Glad they're helpful - thank you for your support and kind words!

Agreed! I had never heard “pedigree” so often until I went to Stanford/Harvard-MGH 😅

Thank you so much for your support and kind words!!

Thank you so much for such a heartfelt reflection. I’m so glad that our videos have been able to help you find meaning and inspiration. Profound personal change requires either inspiration or desperation, and it sounds like you may have a little bit of both, which can be a very powerful combination. We are looking forward to speaking with you and seeing your further transformation into the kind of person who can excel on these exams and in your broader clinical ambitions!

I would definitely do questions timed to practice. I also recommend that you practice never spending more than two minutes on a question (set a timer and reset it every question), since often times problems with timing come from perseverating on questions for too long and losing time for the rest of your block. Finally, you’ll improve with timing if you process more information before you step into the test (rather than try and think everything through for the first time during the exam), so you spend less time and energy thinking (using Anki properly is key).

@ thank you so much for your advice doctor! I’ve seen your amazing youtube channel yesterday, unfortunately I knew that failed step 1 last Wednesday and I was looking if I still have some hope or if I should look for another path… your video gave me so much hope…. I know my mistakes and why this happened to me ( didn’t do enough NBMEs timed mode, didn’t do enough UW, and I was too stressed before the exam because of these two things) I am one of those students you were talking about who focus more on memorizing than application the concept by doing more and more questions. I’ve never tried anki, not sure if I should start doing it or just solving questions for like one month or two as soon as I feel ready. Your advice will be very appreciated 🙏🏻

I'm so sorry to hear that you failed Step 1. It's pretty common these days, and it can definitely be the catalyst needed for real change. Re: whether you should try Anki, personally I would focus on trying to do extremely well on your next attempt - not just trying to "get by" and pass - so that you can have as tiny a chance of failing again as possible. Plus, the better you prepare for Step 1, the better prepared you'll be to do really well on Step 2. For that reason, if you were my favorite cousin, I'd tell you to do Anki, and do a good job with learning how to make cards so you can master the underlying concepts (not just memorize superficial details).

Thank you for your support and kind words! Glad it helps!

Thanks for your support and kind words!

Absolutely! I always found it helpful to see real examples of people doing things that I wanted to do. If they can do it, I can, and you definitely can too!

Great question, I typically recommend for pre-clinical students to use something like First Aid as a filter so that you don’t end up making 200 flashcards on one lecture. Focus on the material that is conceptual/makes sense, and/or that is in First Aid and you can cut down on the number of cards that you make.

Great question. I definitely can relate to wishing that I could only do one thing per day, but I agree with you that doing both simultaneously is the better approach. Generally, I would try to reduce the amount of new things that you do to the point that, you can do your old cards. In other words, at a minimum, you should do your old reviews every day, and any time that you have left over, you can spend learning new things. That, and, if you want to get more done in the day, I highly recommend developing a morning routine / sleeping and waking earlier so you can get more done before your regular day of classes/work/rotations starts rather than studying when you get home.

Thanks for your kind words and support! It means a lot.

Of course! For profound personal change, we need either desperation or inspiration. Seeing others who have transformed their medical careers during some of their darkest times can serve as both.

Yes very good question. According to program directors I’ve spoken to, if you have a weakness on your application, you should try to address it directly. So if you failed one of these tests, your best bet is to do as well as possible on one of the scored ones, like Step 2 or even Step 3.

@alec.palmerton_md thanks for answering that question Dr palmerton

Absolutely!

Yes it is pass fail but the single best predictor of Step 2 scores are Step 1 scores so what you learn for one definitely affects the other

Haven’t taken it, although I’ve coached students who have tried it

Great question, the tutoring depends on your needs, so it’s best for us to be able to learn more about your specific situation first so we can provide the best recommendations.

Agreed! I’d be curious to see what people in emergency medicine have to say, but I think that the bad rap comes less from the number of hours that they work, and more the fact that those hours can be at any time of the day, and for many providers isn’t at a consistent time (eg you might have 2 nights shifts, and a couple days shifts in a given week). Shifting your schedule can be really challenging, especially as you get older

Thanks for your question. Personally, I think minds maps can be useful I just haven’t figured out an effective way to make them work with spaced repetition so don’t use them much. Where I stopped using things like mind maps was when I realized that so much more of my performance depended as much/more on how much I remembered rather than how well I could organize it in a mind map. When I started using Anki and combined it with other techniques of applying concepts, my improvements were dramatic.

@alec.palmerton_md do you mean that I use mind maps + anki ? Don't rely on one thing only but combination between them ?

If you were my favorite cousin, I would say spaced repetition (if used properly to reinforce mastered concepts) is much more powerful for retention than mind maps, and so I would put all of my energy towards figuring how to do that well.

I got a 270. Average Step 1 scores were (and probably still are) lower than Step 2, where you need 280 to get to the top 0.1%. www.yousmle.com/step-percentiles/

Thank you for your support and kind words! Great job, focusing on refining your study strategies. Learning how to use spaced repetition effectively is a game-changer - keep it up!!

Thanks for your kind words and great question. Yes I'd use small blocks of five unused (if available) practice questions on the subject you're learning as an early measure of how well you're learning it. If you can't get 80-90% on that, it's highly unlikely your overall score on a mixed block will be even close to that. I've seen lots of people take an NBME after weeks (or even months) of studying, and only find out then that their studying isn't really working. Much better to shorten the feedback interval so you can keep making adjustments. When you hit a tennis ball, you want to know immediately where it goes, not weeks later - the same is true for studying.

Thank you for your support and kind words!

Great idea, we’re working on adding timestamps

Thanks for your support and kind words!

Sorry to hear about your results. To be honest, your chances for orthopedic surgery residency are not good. Even for US graduates they automatically reject many applicants who have failed any of their exams. That said, if you are already an orthopedic surgeon, you can apply to fellowships in the United States, I believe, where they care much less about your board scores. You still have to pass the USMLEs, however.

@alec.palmerton_md Thanks for your reply! I'm still a medical student, I'm in my final year. But should I consider retaking the exam or maybe change the specialty I want to go into? I just want to know what truly my options are :(

@alec.palmerton_md Thank you! I'm in my final year of medical school. But I'm planning to retake step 1, if I pass will it help in any way?

@@joserobertorodriguez73 It will help to pass, but I suspect that is the minimum standard they expect. You can see more about statistics on how programs view failed USMLE attempts here: www.yousmle.com/step-1-fail/

Thanks for sharing your perspective, I didn’t know that about computers now being better than computer/human combinations, although it makes sense. I agree that financial pressures will certainly play a role. One reason why doctors can be harder to replace from a financial standpoint is for liability reasons. I’m curious to hear others’ perspective on this, but I’ve heard that one reason why physician anesthesiologists can be hard to replace is that the liability if something goes wrong with the anesthesia falls on the physician in the room, who would be the surgeon in most cases. No system is perfect, and when things get missed or mistakes get made, I wonder who would be liable. I doubt it would be the maker of the AI system. I think Dr. Cho may have mentioned this off camera, but one thing that is certainly possible is that radiology reads become more like how EKGs are done now. You’ll have an initial read that’s done by a computer, but then it still has to be checked by a physician. Obviously there is a lot that we don’t know yet, but I’ve also been surprised by how little apparent fear there was of being replaced by AI (in fairness, medicine tends to change pretty slowly)

Thanks for your thoughtful question. Honestly, my opinion is less informed on this topic than an actual academic radiologist's (and one who is Harvard-trained to boot) - if you haven't seen it, I'd highly recommend this interview where we talk AI, radiologist salaries, and much more: kzbin.info/www/bejne/sH2yiayQbNeod9ksi=p_6AXTnkSv_CFJ8G

Thanks! Agreed - hearing a real academic radiologist's views on AI was eye-opening.

Thanks so much for your support and kind words!!

Thanks for your support - I actually don't do the editing for my videos, but I'll be sure to pass along your kind words!

I appreciate the feedback - if you're looking for something more specific and detailed, I did an in-depth profile on one of the students I discussed in this video as a case study for those who sign up for the (free) mailing list: www.yousmle.com/ It includes how many questions he was doing, what his scores were, how long it took, etc. If you see it would love to see if that is more what you had in mind.

Thanks for your question! You can schedule a free consultation with our team here so we can learn more about you and see how we can help: yousmle.com/consultation

@@alec.palmerton_md Thank you! I signed up!

Awesome - we're looking forward to speaking with you!

For sure! As long as you understand it from the perspective of a Program Director, that they’re trying to create a residency class full of future excellent clinicians and leaders in their fields, if you being part of their program can help them solve their problem, then they would be happy to take you.

By the way I use to work at MGH White-9 as a PCA!

Wow, that’s awesome. Small world. Anking provides a valuable service in that lots of people are too overwhelmed, or feel inadequate to the task of making their own flashcards. Personally, I’m not a huge fan of premade decks generally, since they tend to focus more on memorization and not really delving deeply into the concepts underlying medicine, the consequence of this is that people tend to get overwhelmed with the number of cards that they have to do, since everything is memorized as a fact rather than using a smaller number of principles to organize and understand the huge amount of knowledge in medicine.

@@alec.palmerton_md Thanks for reaching back out brother I’m sure you’re really busy so I appreciate that. Are there any outside resources that you would recommend that helped you find the fundamental concept to the things you were learning in Medical School Dr. Palmerton?

Great question - I really liked Goljan and Costanzo. Frankly, though, I found some of the best connections by just always trying to make connections and always asking, "why?" I talked about some of the strategies I used to understand deeper concepts here: kzbin.info/www/bejne/jnSvgIWsrs-cjNUsi=hxDK3NrfLE4B14QD

@@alec.palmerton_md Thank you so much Dr. Palmerton! Looking forward to seeing more of your content brother!

Thanks for your kind words. Your support means a lot!

Thanks for your kind words and support! Without working with you directly and seeing how you're studying, it's hard to know exactly what the problem is. In my experience, however, most people who have done an entire QBank and are still below that low-pass range typically are struggling with the Study Conceptually or Commit to Memory aspects as their biggest bottleneck/areas for biggest improvement. Are you finding yourself not really sure how you should study things that you are learning, and doing things that have helped you in prior exams in med school (e.g., doing a fair amount of passive reading / rote learning / etc.) but that don't seem to work as well for the USMLEs? If so I'd focus more on making sure that you understand things conceptually.

@@alec.palmerton_md I am struggling with the things I should do to improve. Should I read FA again or should I do the Q bank again? From what I have learned after giving NBMEs is that in some questions, I don’t remember but I am aware of the topic. In some questions my concepts are weak and some I am purely making silly mistakes and second guessing.

You're asking a natural "what" question - as in "what resource should I use next?" Frankly, in my experience, the more important thing to do is to focus on the "how" questions - how should you read FA, how should you approach questions, how you study things that you don't know, how you use things like Anki to work on the retention. Here are some videos on the topics that can help: kzbin.info/www/bejne/fZ6bqqeag7WdsNE kzbin.info/www/bejne/n6Wte6OFjL5sd9ksi=GwguDi67UWedjrZM Hope this helps!

Great question - typically what we've found matters more than WHAT resources you use (e.g., B&B, UW, etc.) it's HOW you use them. Most people use the same resources, whether they fail or they score 260+ so what really separates people is how they approach the exams. You might try these videos for more on this: kzbin.info/www/bejne/hJK0apd5nZp5m7ssi=C1qHfxHUbB4q467L kzbin.info/www/bejne/mKbIn4VpYtNlirMsi=tuoOt2rbQ7YdG05c

Thanks for your support! These sorts of things are simple, not easy, which means there is a huge opportunity for those of us who can follow through. Keep up the perseverance (and Drive, Belief, and Consistency)!

Thanks for your support and kind words. He was the business partner / spouse of a family friend of ours growing up, who would have friends over for barbeques at their house. I think we'd had that conversation just after he'd sold his first company, Adaytum. He incredibly warm and open, and he very much lives those principles.

@@alec.palmerton_md He must be thrilled to hear that his words had made such strong impact. You didn’t use cellphone all the through medical school also showed how discipline you were, and you formed several habits such as always asking questions and always on time showed the drive, belief and consistency you were. I looked up his LinkedIn profile, and found that he did a lot of planning software. These three aspects are perhaps even underpinning his products and companies. Are you still in contact with him? Hope there is a chance that he gets to know these :)

Great questions. It's been years since I've spoken with him - he'd moved to Silicon Valley and so when I was in the Bay Area we spent a bit of time together. Re: discipline, frankly a key point I realized was that I do NOT have discipline. And because I don't have discipline, I need to modify my environment with that in mind. I found that if I relied on willpower, I would typically fail. But if I made it harder to be distracted and easier to study, I could nudge myself (sometimes a lot) to follow through the things I'd committed to do. Might be a good KZbin video idea?

@@alec.palmerton_md Will power vs. Environment vs. Habits sounds like a great idea for a KZbin video, especially with the personal experiences and achievements like yours ! I think these are the mechanisms to propel and affect a person, and they interact with the (initial? intermediate?) goals and aspirations of the person, together these are the factors that lead the place where the person will land, kind of an analog of a person’s sailing with a boat - a very crude perhaps imprecise one I know :). Look forward to your videos. Thanks again. 😊

Love it - thanks for the perspective and ideas.

Thanks for your support and kind words!

Absolutely - keep pushing forward with Drive, Belief, and Consistency!

It's never too late, although the longer you wait the harder it can get. Ideally it's been less time since you've graduated, especially since you last practiced medicine.

Thanks for your support and kind words!

Shelf Exams are the short (usually ~110 questions) USMLE Step 2-style questions that US med students take, typically after each required rotation like surgery, IM, pediatrics, etc. IMGs can take NBME versions of these (50 questions each, sometimes called CMS or Clinical Mastery Series) that can supplement Step 2 NBMEs.

@@alec.palmerton_md thank you

You're welcome!

@@alec.palmerton_md thanks man great video and great help keep the good work

Great question - not every sub-subspecialty has reliable data I could find, especially around annual hours worked. Since those are subspecialties of radiology and cardiology I’d imagine they are in the ballpark of the overall specialty - if anyone else with more specific knowledge would like to chime I’m sure it would be appreciated!

Absolutely! Most of that is in this article, which we will update as we get more data: www.yousmle.com/physician-salary-per-hour-by-specialty/