DIP Episode 576 - Differences Between NBME and QBank Questions (a thoughtful discussion)

Welcome, my name is Divine. This is episode 576 of the Divine Intervention Podcast. Into this podcast I'm going to be addressing a topic that is extremely important. This is probably going to end up being one of my highest yield podcasts. And what's today's topic? Today's topic is differences between the NBM Es and Cubans. Differences between the NBM Es and Cubans. If you really spend time listening to this podcast and digesting and understanding what I'm going to discuss, is going to really change the way you think through an approach NBM Es questions. So let's get right into it. So the very first piece of advice I'll give you is that you pretty much need to do all the NBM Es available for the exam that you're taking. Be it step one, step two, step three. Do all of them that you can find. This advice again applies to step one to three. If you choose to not do these practice tests, you're pretty much shooting yourself in the foot. Because ask yourself a question, who is writing the test you're going to be graded on? It's the NBM Es. So don't you think it will be useful to spend time working on materials they have created as prep for the exam? Right? Because if you think about it, the fact that one person you know, or you know you really experience, on a regular SDN, you know, they do it on the test while only doing one practice NBM exam, does not mean that you will do the same thing and succeed. You were not sitting in those people's homes with them while they were studying.

They may not have told you everything that they did. You don't know what kind of background or foundation they have educationally. Right? Because many people fall into this external validity error. And then they are surprised when they don't do well. Right? Again, you don't know the other things that we're done by that person. Right? So one person's success strategy for a USMLA exam will not necessarily be your own. Right? So it's better to at least finish all the NBM Es. Even if you cannot finish a Q bank again, ideally finish a Q bank and finish the NBM Es. But if you're in a situation where, man, I can only finish one or the other, finish all the NBM Es that are possible. Right? Because I've seen this story many times. You see some people. Again, I've done this now, you know, thankfully for a few years. You see some people that are getting very high scores on your world. But when it comes to the NBM Es, they're just full train. Right? It's for many of the reasons you're going to see me discuss in this podcast. So what is one key difference between the NBM Es and Q banks? Well, the thing is, on the NBM Es context matters. So you keep hearing me saying the term context, context, context, context. What exactly do I mean by context? Context is the story behind a concept. Is the story behind a concept? Let me use an analogy of news media. Right?

So if you're a person that uses Reddit, you'll probably notice that a person will start a Reddit thread, put a comment from, or like one line from a news article, because they want to spin a certain narrative just to get people all rolled up to think of a certain thing. But then if you click on the link that they add to the Reddit post and you read the whole article, you get a more balanced view, you're like, wait, this is not exactly the direction that this person was seeing with this one sentence that they decided to take out of context and present to the Reddit thread. Right? The news article will seem to give a more balanced, complete view of that item. Right? Versus that one sentence that the person maliciously wanted to hone in on and get people all rolled up about. So the thing is, the NBM Es, they don't just want to test one line, one line or one concept. No. They want context. You may be surprised that it's one NBME question you're reading and they're combining like three or four concepts together. The NBM Es love context. Right? That's why I love to make integrations. I mean, I've read the feedback from people online on my podcast. And you know, I've heard this story many times. Oh, divine. Jump all over the place. To be honest with you, yeah, it's hard to hear that. And honestly, for you guys, I feel for you as well. It sucks to hear me making all these connections. But sorry, if I were not doing that, I would not be helping you.

The NBM Es are all about making connections. Q Banks focus more on linear algorithmic thinking. And that may work for some questions, but it doesn't work for many questions. Right? Because the thing is when you learn things in this linear algorithmic fashion, here's what it does for you. It pretty much makes the knowledge look discrete to you. It breaks up the knowledge in little chunks. Instead of helping you see that connection, those connections across the different topics, right? It almost teaches you like monkey, see monkey, do you see this? You do this. But that's not the way the NBM Es work. That's not the way the NBM Es work. The thing is on the NBM exams, you need a lot of thinking flexibility to do well. You need a lot of thinking flexibility to do well. The thing is the NBM Es, they will write the question to reflect the algorithm that you've memorized. But they will still find a way to fit out of that algorithm in some way so that you are forced to think. Right? The NBM Es exam is a thinking exam. Right? Don't get me wrong. Again, there is a benefit to learning these algorithms. Again, remember at some point I was a medical student, at some point I was a US Emily test teacher. But the thing is, yes, you're learning the algorithms, but you need to learn the context behind those algorithms. Right? The story matters. Right? The story matters. Like for example, you see many Cubans, they have an approach to origin compatibility. Right?

But the thing is, many of those origin compatibility algorithms, they will give you this diagnostic pathway, but they don't give you much in the way of reasoning behind it. And then you see the NBM Es, they still test origin compatibility or they will test something that is closely related but not exactly yet. Where you have to rely on reasoning and then you see all those algorithms you've memorized, it just completely falls apart. Right? The story matters. The story matters. Like you see some people in micro, they do this mindless memorization. But then you see a lot of the things that people have mindlessly memorized, it ends up not showing up as much as you'd expect on an exam. Right? Again, as you're going to learn, or as you should hopefully learn, is the context behind the bugs that matters a lot more. You'll notice that it's a lot easier to answer the presented questions when you know the context. Right? So again, learn the algorithms, but make sure you learn the story. That's why you see me in my podcasts in my classes. I use lots of integrations, lots of stories, lots of analogies and lots of vignettes. Right? So please do not learn concepts in one dimension, learn your concepts in many dimensions. Right? Again, these are the growing pains of listening to my podcasts. Right? But because you're like, ooh, the vign is making all these connections. Like why don't you just stick to this one script?

What the thing is, that mode of thinking of seeing things multi-dimensionally is going to be very well rewarded on NBM exams. Right? Because again, Cubans, they love to use discrete information. You know, if you use discrete information, you answer the question correctly. But the NBM is, they want you to put the whole story together, not just one discrete piece of information. They want you to put the whole story together to answer the question correctly. Right? They want you to find the best fit versus focusing on just one discrete factor. Now, what's another key difference between NB Ms and Cubans? Well, the thing is, the NB Ms generally have a specific focus on what they are looking for, specific focus in terms of a topic. Right? So for example, sometimes you notice the Cubans, they will address the same topics that the NB Ms are addressing. But they will address them with a different focus compared to the NB Ms. Right? So the Cubans make literally capture the same topic. But their focus will be different from the NB Ms focus. Right? So like for example, the NB Ms may discuss trauma in a certain light. You have a Cuban question that also discusses trauma. But it discusses it differently from the way the NB Ms are attempting to discuss it. Right? Like for example, I get this question from people all the time. You know, I get this from people that have listened to my podcast or people in my classes, especially my classes, they will be like divine.

This topic that we're going over in this class of years, why are you discussing it in this format? Why are you going off on this tangent? Why can't you focus what my Cubans was talking about ABC XYZ? Again, remember, I was a mess student at some point. I took these exams. I've done these Cubans. Right? But you end up finding another way. The NB Ms are going in a different direction compared to these Cubans. Right? That's why again, if you notice, and I say this in many of my podcasts, and I say this in many of my classes, I don't teach. I don't teach to prepare you well for a Cuban. I teach to prepare you well for NBM exams. Because again, they're the ones that are going to generate the scores that are going to matter for your future. All right. What's another difference between NB Ms and Cubans? This one is a subtle point, but it's extremely important. The roles behind NBM questions are different from the roles behind Cuban questions. I'm going to say that again. The roles behind NBM questions are different from the roles behind Cuban questions. Right? The thing is, this is something you probably realize if you've done lots of NBM questions and you've done lots of Cuban questions. Right? You'll notice that, wow, these questions seem to have a different feel. Right? The roles that on the light NBM questions are different. Right? Many people forget this. Well, there are people that are literally employed by the NB Ms.

They are trained in a specific way to write questions in a specific way. The disconnect from many people is that they take these Cuban crews that they've learned as a foundation. And then they apply those roles to an NBM exam. And then they notice that, wow, all this knowledge I have completely falls apart. Right? See, the fact that the same concept is tested. You know, between a Cuban and an NBM exam, it does not mean that the role that serves as the foundation for their testing is the same. Right? Again, the concept that is being tested does not always reflect the same role between an NBM exam versus a Cuban question. Right? Let me give you an analogy. Right? So you may have two houses. These two houses, they may look the same, but they may have different foundations. You know, I like to think of this Bible story of a person that built their house on the rock versus a person that built their house on sand. They both look like houses, but when subjected to different pressures like wind and waves and whatnot, one house falls, the other ones they stand in. Right? So the roles, the logic, the reasoning, the thinking that on the light NBM question can be very different from the rules, the logic, the reasoning, the thinking that on the line on the light a Cuban question. Right? This is why it is so helpful to do as many NBM questions as possible. Right? Because it gives you an idea of how they present things. Right? When you are taking an NBM exam, please, I will encourage you.

Don't modulate your reasoning. Right? Cubans, they will help you learn. But don't use those rules of Cuban testing on NB Ms. This disconnect can absolutely get you in trouble. Now what's another key difference between NB Ms and Cuban questions? The thing is NB Ms depend a lot less on blind memorization. Although don't get me wrong, you're going to see some questions where it's like, if you don't know the fact or you're not getting it right. But NB Ms questions depend less on blind memorization and more on interpretation, analysis and reasoning. Right? So like I give you a good example, right? Like bio stats. Bio stats is a good example of this. Right? I've heard this question from people many times. Oh, divine. When I get into my exam, what should I write on that sheet they give me? Should I write all the bio stats formulas? Blah blah blah blah blah blah blah blah. No, no. Those are all those formulas. You are also beautifully memorizing. It's just a lot less useful than you think on your real exam. Don't get me wrong. Am I saying divine? Oh, never memorize. No, what I'm saying is you should memorize because you need to know things to be able to use them. But that information you are memorizing has to be meaningful. Right? That information you are memorizing has to be meaningful. Right? That's why like for example anyone that has attended my bio stats class, you notice that wow. Divine does not devote half the time to talking about formulas.

The focus is more on hey, how are these formulas created? What is the reasoning behind these formulas? How can these formulas be useful in terms of answering an exam question? That's the meat of the mbm exams. That's the meat of the mbm exams. Right? So the thing is like for example, there is really nothing wrong with using anarchy as a study tool. Right? But you need to use it with wisdom. When you're going through a concept, ask yourself, what is the utility behind this concept? What is the utility behind this concept? Let me try to extract meaning. Let me try to extract integrations from this concept. Right? Again, mbm is the depend less on blindly memorize. So I'm not saying you should memorize because those that memorize information is then the thing you can then draw from to make integrations and to draw understanding and to draw meaning. Right? But you need to do some kind of introspection, some kind of thinking, some kind of analysis. Right? With these things. Right? So that you can get more from them. Right? So you can get more from them. Right? Again, I'm telling you this. I'm telling you this. Don't be so wrapped up in formulas. Don't be so wrapped up in algorithms. Get wrapped up more in the context, in the meaning, in the reasoning, in the thinking behind those things. Right? And honestly, it is very sad that some cubans are constructed exactly in the opposite of this. Right?

You notice that there are some cubans that really pride themselves in emphasizing as much mindless minutia as possible. But then the mbm is end up not carrying as much about those things as the cuban ends up carrying about those things. Right? Don't get me wrong. I don't doubt that these cubans have good intentions. They do have good intentions. But the sad thing is that sometimes they have the wrong execution of their good intentions. Right? So you see people, they've gone through this cuban, you know, I've seen this so many times. Oh my goodness, I've seen this so many times. You see people, they're like, oh, I've come out of this cuban. I've done all the questions in this cuban twice. But then they don't realize that they are walking into the exam with blind spots with blind spots. Right? Please focus on what matters focus on what matters focus on what matters. Right? Focus on the principles. Again, I'm not saying should memorize things, but ask yourself what are the principles behind these memorize things? That's where the middle of your exam is going to be. Right? That's why you see me. I emphasize many times. Don't be making excessive amounts of, excessive amounts of notes with these cubans. Some people they have like 500 700 1000 page cuban journals. What is that a waste of time? Right? And then you see them, they take their real exam and they're like, man, my exam I took only tested 10 to 20% of the things that I put down in this cuban journal. Right?

Again, many of you have probably heard of the 80 20 rule. It actually applies to many areas of life. Right? You notice that while 20% of the knowledge controls like almost 80% of the exam questions. Right? It applies in many aspects of life. Right? So you see people, they end up with their study approach, they end up majoring in the miners, but minoring in the majors. You see them, they spend excessive amounts of time on things they don't really need to spend excessive amounts of time on. And then they end up spending too little time on things that they should probably spend excessive amounts of time on. Right? Again, ultimately you want to major in the majors and minor in the miners. Right? You may notice that with many cuban questions, you know, by knowing the factoid, you can answer the question correctly. Really like think, pause and think about this. Have you noticed that for many cuban questions, you know the factoid, you answer the question correctly. But for MBM Es, knowing the factoid sometimes will still leave you hanging. But you notice that, hmm, if you understand the principle behind the question, you notice that it's a lot easier to answer that question. Right? See, when you have an understanding of principles, when you have an understanding of concepts, when you have an understanding of the context, it makes the right answer a lot more obvious on MBM Es exams. Right?

See, MBM Es questions are written very specifically to depend more on you answering them correctly. If you have a principle heavy mindset versus a factoid heavy mindset. All right. Now what's another difference between MBM Es questions and cuban questions? MBM Es are a lot less buzzword heavy. A lot less buzzword heavy. Right? They are more context heavy. Cubans focus more on buzzwords than context. Right? And one thing people may say is, oh, divine, then if the cubans are focus more on buzzwords, what are the cuban questions this long? Let me tell you something. The fact that a question is long does not necessarily mean that it's emphasizing context. Right? Again, see, let me tell you this. Something I've pretty much said, just saying it differently. The story behind the buzzword is more relevant than the buzzword itself. Think and ponder on what I just said. The story behind the buzzword oftentimes is more relevant than the buzzword itself. Right? Think and ponder on these things. I'm telling you this. Right? Because that that story behind the buzzword is the thing that ends up having way more relevance on the exams. All right. Let me not be liberal, liberal dot point too much. Okay. What's another difference between MBM Es questions and cuban questions? When you're taking an MBM exam, you notice that many of the answers, they may be, they may look very defensible just from the question you've just read. Right? You're like, oh, these answers can be correct.

But obviously there's only going to be one that is going to be more correct than the others. Right? This is why again, you see people, they have a great lack of confidence after they take these exams. Right? Contrast this with many cubans where you know, you feel more confident about that one answer that you're going to be. Right? You know, because many times when we're taking cuban questions, you're like, yeah, this must be the right answer. But then on the MBM Es, you're like, I don't feel so sure. I don't feel so sure. Right? And then you may ask the question like divine. So how do I wait through these answers and arrive at the right answer pathophysiology? Right? Right? Pattern recognition may not help you as much as you think pathophysiology. Right? Knowing when to give fluids in cardiogenic shock versus when you should not requires an understanding of what's going on. Knowing when to give pain control in a person that has hypercupnea versus when not to requires an understanding of what is going on. Right? And again, kind of going back to what we said before, it really helps to also know not just the pathophysiology, but the rules that they used to write their questions, the rules. When you know these rules, these answers that look similarly similar, they all look very close to each other. The end of not looking so similar anymore. If you know the rules, if you know the rules, right?

You almost become good at painting like a bull's eye around the answer to pick it up from the lineup that you have in terms of answer choices. A lot more easily. Right? So please keep that in mind. What's another difference between MBM Es and Cuban questions? MBM Es. They love alternate descriptions of things alternate descriptions of things. Cubans not so much. Right? So you'll see some terminology and vocabulary on your MBM exams that you have never heard anywhere. Right? Again, that's why you see me sometimes when I'm going over things in podcasts or in some of my classes. You notice that I keep saying, hey, this is another way they could describe this. This is another way they could mention this. Right? Again, those things end up usually being very high yield, very relevant things to know for your exams. Now one of shoot of this point I just made is that the MBM Es are novel. The MBM Es are novel. What do I mean by that? What do I mean by hey? The MBM Es are novel. The MBM Es many times they will present scenarios you have never seen before. But it will be presented in the light of something you should know in the light of something you should know. Right? So the thing is the foundation from that thing you know will then be the basis that you use in terms of utilizing knowledge to properly answer this novel situation that is being presented to you. Right?

Again, this is why I've seen many people, you know, you know, they've mostly say that, oh, the MBM Es are testing things I've never seen before. No, that may be true to an extent, but it's not entirely true. What they are doing is that they are testing what you've seen before or they are testing it in a different light compared to what you know and what you're comfortable with. They're basically pulling you out of your comfort zone. Right? Don't get me wrong. The Cubans do this. They do this to an extent. But again, many of them focus on the same scenarios, the same minutia. Right? And then you notice that man, their question is styling. It does not necessarily reflect an opportunity for you to take what you know and extend it path of physiology wise to a new situation. Right? Again, you may notice that's why you see many times in my podcast and in my classes, I will talk about one concept and say, oh, these are other ways they can test the same thing. Just to stretch your thinking into novel situations and novel scenarios that you may never have considered in preparing for your exams. Right? That's why sometimes I tell people this that see, you know, many times Cubans give you a lot more to work on versus an MBME. Because an MBME, the MBME wants you to take, hey, you've learned this concept in this other context. Let's give you a new context. Let's see if you can take the principles from that other concept you know and apply to this novel situation you may have never seen.

But if you take the principle, you end up answering the question correctly. Right? Now, what's another difference between the MBM Es and Cubans questions? See, MBM Es are an assessment tool. They are an assessment tool. Okay? So as you'll see, if you think like a clinician on the MBM Es, you're not necessarily serving your best interests. I'm going to say that again, if you think like a clinician on the MBM Es, you are not necessarily serving your best interests. You're not necessarily serving your best interests. You're not necessarily serving your best interests. Right? Think of Cubans more as a learning tool than as an assessment tool. Right? In fact, Cubans, they are so good for learning. They are, in fact, oftentimes they can teach you to be a very good clinician. But using that reasoning on your exam is not always helpful. Right? Thinking like you will think on the words, you know, in a stepwise fashion, in an algorithmic fashion, is not usually useful on the MBM Es. In fact, it can actually hurt you on an MBM Es exam. Right? I'm mostly, you should learn things deeply, learn things deeply. But many times the MBM Es are more directing their approach with questions versus, hey, thinking terms of differentials, right? Like you see people, they're like, oh, divine, I read the first sentence of this question. And then I made up this differential in my mind. No, making differentials is not your job on the MBM Es. Making differentials is not your job.

The MBM Es, most times they are focused on one thing versus you are also beautiful differentials. Right? Now, one thing I want to say that can actually also help you differentiate an MBM Es question from a Cuban question is, is when you're reviewing, what's the feeling you get? When you review MBM Es questions, you often notice like, man, how did I get this thing wrong? You've got to be kidding me. Right? In hindsight, you notice that, wow, this thing was so obvious. Why did I think myself out of this correct answer? Right? But this is very different from Cubans, where when you review a Cuban question, you're like, man, if I had just studied more, if I had just memorized this fact, this fact, I would have got in this question right? Right? This is why using many more resources and maturing 2 million on key cards will not necessarily make you more successful. I've literally seen this play out time and time again for many people. They've matured so many on key cards. They've done XYZ. They've done 50 different resources. But it doesn't necessarily reflect in the level of performance on the exams. Right? So I've seen people work with a lot less, a lot less. Again, I work with many people that take these exams literally every single week. Right? I've seen people do a lot less work with a lot less and end up having much better scores than people that work with a lot more and end up having much poorer scores. Right?

Now, what other thing you want to realize as a difference between these exams is that see, BBM Es are not trying to trick you. They're not. They're not trying to trick you. Many people may not believe me on this. But honestly, it's true. The Q banks on the other hand, many times they almost intentionally trying to lead you off in a different direction compared to what you should be thinking about. So just be careful about this. They mean they're not necessarily trying to trick you. They're not. They may present the concept in a novel way, but if you have your reasoning right, you usually be in good shape. Now, let me just give you one additional piece of advice here. That I feel like will serve a lot of people. In the 10 days or so before you take any USML exam, bits, step one, bits, step two, B step three, immerse yourself some more in the MBM Es. Why should you do this? Well, it's a very good way. It's a very effective way to win yourself off of Q bank modes of thinking. Right? You want to calibrate your brain as closely as possible to the MBM Es questions you're going to be taking. You want to calibrate your brain? You want to calibrate your brain? So I'm going to go ahead and stop here. Again, if you love the way I teach and again, like I said, I'm a person that is very MBME focused. If you want classes that will really prep you well for MBM Es, I have a lot of classes, especially in the month of March, that will help you.

I have a test taking strategies class, two and a half hours long, a bio stats class, four hours long, a social science and ethics class, five hours long. Those classes are targeted to step one to step three. Actually, in the first week of March, I have a 25 hours step one review is for people taking step one or level one, where people taking step two or step three or level two or three that have poor foundations in the basic sciences, because again, these basic science concepts are beginning to get emphasized more and more on step two, see again, step three. Then I have a 20 hour class that is targeted just for step two and step three. Last minute review, targeted just for step two and step three. In the first week of June, I have a 50 hour step two step three review again. I've made podcasts where I discuss these things specifically and how these classes all over zoom and how these classes are structured differently compared to my podcasts and the advantages you get from attending these classes compared to just my just listening to my podcasts. Then I have these podcasts on Apple Google and Spotify, so check those out. I also have a You Tube channel where I post the videos that I make. Then I also help with what I want you to learn from all the US Emily exams, all the complex exams. I also help people with errors, applications, personal statements, rec letters, mock interviews and things of that nature.

Then finally, I have another website called divine intervention life lessons.com, divine intervention life lessons.com, many of you know, I'm a Christian. Every week I post like two or three podcasts were from a biblical perspective, address a life lesson. Again, many people have listened to these podcasts and they find them to be really helpful. I have like 310 podcasts, I think, on that. There is actually an Apple podcast associated with the website called the divine intervention life lessons podcast. Thank you for listening to me today. I will see you in episode 577. Have a wonderful rest of your day. God bless you and bye for now and please share. Thank you.

Context (the story behind a concept).

Linearly and algorithmically, breaking knowledge into discrete chunks.

It allows for multi-dimensional thinking and integration across different topics.

Do not modulate or restrict your reasoning based on specific Q Bank rules; think broadly.

Understanding why the correct answer is superior and how it fits the overall clinical picture (pathophysiology).

Presenting scenarios or combinations of concepts that the student may have never encountered before, forcing principle application.

Q Banks focus on linear algorithms/factoids; NBM Es require context, integration, and multi-dimensional thinking.

The NBME (because they prioritize the principle/context).

The ability to see connections and integrate knowledge across different topics or systems.

The story, reasoning, or pathophysiology behind those steps (the context).

They are an assessment tool designed to test applied knowledge and reasoning, not just memorization.

The NBME.

Q Banks focus on linear algorithms/factoids; NBM Es require context, integration, and multi-dimensional thinking.

The NBME (because they prioritize the principle/context).

The ability to see connections and integrate knowledge across different topics or systems.

The story, reasoning, or pathophysiology behind those steps (the context).

They are an assessment tool designed to test applied knowledge and reasoning, not just memorization.

The NBME.