DIP Episode 469 - Why are my practice test scores not improving?

Welcome, my name is Devine. This is episode 469 of the Divine Intervention Podcasts. In today's podcast, I want to address a topic that I feel like is relevant to a lot of people taking really any USMLE exam. And it's this topic of my scores are not improving. I want to address some of the most common reasons, and then I will try to prefer solutions as I go through each reason. But again, I think if you're in this situation, I think you would find this podcast to be very helpful. So just pay attention, and if any of these things applies to you, again, I'll encourage you to use some of the principles and I'm going to be stating to make some correction. Again, don't just be a person that you're like, you know, whatever. I mean, obviously I don't know everything. I'll come out and say that right off the bat. But I think with some of the experience I have, I think, and having worked with thousands of students, chances are you'd get something from just listening to this. So again, you might have reached me very, but I think you'd get a lot from this. So let's just jump right into it. So what's the number one reason why people's scores are doing improved? Number one is just that they have a very poor knowledge base. That's the truth. Many people love to deceive themselves. You see them, they take a practice exam and they get a 205. Let's see, they're going to step two practice exam, they get a 205. And they say that, but they feel like they know their details very well.

They take on that practice exam, they get a 207. Oh, but they think they know their details very well. Let me tell you what you're doing. You're deceiving yourself is exactly what you're doing. People don't get 205's or 207's or whatever because they have just very amazing knowledge bases. That's just a truth. That's just a truth. In my experience, I've seen this many times when people are like not even passing practice exams, just check. They'll say, oh, I've literally had this happen many times where people say, oh, divine, my knowledge base is good. And they just ask a few simple questions that just see, okay, these are basic things that anyone taking XYZ, US, and the exam should know. And they just don't know. Right? So, honestly, if you're in that position, you need to get better with your knowledge base. And here's one thing, you need to get surgical with how you build your knowledge base. Like, for example, you see that you have like a huge, huge problem with internal medicine, for example. You should spend quality time trying to truly learn internal medicine. Notice my rejoinder there, quality time. There are many people that spend time learning and it's not quality. They're learning the affunctions in front of them. They're learning the affunctions just buzzing, boom, boom, boom, boom. Or they're watching some show or they're in a place that is very noisy. And they think they're learning. You're just kind of messing, screwing yourself over.

So, when you take practice tests, don't just... There isn't that called practice tests. They are very, very helpful. You can pick up a lot of nuggets from them. You can pick up a lot of patterns in like your thinking. When you see some people, they just take practice exams. They see, well, practice exam 1, OB-GYN performing horribly. Practice exam number 2, OB-GYN performing horribly. And then, they do nothing. They don't do anything surgical. What do I mean by doing something surgical? You pick out OB-GYN, think of it as like a disease that has to be conclusively dealt with. And you deal with it. But they don't. They just keep continuing their study plan, continuing their study plan, doing nothing about specific weaknesses they have. And then they expect to improve. So, that's number 1. Now, number 2, reason why people scores learning prove is that they literally have no mastery. They literally have no mastery. Again, this is a common problem you see with people. Where they memorize a lot of detail. But they just don't truly understand all those things they have memorized. That's the truth. In fact, let me tell you this. If you're a person, and you notice that your scores are not improving. If you're a person, notice your scores are not improving. Sit down and ask yourself this question. Many of the things I know, do I truly understand them? Do I truly understand them? I'm telling you this. Some of you may be like, no, divine.

You know, most people understand, no, they don't. I promise you, like, this is something I used to think. But then when you start truly like working with tons of people, you'll understand exactly what I mean. Many people have memorized the things. They know that 2 plus 2 is 4. They know the answer. But why is 2 plus 2 4? They have absolutely no idea. They know that for a stroke. If a person has an ischemic stroke from a cardidish, they know that, oh, give aspirin. Why do you give aspirin in that circumstance? They literally have no idea. There's some reasoning behind most facts that are tested on the USME Lies. Do you have that reasoning straight? I'm telling you this. This is a huge problem that many people have gotten into with the advent of Anki. Anki is great, but people use it wrong. They just brute-force through things. It's almost like they're like, oh, I'm just going to brute-force my way through all these facts. And then I'll take my exam. No. You can, and many people see posts of people that get like 2, 70s or whatever. Online. They used Anki and they're like, yes. So that must be the key. I promise you, whatever you read online, you are not sitting with the person inside by side as they were going through their dedicated period. Chances are very good. That person that got a 270 with Anki. Many of those Anki facts. They actually truly understand the path of phase behind those things. So again, that's one thing I'll just encourage you to kind of keep in mind.

And honestly, going with this whole concept of new mastery, one of the causes of people not mastering things is that they do questions on random when they have awful knowledge bases. Let me tell you this. It's a very common advice that's peddled online. Oh, do questions random, do questions random, do questions random, do questions random? No. Doing questions random makes sense if your knowledge base is at like a 235 level or higher. But if you're pressing on your scoring on, if I let me tell you this, if you're scoring on the like the 235s on a practice exam, you're not, you shouldn't be doing questions random. And to be honest with you, for me, I'm more of the belief that for most people, regardless of where you're scoring, you shouldn't do questions random. Why? Because you want to end every single day of your dedicated period, able to beat your chest and say, I have mastered XYZ. Like here, for example, you have like an internal medicine day and OB-GYN day. If on that day you're doing content review, no big guy, and then you're doing your work questions in OB-GYN, and then you're doing practice of exams in OB-GYN, by the end of that day, you will have mastered OB-GYN. If you have like one OB-GYN day every week of your dedicated period, then you have like four or five of those mastery days. The synopsis in your brain, your retention of that material is going to be fast stronger, that if you're just doing things random, random, random.

Randomization is best done with the full-length practice exams that exist. And there is many. I mean, there's literally NBN 19, 11, 12, 13, and 14. There are the two U-World self-assessments. And then there is, this is talking about step two. And then there is the free 120. That's nine practice exams. People that are taking step one, well, hello, there is literally all the NBN is from I think like 25, all the way to 31. So you have so much practice in randomization. So I just don't get like honestly like, is one of these things I don't really understand. Because is one of these things that are very common pieces of advice out there, but they're like wrong for most people. Oh, just do questions random. Just do questions random. That's one of the most wise things that a person can do. And another thing I'm going to say on that the second point is this whole concept of just do questions. You see some people, they're just like, I'm just going to do questions. I'm not going to bother with content review. Again, I promise you that is another common cause. Again, let me tell you this. Many of these things I'm saying. And not just like, oh, let me just pull some ideas out of a hat. No, these are things I have literally observed. I have literally seen in real time. You see some people even their mates go say, oh, just do questions. Everyone just those questions. Just finish this queue back and you'll be fine. No, there's a doing questions part of a person's dedicated period.

And there's also a content review part of a person's dedicated period. Many people just do questions. And they literally spend no time on actual content review. Like I keep you not for any of the USML exams. There is a place for doing questions, but you cannot learn everything by just doing questions. You also have to do some element, even if it's not a major part of your dedicated, but there has to be a place for content review. That's just the truth. Now, what is the third reason why people scores don't improve? The third reason why people scores don't improve is that they don't have enough quality repetition. They do not have enough quality repetition. You see some people just make one pass and they think with one pass they're going to be fine. No, even divine back in the day, studying for his exams did not just do one pass. Divine did a lot of repeating, repeating, repeating. And the thing is find a mode of repetition that works for you. If it's on key that works for you, do it. If it's reading your notes over and over again that works for you, do it. For example, for me, I'm an audio visual learner. I learn a lot by listening. So I don't mind listening to the same thing eight, nine times. It doesn't bother me at all. Sometimes for me, I take some quick notes, not detailed notes, but some quick notes just to jog my memory. And then I look through those quick notes early and often. Sometimes I learn, learn, learn, learn, learn.

And then I do a bunch of practice problems on that specific material just to work out the kinks and my knowledge. Again, find a mode of repetition that works for you. Now, what is principle number four? Principle number four is active learning. Many people learn very passively. They literally put no thoughts to their learning. Let me tell you this. Learning is good when it is mindful. We're going to say that again. Learning is good when it is mindful. People don't learn mindfully. You need to learn actively. Your mind has to be racing and thinking through. Like you need to be adding critical thinking to your learning process. Because again, that's one danger of hungry for some people. They just make it passive. They just click the one, the two, the three, the four. Oh, if they don't know a fact, they are not even thinking about, okay, why don't I know this fact? Why is this fact like gibberish to me? But they just click one and say, let me just see it again. If I broke my way through it, it will just register somehow. No, that's not a smart way to learn. You need to actively learn. Active learning involves quizzing yourself as you're learning. Active learning involves you read a fact. Ask yourself. Why? Explain it to yourself. Why? Active learning involves, hmm, I've just learned OB game this morning. Maybe let me go out and pick out like 40 euro problems or pick out an OB game practice. I'll show them and work my way through those things.

Just to again, work out the kinks in your knowledge, work out the kinks. Now, what is principle number five in white people's courses to improve? In fact, this one is one of the ones that, I just scratch my head whenever I see this. Is saturation with trash? Hmm, maybe like, wait, what? What do you mean by saturation with trash? A lot of people's brains are literally saturated with pure trash. You see people, they know a lot of stuff, but a lot of the stuff they know is literally not high-yield. Literally not high-yield. Right? You see people for every concept, they are just like, let me mine all the details. Let me mine all the details. Right? In fact, I see this a lot online. On many of these forums for people prepared for the USML is they'll see how do you differentiate between this and this and this and this and this and this and this and this. And then you'll see in the comments section, people are providing, oh, with this one detail, that'll help you differentiate this versus that. With this one detail, that'll help you differentiate this versus that. No, that's not the way the USML is work. The USML is back in the day. This was like years and years and years ago. We exams were, oh, it may just be one factoid, you know, you're not caught and answered. But many of these USML questions these days are built around stories. Many of these, I'm not saying that the details people are saying, oh, to differentiate this point from the other.

I'm not saying those details are wrong. No, they're right. Those specific ways of differentiating one thing from the other. Those things are right. But the thing is many of those differentiating details, the USML is many times will not supply them because just knowing that detail does not enforce any kind of critical thinking. I'm telling you this, the USML is getting much better at writing their questions. That is one trend I have noticed I will say probably over the last three years. The exams are not just exams where you can just sit down, brute force, memorize things and steam roll right through it. No. Most of their questions have stories behind them. They have stories behind them. That's why you see many times when I'm going over a concept on these podcasts. I tried to not just say this plus this plus this equals that. Yes, I do that sometimes. But the overwhelming majority of the time, I tried to actually help you understand. I tried to give you like a story behind it. I tried to give you a story behind it. You said, oh, how can I differentiate a cervical cancer versus this versus that? No, do you understand a story of like Reno failure in a person that has cervical cancer? Do you understand the story of a person dying from taking some drug because there was some other contraindication with another drug they were taking? Like, be able to see those stories build many people build up a library of facts without building up a library of stories. Don't get me wrong.

I'm not going to sit here and say, oh, wait, you don't have to memorize anything for the USM. No, that's a lie. Many things I know I had to memorize. But as I was building up my library of facts that I was memorizing, I was building up a library of stories that I was understanding. The thing is when you understand those stories and the thing is stories are much easier to remember than discrete facts. If you understand the stories behind the concept, then you are more apt to answering those questions correctly. That's just the truth. Do you know the society story in a person that has paroxysmal noxional hemoglobinary? Do you know the acute limb ischemia story in a person that has mitrostenosis? But you see people who just learn discrete facts and they are like, oh, this discrete fact will help me differentiate this versus that. The thing is the USM is sometimes they will be kind and supply those discrete facts in questions. But many times it's the story, it's the context that will guide you in one direction versus the other. This is one thing that, again, I keep pounding my hands on the table that people just keep losing inside of. I'm telling you if you can correct just this one thing in your study process, your scores will start improving. That is just the truth. Okay, let's go to principle number six. Why do people scores not improve? Well, people have no, the, another big reason is people have no mastery of one good resource. No mastery of one good resource.

You see people, their dedicated plan includes 10 different things. No, no, no. Pick one thing that really works and run with it. And even if it feels like that thing is not working, stick with it. Stick with it. I'm telling you there is a lot of help. There is a lot of wisdom in finding one thing and sticking three thickens thing. But the thing is unfortunately we live in a world where people have really poor attention on spawns. And again, there are many reasons why people may have poor attention on spawns. One of the big reasons is people's minds have been trained to scroll through. I mean, there is a reason why social media is constructed in a way where you just scroll through. You don't have to sit down and like focus on one thing for a while. But as your brain is built to just scroll through, scroll through, scroll through, scroll through. People cannot sit with something and truly learn it for any extended period of time. So that same mindset is being applied. If I let me tell you this, if you are a dedicated period, you should get off social media. That's the truth. If you are a dedicated period, you should get off social media. You're literally not helping yourself. That's just a side point. But many people have not mastered one good thing. And let me tell you this. I'm seeing this as someone that used to do many things all at once. But I know this is a man. This thing is actually not helping me.

Now when I started focusing on a limited set of things and truly mastering them, things got better. Again, that's just something I want to keep in mind as you prepare. Okay. Now, what is the next principle? What is principle number seven I want to discuss? Is this whole concept of having no plan? You see people, they get into a dedicated period and they have no plan. And then you notice, well, I'm two weeks into my dedicated period and three weeks and I've not achieved anything. Well, guess what? You had no guidepost. You had no pathway you were exploring. That's why you got in that trouble. You cannot just mosey through such an important thing like your dedicated period. You don't have unlimited time. You don't. You don't. You don't. So have some kind of plan is very, very important. Okay. Now, what is principle number eight? This principle number eight is non-thorough review of practice exams. Again, these practice exams are probably where you should spend a good majority of your review time on. You need to dig deep into your practice exams. But people don't. The thing is when you dig deep into your practice exams, it gives you a bunch of benefits. One, you notice a recurring theme of concepts that are consistently tested. That's one. Two, you also will notice a consistent theme of errors in your thought processes. If you can fair it all these two things, then you've gotten a lot from your practice exams. You see people did take practice exams and they don't review them.

And the thing is when you're taking practice exams, make sure that you're taking as many practice exams from the examining authority as possible. You see people, they only do like one or two and that's the thing. You read a story of someone that only did one MBA me practice exam or did no MBA me practice exam and got a 260. And then they just suddenly believe that that one person's story applies to all of them. No, that is literally not the way things work. The people that are writing your exams are the MBA me's. Why can't you review all the material they have put out there? Because those materials and indication of what they expect you to know. In fact, one way people are like, divine, how do I know what is high yield? Well, ask yourself, do you know the things that are emphasized in the MBA me practice exams? Do you know the things that are emphasized in the practice of exams? If you know those things and know them well, chances are you know a lot of the high yield stuff. And you will not be saturating your brain with pure trash. Because you see people, the stuff that's heavily emphasized on the MBA me's, they don't know. But the stuff that's heavily emphasized from some Cuban or whatever they know. But the MBA me, the actual people writing your exam, you just kind of ignore them. If you ignore them, how do you think your scores are going to pan out? Again, just be wise. Literally a word is enough for the wise.

Now, what is the next principle in terms of, you know, people scores not improving. And this is going to be, I believe principle number nine is persistently wrong thought processes. Many people have a systematic issue with the way they process exams, with the way they read questions, with the way they think through concepts, with the way they answer questions. Those processes have to be dealt with. And again, you can master many of these things as you do practice exams and ask yourself, how was I thinking when I picked this wrong answer? Okay, what should I think so that I won't make this kind of error in the future? That's a very important component of reviewing practice exams. Okay, now what is principle number 10 in terms of why people scores don't improve? Principle number 10 is people have, people basically do not critically reason with problems. I've kind of mentioned this already, but many people are getting a very aloof. Their minds are not focused when they're reviewing problems. Again, I'm telling you this as you're reviewing problems, you should not just be reviewing them because you want to review them. You want to be critically thinking through them as you're reviewing them. Critically reason with problems. Don't get me wrong, is it slow? Yes, it is slow. But as you're going slow, you are also learning well. You're also learning well. This with you is better to critically reason through 1000 problems from a Q bank and truly learn from them.

Then to just blow through 4000 questions and not build any kind of critical reasoning acumen from those things. I'm telling you this, many people could very likely just do 1000 questions in their dedicated period that kind of samples most of the subject areas and be just fine. Again, I'm not saying to do that. You want to try to cover all the questions in your Q bank if possible. But as you're going through problems, try to not be just learning the concepts, but try to build up your critical reasoning skills. That's something that I think will really, really help a lot of people. Now, what's principle number 11? Principle number 11 is just using resources that does not work for your study approach. Again, the fact that something is a good resource does not necessarily mean that it's the thing that will deliver you to the promised lot. Many people use resources that literally do not work for them. Again, the fact that everyone is using a particular resource does not necessarily mean that that particular resource is the right thing for you. That is just the truth. But again, it's something that many people unfortunately lose sight of. You don't want to lose sight of that. So, when you're studying, make sure you're using the resources that work for your method of learning. Are you a person that works well by reading? Maybe you should use it as book resource. Are you a person that works well by Anki? Maybe you should use Anki. Are you a person that does well practice problems?

Find good practice problems. Are you a person that is audio visual? Find an audio visual tool that works for you? The good thing is with the proliferation of resources that exist for the USMELIS, there is almost always something for every single person. And then, the final principle of our discourse is people just using straight up bad resources. Again, I'm not going to stand here and trash any resource out there. No, that's not my job. But the thing is there are resources that are just not good that are out there. And many people spend hours and hours and hours on these things and get nothing from it. Especially resources that do not emphasize, helping you understand, they just emphasize, oh, let me just teach you some tips and tricks. Or they just emphasize, just know these facts. That's not a resource you want to be spending time with. You want to spend because your time is limited. So the limited time you're spending, you need to be a rational allocator of that time. You want to spend most of your time in things that truly help you understand. So again, I really hope that you find this to be helpful. Again, if you're studying for any of the USMELIS exams, so I'm going to stop here. If you're studying for any of the USMELIS exams, I do offer a bunch of courses that you may find to be helpful. Next week, Thursday, I have an NV Me Testicking Strategies class. It's a class that will help you get good with your test-ticking processes.

Test-ticking processes is for step one or the way to step three. For step one, especially, it will help you with those clinically oriented questions. But the course is really, really helpful for anyone against step one, step two, step three. And then next week on Friday, I have a biostatistics class. It's a four hour class. And again, it's targeted towards step one or step three to help you get your reasoning. The story behind biostat, not just the formulas, all my courses in general are not lecture courses. No, the courses where it's practice problems, where there's stories, where there's scenarios that we use to portray the concepts. So if you want to get your reasoning straight with biostat, the four hour class is exactly what you need. And then on Saturday of next week, I have the five hour healthcare policy, social sciences, ethics, quality improvement, communications, healthcare systems class. It's a class you're going to find to be very helpful. Again, it's for step one or step three. And again, in that class, what do we focus on? We focus on the reasoning. We focus on the story. I'm not just going to sit here and say, oh, what is just culture? And I give you a definition. No, that's a waste of your time. If you get a clinical scenario or a healthcare system scenario, and then you need to understand that weight, this is what just culture means. In context, then that's a much more powerful learning experience.

You'll get a lot more and that information you're learning is a lot more useful for your exams. And then for people taking step two and step three, I have a 20 hour course coming up the week after next week. It's going to be Monday Tuesday Thursday and Friday. So 20 hour course, I'll review a lot of internal medicine, pediatrics, surgery, OB-GYN, psychiatry, neurology, and multi-systems processes and disorders. Again, many people are taking these courses and finding them to be profoundly helpful. And again, these are not lecture-based courses. These are courses where we literally spend time digging through problems and getting a critical thinking straight. So if you're interested, many of them, they are all over Zoom, shoot me an email through the website. I do also offer one or one tutoring for all the USMEL exams, med school exams, shelf exams, offered tutoring for those. And then I also help with applications, personal statements, rec letters, editing your ER As application, your supplemental application. If you're interested, just shoot me an email. And then I also have these podcasts on the major apps Apple, Google, and Spotify. I have a You Tube channel, Divine Intervention, USMEL, Podcasts, and videos. That's where I post the videos that I make. And then finally, I have another website called Divine Intervention Lifelesses.com. On that website, many people said, oh, Divine, I have many people have reached out to me saying, Divine, I love your life lessons.

So I decided to use a different website to start uploading some life lessons. Many of them are biblically based, right? Many of you know I'm a Christian. So every week, I try to post two podcasts. I actually have about 200 podcasts there. So if you're looking for life lessons, many of them attend to 20-minute podcasts. And using the Bible, I try to address a common life problem that many people face. So you can check that out. There's actually an Apple podcast associated with that called Divine Intervention Life Lessons Podcast. So thank you for listening to me today. Have a wonderful time. I'll see you in episode 470. God bless you. Bye for now. Thank you.

A poor foundational knowledge base, often masked by self-deception regarding true understanding.

They must be "surgical"—dedicating quality time specifically and intensely to that single weakness until it is mastered.

Memorization knows what (e.g., 2+2=4); Mastery understands why (the underlying mechanism or rationale).

It prevents the development of deep, structured knowledge; dedicated time should be spent mastering specific systems/topics sequentially to build a strong conceptual framework.

Active learning—quizzing yourself while reading or explaining concepts out loud, forcing your mind to race with critical thought.

1) Recurring themes of concepts that are consistently tested, and 2) Consistent patterns/themes in their own errors or flawed thought processes.

Brute-forcing facts without understanding the underlying pathophysiology or reasoning (lacking mastery).

A "surgical" approach—treating that weak subject like a disease that must be conclusively dealt with.

Stories provide context and are much easier to remember, guiding critical thinking when USMLE questions do not supply explicit differentiating details.

Their own flawed thought process—asking "How was I thinking when I picked this wrong answer?"

The USMLE often tests concepts through clinical stories and context, not just isolated factoids.

Focus on mastering one or two reliable resources to build deep knowledge rather than superficial breadth.

Brute-forcing facts without understanding the underlying pathophysiology or reasoning (lacking mastery).

A "surgical" approach—treating that weak subject like a disease that must be conclusively dealt with.

Stories provide context and are much easier to remember, guiding critical thinking when USMLE questions do not supply explicit differentiating details.

Their own flawed thought process—asking "How was I thinking when I picked this wrong answer?"

The USMLE often tests concepts through clinical stories and context, not just isolated factoids.

Focus on mastering one or two reliable resources to build deep knowledge rather than superficial breadth.