Sunday, April 27, 2014

Tips for Medical MCQs for USMLE Step 1, Step 2CK and Step 3

In your residency campaign, USMLE step 1 , 2 and 3 are most decisive battles and MCQs are your weapons to fight these battles.

For some unclear reason (probably we docs are crazy or something) most important exam for physicians like USMLE Exams, Residency in Service Exam (at least for IM), Board certification exams are crazy long (8-9 hours), nerve racking MCQs exam. Mastering techniques to take MCQs will help you through out your career.

Here are some tips which I find useful

1) Practice, practice and more practice (I cant over emphasize this).
     Its very important to start doing MCQs early in your preparation. No matter how well you are prepared knowledge wise, you cannot perform well unless you practice a lot


2)Practice in not so ideal circumstances
    For many step 1 takers (specially IMGs) a lot is at stake which results in a lot of anxiety on exam days. Personally I was not able to sleep the night before step 1 and step 2 CK. Many people get headache during the exam. Nausea, vomiting is also common. Many people cant eat anything before the exam. Mental exhaustion can set in towards the end.
The solution is practice. Try to practice MCQs when you are not feeling so good, like when you are having headache, when you haven't slept all night, when you are hungry and hypoglycemic or when you are nauseated. Practice when you are very exhausted or sleepy.
In case God forbid something bad happens on the exam day, this hard time practice will save your day.

3)Find you best Approach
   There is more than one right way to approach a MCQ. Specially the long ones. I would personally recommend reading all the question vignette once with good concentration and focus at reasonable speed. While reading I register all important facts in my mind and skip the un-necessary detail.
For example in a question
70 year female present to ER with dizziness. On exam her BP is 140/85, Temp is 98 F, HR is 62 and respiratory rate is 14. On labs eval Her WBC count is 5.6, Hb is 13 and Platelet count is 222.  Na is 121 and K is 5.4
Instead of trying to remember all the details while going over the answers what I would remember is elderly female, with dizziness, normal Vital Signs and CBC but low Na and High K.

Some people read the vignette twice, but it costs in time.  Another useful way is to highlight the important facts.
You have to find what style works best for you and perfect it.

4)First Impression is usually right ?/ Dont change answers    
 Although controversial, but most people believe that your first impression is the right answer in most situations. So unless you have strong reasons to change you answer  (you have a flash of memory triggered by another vignette) changing answer in general should be avoided.

5) If you dont know, guess and move on
  If after spending appropriate time, you cant figure out what the answer is, take an intelligent guess and move on. Mark that question and come back at the end of the block if possible.

6) Consider rule out approach
 If you cannot confidently rule the right answer in, try to rule out the answer one by one. The one which cannot be ruled out is probably the right one.

7) Time Management is very important
 In step one you have 1 minute 18 seconds for every question, practically some questions will take 30 sec and some 90 sec. Sell assessment simulated exams are very helpful. In practice aim for 1 minute (max) for every question,
Share you own views, experiences, recommendations in the comments section below