Prolonging your study plan

By Loren Deutsch

Life has changed a lot in the past few weeks and our rear view mirrors reflect a different world than the one we live in today. Altering personal routines to accommodate social distancing, work and school closings and healthcare needs effect the ways we understand ourselves and undoubtedly, reshape our lives. At LAS we have shifted all work and meetings to online platforms and this includes our weekly Team Meetings. These meetings feel more important than ever as they provide support, companionship and professional collaboration.

Due to the impact of the Coronavirus, we have used our most recent Team Meetings to modify education plans and discuss how to best support one another and our students at this time. Since many students and residents will need to accommodate prolonged or ambiguous timelines for test dates, we have placed particular focus on re-designing our standardized test prep plans for medical education and general education. As an example, the testing centers that administer the USMLE Step 1 in the United States and Canada closed on March 17 for 30 daysl. Step 1 is the first of four required United States Medical Licensing Exams (USMLE) and medical students must achieve a passing score to progress in their medical training.

As a direct result of these closing, some medical schools may need to alter policies concerning when Step 1 must be completed. Typically, students are required to take Step 1 at the end of their second year of medical school, before advancing from the classroom to clinical rotations. With the possibility of medical students starting rotations before taking Step 1, LAS is proposing revised Step 1 plans to help students maintain and enhance their Step 1 preparation and gear up for clerkships and NBME shelf exams. Keep in mind, Step 1 prep and NBME shelf prep are complimentary. They have aligned workflow and consolidation processes.

Below are some immediate steps that you can take to practice your clinical reasoning skills, maintain knowledge and enhance achievement if you combine Step 1 preparation with your first clerkship. Hang in there, we’re here to help!

  1. If you have not read Symptom to Diagnosis (no, we are not paid to say that!) start there! Read chapters 1 and 2 to help clarify a clinical process for evaluating, diagnosing and treating patients. Clarifying this process provides a framework for recall of diseases and treatments in the clinical setting, on board exams and in practice questions for Step 1, clerkship responsibilities, shelf exams, Step 2CK and Step 2CS. Make sure to review Figure 1.1!
  2. Maintain Step 1 prep and knowledge, whether your study plan is elongated or because it has shifted to prepare for clerkship. Based on research associated with the testing effect, an optimal study plan includes consistent recall practice with spaced repetition. Let us know if you need help with this.
  3. Complete your practice questions 4-5 days per week in blocks of 40 questions each, timed, test-mode. Divide questions into three categories for practice starting with self-assessment blocks: 1) Self-assessment (comprised of all subjects and all systems), 2) Maintenance (comprised of only the organ systems associated with questions that you have completed in full at or above, 70% accuracy, and 3) Targeted (comprised of one organ system, all subjects).
  4. Review your clerkship syllabus (if possible) and identify required and recommended resources, clerkship assignments and deadlines and locate a PDF for a “scut” sheet that you can print out and use now and during rotations.
  5. Establish a weekly learning and practice schedule prior to clerkship that includes one resource for learning (reading or video watching), one resource for assessing (immediate recall and comprehension and one resource for maintaining knowledge and enhancing achievement on the shelf exam and Step 2CK. Plan to complete the reading or video watching before starting clerkship (since you may have time to do so now) then complete your first self-assessment before clerkship or within the first week.
  6. Before clerkship, complete practice questions in blocks of 40 questions each, timed, test-mode. Divide questions into three categories for practice starting with targeted blocks: 1) Targeted (comprised of one topic at a time, including all systems, 2) Maintenance (comprised of all completed topics that you have completed in full at or above, 75% accuracy, and 3) Self-assessment (comprised of all topics and systems associated with the clerkship) and a self-assessment for Step 1.
  7. During clerkship, decrease the quantity of daily or weekly practice blocks and if possible, do the question blocks before leaving the hospital (if it’s not too late).


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