Usmle Step 1 Is Reading Comprehension a Big Deal

When I started medical school, I had a major trouble — I was a very inefficient reader. While I could read through a passage or folio very apace, I constantly found myself rereading that aforementioned material every bit many equally 4 or five times earlier moving on. My logic was elementary, withal flawed – medical schoolhouse is hard, every sentence I read could be tested, so I must memorize each sentence. It didn't have long for me to realize that this strategy was unsustainable and that a amend alternative needed to exist institute.

Over the next few UWorld blocks, I stopped re-reading cloth and instead focused on summarizing fundamental details at the cease of each passage or page.

Now, rather than forcing myself to memorize pages of minutiae, I was challenging myself to summarize text down to its' most relevant details and conceptually empathise each topic.

As I transitioned in to my USMLE Step I studying, I continued to utilise a similar strategy. However, despite my strong scores during preclinical courses, my UWorld scores were non where I expected them to be. While I could easily respond think based questions (i.eastward. what is the mechanism of activity of digoxin), I found myself struggling on the two-step and 3-step questions that and so frequently decide the difference between an average score and a 240+. As I analyzed my own performance, I noticed that I was oft overlooking key details cached within the question stem. In doing and so, I was choosing answers that addressed only a small-scale part of the patient's presentation or was struggling to decipher the overall objective of the question. Non being one to accept defeat, I began to devise new methods to approach the questions and ultimately settled on a summary technique that was similar my reading way. Utilizing this method allowed me to master difficult questions, improved my speed, and built a foundation for test taking that I still use today.

My USMLE Question Summary Method:

As I read through questions, I routinely highlight the 4-eight well-nigh important details presented to me. These include things such as:

• Historic period – a good test taker will ensure that the answer choice is in line with the patient'south age (i.e. you tin probably rule out hypertrophic cardiomyopathy in an 89-year-old male person with new onset cardiac symptoms)
• The vigil or chronicity of the presenting symptoms
• Pertinent positive and pertinent negative history and physical examination findings
• Central risk factors
• Key lab and imaging findings

Finally, in one case I take reached the end of a question I will make a summary statement that is 1-2 sentences long and serves to appropriately directly me towards the correct example.

Here is an instance of my technique in action.

For practice, try to create your ain summary statement  of this UWorld-Style Question:

A 75-year-old male presents for evaluation of 3 months of worsening shortness of breath. His symptoms were initially nowadays only with exertion but now occur at balance. He likewise notes shortness of breath that awakens him from slumber at dark and has forced him to lie on 3 pillows. He denies whatever fever, chills, cough, or chest hurting. His by medical history is remarkable for hypertension, type ii diabetes, and a 45-pack year history of smoking. Seven years prior, he underwent stenting of a left anterior descending artery lesion after presenting with a myocardial infarction. His medications include amlodipine and metformin. On exam, his vital signs are: Temperature 98.nine, Heart Rate 85/minute, Respiratory Rate xviii/minute, and BP 145/85. O2 saturation is 92% on room air. His physical exam is remarkable for an early diastolic murmur best heard at the apex in the left lateral decubitus position and ii+ pitting lower extremity edema. Chest 10-ray shows bilateral pulmonary edema and cardiomegaly. What is the next best step in management?

• Metoprolol

• Diuresis

• Coronary angiography

• Azithromycin

• Inhaled Beta Agonist

• Four corticosteroids

As you can see, the above case is a ii-stride question that requires yous to both make a diagnosis and to know how to manage that condition. Additionally, based on the answer choices we can deduce that the diagnosis is either cardiac (answers A-C), infectious (reply D), or pulmonary (answers E-F). Thus, a skilful summary statement should serve to point towards ane of those three options. Every bit such, I try to focus on primal details that would rule one of them in or out:  beingness afebrile points abroad from infection, the presence of an S3 points towards cardiac, etc.

Sample Summary Statement #i :

This is a 75-year-old male with a past medical history of an MI and multiple cardiac risk factors presenting with worsening dyspnea. He is afebrile, has a low O2 saturation, lacks a cough, and has S3 and pitting edema on test. His chest X-ray suggests a cardiac process. How should I care for him?

Sample Summary Argument #2 :

How do you manage a patient with acute decompensated heart failure?

When creating a summary statement, I've found that there are generally 2 options depending on how well y'all know the material. The first argument that I created is made when yous practice not automatically reach the diagnosis past reading the question stem. Here, you are highlighting central details that should help you lot eliminate the non-cardiac respond choices (answers D-F) and thus focus your line of thinking.

As your noesis base of operations grows, y'all should begin to make summary statements like the latter choice. These statements serve to focus your attending to the question at hand and can turn a complex two-step or 3-footstep question in to a uncomplicated, ane-stride problem.

Rules for Creating USMLE Summary Statements:

Every bit with anything in medical school, success with this method requires practise. When I am working with students as a tutor and we are doing questions together, I will accept them tell me their summary statement at the end of each question. In doing so, they can meet what details they may have looked over and start to go masters of this technique early on. I can also requite them several rules to follow. These include:

• Keep your summary statements curt – repeating the entire question stem is a waste of time and defeats the purpose.
• Learn from your mistakes – if y'all miss a question, try to discover if it was because of a lack of knowledge (i.e. not knowing that the treatment of decompensated heart failure was diuresis in the example above) versus a failure of your process (i.e. not realizing that the question stem above was nearly decompensated heart failure in the commencement identify). If the latter is occurring frequently, and then yous demand to expand your summaries to include more than key details.
• Don't over extend yourself – make a summary as to the all-time of your abilities and then starting time using other strategies to answer the question. You don't want to waste time trying to craft the perfect summary or gamble making an incorrect assumption because you lot are trying to answer the question ahead of the multiple-pick options.

One last example for practice …

A 45-year-erstwhile female presents with 3-days of cough. She has a past medical history of HIV and is non-compliant with HAART. On review, she describes a cough with productive, purulent sputum. She too endorses fever, chills, and dyspnea on exertion. She was recently seen past her principal care physician and had a CD4 count of 175. Vital signs:  Temperature 102.three, Heart Charge per unit 105/minute, Respiratory Rate 18/minute, and BP 110/78. Concrete exam is negative for murmurs. She has no lower extremity edema. Chest X-ray shows a bilateral infiltrate. What is the adjacent best step in direction?

• Levofloxacin

• Acyclovir

• TMP-SMX

• Lasix

• Azithromycin

• Fluconazole

• Metoprolol

Sample Summary Argument #1:

A 45-twelvemonth-quondam female with HIV and a CD4 < 200 presenting with coughing, fever, and a bilateral procedure on her chest 10-ray. How should you lot treat her?

Sample Summary Statement #2:

How should you treat Pneumocystis pneumonia (PCP)?

Again, by looking at the respond choices I know that the objective of this question focuses on treatment of either a cardiac or infectious status. Furthermore, I know that I need to distinguish of an infection is bacterial, viral, or fungal. Thus, when creating my summary statement I highlight her fever and HIV condition to push myself in the infectious direction. From there, the bilateral chest ten-ray findings point me away from community acquired pneumonia (answers A and Eastward) and make me call back of PCP.

In closing, I hope that you can utilise this strategy to help yourself main difficult questions on the USMLE. I believe that this method will help you address the of import aspects of a question, ignore distractors, and improve your score. Good luck!

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Source: https://www.medschooltutors.com/blog/usmle-strategy-shrinking-questions-down-to-manageable-size

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