Busy Medical Student's Guide To Score Higher On Any Exam

11/09/2018 Yousmle | Copy of eBook for Mom to Edit
- Th Bus Medica Studen' -

Guide To
Score
Higher
on any exam
By Alec Palmerton, MD
How to study smarter, not harder, so you can

save time and score higher
http://beacon.by/magazine/v4/93757/pdf?type=print 1/99
Table of Contents
1. Introduction
2. About The Author
3. Chapter 1: The Secret to Excel on ANY Medical
School Exam
4. Chapter 2: How to Study for Step 1 Along with Your
Classes
5. Chapter 3: How to Score 260+ on Step 2 CK (Even If
Your Step 1 Score Disappointed)
6. Chapter 4: The Mega Butterfly Effect
7. Epilogue: The Best Advice I Received In Medical
School
8. Conclusion
INTRODUCTION
The key to scoring high on med school exams (and having a
life) ISN'T working so hard that your eyes bleed. Learn a plan
that works, so you can score better and have more time.
You were probably one of the top students in high school. You worked
extremely hard. If an assignment asked for one page, maybe you’d write two. If
the teacher said you didn’t need to memorize something, you’d do it anyway.
You always knew the best resources. Your notes were meticulous.
College might have been a little more challenging. Your note-taking system
may not have been perfect, but you sacrificed, worked hard, and got through.
In medical school, everything started to change. You couldn’t find that one
resource that had all the answers. No matter how many all-nighters you pulled,
you couldn’t keep up with your notes.
It was a never-ending cycle of not knowing what to focus on because you had
70 different professors on each block who didn’t talk to each other.
But other students seem to get it. They know the answers in class, do excellent
research and still have free time. And they seem so NORMAL.
What are they doing that you're not?
Contrary to that nagging doubt in your head, it's NOT because you're not good
enough. Rather, it's your plan. I will explain in this book.
A Plan That Works
In this eBook, you will learn:
The secret to scoring so high on any exam that everyone will be begging you
to be study partners — even if your version of photographic memory says,
“Error: file not found”
How you can score 250s or 260s on Step 2 CK — even if you had below-
average Step 1 scores
Why TONS of students do well on med school exams but disappoint on Step
1 — and what you can do to crush both
Medical school is challenging. However, the most meaningful accomplishments
in life start out like unsolvable puzzles. Let me show you how to solve it.
Alec Palmerton, MD
ABOUT The Author

Learn from one of the most sought-after USMLE tutors and educators
in the world how to improve your scores and get into a top residency
I Will Teach You How to

Score Higher Without
Working Harder
What did I learn from graduating
from Stanford Medical School with a
Step 1 score of 270, honors on every
3rd year shelf exam, then completing
residency at Harvard-MGH - all while
having a family and teaching
students around the world how
to score higher without working
harder?
I learned that people who end up at
top programs:
Aren't smarter than you, and
Don't work harder than you
People at top programs aren't
different, but they do ACT differently.
And YOU can learn to act differently
Alec Palmerton, MD
too.
Alec Palmerton, MD
"THE BEST TIME TO

PLANT A TREE WAS 20
YEARS AGO. THE SECOND
BEST TIME IS NOW."
- Chinese Proverb
CHAPTER 1
The Secret to Excel on
ANY Medical
Sch l Exam
Know WHAT to study, so that you can stop wasting

time and start improving your scores - even if you
suck at memorization
Chapter 1: The Secret to Excel

on ANY medical school exam
Speed vs. Velocity: Why Studying Harder in Med School Doesn't
Always Mean Scoring Higher
In high school, you probably learned the difference between "speed" and
"velocity." Speed is simply how fast you are moving - your total distance traveled
per time. Velocity is speed PLUS direction - it measures displacement, or speed in a
particular direction.
Like in the picture above, I can repeatedly sprint around in a circle, but if I end up
in the same place I started, the meaningful distance covered is zero. Conversely, if
I have a clear direction, but move more slowly, my ultimate velocity will be higher
than if I sprint around in a circle.
This sums up my early experience in medical school. I worked until exhaustion

(high speed), but with meager progress (low velocity).
In this chapter, you will learn:
Why priorities are the secret ingredient that will turn your toil into your desired
test results
What is Bloom’s taxonomy, and how to use it to know exactly WHAT and
HOW you should be studying to save time and score better
How a Harvard student scored 240+ on Step 1 despite doing no UWorld
questions - and how to avoid his subsequent struggles
Why some students do well on med school tests, but tank standardized exams -
and how you can crush both
How Yousmlers have gone from below-average Step 1 scores to 260+ on Step 2CK
Priorities give you a clear direction so you can score higher in less time
In high school, I worked extremely hard, but without a clear direction. I never had
to prioritize, because I took copious notes, created meticulous outlines, and did
every practice problem in my textbooks.
There was a finite amount of information to know, and because of this hard
work, I learned it. I did well.
In the speed vs. velocity analogy, I moved at such a high speed (hard work, long
hours) that I could overcome my lack of priorities (low velocity).
In college, I adapted the techniques I used in high school. Note-taking and
outlining became more challenging as the material grew in volume and
complexity. However, through a combination of hard work and sacrifice, I did ok.
Medical school was a completely different story. People told me medical school
was like drinking from a firehose. To me, it was worse. It felt like they had turned
the firehose so it was spraying the wall, and I had to rush around madly trying to
drink every last drop before it fell on the floor.
I had never learned how to prioritize. I had always been able to work harder until
I eventually covered all the material. In other words, until medical school, I had
always been able to compensate for a lack of velocity by generating more speed.
However, in medical school, I quickly realized that without clear direction,
I wouldn't be able to achieve my goals of scoring well.
Every professor would claim what they taught was "high yield." We sometimes had
70 professors in a block. It was clear they didn't work together to give us clear
priorities - sometimes we had 4 lectures on the same topic, all highlighting
different aspects of the same disease. Many professors didn't know what we had
learned previously; too many lectures began with, "what year are you guys again?"
Eventually I gave up on trying to take notes, and then tried a revolving door of
plans: memorizing each Powerpoint slide, re-reading First Aid, watching and re-
watching Pathoma.
Eventually, I learned how to prioritize the most important kinds of learning.
Next, I will teach you the schema that will describe EXACTLY what you should be
studying at every stage of your career so you can score higher in less time.
What is Bloom’s taxonomy?
Benjamin Bloom discussed learning as a process of moving through a hierarchy of

stages. It is a useful schema for medical students because it highlights what we
should prioritize.
Bloom’s taxonomy describes learning as a hierarchy. It comes from Benjamin
Bloom’s Taxonomy of Educational Objectives published in 1956. Each stage is a
different level in an ascending pyramid and builds on the previous level.
Bloom's Taxonomy provides a way to prioritize what you need to study at every
stage so you can stop wasting time and score higher.
The first stage is “Remember.” You memorize, state, or otherwise reproduce by rote
a body of facts and knowledge. A med school example would be memorizing the
equation for mean arterial pressure.
MAP = cardiac output x total peripheral resistance
The next level of the pyramid is “Understand.” You move beyond recalling facts to
explaining them. This might mean making sense of how increasing resistance would
increase MAP.
The next is “Apply,” using what you’ve learned to perform a particular task or solve
a related problem. Applying might mean using an alpha-1 agonist to raise
someone’s blood pressure.
“Analyze” involves breaking information down into its component parts. This could
be using the MAP = CO x TPR equation to list different causes of hypotension.
“Evaluate” involves forming/defending opinions. An example is critiquing the new
guidelines for sepsis.
“Create” is the highest level, where one produces new work – e.g., the creation of
the new sepsis guidelines.
I found the stages to be intuitive and enlightening. You can read more detailed
descriptions of Bloom's taxonomy here.
Bloom’s taxonomy: clear priorities for ANY exam so you can stop
wasting time
So why discuss an educational framework that is more than six decades old?
Because Bloom’s taxonomy describes what you should focus on at each stage.
Let’s take a closer look:
Stage 1: Preclinical Years = "Remember"
Preclinical years emphasize memorization over true understanding

The medical system rewards two things: research and clinical activities.
As such, many healthcare systems disincentivize quality teaching. No research
grant or bustling clinical work? No promotion for you!
I've spoken with a huge number of dedicated, inspiring teachers in medical school
and residency, and the message is often similar: there isn't enough support for
quality education. The system puts many of these professors in the awkward
position of having to choose between career advancement and their passion for
teaching.
It's much more expeditious to read facts off of a PowerPoint slide than it is to
teach a student to make connections and master the material. Consequently, by
prioritizing research and clinical activity, the system encourages professors
to focus on the easier-to-teach “Remember” level of Bloom’s taxonomy.
The result is that many medical students struggle to learn essential concepts of
understanding and application. As students, we end up memorizing PowerPoint
minutia because preclinical professors cannot afford to expend the effort to teach
how to “Understand” or “Apply.”
Let’s be clear. Understanding and application are crucial for Step 1 and clinical
practice. However, many medical schools neglect these fundamental skills because
their priorities are elsewhere.
The deluge of facts and information overwhelms medical students. The de facto
Step 1 study plan is to memorize the professor’s slides. We regurgitate it on their
tests and do well. The cycle continues.
However, memorization leads to problems at the next stage: Step 1.
Stage 2: USMLE Step 1 = “Understand” and “Apply
Step 1 forces you to Understand and Apply

I have taught hundreds of medical students from a multitude of backgrounds. I’ve
tutored AMGs, IMGs, Ivy Leaguers, and older graduates.
I can see what causes some students to score well on Step 1, and many others to
fall short.
In the frame of Bloom’s taxonomy, two abilities set apart students who score 240+:
“Understand” and “Apply.”
Many students memorize that ventilation/perfusion (V/Q) is highest at the lung

apices. Why? Class emphasized it. Then they memorized it well enough to ace the
multiple choice question.
However, it’s not enough to have memorized that information for the USMLE Step
1.
Test writers know that you memorized that V/Q is highest at the apex. How do I
know? I’ve spoken with Step 1 test writers.
Instead, they might ask what lobes see the highest rates of renal cancer
metastasis.
Test writers 1. Memorizers 0.
“Understand” means you internalized that perfusion increases in a dependent
fashion. In other words, the inferior lobes get the most blood. “Apply” allows you
to infer the lower lobes get the most blood-borne cancer cells, and are thus the
most likely locations of metastasis.
Mastering a lower part of Bloom’s taxonomy in no way ensures success at higher
levels. In other words, memorizing facts won’t help you Understand or Apply them.
Next, let’s find out what your Step 2/shelf study priorities should be.
Stage 3 + Beyond: Clerkships, Shelf Exams, Step 2, etc. = “Analyze” and

“Evaluate”
Clerkships, shelf exams, and Step 2 emphasize Analyze and Evaluate

Bloom’s taxonomy also explains performance at even more advanced clinical
stages. Your clerkships will force you to Analyze and Evaluate clinical data.
Shelf exams and Step 2 CK make a similar jump, moving you further up Bloom’s
taxonomy. Instead of testing your understanding, questions focus on more
complex assessment and management.
If Step 1 emphasizes mastery of information, Step 2 CK and shelf exams will force
you to analyze complex clinical vignettes. The most important skill for these exams
is what I call "question interpretation."
Effective question interpretation means you know exactly what every sentence
means in a vignette and how they fit together. This allows you to get through
questions faster with higher scores. We'll see two examples of students who
developed excellent question interpretation skills to go from below-average Step 1
scores to 260+ on Step 2CK.
Succeed by knowing each stage’s study plan priorities
Like the Memorizers who struggle on Step 1, remembering doesn’t guarantee

success. In a similar vein, the keys to success at one level may not ensure success
at future stages.
How can you be successful at every medical career stage? Success in medical
training is simple, but not easy. For example, you can’t memorize for two years
then expect to flip a switch to Understand and Apply. Those levels of Bloom’s
taxonomy take time, and must constantly be among your priorities.
The same is true if you are to rock your Shelf exams and Step 2 CK. You must do
more than Understand and Apply the medical concepts. You must also Analyze and
Evaluate clinical vignettes in mastering question interpretation (more on that
in Chapter 3).
Harvard student does NO Step 1 QBank. What happens?
So memorizing doesn’t ensure application or understanding. But what about

excellent understanding and application skills? Could you leverage those to
Analyze or Evaluate?
Unfortunately for this Harvard medical student: no.
One of the HMS students I knew during residency did not do ANY Step 1 question
banks. Even more remarkably, he still managed to score in the 240s.
Let that sink in.
This student did no Step 1 QBank questions – including no UWorld problems. Yet he
still managed to score better than 80% of test-takers.
As I got to know him further, I realized one thing helped him overcome his lack of
practice. He had a PhD-level drive to Understand and Apply material! He naturally
understood enough information to answer the majority of Step 1 questions,
despite using no QBanks.
However, this drive to Understand and Apply led him into a Shelf and Step 2 CK
quagmire. Like with his preparations for Step 1, he used minimal question banks for
his Shelf exam prep. However, he wasn’t practicing to Analyze or Evaluate, the Step
2 CK study plan priorities. As such, he couldn’t understand why he was struggling
with the Shelf questions.
Again, success in a prior stage does not ensure success at higher levels of the
pyramid. However, you will see how disappointing earlier performance does not
prevent future success.
Step 2 CK Study Plan priorities took average test-takers to 260s
If you fall behind in one of the stages, are you doomed to lag forever?
No!
Yousmle students have gone from below average Step 1 scores to 260s on USMLE
Step 2 CK (I'll show you an example in Chapter 3). The Step 1 study plan for each of
these students was to follow the dogma. They memorized First Aid and repeated
UWorld.
In each case, they scored far below where they had hoped. As we saw before, these
late-bloomers had been trying to Remember, rather than Apply, or Understand.
However, they completely changed their approaches and recalibrated their Step 2
CK study plan priorities. They learned not only to Understand and Apply, but also
to Analyze and Evaluate.
Through their hard work, they improved their Shelf scores to the 90th percentile.
Each of them scored in the 260s on their USMLE Step 2 CK exams.
Concluding thoughts
Bloom’s taxonomy highlights stages in the learning process and tells you what you
should prioritize in order to score higher and save time - on ANY exam.
What to do next?
If you're a preclinical student, read the next chapter. We will cover exactly how
you should be studying during your pre-clinical classes so you can crush BOTH
your school exams and Step 1.
If you've already taken Step 1 and/or are preparing for Step 2, you should STILL
read the next chapter. While I use Step 1 as an example, the same
principles apply to Step 2. Then in Chapter 3 you'll hear how you can score
260+ on Step 2 CK, even if you had a disappointing Step 1 score.
Image Credit:
Center for Teaching, Vanderbilt University. Accessed 8/7/2018
CHAPTER 2
How to Study for Step
1 Along with your
Cla es
Step 1 studying doesn't have to be different from

class studying. Learn how to learn smarter, not
harder, so you can save time and crush both.
Chapter 2: How to study for

Step 1 along with your classes
Preparing properly for your classes can help you do well on your school
exams AND Step 1
In the Chapter 1, we learned:
Following the proper priorities turns your speed (hard work) into velocity (work
leading to meaningful results)
Pre-clinical exams often test memorization, and
While memorization can lead you to do well on medical school exams, it can
cause you to do poorly on Step 1, shelf exams, and Step 2

How you can study during preclinical years so that you can do well on BOTH
medical school exams and Step 1;
Why my Stanford class failed at Anki - and how to fix it so you score higher and
waste less time;
When you should begin QBanks for maximal learning effect; and
The weekly schedule other Yousmlers and I have used to score 250 and 260+ on
Step 1
Two main priorities to crush both Step 1 and med school exams
As we discussed in the previous chapter, a study plan without priorities is like

having a map without a destination.
In other words, reading First Aid until it’s covered in sleep-drool is neither a plan
nor a schedule. It’s all speed and no velocity.
Following “what medical students do” is a recipe for burnout and disappointing
results.
Instead, to accomplish a huge goal, you must "win the day." Every single day’s
actions must focus on that goal. Like my organic chemistry professor said: the only
way to eat an elephant is to go bit by bit.
Let’s discuss the two "win the day" priorities followed by everyone I’ve ever met
who has scored 250+ on Step 1.
Priority #1: Mastery >> Memorization

My first year Stanford class attended a presentation on spaced repetition and
Anki. In case you're not familiar with spaced repetition/Anki, the idea is that when
we learn something, we will quickly forget it, a concept known as the "forgetting
curve.
However, the rate at which we forget it decreases the more times we repeat that
information. In other words, if I learn something once, I will forget it in a day, but if
I review it the next day, the time it takes to forget it will increase.
Anki is a computer program that shows you flashcards at spaced intervals.

By reviewing those cards at the programmed intervals, you can remember anything
indefinitely. This saves you huge amounts of time that would have been wasted
constantly re-learning things.
(To learn more about Anki, start with my FAQ article here.)
My first year class loved the idea of remembering things forever.
However, while most students initially embraced Anki, most had quit by the end of
the term.
Why? They focused on memorizing.
Many friends copied bits and pieces from professors’ PowerPoint slides. Even
worse, some copied the entire slides. They could recall correctly the contents of
their Anki cards but struggled to make sense of any of it.
Key: the most important thing when you start is not spaced repetition. It is learning
how to master topics.
Mastering information is the holy grail of medical students: you can
retain more information, but spend less time reviewing it.
You may be wondering, "OK, so I understand that I should master something, but
HOW do I do it?"
Master doesn't mean achieving a PhD-level understanding of every topic covered
in medical school. Instead, mastery takes the form of making as many connections
as possible, which improves retention and requires fewer reviews. I like to call this
process "pathogenesis to presentation," where you can explain how a disease will
present based on its pathogenesis.
For example, most people memorized the differences between epidural and
subdural hematomas. They know by rote the presentation, pathophysiology, as
well as the susceptible populations.
To cover this vast amount of information, most people make lots of basic cards,
like the one below. These cards are easy to remember, but you need a ton of them.
Making simple, flashcard-type Anki cards forces you to create tons of time-sucking
reviews that will hurt your Step 1 studying.
Making connections = higher scores with fewer reviews
Instead, let’s integrate and apply the information.

Most people memorize that ruptured bridging veins cause subdural hematomas.
They also memorize the presentation. They memorize that subdurals are gradual
(or asymptomatic), often evolving over weeks to months, but don’t understand
why.
However, we can make tons of connections. The more connections we make
between facts, the easier it is to remember/apply, and the fewer cards we have to
make.
Ever wonder why subdurals present much later than epidurals? Veins have lower
pressure than arteries. As such, the venous bleeding of subdurals seeps, whereas
the arterial bleeding of epidurals shoots out.
Additionally, the mechanism of subdural bleeding explains who is vulnerable.
Diminished brain mass creates longer distances for the bridging veins to travel.
This stretching of the bridging veins creates tension. That tension predisposes
venous rupture.
Thus, who tend to get subdural hematomas? Patients with dementia, alcoholism, or
even low CSF volume.
If I memorized these facts, I would have to make at least one or two cards for each
point. This would create a large number of reviews for a single topic.
Instead, integrating and applying it means I can understand more with fewer
reviews.
As you can see, making more connections creates LESS work in the future. By
creating "pathogenesis to presentation" cards you can improve your medical
school performance, your Step 1 score, AND save time.
Priority #2: Make mastery + retention habitual
If mastery is such a powerful technique to raise your score while studying less in
the long-term, then why do so many people memorize? Because while the total
time spent on mastery is less, it requires more time up-front.
Is the upfront investment of time worth it? In short, yes. However, just like you
can't re-read your notes 10 times, you don't have time to master and re-master the
same material.
To make your studying even more efficient, once you've mastered something, use
Anki to retain it indefinitely so that you can save even more time.
What does this look like?
Classes cover roughly two or three topics every day. Whether you attend class or
watch lectures online, you must keep up.
Your aim: master the day’s topics, then turn them into Anki cards. Don’t just make
simple rote cards like in my first example above. The more integrations you make,
the better you understand it and the fewer cards you have to create.
Then, do all your old Anki reviews.

Every day, you will master new information, and remember the old.
Consider the short and long-term outcome of this approach. Most blocks run from
several weeks to two months. By mastering each day’s topics, by the end of a
month, you would have mastered more than 100 items. Each weekday, learn that
day’s material, and on weekend days, you can catch up or learn new subjects.
Ever wondered what you should do with the many Step 1 topics not covered by
your school? Use weekdays to master class material and weekends to cover the
rest.
For subsequent blocks, continue to do all your old cards every day. Your goal?
Never go back and relearn old topics.
To accelerate your progress, you can use the Yousmle Step 1 Cards. The efficient
pathogenesis to presentation cards will short-cut the mastery process, saving you
tons of time and improving your score. Additionally, by doing high-quality,
integrated cards you can learn how to make your own, so each of your cards takes
less time and boosts your score more.
Overall goal: minimize topics to master during dedicated study
You may be wondering what to do for the topics in previous blocks couldn’t make
cards for. For example, I had developed a consistent rhythm by the end of my first
year. However, I had not created useful cards for things I learned earlier. I had no
reviews for biochemistry, cardiology, genetics, or other basic science topics.
If you haven’t made cards for every subject, what are you supposed to do?
Most people panic and try to cram everything in. For example, during their
cardiology block, they may work to re-learn biochemistry. This is setting yourself up
for failure.
You shouldn’t expect to master and remember every subject before your dedicated
study.
Your current block is hard enough. If you cover too much, you will only have a
superficial understanding. Remembering old topics will be more challenging, as
well.
Instead, you can use breaks, like winter or spring break, to go back and re-learn
a system or two.
Next, I will apply these time-saving, score-boosting principles to what your week
might look like.
USMLE Step 1 Study Schedule for 1st and 2nd Years: General
Principles
As we discussed already, mastery and retention will save you tons of time and
allow you to score higher on both your medical school exams and Step 1. Here,
I will apply these principles to a typical preclinical week in medical school.
Remember, your top priority is to develop a good daily rhythm of mastery and
retention. With that in mind, here is a sample weekly schedule.
My assumptions with this schedule:
You have class all five weekdays.
You have two days of mandatory afternoon activities.
There are three separate classes in the morning.
Your school will likely have a different breakdown from this. However, the
principles will remain the same.
Weekly schedule: a typical week
Monday: morning class, afternoon activity/lab
5:30AM Wake up/Breakfast

6-8:30AM Old Anki Reviews
9-12PM Class
12-1PM Lunch
1-5PM Mandatory School Activity
5-5:30PM Dinner
6-9:30 Finish Anki Reviews / Master 2-3 Topics from Class*
10PM Sleep
*Days with mandatory afternoon activities are some of the most challenging. Focus
on finishing your cards. If you can’t master everything, you can catch up later in
the week.
Tuesday: morning class, afternoon free

9-12PM Class
12-1PM Lunch
1-5PM Master 3 Topics from Class
5-5:30PM Dinner
6-9:30 Remaining Boards-Relevant Material from Monday / Finish Cards
10PM Sleep
Wednesday: morning class, afternoon free

9-12PM Class
12-1PM Lunch
5-5:30PM Dinner
6-9:30 Remaining Boards-Relevant Material from earlier in week / Finish Cards
10PM Sleep
Thursday: morning class, afternoon free

9-12PM Class
12-1PM Lunch
5-5:30PM Dinner
6-9:30 Remaining Boards-Relevant Material from earlier in week / Finish Cards
10PM Sleep
Friday: morning class, afternoon activity/lab

9-12PM Class
12-1PM Lunch
1-5PM Mandatory School Activity
5-5:30PM Dinner
6-9:30 Finish Anki Reviews / Master 2-3 Topics from Class
10PM Sleep
Saturday + Sunday: Catch Up on Week’s Activities / Round Out Studies

9:30-12PM Catch Up / Master Topics Not Covered in Class
12-1PM Lunch
Afternoon/Evening: Catch Up / Master Topics Not Covered in Class / Relax**
**use weekends to catch up on the week’s work. You can use the
remaining time to cover Step 1 topics that are not included in your
classes. For example, Stanford never covered amyloidosis, so it was
up to me to learn that topic.
If you follow along in First Aid, you can cover the topics your classes
miss. Make sure that by the end of the block, you’ve incorporated as
many topics as possible within that block from First Aid.
Frequently Asked Questions

Next, I will address frequently asked questions to help you get started on saving
time and crushing your med school exams and Step 1.
Should I be waking up early every day?

I recommend it. You should experiment, but you’ve chosen a very morning-heavy
line of work. In my clerkships, it was common to wake up at 5 AM. Even in residency,
it was a fantastic day when I could wake up at 6:30 AM.
Mornings are – but not always – the most productive time of day. Waking up
early may mean more productivity during your preclinical years. It will definitely
make the transition to early morning rotations easier.
Isn’t it too early to be studying for my USMLE Step 1? Shouldn’t I be

focusing on my med school classes instead?\
Most students assume the approaches to med school and Step 1 must be different.
This is not true!
I’ve finished medical school and residency. I also have tutored medical students at
every level of training.
In my experience, mastering the material sets you up for success on any exam.
As we learned in Chapter 1, Step 1 tests your ability to understand and apply your
knowledge. Medical school examinations often test your memorization ability. Still,
moving beyond memorization allows you to do even better on memorization-
heavy exams.
Stanford’s block exams were mostly rote, yet I scored in the top 10% of my class in
most. Even if your goal is to understand, you can still excel on tests of
memorization.
When should I work in a question bank? How many questions should I be

doing a day?
Remember, your primary focus is to establish a daily rhythm of mastery and
retention. It’s unlikely that you would have much time for QBanks.
By all means, if you have extra time, work in some blocks of a question bank, like
Kaplan or UWorld. However, true mastery takes time. Every action has an
opportunity cost. Often when first- or second-years do QBanks too early, they lack
time to master the material.
If you follow the Step 1 study schedule above, you will have plenty of time for
practice questions during dedicated study. More importantly, if you use spaced
repetition, then repeating question banks is a waste.
The amount of extra depth you gain with each additional UWorld review is minimal.
Master the topics once instead of going through UWorld three times.
For more thoughts on the topic, read the following article.
What should you do the night before an exam?

Relax! If you’ve been following this Step 1 study schedule, the day before an
exam is no different than any other day. In fact, most schools limit how much they
try to teach you the day before an exam. Thus, to maintain your daily rhythm of
mastery and retention, you should have less to do!
Fight the urge to cram. Instead, try doing a block or two of Kaplan QBank
questions, to assess how well you mastered the material. In other words, before
your cardiology exam, do a block of 40 cardiology Kaplan questions. A good score
would be above 70%.
What exactly does it mean to “master” something?

Mastery is like pornography – hard to define, but you’ll know when you see it. Your
goal should be to create as many connections as possible between the things you
learn. A guiding principle is you’ve mastered something if you can teach it to a
beginner, and have them answer questions on it.
Read my guide on how to master USMLE Step 1 material here.
What about resources like Pathoma, Sketchy Micro, or (name-your-

favorite-resource)?
Remember, your primary goal is to develop a daily rhythm of mastery and
retention.
As such, you must curate your resources.
Most students take an “any benefit” mentality in choosing study aids. If there is
any benefit to using it, they will add it to the pile. No wonder our daily to-do’s
become so overwhelming.
Don’t think of resources as things that you need to get through cover to cover.
Instead, use them as references, something that will help you to master a
particular topic.
For example, I wouldn’t read through Pathoma from beginning to end. Instead, I
would use it in a targeted way. If I don’t like First Aid’s explanation on heart failure,
I can use Pathoma to learn more.
Use resources with the intent of answering a particular question. Don’t make them
part of a checklist to get through.
How many pages of First Aid should I be reviewing a week? How about
the number of Pathoma lectures?
It is hard to know if you’ve mastered something. Depth is difficult to measure.
Instead, we focus on things that are less important, but easy to measure. We track
things like the number of Pathoma lectures we’ve watched, or First Aid pages we’ve
read.
Why is it so stressful to see your first-year classmate halfway through UWorld? Or

your anatomy partner “finish” Pathoma? Because there is a clear measuring stick,
and we fall short.
That said, numerous e-mails to me start like this. “Alec, I’ve been studying for Step 1
for two years. I’ve done 20,000 practice questions. I’ve done 5x First Aid Reviews.
And I just took my first NBME practice exam, and I’m only at a 190. Help!!”
It’s not that you shouldn’t be using these resources. However, it’s the quality of
work and not the quantity completed that matters.
What if I take Step 1 after my first year of clerkships, like Harvard, UPenn,
and a growing number of medical schools? What if I’ve delayed my Step 1
exam and must take it during clerkships?
A growing number of schools now have students take Step 1 after they enter
clerkships. Harvard has joined the list. Duke and UPenn have long had students
register for Step 1 well into rotations. Other students (D.O.’s, second-time test
takers, etc.) may also need to take Step 1 during rotations.
If you must take your Step 1 after clerkships have started, what is the ideal Step 1
study schedule?
While the weekly breakdown will be very different, the principles are the same.
During your preclinical years, you would focus on mastery and retention of
material. Then, during clerkships, you would continue these goals.
During clerkships learn the topics relevant to your patients. Seeing a disease is
much better than reading about it. Step 1 and shelf material overlap a lot. This is
particularly true with internal medicine. Maximize “double-dipping” Step 1 content
with your clerkship studying. This likely will be the organ blocks – cardiology,
respiratory, etc.
Save the less-clinical topics for dedicated study. This would be things like
biochemistry, immunology, or genetics. As you will see in the next question, the
goal isn’t to learn everything before dedicated study. The goal is to minimize
topics to master during dedicated study.
How should I use my various breaks, like summer vacation, winter break,
or Thanksgiving?
Let’s say you develop a good daily rhythm during your second-year. What do you
do for your first-year topics?
As discussed above, you should focus on one goal at a time. Learn the material
from the block you’re on. Don’t go back and try to re-learn everything from first-
year.
Instead, use your breaks to re-learn prior blocks. For example, your 3-month
summer vacation could support mastery of three first-year blocks. Similarly, spring
break is often enough time to master one topic.
Then, by your dedicated study, you will have a manageable number of things to
learn.
Score higher in less time

Tired of working harder, without the results to show for
it? Get the Yousmle.com Anki Cards, to master more
information in less time so you can improve your score
faster.
Sign up now, to get:
My BEST pathogenesis to presentation cards, so you
can master more information without being buried by
thousands of reviews
Curated content, so you can focus on the things you
don't know and accelerate your score boost
Spaced repetition, so you never have to waste time re-
learning anything again
Score Higher Now
CHAPTER 3
How to Score 260+ on
Step 2 CK (Even If
Your Step 1 Score
Disa ointed)
I've had multiple students go from below-average

Step 1 scores to 250 or 260+ on Step 2 CK. The door
was still open for their dream residency - learn how
you can do the same.
Chapter 3: How to Score 260+

on Step 2 CK (Even If Your Step
1 Score Disappointed)
In Chapter 2, we learned:
How creating integrated "pathogenesis to presentation" cards allows you to
learn more with fewer reviews
How mastering new information, while never forgetting the old, is the daily
rhythm that will maximize your score without studying more
In this chapter, Minills, a former Yousmler, will teach you:

The detailed plan she used to go from 168 on her first NBME, to 261 on her Step
2 CK - and how you can do the same
Why even a disappointing Step 1 experience doesn't have to hold you back from
clerkship and Step 2 success
For this chapter, I will let a former Yousmler, Minills, describe exactly
how much her approach had been holding her back, and the
remarkable results she achieved when she changed it – including
95%ile on multiple shelf exams and a 261 on Step 2 CK
How much does your approach hold you back? Most of us never
find out, since we are too busy burying ourselves in textbooks and
recorded lectures until the point of exhaustion. Learn a new
approach here.
Alec Palmerton, MD
Med School Highlights:

Before Yousmle, I was a mediocre student. I scored average or above average on
my MS1/MS2 exams. The first NBME I took a week before my Step 1 dedicated study,
I scored a 168 and went into panic mode. I knew I needed more help. I reached out
to Alec and started Yousmle. In 2 months, I increased my score by 60 points and
ended with 228 on Step 1 – read more about my Step 1 experiences here. Although
I improved my score significantly, I had a long way to go to achieve my Step 2
goals.
After Yousmle, I became, as one attending wrote, “an exceptional student.” Here’s
the breakdown:
Honors in 5 clerkships
95th percentile on IM, Peds and Neurology shelf exams
261 on Step 2 CK
How did I transition from a mediocre to exceptional student? Keep reading to find
out.
My Third Year Game Plan

Third year of medical school is a difficult transition. We go from classroom learning
to clinical application on the wards. Instead of working independently for the next
exam, we work in interdisciplinary teams to provide patient care. We no longer
have the luxury of waking up late and watching recorded lectures online. We pre-
round (sometimes at 4:30 in the morning) and are expected to show up to work on
time and know our patients well. We’re finally practicing to be a doctor out in the
real world.
The week before I started third year, I was filled with dread. I was overwhelmed by
the thought of clinical evaluations, shelf exams and the USMLE Step 2 CK.
A Two-Fold Approach
I met with Alec a couple of weeks into clerkships and expressed my concerns about
third year:
“How can I succeed on the board exams and the wards?”
He shared a two-fold approach: build foundational knowledge and master
question interpretation. This approach was deceptively simple, but provided me
with the exact framework I followed to “exceptional.”
Building a Strong Foundation: Mastery of New Concepts +

Spaced Repetition
Clerkships are hard and exhausting; finding time to do anything outside of clinical
duties is a challenge. Despite that, I developed the habits of deliberately mastering
new material, and never forgetting it by using spaced repetition/Anki.
I was methodical in how I mastered new material. I continued with the
Yousmle.com Step 1 and Pharmacology Anki cards, and added the Yousmle.com
Step 2 cards. I made new cards from practice questions, discussions during rounds,
and management plans my team came up with; my goal was to master any
unfamiliar concept that came up. By putting that information into Anki cards, I set
myself up to never forget it.
This final point is crucial: with so much new clinical information, I quickly realized
the importance of doing my Anki cards daily, to retain what I had already
mastered. As Alec reminded me, it is better to never forget something than to re-
learn it.
To accomplish this, Alec recommended trying to finish my cards before I went
home every day. This was easier during inpatient rotations, when the workload was
heavily geared towards the morning, and allowed me to focus my evenings on
mastering new material and question interpretation (more on this later). Every day
I built a stronger foundation by mastering new material while never forgetting the
old.
Throughout the year, several attendings and residents commented on my strong

knowledge base and active learner mentality. In actuality, I wasn’t spending as
much time reading new material, as I was recalling information I already learned.
Going through Anki cards every day helped me answer random pimp questions,
perform well on exams, and build professional confidence by being able to recall
medical information necessary for patient care. In addition, it also provided the
foundation for the key to my Step 2/shelf success: question interpretation.
Mastering Question Interpretation

Mastering question interpretation was the most important factor to my clerkship
and Step 2 success – moving beyond “buzz words” to understand the purpose of
each sentence in a clinical vignette. To do this, much of my time and energy third
year was spent interpreting questions and understanding pathophysiology.
There are a ton of resources for questions, and each shelf exam has specific
resources better suited for it than others. UWorld is the standard QBank, and I
tried to complete about 10 UW questions during the weekdays, and 50 on my days
off. I learned to be flexible with the number of questions between UWorld and
shelf-specific resources.
It wasn’t the number of UW questions per day I was doing that ultimately led me to
a 260+ Step 2 score. Rather, the quality of my interpretation took my examination
skills to the next level. I took NBME Clinical Mastery Series (CMS) exams regularly
throughout clerkships (there are about 4 NBME exams for each shelf). After I
completed an NBME, I would go over wrong answers line-by-line, contextualizing
each sentence in the overall clinical picture. I would then write down a
pathophysiologic mechanism that could explain the symptoms and presentation in
the vignette.
In addition, I would create a “stand-alone question,” which is a question that can

be answered by itself without knowing the full vignette or question stem. For
example, the stand-alone question for “What is the next step in management?”
could be “What is the next step in management for a man with symptomatic BPH
who presents with acute urinary retention and renal failure?” Without knowing
anything about the vignette or the answer choices, I should be able to answer
from only the stand alone question – hence why it can “stand alone.” I would then
look at the answer choices and do a process of elimination. I also prioritized my
weaker concepts by focusing my content review on questions I missed.
At my school, I had the option to schedule shelf exams in the order that I wanted.
This is rare, but if you have the opportunity, or if you can decide the order of your
clerkships, here’s my recommendation: Pair the shelf exams that have content
overlap.
For example, I ended up scheduling the internal medicine and surgery shelf exams
one week apart. I did the same thing for neurology/psychiatry and pediatrics/OB. I
left family medicine for the end, as it had content spread across all the shelf
exams. I intentionally took the internal medicine exam first because it covered the
most material, had the most number of UW questions, and helped me establish a
broad base of knowledge early on.
Regardless of how your shelf exams are scheduled, you have the ability to perform
well by diligently improving interpretation. This means doing a few questions every
day and writing out the interpretation for questions you missed to identify
weaknesses and high-yield material that needs more review. I would also try to go
to at least one of the many Yousmle question interpretation (QI) sessions each
month, included in Yousmle Group Tutoring. These sessions were invaluable in
building my own interpretation skills, as I could reinforce strategies and
provide/receive feedback from other students.
From Shelf to Step 2 CK Prep
By aligning short term goals (i.e. shelf scores) with long-term goals (performing well
on Step 2 CK), I was able to track my progress over time and prioritize review
topics during my dedicated study period. I ended up honoring my shelf exams for
IM (88%), Peds (89%), Family Med (84%), Neurology (90%), and Psychiatry (85%).
Thus, during my dedicated study period, I needed to prioritize Surgery (76%) and
Ob/Gyn (74%).
I only spent 3 weeks studying for Step 2 CK, and felt that was plenty.
There are 3 NBMEs for Step 2 CK, and I would recommend spacing them out. I
scheduled full-length NBME CK exams at 3 months, 1 month, and 2 weeks prior to
my actual test date. The scores you receive on the Step 2 NBMEs aren’t necessarily
predictive of your final results; my trajectory went from 228 to 219 to 260. Despite
the score variability, I made sure I understood every sentence of each vignette, just
as I had for my practice shelf exams.
I had completed UW before my dedicated study period, and recycling questions
that I already knew felt unproductive. I got the Kaplan QBank and completed 40-80
questions/day for interpretation practice. For content, I focused on understanding
surgery and Ob/Gyn topics, my weaknesses identified by my lower shelf scores. I
referred to Christian de Virgilio’s Surgery: A Case Based Clinical Reviewand the
UWise APGO Question Bank provided by my school for Ob/Gyn. I also went through
my NBME shelf exams for Ob/Gyn and Surgery and made sure I fully comprehended
the questions I missed the first time I took them. When I received my score report
back, Surgery and Ob/Gyn were my two best areas.
The Yousmle Edge

It’s been a year and a half since I first started working with Alec for Step 1 and Step
2. I couldn’t have imagined scoring a 260+ on the USMLE in the beginning days of
Step preparation. By sticking with the two-fold approach of building foundational
knowledge and mastering interpretation, I not only performed well on the USMLEs,
but also became a valuable team member actively involved in patient care. The
skills I acquired through question interpretation directly applied to clinical
situations.
My preparation for the USMLEs was challenging and demanding, but ultimately
rewarding and fulfilling! Most importantly, I ended up building confidence as a
doctor-in-training and thoroughly enjoying third year.
Sincerely,
Minills
CHAPTER 4
The Mega Bu erfly
Eﬀect
How to turn your preparations into a permanent

career boost to not only help you get into a top
residency but also excel once you get there
Chapter 4: The mega butterfly

effect
You think that it's ok to forget everything after your exams...but is it?
In Chapter 3, we learned:
The two-fold approach a former Yousmler used to go from 168 on her first NBME,
to 261 on her Step 2 CK - and how you can do the same
Why even a disappointing Step 1 experience doesn't have to hold you back from
clerkship and Step 2 success

How to prepare now so you will be have more time and success in residency and
beyond
As you learned in Chapter 1, most medical students begin med school with high
ideals and even higher ambitions. Very quickly, however, our best intentions are
stymied by a seemingly endless list of facts and figures to memorize. All too often,
students find themselves struggling just to stay afloat. The ones who figure out a
way to do well in their classes often get there by simply memorizing – then
forgetting – a jumble of words they don’t understand. In Chapter 2, you learned
that these same students are setting themselves up for disappointment on a
USMLE Step 1 that will test them to apply and integrate that information in clinical
vignettes.
This chapter will address the myth that all hard work is created equally, and how
you can work smarter, not harder, to score higher without working more hours. Two
stories will demonstrate how your decisions and actions not only affect your Step
1 preparations, but the rest of medical school, residency, and your medical career.
The Myth: Hard Work is All You Need
When I started medical school, I thought that all I needed to do was work hard. I
had this vague notion that medical students pushed themselves to the limit every
day, stayed up late in the library, and measured their success by how tired they
were the next day.
When I arrived at Stanford, I felt deep down that success would be a battle of
attrition; only the students that pushed themselves hard enough would be able to
succeed.
I was dead wrong. To illustrate this point, I will share two stories of medical
students to demonstrate the cumulative, long-term effects of your actions today.
Each of these students made very different choices during their first years of
medical school, which set very different trajectories through their USMLE Step 1,
clerkships, and residency.
Dina Do-Everything: Poor Prioritization of Mastery/Retention →

Cramming → Lack of Mastery + Forgetting
Let’s start with Dina Do-Everything (a friend whose details are modified to protect
privacy). Dina went to a top-3 Ivy League undergrad, and did extremely well, and
was accepted into Harvard Medical School. She was outgoing, extremely hard-
working, and did a great number of things well. Her gift was that whatever she saw
others do, she could figure out a way to do it better through a combination of
hard work and will-power.
In her first year of medical school, she threw herself into every task. Every quiz,
test, project, problem-based learning discussion, and presentation – Dina figured
out a way to fit in time to do these things. She saw her classmates begin to find
research projects, and so found a project that occupied some of her nights and
weekends.
She began to reach the limits of what she could fit into her schedule. However she
figured out that by spending the first part of a block on her research and other
commitments, she could defer her heavy studying for the week before her exam.
She never really did an all-nighter, so convinced herself that this would be ok.
Plus, she continued to do well in her classes, and her classmates were always
amazed at how many details she could recall before she took her tests.
She had a vague sense that she was “cramming” and not able to truly master much
of the information, but was comforted by the fact her scores on her med school
exams were quite good. Plus, few of her Harvard classmates seemed to be going
much beyond memorization.
Preparation for the USMLE Step 1 was when Dina began to realize that something
might be wrong.
Her first NBME Practice Exam was WELL below what she had been hoping. This was
puzzling given how well she had done in her classes. Because of her limited time-
frame, she willed herself to do UWorld twice, and to get through First Aid multiple
times, each time hoping she learned more than she was forgetting. She could see
that she knew many of the things she was tested on at one point, however had
forgotten them, and didn’t have enough time to go back and re-learn them
properly. Her ultimate Step 1 score was good (a 245), although not what she had
hoped for, particularly given how well she had done on her MCAT and how much
she had sacrificed her personal life in her pursuit of doing everything well.
What she found, though, was that her struggles were only beginning.
Just like she had to re-learn much of the information for Step 1 she had crammed
for her medical school exams, on her shelf exams she found she had to re-learn
huge amounts as well. Her internal medicine shelf exam (standardized exams most
students have to take after each rotation) was so much of a repeat of Step 1
material that she ended up going back to her First Aid book. Her surgery shelf,
because of the overlap with internal medicine, was much of the same, as was Step
2, of which more than half was internal medicine.
Step 3? A continuation of the theme of cramming and having the information
quickly leak out of her head.
Now, in her residency in anesthesiology at one of the top programs in the country,
her cram and purge rhythm continues to challenge her. She had to meet with the
program director recently, because her latest annual “In-Training Exam” put her at
risk of failing. She’s so worried that instead of taking her last vacation to rest like
she needs, she spent most of it bouncing between coffee shops, studying for her
next In-Training Exam.
Her experiences are, unfortunately, all too common. Because they are so common,
we come to accept these as just “normal medical student experiences,” that
“everyone goes through.” I remember being told the same thing. However, as you
will see, my journey was considerably different.
The Road Less Traveled: Slow Growth of an Ever-Expanding Sphere

of Mastery
Knowledge is like a sphere. As the radius grows, the more of the

unknown the surface contacts; the more you know, the more you
realize you don’t know. However, as the radius grows, the rate of
knowledge volume growth increases exponentially.
My Grandfather
A wise person said once, “Urgent things shout, important things whisper. Listen to
the whispers.” This was used in the context of prioritizing important over urgent
tasks, and can be used in all aspects of one’s life.
Early after I entered Stanford Medical School, I had been encouraged by my
advisor to cultivate a calm ear, one that would listen to the whispers. He
encouraged me to focus on important tasks, and that would ignore the many
shouting, seemingly urgent things that constantly cropped up.
When my classmates at Stanford started immediately looking for research projects,
I could feel the pangs of guilt. They were already working hard for the promise of
publications, research stipends, and connections in their (supposedly) desired
residency fields. In addition, my friends quickly started to do every extracurricular I
could imagine, and some I hadn’t even thought of. They were taking leadership
positions in various clubs, organizing classes, directing the free clinics, learning
phlebotomy and other practical skills, or doing media internships with major
broadcast organizations.
Me? As discussed in Chapter 2, my sole focus was to find a sustainable, daily

“rhythm.” Every day, I made it my goal to simply master the things that we had
learned in class, turn them into Anki cards, and make sure I did all of my old cards.
Every single day, my goal was to master a modest number of new topics, and make
sure I never forgot them or anything else I’d learned previously.
My fundamental goal was to slowly grow an ever-expanding foundation of things
that I had mastered.
While I had to work hard to overcome my feelings of inadequacy, and to fight the
feeling that I wasn’t doing “enough,” I believed deep down that my own
professional satisfaction, my ability to help patients, as well as my exam scores,
would directly depend on my ability to master and retain an ever-growing body of
knowledge.
I believe that was right.
Early Results from Mastery/Retention Similar to Cramming

In the beginning, my results were indistinguishable from many of my classmates. I
scored well in my exams, but so did others. Even though I felt that I understood
the information at a deeper level, it didn’t necessarily show on the exams. Most of
the exams would test us on minute details that were memorized from PowerPoint
slides, rather than testing our ability to integrate and apply the knowledge.
In subsequent blocks, I would still do my old cards from previous blocks, even
though that information wouldn’t be tested on my next midterm examinations.
This made learning the new information harder in many ways, since not only was I
trying to master new things but also to hold onto all of the old things I’d mastered.
I pushed on, however, since I could still hear the whispers that my goal was larger.
I wanted to remember all of the important information that I’d mastered, not just
do well on each of the Stanford exams.
This was a whisper that I was particularly grateful for, one that has laid the
foundation for not only success on standardized examinations, including Step 1,
but also allowed me to have enough balance in my life to have a family (and grow
Yousmle!) during a busy residency.
As time went on, many of the subjects that I learned in the previous months were
repeating themselves. By the third time we’d covered diuretics, I barely had to
study, since I’d already learned it twice, first in our cardiovascular block, and
second during a pharmacology section.
Because my goal was to master whatever topic was learned that day, and to make
sure I never forgot what I mastered, as Step 1 approached, I had very few gaps in
my knowledge. This allowed me to focus all of my energy on mastering what few
topics I hadn’t mastered the first time around.
Spaced Repetition: Retain More and More Information for Less and
Less Time
Because of the incredible power of spaced repetition, during my dedicated study
period, I only spent a modest amount of time every day to remember the things
that I’d mastered during my first two years of medical school. As all my friends
were frantically cramming paper flashcards filled with the names, mechanisms,
uses, and adverse effects of hundreds of drugs, I simply did the reviews that were
due each day.
I could recall in several hours of work each day, all of the important information
that I learned in my first two years of medical school.
Additionally, because I could recall so much information with comparatively little
effort, I threw all of my energy into mastering the art of question interpretation. I
figured out what each sentence was trying to tell me, and developed an approach
to tackle any question on the exam in a systematic way that limited “silly” mistakes
– questions whose topics I had mastered, but that I still got wrong because of
careless errors.
My score of 270 on the USMLE Step 1 wasn’t my goal, but rather a byproduct of
mastering, retaining, and learning how to integrate and apply a vast and growing
body of knowledge during my first two years.
My goal was to retain and apply what I learned in medical school and residency in
the care of patients. As such, I continued with my cards, even in subjects like
biochemistry, genetics, or immunology, even though they won't show up on
another standardized exam.
In part, this was so I could continue to use that information, and in part, it was
because it didn’t take much time to remember. As you'll recall, during my dedicated
studying, it took several hours each day to retain all of the information that I
learned in my first two years of medical school. By the time I entered clerkships, it
took half that time.
This was an incredible help for my Shelf exams. By doing a modest number of
questions, but keeping on top of all of the old information that I’d learned, and
using my question interpretation skills, I honored every third-year shelf exam.
The benefits of gradually growing my mastery of topics over time only expanded
during residency. To retain all of the information in my Anki cards I had learned in
residency and medical school, took only 45 minutes a day.
45 minutes a day to remember everything I had mastered in all of medical school
and residency!
With that modest investment in ongoing studying, I still scored in the top 10% on
my In-Training Examinations, tests residents take to prepare for their official
written boards. I even got a special letter from the national Board organization in
anesthesiology congratulating me on my performance on the basic examination.
Not only did it take so little time to retain everything in my Anki cards, but I also
needed to create many fewer cards during residency. Although I made nearly
20,000 cards during medical school, I made fewer than 2000 cards through all of
residency. So much repeated itself that there was that much less to learn.
Now, even after finishing residency, I continue to do my Anki cards daily. The
amount of time it takes to retain more than 20,000 cards worth of mastery?
Less than 30 minutes a day.
Concluding Thoughts
What’s the point of my story? I’m not trying to brag. Rather, I want to show you
that you have a choice in how it is that you learn the information.
How you choose to use your time, and whether you listen to the whispers, or let
the shouting, urgent tasks of your medical training overwhelm you, will have long
reaching implications. Your future clinical training and even personal life depend
on how you prioritize your time now.
The cram and purge cycle is all too common in medicine and can get you through.
Medical students are smart and hard-working, which is a potent combination, even
when faced with poor studying techniques. However, when that same intelligence
and industriousness is turned towards gradually building a strong foundation over
a long period of time, the difference can be immense.
Your Next Step Can Change Your Life

What you choose to do next has the potential to change the trajectory of your
preparations, your career, and your life overall. What would you do with your extra
time during clerkships or residency if you only had to spend 30-60 minutes
recalling everything you'd mastered up until that point? What parts of your life
have you been neglecting, because you are spending so much time cramming
information? And how high would your scores be if you mastered information,
rather than memorizing it?
So what is the next step?
You must develop an effective daily rhythm. Master a small amount of new
information every day, and make sure that you never forget it by doing your old
cards. Every day. This daily rhythm of mastery and retention will build a strong,
durable foundation.
If you’re not sure where to start, or would like to accelerate that process, check
out the Yousmle Step 1 Cards. Here, you can find pre-made cards divided
into major subjects that will teach you how to master some of the most difficult
subjects, so you can save time and score higher.
Epilogue
The Best Advice I
Received In Medical
Sch l
You can have anything you want, but you can't have
everything.
“if you work hard and creatively,

you can have just about
anything you want, but not
everything you want. Maturity
is the ability to reject good
alternatives in order to pursue
even better ones.”
- Ray Dalio, Principles: Life and Work
Epilogue: The Best Advice I

Received In Medical School
Chasing too many goals can paradoxically cause you to achieve none of
them
One of the biggest reasons students fail to achieve their goals isn’t because they
weren’t capable. The biggest reason is that they lack focus.
Let me explain.
Early in medical school, I was constantly comparing myself to others. I couldn’t
help but notice that some of my classmates had already begun research during
their first term of medical school. Others were already scrubbing into surgical
cases, or were starting clubs and leading organizations.
Out of necessity, my focus at the time was simply trying to stay afloat – it had been
two years since I’d been a student, and I was rusty on virtually everything. [As an
aside, I was accepted into Stanford Medical School straight out of college. However,
Stanford allowed me to defer for two years to do a Fulbright grant in Korea, so when I
matriculated it had been two years since I had been a student.] But a part of me felt
this gnawing sense of guilt and inadequacy, like maybe I should also be doing all of
these other projects.
I was fortunate to have one of the greatest advisors on the face of the planet, Dr.
Oscar Salvatierra, who told me something I will never forget. He said, “Alec, the key
to success in your career is focus. If you chase one rabbit, you will catch it, but if
you chase two rabbits, you will catch neither.”
In that context, he meant that I should focus on my studies, and once I had
mastered a method for succeeding in my coursework, then to expand outwards to
doing research and other extracurriculars. This is coming from a man who was a
world-famous renal transplant surgeon; who worked with former Vice President Al
Gore (he calls him “Albert”) as the doctor most responsible for designing the
current transplant distribution system; but who also has a wonderful family, and a
fantastic relationship with everyone around him.
In other words, if there was someone to listen to on the subject of success and
failure, it would be Dr. Salvatierra.
So, how can you apply focus to your life to maximize your chances of success?
If you’re a preclinical student, remember that it’s ok to “just” focus

on your coursework.
If you are planning to go into something super competitive, you will likely need
research or some extracurriculars at some point. However, remember that there
are many ways to accomplish this, including taking an extra year between your 2nd
and 3rd (or 3rd and 4th) years.
Those classmates who began research as soon as the entered medical school?
Some of them eventually published, but many of them ended up not going into
the specialty they originally thought they would. Many ended up regretting taking
on a research project so soon, particularly when it came time to study for Step 1.
If you’re in your dedicated study period, your sole focus should be exam
prep
I thought I could do research once a week while I was studying for Step 1. Huge
mistake. Even just taking 2 hours a week, I couldn’t help but feel behind, and I
quickly became resentful of my cell cultures.
Most of the people I knew who tried to balance other things while studying for
Step 1 ended up having to delay their exam. This cost them more time than if
they had simply chased each rabbit sequentially.
If you’re in clerkships, particularly in one of the “cores” of internal

medicine, surgery, pediatrics, or ob-gyn, you should devote most of your
energy to those clerkships.
Performing well on wards is difficult enough. You also have a shelf exam that
determines a large part of your final grade. Remember that the only thing arguably
as important as your Step 1 score is how well you do in your clerkships. Apportion
your time accordingly.
If you’ve already graduated, and are studying for your USMLE, focus on
that single rabbit
Many of you are either IMGs/AMGs who have already graduated, some of whom
have already completed part or all of residency elsewhere. If that’s true, then you
can’t afford to chase multiple rabbits. Scrutiny is unfortunately higher for these
residency applicants, and as such, the margin for error is much smaller. Be sure to
put your best foot forward by devoting the time necessary.
Concluding thoughts
The upshot of my story? Paradoxically, by chasing only one rabbit at a time, I

ended up with much more and varied successes than I’d dared hope beyond just a
270 on Step 1. I also received a prestigious HHMI Medical Research Fellowship for
my year off for research, created lectures that were featured in a New England
Journal of Medicine perspective piece, founded a class on mindfulness meditation,
and met/married the woman of my dreams. The key: none of this would have been
possible had I tried to do all of these things at once.
If you are struggling, and feeling overwhelmed, remember that it is ok to slow
down, and focus on one thing at a time. Try mastering a single thing first, then
when you feel comfortable with it, move on to something else.
Whatever your definition of success, I’m confident that you will improve your
chances dramatically by this one key ingredient: focus.
Conclusion
What is the next step to work smarter, not harder and score
higher while saving time?
If you've made it this far - congratulations! You've made a smart

investment of time to learn a much more effective way to learn so
that you can score higher on any exam without working any harder.
So, what's the next step?
Learning what to do is just the first step in a long and meaningful
journey. The next step is to take action. As we've learned in this
eBook, the next steps are:
1. Identify your priorities to know what you should study so you
can score higher without wasting time
2. Develop your plan based on these priorities
3. Chase only one rabbit
4. Start mastering information and using spaced repetition
If you're interested in improving your scores faster and saving time,
I would highly recommend the Yousmle.com Anki Cards. Not only
have I done the work for you to make connections, but I've also
created hundreds of pathogenesis to presentation cards, so that
you can master information most efficiently - saving you time, and
maximizing your score improvement.
Click on the following links to learn more:
Yousmle.com Step 1 Anki cards
Yousmle.com Step 2 Anki cards
Alec Palmerton, MD

Busy Medical Student's Guide To Score Higher On Any Exam

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Busy Medical Student's Guide To Score Higher On Any Exam

Caricato da

Copyright:

Formati disponibili

11/09/2018 Yousmle | Copy of eBook for Mom to Edit

- Th Bus Medica Studen' -

How to study smarter, not harder, so you can

ABOUT The Author

I Will Teach You How to

"THE BEST TIME TO

The Secret to Excel on

Know WHAT to study, so that you can stop wasting

Chapter 1: The Secret to Excel

This sums up my early experience in medical school. I worked until exhaustion

What is Bloom’s taxonomy?

Benjamin Bloom discussed learning as a process of moving through a hierarchy of

Stage 1: Preclinical Years = "Remember"

Preclinical years emphasize memorization over true understanding

Stage 2: USMLE Step 1 = “Understand” and “Apply

Step 1 forces you to Understand and Apply

Many students memorize that ventilation/perfusion (V/Q) is highest at the lung

Stage 3 + Beyond: Clerkships, Shelf Exams, Step 2, etc. = “Analyze” and

Clerkships, shelf exams, and Step 2 emphasize Analyze and Evaluate

Succeed by knowing each stage’s study plan priorities

Like the Memorizers who struggle on Step 1, remembering doesn’t guarantee

Harvard student does NO Step 1 QBank. What happens?

So memorizing doesn’t ensure application or understanding. But what about

Step 2 CK Study Plan priorities took average test-takers to 260s

How to Study for Step

1 Along with your

Step 1 studying doesn't have to be different from

Chapter 2: How to study for

In this chapter, you will learn:

As we discussed in the previous chapter, a study plan without priorities is like

Priority #1: Mastery >> Memorization

Anki is a computer program that shows you flashcards at spaced intervals.

Making connections = higher scores with fewer reviews

Instead, let’s integrate and apply the information.

Priority #2: Make mastery + retention habitual

Then, do all your old Anki reviews.

Overall goal: minimize topics to master during dedicated study

Weekly schedule: a typical week

Monday: morning class, afternoon activity/lab

5:30AM Wake up/Breakfast

Tuesday: morning class, afternoon free

Wednesday: morning class, afternoon free

Thursday: morning class, afternoon free

Friday: morning class, afternoon activity/lab

Saturday + Sunday: Catch Up on Week’s Activities / Round Out Studies

Frequently Asked Questions

Should I be waking up early every day?

Isn’t it too early to be studying for my USMLE Step 1? Shouldn’t I be

When should I work in a question bank? How many questions should I be

What should you do the night before an exam?

What exactly does it mean to “master” something?

What about resources like Pathoma, Sketchy Micro, or (name-your-

Why is it so stressful to see your first-year classmate halfway through UWorld? Or

Score higher in less time

How to Score 260+ on

Your Step 1 Score

I've had multiple students go from below-average

Chapter 3: How to Score 260+

In this chapter, Minills, a former Yousmler, will teach you:

Med School Highlights:

My Third Year Game Plan

Building a Strong Foundation: Mastery of New Concepts +

Throughout the year, several attendings and residents commented on my strong