What is the Most Important Strategy to Use on the Step 1 Exam?

Posted by Mac S. on 12/7/16 5:05 PM

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When I was practicing for my Step I exam, I often found myself frustrated. I would take what seemed like a simple case, find some minute detail, and then pick some crazy complex answer. Eventually, I found a strategy that helped me get over that: treating the patient in the question like a real one.

Diagnose the Patient, Diagnose the Problem

The exam is very removed from the actual practice of diagnosing a patient. It would be fantastic if patients came in with the differential diagnosis tattooed on their chests!  Just imagine: “Mr. Jones, I’m a little confused about your chest pain - Can I see your tattoo? Ah! I hadn’t thought of pericarditis! Thanks for that!”  Unfortunately, they don’t. Instead, a doctor has to build a differential diagnosis, think about what’s going on, and reorder the differential as you find out different pieces of information. You’re learning how to do that in all of your classes (and you’ll be doing it in real life), so do it on the test!

1. Cover your Answers -- Your Patient Diangosis Won't Be Limited to Muliple Choice

I would take my hand, place it on the computer screen, and cover up the answer choices. Then, I would read through the question, as if it were a case report. I would reorder my differential and think about why the test was giving me different pieces of information. Then, when I got to the end of the question, I would remove my hand from the screen. If I saw the diagnosis I had been thinking listed as an answer choice, I would pick it and move along. Having that validation from the test made me feel more comfortable with my answer. This helped me move through the test more quickly.

2. If Your Diagnosis Isn't There, Go Through Each Option One-By-One

If I didn’t see what I was looking for or didn’t have any idea what the question was asking, then I would go through the answer choices. Quite often, if I didn’t immediately see the answer I expected, I would actually find that choice in a convoluted form. For example, If I was reading a story about a caucasian 24 year old male with recurrent respiratory infections and greasy stools, I would think about Cystic Fibrosis. If the question turned out to ask why he was infertile, I would already be thinking about cystic fibrosis and be able to jump to a classic association (bilateral absence of the vas deferens).

While there are going to be questions where you read through the diagnosis and ask yourself “What the heck!?”, this strategy will allow you to diagnose and answer questions about recognizable diseases without making errors.

Quickening Your Speed

I found as I applied this strategy, my speed increased and the number of times I was able to second-guess myself into changing an answer away from the right choice decreased. Also, being able to run through the exam and be able to pull correct answer choices out of thin air was a huge boost to my confidence in both practice exams and the real test! So, when you’re doing your next medical school test, give it a shot. A multiple choice test is really a bit of a crutch. Eventually, you’ll be asked to pick the right answer out of thin air. Why not get started now?

Are you interested in learning more about ways to prepare for the Step I exam? Reach out to get connected to one of our incredible test preparation tutors in Cambridge and New York!

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Check out the introduction to this blog post by following the link below, and stay tuned for additional chapters on the Step I exam from Mac, one of our Cambridge tutors!

USMLE Step I Exam: Introduction

Why the Step I Exam Should Matter to You 

The Tools for Success on the USMLE Step I Exam

Tags: study skills, USMLE