TEST-TAKING

STRATEGY FOR THE

USMLE EXAMS

Copyright USMLE Success Academy

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INTRODUCTION


The two biggest questions we get from our new students at The
Academy are: How do I properly prepare for the Step 1? and Can you
help me overcome my test-taking difficulties? Well, weve already
written a highly detailed preparation strategy guide for the USMLE
exams, which if you dont have yet I highly suggest you download at the
following address:

http://www.usmlesuccess.net/the-ultimate-usmle-preparation-
strategy-download-for-free

And in this document, we are going to give you a tried-and-proven
strategy for tackling USMLE questions. First thing that every student
must realize is that there is no secret for scoring well on the exams.
There are however proven strategies that work very well, and as long as
you follow them and bring to the table a strong desire to succeed and a
strong work ethic, you too can succeed!

The following pages contain our Test-Taking Strategy. There is no fluff,
just the details you need to know in order to put it to good use. We will
give you as much detail as youll need in addition to examples so you
can see how it works in action.

Lets get started.





To your success!

Dr. Paul & Dr. Stavros

TEST-TAKING STRATEGY


The first thing that you absolutely must know is that success on any of
the USMLE exams is mainly dependent on how well you know the
information that is presented and how properly you perform practice
questions during the preparatory phase. Test-taking strategies will do
you no good if you havent worked extremely hard in order to master
the information and have practiced hundreds upon hundreds of
questions in order to build the stamina you need to get through the
rigors of the actual USMLE exam.


A simple question becomes a guessing game when you dont know the
simple differences between similar conditions. Consider Marfans
syndrome and Homocystinuria; very similar, with some important
differences. A question asking the main differences is quite simple, but
if you failed to study enough detail then it becomes a difficult question.
If you understand this, you realize that intense studying is essential to a
good score.

A bunch of simple questions also become quite challenging when you hit
question 100/350 and you are exhausted, your eyes are strained, and
you are falling asleep because you didnt train your brain and body to
withstand the rigors of the long 8+ hour exam. How can you possibly
expect to perform adequately if you cannot get through the exam in
peak condition?

The point of the two pieces of information above are that 1. You must
study extremely hard and actually know the information, and 2. You
must train yourself to withstand the demands of the exam. How can you
ensure those two criteria are met? Study very hard and perform
questions in a timed mode doing full blocks at a time.

Once youve put those pieces of the puzzle into place, you can use the
test-taking strategy were about to discuss in order to maximize your
score.

The Basics Overview Of Our Test-Taking Strategy:

We will outline the important steps now, then go into greater detail
about each in order to fully understand how to implement the strategy.

The ability to best answer a USMLE test question can essentially be
broken down into FIVE easy-to-implement steps, which are outlined
below.


Step 1 Always read the last line of the question first
Step 2 Read the question fully and slow enough that you dont
overlook anything + use the highlight function
Step 3 Predict/Formulate your own answer
Step 4 Select the answer you predicted/formulated if present
Step 5 Eliminate any incorrect answers to narrow your selection


Those steps will help you to remember the sequence of events once you
fully understand what they mean, so lets get into the details.

Step 1 Always Read The Last Line Of The Question First

The reason why you should read the last line of the question before
doing anything else is because often times you will find that this is all
you need in order to answer the question.

For example: Which of the following best describes ________________.

A final line that specifically names a disease or disorder often doesnt
require you to read the entire question. Consider the two similar but
very different questions below, while they both refer to Marfans
syndrome, one can be answered without the question stem and one
cannot:

A 23 year old male is 69 tall and has long limbs and a very wide
wingspan. He is seeing his cardiologist today in order to determine
if he is afflicted with a common cardiac anomaly associated with
his genetic condition. Which of the following is the most significant
cardiac anomaly he is likely to be afflicted with?

As you can see, you must read the full question in order to determine
what genetic condition he has before you can choose an appropriate
cardiac anomaly. But simply reading the last line immediately let you
know that. If you hadnt read the last line first, you may be tempted to
re-read the question, ultimately wasting time.

Now consider this question.

A 23 year old male is 69 tall and has long limbs and a very wide
wingspan. He is seeing his cardiologist today in order to determine
if he is afflicted with a common cardiac anomaly associated with
his genetic condition. Which of the following is the most serious
cardiac anomaly most likely found in a patient with Marfans
syndrome?

As you can see, these questions are the same, with the exception of the
final line of the stem. If you start by reading the entire question and
come to the end only to realize that theres no valuable information to

be gained by reading it, youve essentially wasted time that could be

better spent on longer questions that need to be closely evaluated for
clues and hints. If you have around 15-20% of questions that dont
require you to read the full question, you will find that you save a ton of
time and you will finish blocks of questions with time to spare. This
extra time can be used to go through tougher questions that are loaded
with lots of important pieces of information, which can have a major
impact on your score.

So you have two options after reading the final line 1. You either dont
need more information and base it solely on the answer choices, or 2.
You need more information from the question and you must go through
it carefully (we will discuss how to approach this type of question in a
bit).


Lets assume that you dont have to find any more information and you
can base it solely on the answer choices You should NOT just look
down at the answer choices, as it can still be tricky, so instead what you
should do is formulate an answer in your head based on what you know
about the question that was posed. So lets take the example we used
above about Marfans syndrome; the though process should look
something like the following:

Which of the following is the most serious cardiac anomaly most
likely found in a patient with Marfans syndrome?

Your thought process: I know that Marfans syndrome patients can
have a variety of cardiac issues such as palpitations, shortness of breath,
fatigue, and even murmurs, but the most worrisome possible cardiac
anomaly they may experience is an aortic aneurysm and even an aortic
dissection, which I know is a surgical emergency.

Now, if the options include the following:

A. Racing heartbeat
B. Dissection of the aorta
C. Ascending aortic aneurysm
D. Right-sided heart failure

E. Left-sided heart failure

Based on these options, weve already discussed that the most
worrisome cardiac problem that may arise is the aortic dissection. Now,
this obviously isnt possible if you dont have a thorough knowledge of
all of the testable material, which is why it is very important to master
the material tested on the exam. And thats how we need to approach
this type of question it is very simple and straightforward as long as
you know your stuff!


Moving on And assuming that the question requires more than what
we just discussed



Step 2 Read The Question Fully And Slowly Enough That You
Dont Overlook Anything


Lets assume that after reading the last line of the question weve
discovered that we need to gather more information. There are some
important points that you need to understand in order to use your time
wisely and efficiently, and they include:

Only read the question one time
Make good use of the highlight function in the exam software


Only read the question one time: Many students will skim through or
read quickly in an effort to save time, but when you skim or try to speed
your way through a question, you most likely end up going over it again,
which ultimately causes you to waste more time than if you would have
just gone through at a moderate pace in the first place. This doesnt
mean you need to read slowly, it just means that you need to read slow
enough so that you can absorb what youre reading.

Make good use of the highlight function in the exam software: This
is quite possibly the most underused tool available to students taking

the Step 1 exam, but when used properly will save time, improve your
ability to answer questions, and ultimately improve your score.

So what should be highlighted? Well, based on what we learned from
the final line of the question (dont forget to read the last line first), we
know what we are looking for It may be signs/symptoms that help us
to diagnose a condition (Ex. If the last line reads something like Which
of the following is the most likely diagnosis?), or it may be
signs/symptoms that help us identify a condition, which then allows us
to identify more findings associated with that condition (Ex. If the last
line reads something like Based on the patients condition, which of the
following is true or most likely?). It really depends on what that last line
asks us. Always highlight abnormal labs/test results so that you dont
have to search for them more than once. Be sure to highlight age,
gender, and ethnic factors that may alter a diagnosis (common for
genetic conditions).


Once youve read through the question and highlighted all of the
pertinent information, it is time to move onto Step 3.





Step 3 Predict/Formulate Your Own Answer


One of the more common themes you will hear when people talk about
how to best answer USMLE questions is to never look down at the
answer initially; well this is completely correct. True, you should NOT
look at the answers, but the reason behind it is extremely important,
and if you realize WHY you shouldnt cheat and look down, then youll
be much less likely to actually do it.

So WHY shouldnt I look down at the answers? There are a few

reasons, but the big ones include the following:

1. They are designed to all sound appealing
2. They can persuade you into looking at the question stem differently



So WHY should I be predicting/formulating my own answer? The
main reason for doing this is that it:

1. Lessens the chance that you will be drawn into an incorrect answer

You see, the USMLE exam (Step 1, Step 2 CK, and Step 3) questions are
all written by experts in their respective fields, and are in fact designed
so that an expert in that field should be able to draw a reasonable
conclusion/answer based solely on the question posed, without the
need to see a selection of answers. And this is extremely important to
realize as a USMLE test-taker, because it means that with the proper
approach to your studies and preparation, you too can learn the
information well enough to the point where a good majority of the
questions can be answered by simply drawing upon your own
knowledge and formulating an answer.

Now, obviously you know the USMLE isnt a straightforward exam, but
even just developing a train of thought with respect to the answer will
help you to answer questions with a significantly greater accuracy that
simply reading the question and then perusing the answer options.


Now that you understand the basis for this prediction/formulation
portion of the answering process, it is time to move onto Step 4

Step 4 Select the answer you predicted/formulated if present

Is the answer you developed in your own mind present in the answer
options?

If it is, choose it and move along! Now keep in mind that some answers
will be fairly obvious, while others may require a bit more detective
work; meaning you need to identify the most correct answer. When
this is the case and you have several options that are technically
correct, you need to choose the answer that you formulated and that
meets the criteria that you highlighted from the question stem. Think
back to our question about the cardiovascular system and Marfans
syndrome from before Many of the answers were technically correct,
but only one met the criteria for most worrisome, which was a
dissection of the aorta.

You see, there are often clues in the question stem that will help you to
better choose the correct answer. When you see phrases such as: Most
likely or Most correct or Most lethal in addition to factors such as
sex, age, and ethnicity these are placed within the question stem for a
very specific reason, and unfortunately many students fail to register
that this is being given to you; which is why you should make use of the
highlight feature and identify absolutely anything that may help you out
when the time comes to identify the correct answer.


SOME IMPORTANT POINTS TO KEEP IN MIND

1. If the answer doesnt jump out at you and isnt very obvious, do
not make the assumption that there must be a trick.

More often than not there is no trick to a question, it is just that you
didnt identify the pertinent info and/or you missed something
important.

What do students typically do when they arrive at this point? They will
start to panic and then read into all of the answer choices. This is a
dangerous game because what happens when you do this is that you
start to formulate and justify reasons why each answer may be correct.
So what youve essentially done to yourself at this point is taken
yourself from a point where you had a 50% or greater chance at
choosing correctly and moving that likelihood down to 20% or less
depending on the number of choices.

So if you find yourself doing this on a regular basis STOP! It is not the
way to achieve a good score.

How to overcome this? Practice, practice, practice
With what? Questions! This is why The Academy is a firm advocate of
performing USMLE World questions (and other banks if you want) in a
very specific manner; namely performing full blocks in a timed mode.
Not only does a full block + timed mode help you to develop the mental
toughness and endurance needed to sit through the entire Step 1 exam,
but it helps you to master the tricks that are outlined in this guide (ie.
Looking at the last line first, reading the question + highlighting the best
given information, formulating your own answer, identifying the correct
answer, etc. [You can learn more about using your question bank the
right way by downloading our free Success Strategy Guide from our
website].

At The Academy, we are NOT believers of the phrase Practice Makes
Perfect. We are believers in the phrase Perfect Practice Makes
Perfect. This means that you can do all the questions in the world, as
many students will attempt to do, and still you wont get very far. It is
only those students who do questions with perfect form who end up
scoring exceptionally high on their Step 1 and other USMLE exams.

2. When two answers are almost identical and/or very similar,

neither of them are often the correct answer.

Many students fall into the trap of seeing two very similar answers
and falling under the assumption that one of them is the correct
statement while the other is slightly wrong; but this is not often the
case.

How to overcome this? Learn to identify very similar answers while
practicing your questions, and realize how often neither is the correct
answer. (Note: This is not the same as arriving at two final answers and
being unable to differentiate between the most correct and lesser
correct we will discuss that issue shortly).


And now onto Step 5 When the above Steps 3 & 4 failed to bring you to
the best answer



Step 5 Elimination Round


Its going to happen whereby youve done everything correctly yet you
still havent found the right answer, and thats okay, because we will
implement our 5th Step, which is usually our safety net.

What you need to do when youve done everything correctly but still
cant find the answer is start eliminating answers that you identify as
incorrect. You should be able to do this based solely on 1. Your
knowledge of the material and 2. The pertinent information from the
question that makes them incorrect.

Now, the nice thing about the Elimination Round is that it typically
eliminates 60% of the answer options, and the bad thing about this
round is that it typically leaves you still with two final options. And if
you think this just happens to repeatedly occur by coincidence, then
youre wrong. These questions are meticulously created and dissected
to ensure that the average students fall into traps that put the majority

within 1 standard deviation of the mean. Although bringing your

chance at answering correctly from a purely guessing standpoint from
20% up to 50%, that is still only 50%. Sometimes you will arrive at two
final answers and one will look better, giving you that gut feeling that it
is the best choice when this happens, choose it and move forward.


When you arrive at two final answers and neither looks better than the
other, the way you can overcome the trap is by realizing that if you do in
fact make it to this point, endless data and statistical analysis
demonstrates that your best bet is simply to choose one and move
along. The reason why this is the case is simply that often the answers
are both essentially correct and the average student cannot differentiate
between the two, so what most students will do is ponder and ponder,
go back and re-read the question stem, waste a ton of time, and
ultimately end up just making an educated guess either way. So if you
just choose one and move onto the next question, you save yourself lots
of time, energy, avoid a headache, and are still left with the exact same
odds of answering correctly anyway. Re-reading the question will only
convince you that the choice you make is the right one, it wont give you
a statistical advantage!

It is important to realize that if you are doing practice questions and
repeatedly coming to this point, you need to study differently so that
you know the information better; theres really no easy way around it.



So lets recap:

Step 1 Always read the last line of the question first
Step 2 Read the question fully and slow enough that you dont
overlook anything + use the highlight feature
Step 3 Predict/Formulate your own answer
Step 4 Select the answer you predicted/formulated if present
Step 5 Eliminate any incorrect answers to narrow your selection

If you master these steps with Perfect Practice, your scores will
improve!

To your Step 1 Success!!

Dr. Paul & Dr. Stavros
USMLE Success Academy





For questions please contact us on our website at the following address:

www.usmlesuccess.net and visit our Contact Us page.