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How to Ensure Your USMLE Studying is “High Yield”

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by Alec Palmerton, MD in Plan
High Yield Studying

As a med student, do you struggle with the sheer volume of knowledge? Do you end your day feeling like you should be doing more? Do you feel like you can’t keep your head above water? That you’re drowning in facts, figures, and unfiltered information?

If so, then you may be having a hard time learning high yield information.

The stakes are high. Residency programs screen out nearly 50% of all applications. The most common reason? Low USMLE scores.

To get high USMLE scores to stand out to residency, you need to identify high yield information, and study it effectively.

This article will help you identify:

  • What exactly is “high yield” information
  • How to identify high yield information for any topic
  • How most people hurt their USMLE scores by studying high yield topics incorrectly
  • The right way to study so you can do well in both med school classes and the USMLEs

What Makes Med School So Much Harder?

What is the crucial difference between med school and undergrad?

In med school, it is impossible to know everything. In undergrad, each class had a textbook and a set of lectures. It wasn’t easy, but it was possible to learn the content of each.

In a hard undergrad science course, I might spend an hour on a single page of my textbook. In med school, spending an hour on one page would be suicide.

Why? In medical school, it is impossible to know everything. Spend too much time on one thing, and I won’t have enough for another. (This tradeoff seems to be hardest for engineers/PhDs/physical science-majors). The explosion of medical literature over the past several decades has overwhelmed the modern med student.

High Yield Studying

“High yield” studying means knowing what to focus on

As a consequence, medical students need to know what to focus on. Maybe your classes covered 100 topics in a block. Because of limited time, you have two choices:

  1. Cover 40% of the material well, or
  2. Skim all 100% but learn it poorly

Try to cover everything equally, and you’ll learn nothing well. Knowing only a little of everything is a problem for the USMLEs, as we will see.

But choose the wrong 40% to focus on, and we’ll also be wasting our time. What is a busy medical student to do?

What Do People Mean When They Say, “High Yield”?

There isn’t an official definition for “High Yield.” However, people usually mean, “material likely to be tested,” usually on the USMLEs. The implication is that high yield material is worth studying.

This is to contrast with “low yield” material. “Low yield” material are usually things covered in classes that won’t show up on Step 1. An example would be professors talking about their obscure research.

The Problem with Thinking of “High-Yield” as Strictly Content

The problem with the traditional definition of “high yield” is that it focuses only on test content. It ignores our ability to use that information.

Why is it so important to know how to apply information? Let’s say you were going to be in a cooking contest. To win, you had to cook food for a panel of judges. The winning food must taste good, and be well presented.

Let’s say that you knew in advance that French cuisine was trendy in previous contests. Thus, French food would be “high yield.”

USMLE High Yield Studying

Could you make this cake if you memorized the recipe? Then why do you expect you’ll be able to apply information that you’ve memorized?

Let’s say that you memorized a bunch of ingredients from French recipes, but never actually cooked anything. You could recite the ingredients in your sleep. However, you’d never actually made the food once. Even worse, you never learned how to use those ingredients.

In other words, you were focusing only on the content, but not how to use it. Technically, you are studying “high yield” material. But you’d be going about it all wrong!

The USMLE Tests the Ability to Apply Concepts, NOT Regurgitate Facts

Most med students make the error of focusing only on content. They focus on the material but ignore how they are tested. Just replace “cooking show” with “USMLE,” and “memorize ingredients” with “memorize facts.”

There are many reasons students focus on mastery of facts, rather than learning how to use them. The biggest is that most med school exams test regurgitation of information, rather than application.

Here’s a concrete example. Let’s say that heart failure was “high yield” for any USMLE. (This is true, by the way). Clinically significant subjects like heart failure have more questions on the USMLE.

If I turn all of the information in First Aid into Anki flashcards or memorize Zanki, might I pass my med school exams? Most likely. However, will I magically do well on Step 1? Of course not! Why?

Because the USMLEs test the ability to apply knowledge. They specifically design questions to weed out people who memorize.

How do I know this? Because the National Board of Medical Examiners publishes a book with the rules they give all USMLE question writers. In this 100+ page document, they are abundantly clear. They care that you can apply concepts. The NBME wants you to use the knowledge.

They don’t care if you can memorize large amounts of facts. They even design the vignettes so memorizers will get the questions wrong.

How to Find High Yield Content and Study Effectively

So, what’s a busy, stressed-out medical student to do? How do you study the right material in the right way? How do you avoid wasting your time on low-yield material using low-yield techniques?

1. Identify High Yield Content

The first step is to identify content most likely to be on your exam. While anything could, in theory, be on your test, you can’t study everything.

For example, let’s say your preclinical class discussed thyroid hormone synthesis. The course is likely to cover tons of material, some of it “high yield” and much of it not. But how would you know what is high yield? Unfortunately, I’ve never heard a professor say, “this is the most important thing you need to know about this topic.” Instead, it’s up to you to find it.

The best place to start is a resource like First Aid. Find the First Aid paragraph/section most relevant to the material. For thyroid hormone synthesis, an excerpt would be:

“Follicles of thyroid…Functions of thyroid peroxidase include oxidation, organification of iodide and coupling of monoiodotyrosine (MIT) and diiodotyrosine (DIT). Inhibited by PTU and methimazole. DIT + DIT = T4. DIT + MIT = T3.”

2. Understand/Make Connections Between That Content (and Make Anki Cards for Retention)

Notice how what could be an hour lecture is condensed to 4 lines of text. But what exactly am I supposed to do with this gibberish?

Books like First Aid have few explanations. Their goal isn’t to teach. Instead, it is to identify the most important topics for you to learn, and what kind of information you need to know.

What many med students do is to memorize the words, without understanding the meaning. They write/rewrite notes or drill themselves until they can regurgitate the text. As we discussed before, memorizing First Aid is akin to cramming recipes for a cooking contest.

Instead, your goal is twofold: understand the material, and learn how to make connections. You can use other, more detailed resources (see recommendations here), or you can use the lecture itself. For example, I don’t understand what “DIT + DIT = T4” means. So I might go to Costanzo’s physiology, to learn more. Or I could use my med school lecture itself.

Basic Flashcards Are Easy to Remember, but Don’t Help With Application of Knowledge

Once I understand the material, I can begin to make connections. Making connections is critical for creating useful flashcards that improve your USMLE scores.

For example, tyrosine is a nonpolar amino acid and is one of the major ingredients of thyroid hormone. (That is what the “T” refers to in “MIT” and “DIT” in the First Aid passage above). A typical med student flashcard for this material might be something like:

Front:
What amino acid is used to make thyroid hormone?

Back:
Tyrosine

Simple. Easy to remember. However, it is also worthless.

The NBME explicitly says they don’t test recall of random facts. Thus, having memorized that thyroid hormone is made out of tyrosine won’t help you with Step 1.

The Best Flashcards Will Help You Make Connections

Instead, try asking yourself, “why is that important?” Or “How can I connect that to something else?” Let’s see what we can find.

Because tyrosine is nonpolar, thyroid hormone is nonpolar and thus can cross cell membranes. (Recall that cell membrane’s lipid bilayer is non-polar, as well, and thus non-polar substances cross it). Because thyroid hormone can cross cell membranes, its receptor is not on the cell surface like most other hormones. Instead, the thyroid hormone receptor is intracellular and directly affects gene transcription.

A better flashcard might be something like this:

Front:
Thyroid hormone: use what amino acid it is made from to understand its site of action

Back:
Thyroid hormone made out of tyrosine, a nonpolar amino acid. Because it is non-polar, it can cross cell membranes. As such, its receptor doesn’t need to be on the cell surface and is instead intracellular.

Is this longer? Absolutely. Does this help you recall useful information? You bet.

I can connect the structure of thyroid hormone with its mechanism of action. Use more detailed resources to make connections, then make Anki cards never to forget that information.

It is critical to understand how to apply information, not just memorize it. As such, the Yousmle Step 1 flashcards contain many of these connection-type cards.

That’s also the reason that for every lecture in the Yousmle Online Course, I teach you these connections. Then afterward, I provide ready-made flashcards to reinforce the relationships. That way, instead of the typical “forget everything after watching a video,” you can retain that information forever.

Concluding Thoughts

Being a modern medical student may feel impossible. You’re expected to know an overwhelming amount. No one tells you what to focus on. The demands always seem to multiply.

What solace can you find? Most residencies don’t care about your preclinical grades. They put a strong emphasis on Boards scores and clerkship grades. This may feel like a lot of pressure, but it is also liberating.

Instead of trying to learn every fact you come across, focus on understanding the most critical information, and learn how to apply it. Remember, the USMLEs emphasize the application of clinically important concepts. The NBME doesn’t want you to memorize minutiae.

You don’t have to know everything. Focus on mastering the key concepts, and learn how to use them. You’ll do better on your Boards scores. Most important, I think you’ll also be a better, happier doctor.

Source: First Aid for the USMLE Step 1 2018, 28th Edition.

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored 270 on the USMLE Step 1 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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