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DIP Episode 155 - Common USMLE Problems (Drug Ads, Timing, New 2CK Exam, Studying) + New USMLE Booster Course

MixedMedium4 - HighHas Q&A

Step 1Step 2Step 3MedicineUSMLEStep 1Step 2Step 3

Topic

Test-taking strategies; USMLE timing and efficiency; High-yield study resource utilization (Anki, video); Interpreting descriptive clinical vignettes.

Key Takeaway

Optimal board performance requires mastering efficient test-taking algorithms—such as pacing per question, strategic review of drug add sections, and adapting to the MDB's trend toward using detailed lab/clinical presentations rather than relying solely on memorized buzzwords.

Runtime: 25 min

Published: 2019-09-20

Completed audio: Yes

Completed notes: Yes

Anki made: Yes

Section: —

Open Notion notes Episode source

Episode Notes

Source / episode info

Episode: 155
Title: Divine Intervention Episode 155 – Common USMLE Problems (Drug Ads, Timing, New 2 CK Exam, Studying) + New USMLE Booster Course.
Published: 2019-09-20
Source: Episode page

One-liner

High-yield summary

Answer Changing Algorithm: Only change an answer if you are 100% certain that your new choice is correct; otherwise, maintain the initial selection to prevent careless errors.
Drug Add Approach: Always read the drug add section first (3–4 minutes) to register key concepts and locations. When answering questions, use the question stem to guide your return reading to the specific relevant part of the text.
MDB Question Trends: The MDB increasingly uses unusual or atypical presentations of diseases (e.g., presenting CSF labs instead of just stating "oligoclonal bands") to test deep understanding of pathophysiology rather than rote memorization of buzzwords.

Learning objectives

Master efficient test pacing techniques to maximize time for review and second passes on high-yield material.
Apply a systematic algorithm when reviewing and changing answers during board exams to minimize careless errors.
Develop an effective strategy for approaching large, information-dense drug add sections by prioritizing initial rapid reading over immediate question answering.
Recognize the MDB's trend of using descriptive clinical data (e.g., specific lab values) rather than relying on simple buzzwords or classic textbook phrases.
Understand that space repetition is a concept, not a single tool; adapt study methods to fit personal learning styles (audio/visual vs. flashcards).

Board exam buzzwords

Condition	Key Finding	Association	Board Exam Tip
Test Pacing	12 minutes per 10 questions	Time management	Do not mark up the entire block; only mark questions you are absolutely sure about for review.
Drug Add Section	Initial rapid read (3-4 min)	Question answering strategy	Read the whole thing first to register concepts, then use the question stem to guide your return reading.
Space Repetition	Concept of spaced recall	Learning efficiency	Do not limit yourself to Anki; utilize audio/video lectures or self-generated notes for spaced review.
MDB Question Style	Atypical clinical presentation (e.g., labs)	Pathophysiology understanding	Focus on why the finding occurs, not just memorizing the buzzword associated with it.

Rapid review table

Topic	Key Point	Context	Exam Relevance
Test Pacing	12 minutes per 10 questions (Target)	Initial pass through a block of questions.	Ensures sufficient time at the end for reviewing marked, high-yield questions.
Answer Review	Only change if 100% certain	Final review phase of an exam section.	Prevents point loss due to second-guessing or making careless errors.
Drug Add Reading	Read entire document first (3–4 min)	Preparing for drug add questions.	Establishes a mental map of the content, allowing targeted reading when answering specific questions.
Study Methods	Space repetition is the principle	Long-term knowledge retention.	Adapt your study method (Anki, video, notes) to maximize efficiency and fit your personal learning style.

Board-speak -> diagnosis

Board-speak / Vignette phrase	Diagnosis / Concept	Why it fits
Patient presents with a posterior fossa mass, multiple spinal lesions (meningioma, pylocytic astrocytoma, metronidazole).	Medulloblastoma (atypical presentation)	The MDB may present an atypical constellation of findings to test understanding of the most common or aggressive tumor type in that location.
Patient has muscle weakness; CSF shows high protein count but only 1-2 white blood cells.	Albuminocytologic dissociation	This is a classic lab pattern for Multiple Sclerosis (MS). The MDB may use labs instead of stating the buzzword to test recognition.
"I am unsure if I should change my answer."	Answer Changing Algorithm	Never change an answer unless you are 100% certain, as this often leads to careless errors and point loss.
Reading a large drug add section for the first time.	Drug Add Strategy (Initial Pass)	Spend 3–4 minutes reading through every word of the entire document quickly to register key concepts before attempting questions.
Studying for board exams using only flashcards.	Space Repetition Principle	While Anki is effective, it is merely one tool; the core principle is spaced review, which can be achieved via audio/video lectures or generated notes.

Differential diagnosis / distinguishing features

MDB Question Style

Key Features	Distinguishing Findings	Next Step
Buzzword Memorization	Rote recall (e.g., "MS = OC Bs").	High risk of failure if the question is phrased atypically.
Descriptive Vignette	Uses specific lab values, unusual demographics, or atypical presentations.	Requires understanding the underlying pathophysiology to connect the dots.

Management pearls

When taking a timed block of questions, treat time as your most valuable resource; do not spend excessive time on one difficult question if it compromises your ability to complete the rest of the section.
Always allocate the final 10–15 minutes of any exam session solely for reviewing marked questions and revisiting areas of uncertainty.
When encountering a large drug add, treat the initial read as an overview (3–4 minutes), not deep study; this primes your memory for later retrieval during question answering.
If you struggle with flashcards, consider shifting to audio/video resources that allow for spaced repetition while engaging multiple senses, which may improve retention.

Don't miss

🚨

Answer Certainty: Never change an answer unless you are absolutely certain of the replacement choice; this prevents careless errors.

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Drug Add Flow: Always read the drug add section before looking at the questions to establish context and guide your subsequent reading.

🚨

MDB Focus: The MDB is shifting away from simple buzzwords toward complex, descriptive clinical scenarios that test deep pathophysiological reasoning.

Integration & clinical reasoning

Pathophysiology Integration: Instead of memorizing "Buzzword X = Disease Y," ask: "What physiological process (pathway) is disrupted in Disease Y?" This allows you to interpret atypical presentations using the same core knowledge base.
Study Method Flexibility: Recognize that study efficiency is highly individualized; if a student performs better with video lectures than flashcards, they should prioritize and build their entire review around that medium.
Exam Simulation: Treat practice blocks as timed simulations, adhering strictly to pacing rules (12 min/10 Qs) and the answer changing algorithm to replicate real exam pressure.

Concept connections / cross-references

No explicit cross-references.

High-yield association table

Condition	Association	Mechanism	Clinical Significance
Test Anxiety	Poor timing, over-marking questions	Cognitive overload; inability to allocate time efficiently.	Implementing strict pacing (12 min/10 Qs) and limiting marked questions improves performance.
Drug Add Section	Initial rapid read -> Question review -> Targeted re-read	Memory encoding and retrieval practice.	Ensures all key concepts are registered before the pressure of answering specific, high-yield questions.
Space Repetition	Spaced recall over time	Optimal memory consolidation curve (Ebbinghaus).	The principle is universal; it can be applied to any medium (audio, video, notes) for long-term retention.
MDB Questioning	Descriptive labs/scenarios	Testing deep understanding of underlying pathophysiology.	Forces students to think like clinicians interpreting data, rather than just recalling textbook definitions.

Key terms glossary

Term	Definition	Context	Example
Space Repetition	A study technique that reviews information at increasing intervals over time.	Study planning; optimizing memory consolidation.	Reviewing a concept 1 day, then 3 days, then 7 days later.
Drug Add Section	Comprehensive resource detailing pharmacology of specific agents.	Board exam preparation; high-yield content review.	Reading the entire section on anti-diabetics before answering questions about metformin vs. sulfonylureas.
Albuminocytologic Dissociation	CSF finding of elevated protein with low or normal white blood cell count.	Neurology/Multiple Sclerosis (MS).	A patient with MS may present labs showing this pattern, requiring recognition despite the lack of a classic buzzword prompt.
Pacing Strategy	Allocating time consistently across all sections of an exam block.	Test-taking skill; maximizing review time.	Completing 10 questions in 12 minutes to save time for reviewing marked items.

Study optimization

Topic	Study Approach	Priority	Resources
Test Pacing	Timed practice blocks (simulations)	High	Use official question banks and strictly adhere to the 12 min/10 Qs rule.
Drug Add Mastery	Initial rapid read -> Question-guided review	Medium-High	Practice this method on every major drug add section; do not skip the initial overview.
Conceptual Learning	Focus on "Why" (Pathophysiology)	Highest	Use video/audio resources to understand mechanisms, rather than just reading bulleted lists of facts.

Question pattern recognition

The Pacing Trap: Students often spend too much time on one difficult question, compromising their ability to finish the block and review marked items.
The Buzzword Trap: Assuming that a board question will use classic textbook terminology; instead, expect descriptive clinical data (labs/scenarios).

Test yourself

Common mistakes to avoid

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Mistake 1: Over-marking questions. Marking every question that is "maybe" wastes valuable time and prevents a thorough review of the entire block.

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Mistake 2: Changing answers based on doubt. Second-guessing leads to careless errors; only change if certainty is absolute (100%).

Common traps

⚠️

Trap 1: Assuming that a high score requires memorizing every single buzzword; instead, understanding the underlying mechanism is key.

⚠️

Trap 2: Spending too much time on one difficult question, which compromises overall pacing and review time for the entire block.

⚠️

Trap 3: Believing that all study resources must be used equally; efficiency dictates finding the best method (e.g., audio/video) for your personal learning style.

Original transcript with highlights

Okay, welcome. My name is Divine. I'm a resident. This is episode 155 of the Divine Intervention Podcast. This podcast is actually going to be a pretty short one. There are just three things I want to tackle and to be honest it's actually not really like concepts I'm planning to cover. I just want to talk about like three common problems that people face on the USMLA exams and also again say some thoughts on the new USMLA step to seek the exams. Basically the exams that have been showing up within the last like three months. So to talk about my thoughts on them especially like again like having to read a ton of people that took those exams and being aware of their scores and stuff like that. And then at the end I will talk about this I guess like I'll call it like a booster USMLA course that have been offering actually for a couple of months but it's not something that you know I said let me go ahead and test out first see how the results are show up before I start advertising this to people but I'll do that at the end. So first common USMLA problem I'm gonna go ahead and talk about is is an issue of timing right. So people if you have a timing problem on the USMLA's to be perfectly honest with you the thing you should really try to do is hold yourself to this standard for every 10 for your first pass through a USMLA block okay your strategy should be that in 10 hour I mean sorry not in 10 hours so that will be bad.

In for every 10 questions you spend no more than 12 minutes that should be a target on any USMLA exams that one two CK step three doesn't matter right.

Like for every 10 questions hold yourself to that standard for every 10 questions I will spend no more than 12 minutes so like if I'm doing a block like questions one to 10 I should be done by me 12 questions 11 to 20 actually done by me 24 questions 20 to 30 as we done by me 36 and then question 30 to 40 actually done by me 48 okay hold yourself to that standard that would fix most of the most of the timing issues that you may have and one thing you want to keep at the back of your mind is mark questions that you want to go back and revisit resist the temptation to mark up half the half the block right just go back to questions where you're like I know for sure I want to come back and look at this question if a question you're like really you know I think I may have gotten this one right don't mark it just mark the questions where you're like I know for sure like this question I absolutely need to see it again mark those questions and then the extra time you have at the end go back and review those questions I mean like personally my experience like my own experience like I even hold myself to even higher standards I can I take you a semi-exams I try to spend no more than a minute per question right on the initial pass I just zoom through the test and then I use like the 30 minutes or so I have at the end of a block to go back and review all those marks questions that I'll see in general most of the people have treated they have been very successful with doing like 10 questions 12 minutes it really it essentially gives you 20% of your block time at the end to go back through marked questions now the second problem I'm gonna deal with in this podcast is the issue of changing answers so the issue of changing answers so here's the thing there is this algorithm that I talk people that I tear for the exam through with regards to changing answers and here's the deal before

you ever change answers ask yourself this question am I 100% sure of the answer choice that I'm about to choose in place of the initial one I've chosen am I 100% sure that it's correct if you answer to that question is yes change the answer if you answer to that question is no don't change the answer simple as that there's literally people that I have treated where they literally just started following that algorithm and improve their performance on like MBM exams by like anywhere from like five to there was this particular person that they are scores improved by like 12 to 13 points consistently just from not changing answers right so just use that algorithm it it essentially like prevents you from making dumb mistakes with regards to like changing your answers now the third problem I want to deal with here I actually think so I really think I need to deal with a few more problems because a few more things are just popping into my mind as I'm giving the spot cast so another common problem is the drug at questions people are like oh divine these questions are so hard how do I deal with them bloody bloody blood okay so here's the deal whenever you get a drug at question the dumbest thing you can do is to try to do that question first don't do that question first that is a terrible idea you'll absolutely regret that never do a drug at question first you'll always leave a drug at question for the end of a book always without exception you should always leave a drug at question for the end of a book that's one two when you get a drug at question the smart thing to do is it kind of sounds a counterintuitive but I will encourage you to read the drug at first really really but really fast so don't spend time don't spend like 10 minutes reading the drug at no that that doesn't make any sense right don't do that the thing you want to do is spend like three three quick minutes

read through the drug at read through the tables just make sure that you read every single word of it right so don't like say oh let me just read the first line of each paragraph no that's not smart read the whole thing read the whole thing just try to make sure that your eyes go over every word in the drug add and the graphs right and then after that then look at the questions and then when you look at the questions so you look at the question and then ask yourself oh I just read this thing real quick I remember seeing this concept in this part of the in this part of the drug at go back to the part of the drug that deals with that question look at that part to read it and pick your answer based on pick your answer based on that that is one thing I have done that is the way of always a pro drug at questions you may see but divine why can't I read the questions first before looking at the drug the thing is when you read the questions first I've noticed in general with people like that I too and also even with myself I never read the drug at first I mean whenever I read the questions first it tends to kind of like confuse me a little and mix me by asked when I'm reading the drug at so I've noticed I mean because to be honest with you again I'm a very dear driven person so I've tried many different strategies for approaching drug add questions and the strategy that has worked the best for me and for the people like Titor has been that they read the drug add real quick for like three to four minutes just to basically the reason you're reading a real quick is to try to register in your mind where key pieces of information are you just want to like and the thing is don't go back and like oh I think I may miss the word there let me go back and read it again no just read through the whole thing real quick three to four minutes but read through every single part of it you do

that right and then you look at the questions when you look at the question you ask yourself okay what part of the drug add did I see this thing you go you console that part you read it and then you pick out the answer I've noticed in general using the strategy most drug add like like the between reading the drug add on answering the questions successfully probably take me like six maybe like seven minutes max for these are questions and I feel like almost as a role I mean I'd be willing to open that I've probably got in like 95% of the drug add questions I have seen in my interior like I guess USMLA life if you may or do I guess at this point not exactly a USMLA person again because don't with step three okay so that's how I approach our drug add questions kind of counter intuitive advice but really I most people that I've recommended this to have used it they've been quite successful with it and then the fourth problem I want to deal with is the Anki problem the Anki problem so I know I'll probably get some blowback from people on this and apologies in advance again I proud not my intention to you know cost chaos or commotion or whatever but I just want to again this is just coming from the experience of a person that has thought on Twitter thousands of people right and taking again all the I mean I've taken a crap ton of NV Me exams I know pretty much most of the study resources that I'll be and the thing is Anki right is based on space repetition right and here's the thing space repetition is great it's it's phenomenal I mean like I've read like papers on this stuff and we weren't talking with like psychologists on this stuff like educational psychologists and speech repetition it's a great strategy it's a great study strategy but the thing people don't seem to realize is that there are many means of space repetition and one method of space repetition may not work

well for a person and that same method may work extremely well for a different person the mistake I feel like most medical students and I guess medical professionals are meekiness when they hear the word space repetition the only thing they think about is Anki right Anki again is great don't get me wrong I'm not seeing this to this Anki Anki is wonderful I have had like you know students that have done extremely well with Anki but the thing is Anki is not the only means of space repetition and I'm and I'd be willing to propose a theory of mind that if you can find the space repetition method that works the best for you you can end up being like very successful and also like budget your time wisely so I give you an example right like my own personal experience I don't mind flashcards but I don't do well with flashcards either I mean again I've probably gone through like thousands and thousands of flashcards in my day because people ask me about this deck or whatever deck all the time right so occasionally I will just give like a weekend like let's say I have like like a couple hours free here and there I just bust through like a thousand like a couple thousand flashcards right just to evaluate the quality so that when people ask me for advice I can give like informed opinions but the thing is personally from here I'm like doing Anki not really my cup even flashcards in general not really my cup of tea reading books not really my cup of tea again I don't mind reading books but not really my cup of tea but personally for me right I found that I love like audio visual learning I mean that's probably one of the reasons why I make these audio podcasts because it kind of fits my style of learning but the thing I did like throughout my school was to essentially like figure out okay this is the exam I'm trying to tackle what is the video audio resource that covers the bulk of

the information that I need for this exam if I figure that out then the thing I just do is I just listen to those videos repeatedly on a space-stought basis right and I mean there's a lot more detail in the way like the way I study but that's kind of like the Clifch Notes version but I noticed that by essentially using space repetition but doing it with like videos and audio stuff which I love then I noticed that I was extremely successful I mean thankfully at least on exams I've done extremely I've done extremely well so the thing is space repetition is not a bad study idea but you can do space repetition with notes that you generate you can do space repetition with videos you can do space repetition with audio materials you can do space repetition with Anki you can do space repetition reading a textbook like basically space repetition the concept works or you need to find that concept like you need to find that concept in the context of a method that works well for you so that's the thing I would like to like throughout there because again people always cite oh divine I noticed person that used this Anki deck and got like in the two seven years on the exam yeah that's true but for every like I'm willing to propose that if you took a hundred met students that religiously used Anki to study for like step one or step two seek or whatever probably less than 10 percent of them will get those super high scores that everyone desires on exams right so the thing is against space repetition is not bad it's great if Anki based space repetition is the best strategy for you then use it right well you know best how you study I mean like for me I do like like assessments of people to like figure out the study strategies that's what I do like for every first time that I like whenever I meet people for the first time to tutor them but find the method that works for you and then use

it to advantage because the thing I've noticed is if you can find the the space repetition method that works the best for you then when you learn the information like much easier and then too you will also be more efficient in learning that information like I could you not like there are days when I was studying for step one where I could watch like let's see like 40 hours of video like 40 or 50 hours of video in a day right so it's like I have essentially figured out I mean obviously this is watching at like insanely high speeds but I figured out a strategy that works for me and I used it to my own benefit okay so that's something to give me my space repetition works what find the efficient space repetition method that works for you aren't is not the only means of space repetition again I promise you have I've worked with tons of students that have used other means of space repetition and if done extremely well on tests and that means did not involve aren key but if aren keys the thing that works for you by our means please use it because I feel like like I just like you know read on SDN read on red you know you have these cases of like you have like all these like some cases of people that you know use on key get 260's to 70 stuff like that but then there's also like a large a much larger sample of people that used on key and they got like below the average or they got just the average stuff like that right and they used on key religiously like they used all the dex known to man so just something to keep at the back of your mind and then the big thing again I want to say with a new usm list of to seek exam right the thing is the mdm is beginning to introduce like unusual presentations of things so they are becoming like a little more descriptive so I will encourage you on the usm exam like try to learn as much as you can like don't just try to learn the boss phrases

for things like try to understand what do they mean by that boss phrase right so say for example they give you a question like you everyone has memorized that oh you know if a person has multiple sclerosis you observe oligoclonal bands in the CSF yeah that's true but what would oligoclonal bands stand for or they give you a question and you're like oh Guillembris syndrome is associated with like Albuminocyteologic dissociation yeah that's that's all well and good to know but you need to understand what they mean by Albuminocyteologic dissociation because the thing is the mbm is the mbm the realize that people have memorized these buzzwords so the reason people are seeing some of again there are many more reasons and again I can always discuss this in a in a later podcast but one of the principal reasons why people find the new like especially like the usm list that are over the like the past like you know two to three months to be quite challenging is primarily because the mbm is like giving these unusual presentations right so like if you like for example instead of saying like Albuminocyteologic dissociation what the mbm can do is they can you know sort of put like say that oh they give you like CSF studies in a person that has like muscle weakness and then you notice that the protein count is very high but you notice that the person only has like one or two wide blood cells and that's literally all they give you it can even be like a very short question the thing is they've essentially used the labs to describe Albuminocyteologic dissociation right because whenever you have a high protein count you should have a high number of wide blood cells right so a person that memorizes the buzzword like memorizes whatever on the card or whatever right and then they see those labs they won't think anything of it well the mbm on that those circumstances is trying to guide you

towards Albuminocyteologic dissociation so that is one big that's one big thing they do these days and again another thing is again like the unusual presentations of things right so like things like take for example they can give you a question about like a patient that has like you know they tell you it's like a kid they tell you that oh the kid has like a posterior fossa mass and then they tell you that oh they perform an MRI of the brain and spine and they notice like you know the lesion in the posterior fossa like in the midline of the cerebellum and then they tell you that they see multiple lesions along the spinal cord right and then they then give you a bunch of answers right so they give you like men in geoma, pylocytic astrocytoma, metroloblastoma they give you all that stuff right and then when people read those questions right like they're like what am I supposed to do and then what most people defaults to is to say okay well what is the most common pediatric primary prediatric or brain tumor, pylocytic astrocytoma let me pick that answer but the thing is they pick that answer and they're like, hey now you got this thing wrong what happened all right the thing is the endgame essentially just give you like an atypical presentation of metroloblastoma because metroloblastoma of those primary pediatric or brain tumors it loves to form these things called the drop metastasis okay so the thing is the drop metastasis is not something that you necessarily think about but it's still associated with the same concept that you've learned you've learned I'm sure you've all learned abombody roblastoma right so the thing is these unusual atypical presentations that's the all like being descriptive with buzzwords is the endgame is new stocking trade is not like the endgame you like decided to pick a whole new set of topics that they are gonna test on no they don't do that

I mean like if you because for me like I actually have again kind of like I'm a data-driven person so I tend to like deep into many of these things right and if you really look at it if you notice the endgame is has if I'm not mistaken they only have like one content outline for all the USMD exams step one two three key step three the thing is the endgame is stocking trade is not like saying oh let me go and test this obscure brain tumor yes they do test some obscure facts every now and then with those obscure facts are very few and like if the questions you're getting wrong adjust those obscure like new facts that like oh no one has ever heard about before then you would be very likely be able to get at least above a 250 right but they still test like the same concepts they tested like in the year 2000 for the most part the same concepts they are still testing in 2019 but they are just testing those concepts in different ways that is the thing that people don't seem to realize so the thing is whatever concepts you know just try to like know them and know them well right and try to not just memorize the boss phrase but actually try to understand like pathophysiology like what's the reasoning behind this for this boss word what like that is one thing I expressly tell people for this boss word can you describe it like in a sentence or two like would you understand by this boss word okay that is like the optimal way to think about preparing for the USMID exams these days and then I said at the end of the podcast I'll talk about a booster course that I've been offering I've been offering actually for about a year but I just wanted to like test it out for a year see what the results look like and then kind of go from there but basically this booster course is essentially like at least for step two seek in step three it's like a 10 hour course where I essentially meet you

for like you know like to like it's I typically do this with people like in the last week before the exams right and so for like five days I meet you for like two hours every day right and then I we essentially do like a very I call it like almost like a hyper rapid review of like the big picture concepts that tend to be tested on the USMID exams and also like a bunch of unusual presentations right so like for example like step two seek it like in a 10 appeared review like a lot of like high-yield like surgery, peds, obi-guin, psych, internal medicine, neuro right review those in like a 10-up period and the vast majority of people that I've worked with that I've sort of like worked with with this booster course the vast majority of them have done extremely well and many times I get like these testimonials from people that oh divine that 10-up period I would talk about like 30 to 40% of the things I saw my exam we actually did talk about them in my last week so it's one of those things that are good for you to do like when it I won't say it's a course that you should but like enrolling like to like learn information like primary information from them not very smart to do that but if for example you've got into a point you on the decade period where you feel like you've studied a lot or you've got into a point you on the decade period where like you're like okay I'm like a week out from my exam I want to put everything together this is it's a good it's a good course for you to enrolling so if it's something you're interested in like for pricing and stuff like that just reach out to me that through the website or send me an email at divine intervention podcasts with an sdn.gmail.com it's something that for step two ck and step three it's something that I like those courses are 10 hours long for step two ck and step three for step one it's more like 20 hours step one is j

ust a more nebulus exam so the month's more time so step one is more like 20 hours but step two ck and step three it's more like 10 hours for step two ck 10 hours for step three and then like I do at the end of every podcast I do offer one on one tutoring for many exams right so step one two ck two ck step three I do offer tutoring for the for the internal medicine board exam and the internal medicine training exam and then if you're a med student applying to our residency so like an ira application that's long gone that's like September 15th and then if you're a med if you're a college student applying for like med school so like an Amkus app I do offer again like one on one advice you know coaching for those so like personal statements rec letters editing applications mock interviews again I have a ton of experience working with people a ton of experience working with people and most of the people have worked with have been again extremely successful with a much process and then if you have like a college buddy that needs to do for like Genkamp, Okamp Physics, Biochem, Histology, Physiology, Alpha Tutor for all those things and then I've talked about this admosim like a longitudinal tutoring so if you're like a new first year med student or a new second year med student or a new 30 year med student I do offer this thing called longitudinal tutoring where tutor you with your class exams or like your shelf exams but at the same time I tutor you for the board exam that is upcoming for you it's something that I've done with a select number of people but again essentially everyone I've done that with they've been like wildly successful on their tests so if that's something I'm interested in feel free to reach out to me again either through the website or you send me an email divine intervention podcasts with an essay at the endagimo.com so have a wonderful rest of your d

ay I will see you in the next podcast God bless you thank you

Practice questions — USMLE style

Question 1 — Pharmacology/Study Strategy

A medical student is preparing for a high-stakes board exam and encounters a lengthy drug ad section in their review book. The student recalls advice suggesting that they should not spend excessive time reading every detail of the drug ad, nor should they attempt to answer questions before reviewing the content. According to this recommended strategy, what is the optimal approach when approaching a drug ad section?

A) Attempting to answer all related questions first to identify areas of weakness, and then returning to read only those specific sections in the drug ad.
B) Reading through the entire drug ad quickly (e.g., 3-4 minutes), ensuring that every word is visually registered, before proceeding to the associated questions.
C) Spending significant time reading each paragraph thoroughly to ensure deep memorization of all mechanisms and side effects before attempting any questions.
D) Skipping the drug ad section entirely if it appears too dense or complex, and instead relying solely on previously learned concepts.

Answer: B. The podcast advises that when encountering a drug ad question, the student should first read through the entire ad quickly (3-4 minutes). This rapid review is designed to register key pieces of information in the mind without getting bogged down in detail. After this initial pass, the student then looks at the questions and uses their memory from the quick read to recall specific concepts within the drug ad text.

Question 2 — Internal Medicine/Exam Interpretation

A resident notes that recent board exams are increasingly challenging because they move away from classic "buzzword" questions (e.g., Multiple Sclerosis $\rightarrow$ Oligoclonal Bands). Instead, the exam often presents unusual or atypical clinical scenarios using detailed laboratory findings to guide the student toward a specific diagnosis. A student is presented with CSF studies showing high protein levels and only one or two white blood cells in a patient with muscle weakness. The underlying pathophysiology suggests albuminocytologic dissociation. What should the resident prioritize when interpreting this question?

A) Memorizing the classic buzzword association (e.g., MS $\rightarrow$ Oligoclonal Bands), as these are the most frequently tested facts.
B) Assuming that if the presentation is unusual, the question must be flawed or poorly constructed.
C) Focusing on understanding the underlying pathophysiology and mechanism of the findings rather than just recalling the associated buzzword.
D) Selecting the diagnosis that represents the most common pediatric primary brain tumor, regardless of the presented lab data.

Answer: C. The podcast emphasizes that the board exams are increasingly descriptive, using labs or atypical presentations to describe a concept (like albuminocytologic dissociation). Therefore, students must move beyond rote memorization of buzzwords and instead focus on understanding the underlying pathophysiology—the "why"—behind the clinical findings.

Question 3 — Test-Taking Skills/Timing

A medical student is taking a block of multiple-choice questions during their board exam preparation. They are advised to maintain strict pacing throughout the entire section to maximize time for review and reflection. Based on the recommended strategy, what should be the target pace for completing this block?

A) Spending no more than 1 minute per question across the entire block, regardless of difficulty.
B) Allowing up to 20 minutes for every 10 questions to ensure thorough consideration of all options.
C) Limiting time such that they spend no more than 12 minutes for every 10 questions.
D) Spending a variable amount of time based on the perceived difficulty, allowing up to 30 minutes per block of 40 questions.

Answer: C. The podcast explicitly recommends holding oneself to the standard of spending "no more than 12 minutes" for every 10 questions during the initial pass through any USMLE block. This pacing strategy is designed to ensure that a significant portion of time remains at the end of the section for reviewing marked, difficult questions.

Question 4 — Study Methods/Learning Science

A medical student finds themselves relying heavily on flashcards (Anki) as their primary method of spaced repetition review, despite hearing about other effective learning techniques. The educator advises that while Anki is excellent, it is not the only means of space repetition and suggests finding a method best suited to the individual's learning style. Which alternative study modality would align with an audio-visual learner who wants to utilize spaced repetition principles?

A) Reading textbooks cover-to-cover multiple times until the material feels familiar.
B) Creating detailed, handwritten summary notes for every single concept encountered.
C) Listening to and reviewing recorded video lectures or podcasts repeatedly at spaced intervals.
D) Only relying on self-quizzing from practice questions without any supplementary reading material.

Answer: C. The podcast highlights that space repetition is a concept, not limited to Anki. For an audio-visual learner, the optimal strategy involves using videos and audio materials (like recorded lectures or podcasts) repeatedly at spaced intervals. This allows the student to leverage the principles of spaced repetition while matching their preferred learning style.

Quick fire review

What is the recommended target pace for a first pass through a USMLE block?

No more than 12 minutes per 10 questions.

When reviewing answers, what is the absolute rule before changing an answer choice?

Only change it if you are 100% sure that the new option is correct.

What is the optimal strategy for approaching a drug ad question?

Read the entire drug ad quickly (3-4 minutes) first, then read the questions, and finally return to the specific section of the drug ad relevant to the question asked.

When studying for USMLE exams, what should be the primary focus when encountering unusual presentations?

Understanding the underlying pathophysiology and reasoning, not just memorizing buzzwords.

What is the key takeaway regarding study resources like Anki?

Space repetition is a concept; find the method (audio, video, notes) that works best for you, as Anki is not the only means.

What core principle does space repetition rely on?

The idea that reviewing information at increasing intervals of time enhances memory retention and efficiency.

If a student finds flashcards difficult but loves audio-visual learning, what study strategy should they adopt for spaced repetition?

They should use video or audio resources (like podcasts/lectures) and review those materials repeatedly on a space-repetition basis.

Why is it advised to read the entire drug ad quickly rather than reading only the first line of each paragraph?

To ensure that the eyes pass over every single word, helping to register key pieces of information across the whole document for later retrieval.

What does "longitudinal tutoring" entail in the context of medical education preparation?

Tutoring a student concurrently on their class/shelf exams while also preparing them for an upcoming board exam (e.g., Internal Medicine Board Exam).

When approaching USMLE questions, what is the most effective way to prepare for unusual presentations?

To ask oneself, "Can I describe this buzzword or concept in a sentence or two?" This forces understanding of pathophysiology rather than rote memorization.

Quick recall / Anki-style questions