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How to Answer USMLE Questions & How to Study From A Question Bank

by Mohammad Hajighasemi-Ossareh, MD, MBA
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    00:00 Welcome back to the 2nd Year of Medical School lectures. Now in this one we're going to discuss how USMLE questions are composed and the format that they use called clinical vignettes. Then we're going to discuss how to study effectively from a question bank with the aid of a book and a video reference, 2 critical topics. So, USMLE Step 1 uses what are called clinical vignettes to assess each student's basic science knowledge. Each question that you will see has the same general format. So, each question will have a single patient-centered vignette. This is a fancy word to just mean that each question will discuss a single patient, so simple. Then each question will have an associated 4 or more response options. This again just means the question will give you 4 or more answer choices so you'll see the question is a paragraph and then a, b, c, d, etc.

    00:59 with an answer. Then, each question requires you to be able to assess the patient in the question and depending on how the question is designed it may ask you to interpret laboratory data, radiographic data, or graphic charts. This means again in more simple language lab values. Sodium is 142, potassium is 4.6, whatever. Radiographic data, here's a chest x-ray, see what you see or graphical data, your charts of a biostatistical study. What do you see? Then, each clinical vignette will end with a single question that they're being asked and the test takers then require to select the single best answer to that question. Now I said those 2 parts are kind of weird to highlight it to you because this is the trick. They will give you a single patient to talk about. Well that makes sense and they will have information and they're about the patient. Could be historical, could be numbers, again that kind of makes sense in the practice of medicine. Here is where it gets tricky. They're going to be asking you a single question. So the first thing you have to do is know what the questions being asked. Vital to knowing every single test question, always say to yourself "What's the question being asked here?" and usually it's pretty obvious. The hard part is this. You are required to select the single best answer and if I could scream that actually louder I would. That's where it gets tricky. A lot of answer choices may be correct. So often more than 1 answer may seem correct or could even partially be correct and the test taker then is required to select the single best question being asked. This is the root of the challenge of all USMLE Step questions, finding the single best answer. So the question becomes "Well, how do you answer USMLE questions?" You're emphasizing the single best concept. What do I do? Now, every single student will have and develop their own strategy on how to set up and answer a USMLE Step 1 question; however, in general the following strategy is the core of what all students do and it's what I recommend as well. So here's what I want you to do. You're on test day, you're practicing using a question bank, using a book, whatever. You have a question in front of you. I want you to start by reading the last sentence or two of the question first. It's best to know what you're being asked before you read the entire question stem. Often, question stems can be long and full of information that's not necessary to get to the right answer. So start with the last sentence or two. Find out what they want you to ask or what they want you to answer, that is. After you know what question they are asking, quickly scan the answer choices. You don't have to read them carefully, just get a sense of what type of answer choices are available to the question they're asking. Now this is a bit of an elevated point. What you're going to be doing when you're looking at answer choices is ask yourself, "Is this is a diagnostic question? Are they asking me what would I do to help diagnose? Is it a therapeutic question? What answer might going to pick it? Give a treatment therapy? So just look at the answers and figure out the gist, so the general category of what answer you're looking at. So, by looking at that and thinking in that category sense, you may be able to eliminate answers right away. An answer choice may not be like the others, 2 are identical but with little different wording. So you can use basic test-taking strategy just by looking at the answer choices before you've even read the vignette. So, you read the last sentence or two to find the question what they're asking you.

    04:32 You quickly scan the answer choices and figure out the categories then I want you to carefully read the question. So, we've timed it out. We looked to the total number of questions you have and a total number of minutes on test day. You have over a minute and a half to read and answer each question. So, read carefully but read quickly, a minute and a half, so that long. Now for some you're going to have to interpret not just the paragraph about the patient but also laboratory, radiographic data or charts. Now, this is where having lots of Qbank or question bank experience comes in handy. When you do lots of question banks, you will learn the wording of these questions.

    05:14 You will become familiar with how they present laboratory data, imaging data, and this familiarity allows you to move more quickly. Since you already know the question being asked when you're tacking a question, you scan the answers, try to come up with an answer in your head before you go on to the answer choices. Once you have an answer then go to the answer choices and start eliminating ones that are just totally wrong. Then hopefully by the end you'll have a single best answer but let's be honest life isn't that perfect. You're probably going to be left with more than 1 then you're going to use test-taking strategy to help you narrow your choices. Okay. So what is the point of this strategy? 1) The point of the above strategy we just went through is to never ever, okay listen, never ever start by just reading in the question from the top, working your way down, getting to the answer choices. That's not the ___. What seems natural, read the question, read the answers is actually the wrong technique. Our strategy is reverse, it's bottom up essentially and it's dynamic. You go from the question, the answer choices, you read, you come back to the answer choices, it's very fluid. This leads you to answering the question more often than not correctly. So we talked about how questions are formed and how you should attack them but we also mentioned the importance of becoming familiar with the question bank. So, how do you use them? How do you study from a question bank? Now, question banks are amazing.

    06:44 What better way to actively engage yourself then with questions and then be able to learn with a response but not all students use these question banks correctly and that's what we're going to address. How to effectively study from a question bank according to each variable that we see in a question bank? So let's go through those. First, when using a question bank you have the option of how many questions for the question bank to give you in a block. A block is just, all that means is they're going to give you a bunch of questions, how many do you want them to give you at each time. We just call that a block. Now, I want you to always. Did I say sometimes? No. Always, I want you to do 40 questions. Okay? The real exam you need to emulate. So the actual USMLE exam you need to simulate it with the question bank and the real exam has 40 questions.

    07:37 So how many questions do I want you to do? That's right, do 40. If you said 20, come on you're killing me. There is no value in doing 20 questions, doing anything but 40. Simulate the actual exam every single time. Build that endurance to say "Whenever I sit down with the question bank I'm going to be hit with 40 questions." So when you sit down on test day, boom, you get hit with 40 questions, it's automatic you have reflexes, you're going to do great. Now, some students may make the argument. You may be making this argument while listening that "You know what I just want to do 10 questions because I'm short on time." Well, this is actually kind of a tough talking point since you should only be doing a question bank when you are studying and you have time to sit down with full uninterrupted focus. Don't do question banks on your cellphone while in shopping line and coffee shop. Now why do I have such a specific example? I saw it just last week. It's Step 1 season, a lot of question banks you can bring up on your smart phone. This guy is sitting there and I line at a Starbucks, going into his question bank. That's not how you use a question bank. If you just want to review an old bank for good old fun sake that's fine but if you're going through the question that's not the way to do it. Use the time when you're standing in a line at a coffee shop to watch Lecturio videos. You can access them on your phone.

    08:57 Pull up PDFs of a book you're reading that's high yield. Use question banks only when you can give it your full simulated test day experience with full focus. It is not something to be used passively and let me tell you why. You will build within yourself false confidence. If you are doing a question bank kind of passively, you're kind of getting it right, you're kind of getting it wrong, you're quickly reading the answer choices, you're going to go through that question bank and some point finish it, you're going to feel "Oh, I've done a bunch of the question bank, I'm doing great." Unfortunately, you did that question bank but without full focus and you didn't pull all the great stuff out of it. So, only do question banks when you can give them your full undivided attention. Second, the question bank itself will then ask you. Okay, so I am giving you now 40 questions because that's how much you're going to do every time. If you want the exam timed or untimed and if you want it in test mode and in tutor mode. The answers here are simple.

    09:56 Always do them timed and always do them in test mode. Again, you're trying to simulate the exam day. Timed just means do you want there to be a countdown timer at the bottom so doing 40 questions will give you 60 minutes. Do you want them to put that timer there and when the clock runs out close the test. Of course you do. You always want to simulate that exam experience so when you're sitting at home and doing these timed tests, you're going to be doing the question, looking down at the time and going "Oh time is kind of running out, I better speed up." So on test day when you're taking it and you're seeing time go down, you've already built the mental and physical reflex to speed up or slow down depending on how much time you have. The next variable there was, remember, test mode. You do not want to ever do tutor mode. Test mode says you're going to do 40 questions in your block and you're already going to do them in 60 minutes timed. Test mode, means you have to take all the questions and answer them and after you finish the test and hit submit then it will give you all the answer choices and the descriptions. Tutor mode means every time you hit a question and give an answer, right then it will give you the answer, right or wrong, and the solutions. That's not how test day is. Test day is test mode. So always do 40 questions timed and test mode. There is no other reason for anything else. Now, the benefit here is that you spend with this technique a solid hour in time mode going through 40 questions just like on test day. After you finished the block, then you can spend dedicated time going through each question in full study mode. Thus, studying from a question bank then comes in 2 modes. First, you sit down for an hour and you take the test block then you study the test block afterwards with a textbook and reference. The 3rd variable to consider here is your environment. When you sit down to do a block of question bank questions, it will take you 1 hour because you're always going to be doing 40 questions. Since we're always trying to simulate the exam, you want to make sure you're sitting down in a quiet location without interruption.

    12:06 Put your cellphone in airplane mode, everything goes on hold, for that 1 hour you do the block and nothing else. Now, after you've done that block in full test day simulation format, now you have to go through each question and study it. This is where it actually gets fun and this is the entire purpose of the Qbank. So, you've done the test, right, okay. You did a great job, sat down for an hour, simulate the test, let's go through it, let's learn. So, start with the first question. What I want you to do when going through and studying is re-read the question quickly and scan the answer choices again. See if you got the answer or the question that is, right or wrong, and see what the other answer choices was. Then go to the description below the correct answer choice. Whether you got the question right and wrong, I want you to do the exact same thing. Doesn't make a difference if you got a right or wrong? So underneath the question and answer there's going to be a description. Read the description and see if there was an absence in knowledge or a lack of ability to interpret the data. That was the cause of you possibly getting the question wrong. Maybe you misunderstood the question being asked or maybe you selected a partially correct answer and not the single best answer. The purpose of going through to the correct answer is to figure out why the correct answer is correct and if you got it wrong where along the decision-making progress you went down the wrong path. What you need to be able to do is identify from each question why you got it wrong or even if you got it right what led you to that process. So if you get it wrong, you need to see if you lacked knowledge and if so if you need to read more about that topic. If you lacked test taking strategy or were tricked by the wording of the style of the question, you need to then make yourself aware of this. "Oh, I didn't know what the question was being asked." That's okay. Go back and see how they played with their wording, become familiar with that. "Oh, I picked a partial correct answer." That's okay. Go back and say "Why was the other answer more correct that the one I picked?" This is how you learn from the mistakes and actually strengthen which is arguably extremely very important variable your USMLE test taking skills. So, knowledge is 1 component and simple test taking skills are another and thankfully with the Qbank you get to know both. Okay, now that you looked at the correct answer choice, I want you to go through all the other answer choices that were were wrong and figure out why these answer choices are wrong. Learning why the other options are wrong is actually just as important as knowing why the actual answer choice that was correct was correct and here is why. On the actual test day, so an actual question on test day may concern a topic from one of the wrong answer choices in a question. So, while going through a Qbank not only are you learning knowledge from the right answer but you're also learning knowledge of all the wrong answers as well. So every single Qbank question really can turn for more learning points. So remember and this always stuck in my mind, if I'm looking at a question bank question and I got it right and I look at the wrong answers ask yourself "Why are these wrong" and learn them because on test day one of those wrong answers maybe right for another question. Now that you've gone through all the wrong answers open your book to a section relevant to the question bank in that topic and you will review and add information that is valuable from the question bank into the book itself. So open the book, read the stuff. Okay so it's kind of here. Look at the Qbank. If there's any more high-yield information go ahead and write it in there and if you find yourself going you know what I need to do more learning on the topic, now is the absolute best time to review the material from that question. What better time to learn more about a topic than when you're going through a Qbank question, going through your high-yield book.

    16:08 That's the golden moment for you so take advantage of that time, pause what you're doing, go to a resource. So as you can see this process of going through a question is quite lengthy. This is how you attack a Qbank and a USMLE type question. So studying from a question bank is without without a doubt time intensive, it's a very active process of reading, thinking, strategizing questions, and then looking up information. It is time intensive and it requires your full undivided attention once again highlighting why you should always be emulating test day and only sitting down when you can give it your full attention. So let's summarize what we've talked about. The USMLE Step 1 exam questions are in the form of what are known as clinical vignettes. Each question will have a single clinical patient, ask a single question, and have a single best answer. Studying for the USMLE exam requires using a question bank. There's no question about that. When doing questions make sure you always simulate the actual exam day. When studying from a question bank, use the careful process of learning from each questions both right answers and all the wrong answers and make sure that you're using a text or video reference to help you study while you're studying the question bank. Thank you.


    About the Lecture

    The lecture How to Answer USMLE Questions & How to Study From A Question Bank by Mohammad Hajighasemi-Ossareh, MD, MBA is from the course Med School Year 2. It contains the following chapters:

    • How to Answer USMLE Questions
    • USMLE Question Format
    • How to Answer USMLE Questions
    • How to Study from a Question Bank
    • Lecture Summary

    Author of lecture How to Answer USMLE Questions & How to Study From A Question Bank

     Mohammad Hajighasemi-Ossareh, MD, MBA

    Mohammad Hajighasemi-Ossareh, MD, MBA


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