Making the Most of your Worst Subject

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We all enjoy spending time with the people we like, and try to avoid even seeing the people who make us uncomfortable. Good friends, the people who make us feel good, are one of the prime joys of life. And who needs anxiety? Is not avoiding those people who make us feel bad a sign of good mental health?

Unfortunately, this good, even instinctive, strategy for enjoying life is a disaster when applied to how you allocate your time when preparing for the USMLE. The pleasure you get from USMLE preparation is not from the experience itself. Preparation is hard work. Rather, your real satisfaction will come from the score you achieve at the end of the process. Let me repeat, the process is not fun (at least for most people), but the feeling you will get when you are told about your superior score will more than make up for the deprivation you put up with.

Successful preparation for the USMLE, therefore, begins with answering a simple question, “Can you endure short-term discomfort in order to achieve ultimate success?” Are you able to defer your gratification? Can you live with the anxiety and uncertainty of facing up to what you do not know and correcting the deficits you find? If the answer to these questions is a resounding “Yes”, then you are ready to begin the labor of study which will bring you ultimate prize. If your answer is “No”, then no amount of resolve or commitment will see you though to the end.

So, if you are ready, where do you begin? Many people think that USMLE preparation requires simply doing more and more practice questions. As I have pointed out in previous postings, practice questions test you and tell you where you are, but they do not teach you and make you better. Learning comes from study, not from questions. We tend to like questions because they are, well, more fun than studying. The mental challenge of deriving an answer is simply more engaging to most people than the routines of rote study. In addition, questions are “bite-sized”, presenting us with a defined cognitive task and freeing us from the vertigo we feel when confronted with the mass of information the USMLE requires. A question just feels more manageable than the bulky weight of study material.

Study is the core of your preparation and the foundation of your eventual success. Only by concentrated effort of reading and understanding can you absorb the basic facts at the core of the USMLE questions. Without this knowledge in you head, no amount of question expertise will help you. Faculty can help you by explaining what is unclear and indicating what is most important, but the actual work of making the knowledge your own must be done on your own.

You get the most out of this study time by focusing on the subject matter where you are weakest. If we are honest, all of us have some subject, or at least some subject area where our mastery is less than complete. We know we are not good in this subject. This sense of not measuring up makes us feel uncomfortable. To avoid the bad feelings, we often simply avoid the subject. And so, the weak area continues to be weak. Some people even take on a subject are weakness as a self-defining characteristic. It becomes a part of the label of who we are, “I’m just not good in…”

The point to USMLE preparation is not just to perpetuate these weaknesses, but to fix them. Rather than accept that you are not “good” in a certain subject, now is the time to change that. USMLE preparation grants you the unique opportunity to elevate yourself, to take a step up from the knowledge you acquired in medical school to a broader, more integrated comprehension of basic science and clinical knowledge.

So, organize your study time to give extra attention to those weak subject areas. You will not like it. You will feel anxiety as you face your deficits. But, this is simply the best way to reap the rewards of a superior score at the end of the process. Start your study time with your worst subject, and then look at it again just before the exam as added reinforcement. Or to really master the subject, spend ½ an hour every day on it in addition to whatever else you are studying. Don’t run away from your weak areas, embrace them. Meet your weaknesses head on.

USMLE is about problem-solving. But, if you can not call the basic facts to mind, is you do not have the knowledge you need to apply to answer the question, even the mostly finely-honed reasoning skills will be to no avail. Without a usable grasp of the basic knowledge, you will fail. Organize your time so you can focus most on the area where you are the weakest, and you will discover during the exam that you have the facts you need to solve the UMSLE questions you encounter. Rather than your worst enemy, you fill find that you have converted the subject you hate into your best friend.

Steven R. Daugherty, Ph.D.

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