 Today's video is brought to you by Pickmonic. Going through USMLE step one questions can be very overwhelming and stressful, but today we're going to talk about a three step process that you can use to effectively answer your questions with confidence. And make sure you stay tuned to the very end of the episode because we'll be talking about some advanced tips that you can use to effectively get through a block, even if you're struggling to make sure you get the highest score on step one and pass with confidence. Let's get into it. So to illustrate the three step process, I'm just going to go ahead and do a sample block of step one questions. Now this is the free NBME 120. If you just Google it, you can essentially come up with 120 questions that NBMEs will give you for free. If you just want to test yourself towards the end, but here is the very simple three step process to get through any step on question and typically a student will read this and they'll go ahead and start highlighting and eventually they'll get to the question. They'll look at the answer choices and they become overwhelmed because they're like not really confident after reading that. They'll go through all of this again and it wastes time and causes anxiety. So on the flip side, what I recommend doing is taking a three step process where number one is you look at the question number two, you look at your answer choices and then number three, you finally go back to the stem. So let me show you an example of what this would look like for this particular question. So step one, we have to look at the questions. So this one saying examination of the kidney on autopsy will look and show which the following. So perfect. I already know I'm thinking about what condition does this patient have and what would it look like if I'd actually look to their kidneys. Now to avoid my mind going through all the options, I'm going to just see, okay, acute inflammation, a normal kidney, granulation, hibernus exudate. And after going through these answer choices and having some foundation in renal pathology, you can say, okay, perfect. Let me see what type of conditions may be associated with granulation or acute inflammation or our normal kidney. So now we get into step three and look for specific pieces of evidence that may answer each individual answer choice. Now, usually a typical student would still start at the first line. And one advanced thing I like to do is to read the line before the question. So this was our question. I would usually read this. So it says four weeks ago is oligarous responded, resolved, and his creatinine return to normal. My head, I already know that this patient has a condition that improved and now I'm going to essentially be asking what kind of conditions look like that. So we have a 40 year old gentleman who looks like he had a cardiac arrest and he had oligarous renal failure. Five weeks ago, his creatinine was really high, but now we know it's improved. Oh, and look, they give you a urine study of granular cast. I already know based off the answer choices that this person likely had an ATN from having a cardiac arrest and because I read the last line that everything looks normal, I expect them to have a normal kidney and sure enough, that's the answer. Now I'll show you a few more examples just so you can start to appreciate the speed and efficiency that this occurs, but I do want to share why this is so effective. If you think about the person who's making the test, they want to come up with an answer, but they also want to give you a bunch of little traps within the question stem to trick you. And this is often why we end up with 50 50 questions and never feel confident on step one exams. But now when we flip our approach using this three set process where number one, we go to the question number two, actually look at the answer choices. And finally, number three, we go to the question stem and look for the evidence. You're starting to think more like the test maker and less like the test taker. And this will be less likely to fall into those traps they created for you. So let's go ahead and do another example. So here instead of reading, I'm just going to go jump right into the question. We're asking about most likely diagnosis and I already start to see just from my peripherals, this is going to be a pulmonary related question. Cause I see like FEV1 and FPC ratios. My choices are asthma bronchiectasis, cystic fibrosis, emphysema, pulmonary fibrosis. In my mind, I'm already thinking about what do I know about each of those? You may not even know or remember details about each individual diagnosis, but the ones that we know, we're going to try to see if we can answer it. Now again, using your three step strategy, we already know what we're going to be asked to look for. We know what our answer choices are, but before we actually jump into the stem, usually again, I like to read the last line or two. So in this one, they say that this person has a decreased FEV1, FEVC ratio, increased residual volume, decreased diffusion capacity, and they have hyperinflation, hypertranslucency of their lower lobes of both lungs. Just with that alone, I already know that this patient has a decreased FEV1, FEVC ratio. So in my mind, if I have to go pulmonary foundation, I know this person has obstructive lung disease. So either they have something like asthma, emphysema, COPD. So I can already take out the other answer choices that won't necessarily fit. So I can take out this one, this one. And again, I haven't read anything about who this patient is. Now I see a 39 year old, six month history of shortness of breath has a smoking history. Look at that for 16 years. I'm already going to go ahead and say that this is emphysema without reading all of these things. Just by going through those details, I already have enough evidence that this person likely has emphysema or COPD much more likely than they have asthma. If I answer it, cool. As you guys can see, I'm talking this out loud. So it's actually taking me longer than it would be. I was just thinking about this. But again, using the question to guide what I'm going to be looking for the answers, using the answer choices to then guide what evidence I'll be looking for. And once I have enough evidence, I'm going to go and answer. Now, if you're using the traditional model where you're going through the question stem and then trying your best to answer, but typically we'll have to go back to the question stem to figure out what evidence actually points to your answers. Transitioning to this quicker model where you're going to the question, and then they answer choices and then back to the stem is going to require a little bit of transition. Some students may even find that as you're making this transition, you may actually be making more mistakes because in the process of going fast, maybe you missed a piece of the clue in the question stem that you just didn't actually look out for. And so for those students who provide feedback that this approach is too vast or making too many mistakes, usually my response is perfect. Make the mistakes now as you're going through UL as you're going through NBME practice exams and understand, okay, cool. There is a piece of evidence that I didn't account for that I should look for the next time I see a patient with asthma or emphysema. But it is okay to miss a question on your practice tests, on your practice blocks of your world and make those mistakes and try to be efficient. And then as you do more and more questions, you already know what piece of evidence to look for. So let's go ahead and do this question. I am going to read the last thing. So it's most likely diagnosis and I'll probably read the lines before this. But let's see, this looks like a site questions. So I'm dealing with a bunch of answer choices that are frankly are very similar to me when I was a med student and I didn't really know how to answer these. But let's go ahead and read the last two lines. So this patient says that they only use natural substances. They don't let them essentially get a drug test. I don't have time to wait. So this is going to be a question stem where the last two sentences don't give me the answer right away, but that's okay. Because now what I'm going to do is just the typical. We have a 33 year old lady. She's stalking the president for two months. Cool. And she claims that she's married to his twin brother and then just had his twin kidnapped to avoid competition. So it sounds like a lot of delusion going on. She speaks rapidly. Okay, that's interesting. Difficult to interpret. Associates are loose and she hasn't slept in days. Now that's changing what evidence I'm looking for. Originally I was looking at delusional disorder, but I'm already starting to find features that this patient may have by fuller and be in a manic state. And she says, God has been instructing me to take over the White House. I can't wait to be reunited with my husband. I hear this voice. Tell me what to do. Okay, perfect. This is frankly actually a pretty difficult stem and I think it would have been more difficult if I'd gone from the top to the bottom and then looked at the answer choices because all of them could be right. For going backwards, I already start to see features a more likely a manic death episode with psychosis than somebody who just has schizophrenia. So I think this is not it. I don't think this patient has a general medical disorder that points to psychosis and I don't think that is just delusion. I think this person is talking about hasn't left in days and this brief psychotic disorder again wouldn't be the best answer choice. I'm going to say this patient is in a manic with psychosis. Let's see. Beautiful. Okay. So again, working backwards to find the clues and yes, because the test taker is designed to create traps you will find clues that point to multiple answer choices but because we're working backwards we're saying that there are more answer choices for one of them than the others and that's how we tend to get more questions right this way. I'll do one more before we get into advanced tips. So for example here is which is the following nutrition deficiency is most likely. I can already see peripherally that I'm going to be looking at magnesium vitamin A, B, C, zinc and then I'm going to read my last line as well. They say his stools have a large volume and float. Now, knowing this again, having a foundation in GI I know that if you're going to describe stool that floats you're likely dealing with a fatty content. So in this setting I'm already thinking about vitamins and nutrition that are fat soluble and not so much water soluble. So for me, I already remember it's ADEK someone try to see if there's multiple choices and actually just looking at that I already see that the only fat soluble vitamin that I see that could be messing something is just vitamin A B is water soluble so C and so boom and there you go. Again, this is the answer choice and this is a question I can make much more time for difficult questions later in the block because I can easily just use the last two lines literally and there's nothing in the earlier question stem that I necessarily need to answer this question. Sure, if you wanted to remember dry scaly rash but I feel like I have enough inside move forward. So hopefully you guys can start to see how effective and how quick going through the questions the answer choices going through those last two lines and then looking for evidence your stem really speeds up your process especially if you're doing this in the world trying to make a habit of this makes you again look for those clues. So if you miss a question because you didn't think something was useful actually ended up being the reason that was the answer choice. So in that example that we just had with our bipolar patient you can say I may have missed that they were talking to pass and had all the other features of dig faster that acronym because they do that is the best answer. So next time I answer a site question where bipolar may be an answer choice I'm going to look for those clues and if I don't find it maybe it's not the best answer choice for that question but again I'm looking for pattern recognition most importantly thinking like the test maker and not the test taker. Now before we get back into today's episode let's take a quick second to talk about today's sponsor which is Picmonic. Now if you're unfamiliar with Picmonic and you're on your medical journey they have hundreds and hundreds of videos for literally any class or material that you may need. And what makes Picmonic so unique is that in addition to having so many videos on literally any topic you need so for example here where in microbiology you can click on any video so here's staff warriors and the videos themselves are very short so this video is about one minute 54 seconds but essentially we'll break down the most high yield components that you have to know in this setting about staff warriors in this very nice story format using images so here's a very nice Oreo cookie that essentially will link an image to your brain on important concept about that and the future videos you may find that the same memorable images included in another related video so then you can link together concepts for example here this venom jar with green represents food poisoning so any bacteria that may cause food poisoning may have this image in their overall picture and video so you can say okay I know all different bacterias that have food poisoning and then whenever you feel comfortable with a relatively short story you can easily go into the review and quiz phase and actually quiz yourself on the various different high yield components now in addition to having a very unique and easy way to remember information for your quizzes and tests you can also add all of the videos you're watching into a relative playlist so if you're setting for a microbiology class you can go ahead and essentially click all of the videos you add and add it to those playlist and then whenever it's time you can come back to your individual playlist and either watch those individual videos again or ask for specific quiz questions related to the videos that you've now said that you've mastered or at least learned the first time and that's just scratching the surface in terms of features that Picmonic has to help you on your medical journey other cool things include having a weakness guide so you can see which topics here are the weakest in as well as their study scheduler so you can actually say these are the topics I need to know and here's my test day and then it will essentially will give you a study schedule based off of that so if you're looking for an all-in-one resource your on your medical journey and you haven't quite found it definitely recommend checking out Picmonic if you're interested there'll be a link down below and our friends at Picmonic have also been nice enough to include an extra 20% discount if you use the code the empty journey at checkout and so if you're interested in learning more about Picmonic that link will be down below and as always thanks to Picmonic for being today's sponsor now finally to close off the episode where I feel like the three step process is more than enough to get you better grades sometimes people still struggle with anxiety and just getting through actual test blocks I want to talk about a few things you can do to effectively get through a block particularly on test day so firstly talk about how to effectively mark questions so let's jump back in and go through some of the questions we haven't done now as you're going through your questions you know you're likely obviously going to mark the questions you have no idea about maybe this is a biostat question I just didn't understand what hella was asking me but then you also have some questions where you may have been able to narrow it down to one or two answer choices but you weren't quite confident and you move on but we still have a natural tendency of marking those now where most students go wrong as I'll do all their questions and with whatever time is left then they'll go back chronologically to all more questions the problem with that is that if you had a bunch of questions at the very end where you had no idea what you were doing and then some questions would be more towards the start now you're giving an inappropriate amount of time to those questions where you already feel confident and not giving yourself enough time to answer and earn those points for the questions that were difficult and so usually what I recommend to students is one you have a question so let's say question three in this example is to go ahead and on your scratch piece of paper and you can do this even with your practice you world is to write down the number of the question that is the most difficult so maybe three and then a bunch of questions down here so then my first pass of my flag questions I'm going to go to those difficult questions first to make sure that if I have an epiphany that I can go ahead and earn those points so my first time I'm around I may have not even known what to do with this question but I see that they say the mean is 7500 and approximately 50% will have which of the following well in my head now I may say oh that's easy some means so it should be they're higher above so let me see there's an example where the answer yep answer choice is you know less than this below the mean perfect now I've earned points for a question that didn't make sense and then I'm going to do this with all of the other difficult questions that I have on that piece of paper once I'm done with that with whatever time is left now you can do chronologically the remaining questions that you may have been 5050 on because the nice thing about these is that even if you only have two or three minutes left ideally you've already walked away the answer choices you don't think are appropriate so now you're just thinking about is this Canada is this trick or something else and then you can go back to that three step process to look for evidence that may point to one versus others this person has white discharge so where that's why Canada was I'm more likely option next up to talk about the benefit of getting into an earning point mindset I know particularly when I was taking step one after four blocks I felt like I was doing terrible I literally look myself in the mirror in the bathroom I was there and said like you got this like you really just need to go one question at a time because all of them are going to be hard from this point you're tired you're overwhelmed and so really one of the best things that I did for myself at that point and I recommend this to you is as you're doing a question if you really know the answer let's say this question I had no idea to answer it but this one like we answered already I felt pretty confident when you have questions that you feel confident of the answer even if you end up being wrong use that as like perfect got a point there and then as we came here and we answer this question later well beautiful got another point now you're in a momentum state versus you may come to a question like this and saying or you know one of these and saying I have no idea how to answer this I don't even know what the hell they're asking me most students will get caught up on not knowing how to answer this question and less so focused on the questions where they have earned points it seems like a small difference but the student who focuses on the questions they don't know may come to a question like this and not know the answer which is fine I may not either but then may come to an easier question like this and still get it wrong because they're separating on how difficult the last few questions were this is particularly important especially if a block just gets stacked with questions the first 10 15 they're just hard for you maybe the last 25 ended up being stuff that you could do but if you get focused too much on the first 10 15 or difficult you won't be able to answer the questions later on they're really meant for you so make sure you look at every pitch some of the pitches are going to be difficult and you're just try your best to swing at them but somewhere are going to be just be easy and you can knock them out of the park you have to be focused on still hitting them and the last thing we're going to talk about is just efficiency now ideally using the three step method you're already answering questions quickly comparatively to what you were before obviously if you're using you will you'll be able to see how long it took you to answer an average question and then use that as your average so if it takes you about two minutes to answer a question to improve your efficiency and to prove more time where you can actually do all the questions but also come back one thing I recommend is to cut down your time average time per question by 25% so if you took you two minutes saying perfect I'm going to try to do every question within a minute 30 a minute 40 maybe have a timer on your phone going as you're doing your practice of your worlds and your practice of your MBAs because now that extra time will be added to the reviews you'll be doing for your flag questions ideally using the three step method you may be able to come to a question like this and saying cool that only took me for another hard question this is the efficiency tool that's made all of my setting for all my board exams step one step two step three so much more effective and I rarely have come to an end of a block where I don't have any time left again using that three step process really helps with this but having a mental timer and if you need using your phone as a visual timer will force you to move along and not start getting perseverated on small details if you found this episode helpful and you're interested in more definitely check out the step on Academy to get a step by step blueprint on how to get the highest step one score and pass with confidence but if you did on how to create a step one schedule step by step as well as this episode right here on everything that I used to do in medical school to get a 3.9 tp a as always my friends hope you guys enjoy today's episode thanks for being a part of my journey hopefully I was a little help to you guys on yours and I'll see you guys in the next one peace