the key to understanding the information presented to you in a USMLE question. Particular facts mean different things in different circumstances. Meaning comes as much from surrounding data as from the presented detail itself. Fatigue, reported by a patient, may be an important symptom or merely the result of too little sleep. The meaning rests with the full set of symptoms and life circumstances presented. Single symptoms are ambiguous. Context provides the pieces to let you see the essential presented patterns.
- Combination is the key process for the problem-solving required on USMLE questions. You must combine the information presented in the question with the information in your own head. The patterns you see plus the patterns you remember give you the insight to reason though to the best answer. If the question presents a symptom constellation, you must have the knowledge in your head to recognize the disease that this signifies. Recognizing a pattern in the question, but not remembering what it signifies means that you will not get the question correct.
Answer each USMLE question by first deciding, “What is given in the question?” and the deciding, “How does that relate to what you know?” This process, not simple association is the solution you seek. Content and combination result in the clarity you need to pick the best answer.
On medical school exams, recognition and paired association are the keys. A typical exam item presents a concept in the question stem and asks you to select the proper association from the presented choices. If you have studied sufficiently so that seeing a particular symptom reminds you of a disease diagnosis, or seeing a particular disease reminds you of the commonly used pharmacology, you will get the question correct.
The content is taken and reposted from THE PINNACLE from BECKER