Whether you’re studying for COMLEX or USMLE, the stakes are high. In both cases, the amount of material feels overwhelming. Additionally, their importance in your residency application is colossal. This is particularly true for competitive residencies. For competitive specialties, high-demand cities, or top hospitals, Boards scores are critical.
We’ve covered the importance of mastery and retention in doing well on the USMLEs. However, what about other exams? Do the principles of mastery and retention apply equally to other Board exams?
In this article, a former student describes how she transformed her approach. Her COMLEX scores skyrocketed. Even more impressive, she matched into a super-competitive specialty, dermatology!
Here is Hailey’s account:
The Difference Between COMLEX/USMLE vs. Preclinical Exams
Throughout the first and second year of medical school I was able to adapt. In our classroom exams, they were clear on what would be covered. I crammed the details before each exam. Even though I forgot most of it afterward, I performed well on my preclinical tests.
However, like all DO students, I knew COMLEX would be different. The thought of covering “everything” from these first two years overwhelmed me. Additionally, like with the USMLEs, I knew these exams were the ticket to my dream residency. The high-stakes nature created even more anxiety.
The Difference Between Mastery/Spaced Repetition vs. Rote Flashcards
Like many med students, I had used flashcards in school. However, in retrospect, I had been using flashcards all wrong.
First, I had never utilized the concept of spaced repetition. In spaced repetition, information is shown at varying intervals. By reviewing information at increasing intervals, you can remember things effectively forever. Additionally, I often made cards filled with specific, unimportant details. As such, I filled my head with facts I could never use. Even worse, I continued to forget them.
I needed to change something.
Like many people, I turned to the internet in search of an answer to my questions and method for success. I came across the Yousmle website. I liked the idea of actually mastering the material, rather than merely memorizing it. Even more, I wanted to build a foundation gradually I’d never forget. I began working with Alec around April. This was several months before my COMLEX Level 1.
Alec enlightened me about Anki, and I began studying the Yousmle Step 1 Deck. (Even though it was geared towards USMLE material, most of it overlapped with COMLEX Level 1.)
It was a revelation. I kept thinking, “this is what I’d been missing from my board studying!” The Yousmle cards reinforced physiologic and pathologic concepts. Even more, they provoked me to recall this knowledge through specific scenarios.
My process of learning and retention was simple. First, I’d master the material, by focusing on high-yield content. Next, I made well-integrated cards to reinforce those concepts.
An Effective System to Deal with Information Overload
One of the most challenging aspects of Board exams is the massive volume of information. Despite my success with preclinical exams, I struggled to retain the information.
Ever feel overwhelmed by how much you need to know for Boards?
Learning Alec’s approach to mastering material changed everything. I developed a system to tackle the massive amount of information covered on these exams. This allowed me to improve my score in other ways, particularly question interpretation.
(To read The Secret to Scoring 250/260+ You Can Learn Right Now: Question Interpretation – click here).
In the weeks leading up to my exam, Alec and I practiced question interpretation together. I learned the importance of specific details in the question stems. I learned to think like the author, piecing together the clues they gave me in the stem. Instead of feeling overwhelmed, working through difficult questions became a fun challenge. Each vignette became a puzzle, and I enjoyed studying.
A Good COMLEX Level 1 Result, and Even Higher Ambitions
Test day went smoothly, and I was pleased with a 581. (Good for the 61%ile, or the percentile equivalent of the high 230s on Step 1). I knew, however, I had not reached my full potential. If I could do well with only several months of a better approach, what could I do with a year of preparation? I knew I could do even better on my COMLEX Level 2.
After Level 1 I took a much-needed vacation. I came back ready to transition into the clinical world and learn as much as possible during third year. I wanted to prepare not only for Level 2 but also for the benefit of my future patients.
COMLEX Level 2 Prep: Question Banks and Mastery of my “Gaps”
Anki cards and practice questions were the backbone of my third-year routine. This time I had an entire year to work with Alec and apply his techniques.
I went through the COMQUEST Shelf question sets for each rotation. Studying related diseases simultaneously helped me see the key similarities and differences between each. I found the question formats and topics tested on each COMAT were like COMQUEST. (COMAT is the DO version of Shelf exams for MD students.) Since I was taking the COMAT rather than Shelf exams, I went through all the COMQUEST questions first. Then I would go through the related UWorld items. I found the COMQUEST questions to be more representative of the COMAT exams.
My goal was simple. I mastered the material for each rotation and made integrated Anki cards. Then I retained that information in later rotations, gradually growing my knowledge base.
Besides the Yousmle decks, I made my own cards to reinforce subtle but essential facts. Things like which SSRI had the longest half-life. Or the importance of a painful vs. painless bleeding gravid uterus.
I’d fallen behind on many of my Level 1 cards. On each rotation, I caught up on the related Level 1/Step 1 cards, while also learning the Step 2 Yousmle cards.
My performance on the COMAT exams was excellent. It also reinforced my belief that I had finally discovered the best study routine.
My COMLEX Level 2 Dedicated Study
I scheduled my Level 2 exam for the end of July. By spring, I had done all the COMQUEST questions for most of my rotations. (Family and internal medicine, surgery, psychiatry, and pediatrics.) Having finished most of COMQUEST, I was able to focus my time on UWorld questions.
Throughout my dedicated study, I did my UWorld questions randomized and timed. Doing timed blocks was particularly crucial for COMLEX. The time allotted per question is even less for COMLEX than the USMLEs. I knew I had to have the timing down precisely.
(To read UWorld: Is Your Strategy Wrong? (I Scored 270 By Ignoring The Dogma, click here)).
Doing the questions on random highlighted my areas of weakness. Subjects such a renal and musculoskeletal stood out. I made sure to go back over some of my notes from class and clinic related to these topics.
I also started using various online review videos (e.g., Online MedEd, Dirty USMLE) to fill in my knowledge gaps. However, I found these videos too mindless. Even worse, whatever I learned I’d forget quickly. To reinforce the knowledge, I continued to make and review Anki cards. Using this routine, I finished all but 80 UWorld questions. This was a significant improvement compared to only getting through about half of UWorld before Level 1.
OMM Studying More Rote, Using Familiar Resources
For the OMM studying, I went back to my class notes from second year. The teaching fellows at my school did an excellent job covering high yield OMM topics. Plus, I liked reinforcing the material in a manner that was already familiar with me. (One of these fellows went on to make the Online MedEd OMM videos, but these came out after my exam.)
For the OMM material, of course, I made Anki cards. However, some of these OMM cards were much more fact-based compared to my other cards. These included details such as Chapman points and counterstrain treatment positions. To facilitate memorization, I created individual treatment cards. I also included shared treatment positions to emphasize easy-to-confuse similarities.
Test Day: COMLEX Level 2
I walked into my Level 2 test day feeling prepared. The day prior I envisioned how every detail of test day would go. My favorite songs to listen to on the morning drive. What beverages and snacks I’d have during my breaks. When/how long I’d take rests. I wanted to concentrate only on the content of the exam.
The questions were challenging. Many presented material I’d never seen before. I’m convinced I would never have ever come across some topics, even if I’d studied for an extra year. However, because of the approach I’d taken, it didn’t matter that I’d never seen many of the topics.
For more than a year, instead of cramming, I had mastered principles and foundations. I strengthened my clinical reasoning skills with practice questions. Because of this practice, I knew each condition, and what the question was actually asking. Each of my answer selections was based on sound clinical reasoning. Although I wasn’t always sure, I trusted my months of preparation.
My countless hours of dedication paid off. I scored a 683 on Level 2, a 102 point increase from my Level 1 score! (683 would be in the 90%ile, or roughly the percentile equivalent of a score in the 260s on Step 2 CK).
Hailey’s Level 2 score was in the 90%ile. She happily matched into her dream specialty: dermatology!
Concluding Thoughts
Getting into dermatology residency was a dream come true for me. I’ll leave you with things I’ve learned along the way.
Things I wish I’d known sooner:
- I wish I’d known the importance of incorporating questions into my study routine sooner.
- It also took me a long time to realize that it was ok to decline invitations during my dedicated study time. Once I realized I did not have to be social or get dinner with friends, my anxiety improved drastically. This is a critical time in your career. Being selfish is ok. Your family and friends will understand.
On the importance of the scores:
- Exam scores are important but if you don’t perform as well as you hoped or expected, don’t let it define you. Instead, focus on the things that you can change. Evaluate yourself and study habits – how can you do better on Level 2? Can you get involved with research projects, tutor peers, volunteer? Write a killer personal statement and secure persuasive letters of recommendation.
Final pieces of advice:
- One of the most helpful things I did was attend conferences. Meet people currently in the field of Dermatology. Making connections and finding mentors will be invaluable.
- Talk with current residents. They were just in your shoes. They can help guide you through the stressful residency application process.
- The process is mentally challenging; you’ll have times when you doubt yourself. This is when my mentors really helped and provided advice and words of encouragement.
- Lastly, don’t ever give up. You will likely encounter people that doubt you but stay true to yourself and your passion. If you want something badly enough, you can make it happen. Even if it takes a few tries, in the end, it will be worth it.
Photo by Mikito Tateisi.
