29 March 2011

Standardized Tests

Standardized Tests
Let’s face it, standardized tests are a “fact of life” if you attend public school in the United States, anticipate attending college/university in the United States, want to enter professional school in the United States and practice any profession (especially medicine) in the United States. These tests are required for medical licensure in every state and most medical colleges require applicants take and score well on the Medical College Admissions Test (MCAT) for admission. These standardized tests need not engender any great “fear” in the test-takers as they are simply tests that are administered (and scored) under some kind of standard conditions. They are tests and like any test, they have characteristics that need to be examined in terms of preparing yourself. Just as you prepare for a course examination, you need to prepare for any type of standardized test that you need to take and score well upon.

Getting your “head” in the game
If you constantly tell yourself that your “bad at” standardized tests, you will fulfill your prediction. You can’t give any standardized test any more deference than you would give any examination in your academic history. Every test tries to measure something and that “something” is what you have to maximize your knowledge of , in order to do well on any test. In short, you survey,prepare, and master the knowledge that is tested on any test under any conditions. Every standardized test has a description which needs to be read, analyzed and used as a guide in your preparation for taking the test. If you decide ahead of time, that you can’t do well on a particular test, you have made your preparation that much more difficult. Any standardized test can be prepared for, taken and mastered by anyone who diligently and systematically prepares for the test.

Timing is everything
Once you know that you have a standardized test (in addition to your course exams), get a description of what will be covered on that particular exam. In the case of the MCAT, there are detailed descriptions of the subject matter for each section of that exam. Download those descriptions when you start your pre-medical preparation (when you start college if you know that you want to enter medical school) and pay close attention to your coursework in order to make sure that you have adequate coursework to cover the subject matter of the MCAT. Make sure that after you download a test description, prepare for the test according to the description and not according to how you prepare for other tests.

If a description says that a test requires that you apply knowledge from a specific knowledge base, simply memorizing that knowledge base is not going to prepare you for that test. In addition to thoroughly mastering the knowledge base, you have to be sure that you master the application of that knowledge base to problem solving. Standardized tests such as USMLE, MCAT and COMLEX have such broad knowledge bases that you can’t hope to memorize every factoid in those bases. You must master the prerequisite coursework (not memorize/cram for each exam) and build upon each courses within that knowledge base in order to apply that knowledge to problem solving.

What about problem-solving?
For many people, anxiety and poor reading skills can destroy any chance that they had of actually answering each question as it comes. If you are thoroughly familiar with the manner in which each test will construct problems, you can greatly decrease your anxiety level and improve your experience and reading skills. You can find reading skills courses (critical reading and analysis) that will hone your ability to pick out the significant parts of any argument, problem, question or survey that will help you extract the information that you need to answer a question about that argument, problem, question or survey. You can practice self-questioning as you read textbooks, newspapers, position papers and peer-journals to learn how to extract pertinent information for problem-solving. Turning off the television and getting away from the social media sites on the computer can free up valuable time for reading and analysis of a wide-variety of journal, texts and other learning materials. In short, you can read and analyze something every day that will hone your reading skills.

Get away from the Powerpoint!
Just attempting to study anything from a Powerpoint summary can be problematic. Professors use Powerpoint to summarize facts which may not be detailed enough for through mastery of any subject matter. If there has been assigned reading from a textbook, make sure that you have completely and critically covered the material. As you are reading, be sure that you look up any unfamiliar words and constantly question yourself in terms of knowledge mastery. If you have a Powerpoint lecture summary, be sure that you thoroughly cover and understand (in the textbook) the material that has been outlined in the Powerpoint lecture. Only after you have completely summarized and learn complete concepts, can you utilize a review-type book for reinforcement of learning. Trying to learn the basics from a review book is not going to give you the in-depth knowledge base that you can use to apply to standardized test problem-solving.

Review courses
A review course is worthwhile if you have a thorough mastery of your coursework in the first place. Just like review books, Powerpoint reviews and other review-type materials, you can successfully utilize these things unless you have had a through underlying knowledge base in the first place. If you are a medical student and you anticipate taking any of the USMLE/COMLEX step exams for medical licensure, you need to have thoroughly mastered your coursework before you begin any type of review course for these exams. This is why review courses are most valuable as soon as you have completed the prerequisite coursework that will be covered in the review. These review courses are not a substitute for thorough mastery of coursework. This same strategy works for pre-med students in that purchasing and taking a review course before you have completed the pre-med courses is largely a waste of time and money.

Most standardized tests have a recommended study time frame. If you can’t find this study time frame, make sure that you ask people who have taken (and done well) on a standardized test, how much time they put in. Also be sure to ask a number of people (not just one person) so that you can get an average. Keep the following in mind:

•Don’t tell yourself that you are “bad” at standardized tests because you add to the difficulty of any prep for a particular exam.
•Don’t expect to memorize a review book and be prepared for a particular test or exam.
•Don’t tell yourself that your “whole career” depends on one exam as no exam can totally determine your vocational destiny(influence yes but not totally determine).
•Regular if not daily systematic preparation for the major standardized tests is a sound strategy. Your daily prep can be as simple as practicing your reading comprehension.

11 March 2011

Match Week (and the scramble)

Most fourth-year medical students are eagerly awaiting noon on Monday of Match week to find out if they matched. If they didn't match or matched to a second-year position but not first-year, these is a process called the "Scramble" that they will be taking part in if they do not have a PGY-1 position. The majority of US medical school seniors will match if the process has worked well. By process, I mean that they have ranked places that interviewed them and the places that interviewed them, have ranked them. The computer attempts to match the applicants highest choice with the place that ranked them the highest. Most of the time, the process works out fine but sometimes it doesn't and an applicant will know on Monday if they need to actively look for a position.

There will be a scramble list published on noon of Tuesday that will include programs that didn't fill all of their PGY-1 slots. Some programs will elect to offer positions to people who applied outside of the match. This means that you need to be aware that many programs that you might have applied to will fill from people who have either applied and are eligible to accept a position outside of the match which means that those programs may show open slots but those slots are filled (usually by FMGs who have already signed contracts). The only way to find out that a slot on the scramble list is truly open is to call the program on scramble day and find an open slot. You also need to have your application materials ready to fax/send by e-mail thus you would need to be next to a fax machine or have your materials in electronic form and ready to send if requested.

On scramble day, programs that didn't fill (and want to fill) will have the program director and a couple of faculty, reviewing applications received and ready to make an offer of a contract on the spot. This is why is makes sense to be at your medical school (most schools will have a scramble set up) and have your materials ready to send. On scramble day, some programs that show openings will be literally deluged by unsolicited faxed applications from commercial services for applicants who didn't match. Most of those folks will receive an e-mail that stated that the program will not review unsolicited applications. Some unmatched applicants will spend literally hundreds of dollars with commercial services that will sent applications but be aware that unless you have spoken to a program, they are not likely to review your application.

Many very high-powered and excellent residency programs may not fill for a variety of reasons from clerical errors to not interviewing enough candidates. Every year some places that have national reputations may have openings. Most years, the preliminary spots at many programs will not fill completely because not enough people applied for those slots. This means that a US grad (who is at their medical school on scramble day) stands a good chance of getting into one of those unfilled preliminary spots. Many programs will call deans looking for unmatched candidates for slots which is a great way to snag an open position at a top-ranked program.

The scramble situation is very stressful for those who go through it but the worst case scenario is that an applicant spends one year in a preliminary position and enters the match as stronger candidate the next year having done one year of excellent work. If a candidate accepts a preliminary position, they have to work very hard to be sure that they get good letters and good experience to take into the Match for the next year. Most good program directors will help a preliminary candidate find a categorical position for the next year if they have done an outstanding job with the preliminary year. In short, doing a prelim year isn't the end of the world and can provide valuable time for making good contacts with programs that interest you for the next year. If you know that you will be going into the Match after a preliminary year, be prepared to make sure that your letters and application materials are sent to your medical school for uploading as early as possible. You don't want to risk not matching a second time.

My other piece of advice for anyone reading this post who receives a letter on Monday that says they are going to scramble, is that you need to immediately contact your dean of students at your medical school. You don't want to try to go through the scramble from a remote location without having the advantage of experienced people to help you through this. You need to learn as much about the process as you can in the 24 hours before the scramble starts. Positions, even the preliminary ones, will go very quickly. If you find that you don't have a PGY-1 position after the first 24 hours of the scramble, you are going to need to contact your medical school to let them know. Again, programs that don't fill (or who have open positions) will contact the deans at medical schools looking for candidates first. You want to be sure to let your school administration know that you are looking for a job.

To those that match and don't make the mistake of thinking that you are inferior because you didn't get your first or second choice. If you didn't have to scramble, you are definitely more fortunate that those who end up with no position for the next year. If you ranked the places that you would accept a job and you received a position, you are ready to start your residency. No one who goes through the scramble would ever say that the situation is wonderful but it's part of the experience and with that experience comes wisdom.