The Main 5 Areas where students falter in their ISP (Intensive Study Period) and how to break out of these traps

 1. They don't re-do their incorrect questions.

We recommend that students re-do their incorrect questions before moving on to the next subject/system. You can't say that you have mastered a topic until you have re-done your incorrect questions. We recommend doing your incorrect questions before moving on to the next topic. When re-doing incorrect questions, the goal is not to remember the exact question, but to realize that the topic at hand is a hole in your knowledge base. You should apply the S1M framework to that topic and know that the next time the Boards' examiners ask you about the topic, it will be about a different element of the framework.

2. They don't attack their weaknesses seen in practice tests

Many students will take a practice test at the outset of their ISP, then take another NBME halfway through. Many of the areas that were weak are still weak because the students did not attack them. Also, areas that were previously strong, can become weak if they are not reviewed prior to taking a practice test.

If students see little improvement between the two tests, they get very concerned because the score hasn't changed much, but rarely do they look at the score report to read between the lines and figure out what happened. Often times, the areas that were initially weak have become strong because they were attacked, and the areas that they have yet to cover and have not seen in a while, have become weak. On the contrary, this is a reason to feel good. You prioritized your weak areas and you have seen great benefit. Now is the time to attack areas in which you were once strong; it will only require basic review (doing the questions in the S1M format) in these areas because you already have a good foundation. The key will be to not forget the topics that you covered at the beginning of the ISP.

Weekly review (1-2h) -- at the end of every week -- of topics covered prior will make sure that you don't forget old topics. This simply is flipping through your FA and glancing at your annotations, which will jog your memory back to individual questions and frameworks.

Also, we recommend that you spend some time (btwn 1h - 4h, depending on your need) prior to an NBME -- not necessarily on the same day -- to review topics that are remote and distant from your mind.

Your practice tests are you telling you where your extra points lie. You should superimpose your practice scores (put them side by side, one on top of the other), so that you can see the trends. Remember these basic rules:

** Get everything out of "lower performance." What this means is that you missed a "basic" question that they expect most students to answer correctly. This requires the basic review and knowing basic 1-2 step questions. Get the enchanced feedback version of the NBME tests to see exactly which questions you missed. Don’t rest with just learning the answer to that question; realize that there are other peripheral areas to that topic that are also likely weak. **

** When you notice that something is persistently weak, pay attention, this is telling you something. Attack this weakness before the Boards does, because you know they will.**

3. They spend too long on individual questions (20-30min per question) and don't make it through at least 2 blocks/day.

Many times students will get stuck on a particular question where the answer explanation is vague or poorly worded. The student will spend forever searching through multiple sources and the Internet looking for more clarification. After they know it, 30 min have passed and they still don't have a good understanding of why the answer is what it is. As a rule, you should not spend more than 15-20 min per question. In fact, you should try and target under 10min per question. For topics on which you have seen previous questions, you will go much faster because you have already done the annotation and review.

To do this, keep the following in mind. Keep the structure of the S1M format of doing questions. Go through the steps: do the question, then go to the FA and make short and only necessary annotations. Don't write paragraphs or things that may seem unnecessary. If you have to think about whether it’s necessary, then it is probably bordering on unnecessary. Keep things to 6-7 word stems if you can.

If after reviewing both of these sources (answer explanation and FA) and you still can't find the answer or explanation to your particular question, you can try using a supp source or googling the topic on emedicine; but understand that you will have diminishing returns at this point. If FA and the qbank don't have adequate coverage on a topic, chances are that it is not that high yield, and you likely won't be tested on it. The extra 15 min you spend will not benefit you much.

2 Blocks of q's a day is not too much, in fact, you could do more if you wanted to. Make sure you use this as your guide to keep moving.

4. They lose hope for improvement.

We've definitely seen student scores increase 20+ points from the halfway NBME exam. Especially when there are major fundamental areas that need to be covered. Remember, it is easiest to get things out of the lower performance category; but it's much tougher to take things from borderline-high to higher performance. Thus, make sure that you hit your weaknesses. But at the same time, don't forget to review the areas you are strong in because you don't want to give up the ground you have gained.

Make sure that you pass an NBME practice test (hopefully with a good margin, 5-10pts) before taking the real exam. Some students may be avoiding the NBME practice test for fear of what they may find out. Remember, knowledge is power. You don't want to walk into the test with glaring weaknesses that could be attacked one last time during your Comprehensive review period. Many students in the past have made this mistake; please don't repeat it.

5. You have the opportunity now to do your best!

Hopefully this analysis helps you target areas of improvement in the remaining time of your ISP. Stay positive and motivated and always focus on learning and understanding the material. Prompt yourself to make connections and anticipate potential questions. Ask yourself if you know the S1M framework about a particular topic to see if you have reached mastery level. Then see if you can freely associate that framework with other similar disease processes and topics.

Remember, all of this studying is to benefit your future patients. The way we teach the info is the same way you will learn it on the wards and in residency. Fortunately, focusing on all the connections is also the way the Boards examiners ask questions. Now is your protected time to learn things that you never had the time to. Seize this opportunity to master the information before moving on to the 3rd year. Don't worry about the score, if you learn the info the right way, the score will follow. We know that you can do it!

Finally, don't burn out. If you feel yourself hitting the breaking point, take the afternoon/evening off, and come back refreshed the next day. Take frequent breaks and plan effectively. Make sure your studying days are high yield. In our motivational module, we teach you to turn off all distracters (phone, Internet, email, etc) so that the 8-10h you spend is high yield. Get plenty of rest and exercise so that you are not falling asleep and being unproductive. This will lead to the highest yield retention and integration.

I've found it's the times when we're making the most ground that we feel the most vulnerable. It's because you are in completely new territory, and your mind can sense it. This is when you need blind faith to keep pushing forward. If you persist, you will be rewarded greatly. You are doing all the right things, keep up the great work.

Best of luck and happy studying.

S1M Format for Doing Questions:

Step 1: Do questions one by one (Question blocks should be focused -- subject/systems based -- not random)

Step 2: Read and understand the answer explanation and answer choices after attempting the question

Step 3: Read the corresponding section in the central text after reading the answer explanations

Step 4: If the key info is missing, annotate the section with the key 4-5 word association found in the question regarding the right answer (avoid annotating regarding wrong answer choices)

Step 5 (optional): If you need more clarification, go to your supplemental source, emedicine, etc as needed

The S1M Framework (What you need to know for the Boards):

1) Presentation

2) Mechanism/Pathogenesis

3) Course/Complications

4) Treatment/Diagnostics