Exam skills: The recall muscle will be built over time, effort and energy.

I am of the belief that there are several key skills associated with doing well on the USMLE Step 1 exam. All of which come together to deliver a day in which all we have learned, all the we have strived to become, dovetail together and culminate in a day we will never forget.

Skill One: Determination & perserverence
This skill is developed by doing the absolute best you can do during your 1st two years of medical school. The determination is honed by working daily. Now, there were several in my class who understood this very well. They took every opportunity to study and move information from short-term to long-term memory. Always pre-reading lecture material, always attending class, taking notes, asking questions, involving every sense into the time spent learning material. During breaks b/w class, I would see students huddled in groups discussing the intricacies of the previous lecture materials, going over objectives or planning new strategies. After class, spend time with the material of the day. Go through the objectives and attempt to answer these objectives without your notes (Recall muscle: this will come up again later, so this is important)! Now, break up the material into chunks, working from the area of most familiar to could not recall any part of an objective. Move quickly and effeciently and leave enough time and importantly, energy to cover those items you were not familiar with. How much time is this? Really, it will be up to you, your priorities and obligations.
What did I do, you say? My ave. day was to school by 7am. Whether class was at 8am or 10am, noon or whether we were off that day. I spent at least one hour prior to lecture organizing my day, outlining objectives for my learning that day, making small goals and some pre-reading of lecture material (I also would do some pre-reading after my children had gone to bed). Then, I would attend lecture. I know all you podcasters out there are saying, "ahh, pooey". But, I still attest to the school of thought of involving senses to my learning experience. That involves sight, smell, feeling, writing, & hearing the talk of students all clearly and in the moment. I did use a tablet PC, but the closer I came to exams, the more pencil and paper I used to crunch the info into a study format. After lecture is where the real money is made. If you can get to a point where you can recall information and teach it to someone else, you're golden.

Skill Two: Teach.
Speaking may not come naturally to you, but if you can teach material to someone else, do it. Some people say skill two should be memorize. This is important and they go hand-in-hand, but if you can teach someone material, it will stick @ 5x the speed b/c you have to know it and not look bad doing it and then it will go to long term memory b/c it requires a different set of neurons to store and then retrieve in your own language! You can do this, but you should attempt to not use notes and if you use notes, only crib notes should be allowed. My good friend and I found would do this by learning the material, then coming back with "slick" ways to remember it and teach by going up to a board and writing/drawing/illustrating, etc.

Skill Three: Crunching and Prioritizing.
The exams you will take throughout your med school career all seem to come down to 10 pages of must know material. How you organize this material will be a completely individualized function. I used a lot of keywords, buzz words and major themes that enabled me to conceptualize large amounts of information with as few words as possible. This is the memorization and recall you will put to use.

Skill Four: Practice.
This is a must. Taking the USMLE and for that matter any exam is a matter with being comfortable with the exam questions and how they are asked, what foil answers are there and how to identify key words. Therefore, practice questions and review the answers (even the wrong answers) and why they are the answers or not the answers. I spent a lot of my final days doing question after question. This will deepen your understanding of simple concepts and firm up your understanding of weaker areas. I did this for any test I've taken.

Skill Five: Crunching and Prioritizing.
Once you have crunched once and done some questions, do it again and again until you have the material down to 2-5 pages! This forces you to review, review, review and build your confidence. This will become a cornerstone to your program and will enable you to b/c comfortable answering questions with pressure. It will also put info in that deep, long-term material and build your recall muscle.

Skill Six: Confidence.
You have done the work and then some, you have studied, you have taught, you have crunched and prioritized. This material is there. Speak into your head. Visualize success and the feeling of doing well. Develop an energy of confidence as you enter that room that you are ready to take it on and smoke this thing!

Skill Seven: Calmness.
Once you are psyched and ready to roll, compose your mind, purposely think of focusing your mind on the attack you about to undertake and the single minded alertness to the moment. Let go of distractions of noise and talking around you and focus.

Skill Eight: Taking the Test.
This is important and involves steps (That's an understatement!).

1. Cover the answer choices. Now, I realize this isn't possible with computer exams. However, it is important that you not look at the answers. So, when you are practicing and for a period of time, do this and it will then b/c 2nd nature. We are working on a system here. Stay with me.
2. Read the Stem. What is the question asking you? Many times the vignette will ramble to all ends of the earth and come back to a question that you were not thinking they would ask. Therefore, read the stem of the question 1st.
3. Go back and read the vignette, making note of important keywords, concepts and data a. If you believe you can answer the stem without the vignette, you can attempt it. And, be willing to go back to the vignette if you need to.
4. Recall. Try and answer the stem without seeing the answers. This is where all the recall work & muscle you have built up will come to life and live in the moment. a. If you don't just know it, write out on the side or on a piece of paper what you do know. This will help you build a case and bring in different pathways to answering the question.
   
5. Uncover the 1st 3 answer choices.
6. Eliminate one of those choices.
7. Uncover 1 more and eliminate 1 more.
8. Continue until down to 2 choices.
9. Which of those two choices answers the question best and fits with the information you know about the subject. Or, which of these does not or does not quite fit.
   
10. If you are still unsure, go with the one you have the best gut feeling for.
11. Important step, especially when practicing questions. Rate yourself. Rate yourself on how well you think you did by confidence level. I would put a (+) or a (-). Plus for confident, minus for not confident. Some people used 1 - 3 - 5 (not confident - wavering - confident). By doing this, you can develop some data on yourself, develop confidence in your ability to take exams as you continue to do this. It will give you data on types of questions that make you stumble and those that you rock!

Skill Eight: Is given more in depth to students at the University of Kansas School of Medicine by Student Resources.

Motto of the day: The recall muscle will be built over time, effort and energy.

You can do it!