Approach to the Patient with Altered Mental Status Robert L' Hernandez, M'D' Assistant Professor of

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USMLE STEP 1 SURVIVAL GUIDE
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Overview

• Licensing Exams
• USMLE Step 1
• Content
• Application and Scheduling
• Strategies for Success
• Special Issues

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Licensing Exams
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To become licensed to practice medicine in the
United States, one must

• Earn a medical degree
• Pass several licensing examinations
• Complete one or more years of residency training
• Apply for licensure from a state medical
  licensing authority

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The National Board of Medical Examiners (NBME)

• www.nbme.org
• The NBME is an independent, not-for-profit
  organization that provides examinations for the
  health professions.

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The United States Medical Licensing Examination
(USMLE)

• www.usmle.org
• The USMLE, co-sponsored and co-owned by the NBME
  and the Federation of State Medical Boards, is a
  three-step examination for medical licensure in
  the United States.
• Step 1
• Step 2, Clinical Knowledge (CK)
• Step 2, Clinical Skills (CS)
• Step 3

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The United States Medical Licensing Examination
(USMLE)

• The USMLE assesses ones ability to apply
  knowledge, concepts, and principles, and to
  demonstrate fundamental patient-centered skills,
  that are important in health and disease and that
  constitute the basis of safe and effective
  patient care.

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The United States Medical Licensing Examination
(USMLE)

• Results of the USMLE are reported to medical
  licensing authorities in the United States for
  their use in granting the initial license to
  practice medicine.

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USMLE Step 1

• Computer based examination
• Assesses whether medical students can understand
  and apply important concepts of the sciences
  basic to the practice of medicine.
• Step 1 is usually taken at the end of the second
  year of medical school.

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USMLE Step 2

• A two step examination that assesses whether
  students can apply medical knowledge, skills, and
  understanding of clinical science essential for
  the provision of patient care under supervision
  and includes emphasis on health promotion and
  disease prevention.

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USMLE Step 2 Clinical Knowledge

• A computer based exam consisting of
  multiple-choice questions that focus on the
  principles of clinical science that are deemed
  important for the practice of medicine under
  supervision in postgraduate training.

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USMLE Step 2 Clinical Skills

• Uses standardized patients to test ones ability
  to gather information from patients, perform
  physical examinations, and communicate findings
  to patients and colleagues.
• Usually taken during the fourth year
• Five test centers in the United States

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USMLE Step 3

• A computer based exam that assesses whether
  medical school graduates can apply the medical
  knowledge and understanding of biomedical and
  clinical science considered essential for the
  unsupervised practice of medicine.
• Step 3 is usually taken during or after the first
  year of postgraduate residency training.

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UMMSM Requirements

• Students must pass Step 1 for promotion to the
  third year
• Students must take Step 2 CS and CK as a
  condition for graduation
• Passing Step 2 CS and CK is not a requirement for
  graduation

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USMLE Step 1
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Important Websites

• USMLE
• www.usmle.org
• NBME
• www.nbme.org
• Prometric Test Centers
• www.prometric.com

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2009 USMLE Bulletin

• http//www.usmle.org/General_Information/bulletin/
  2009.html

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Step 1 Content

• Anatomy
• Behavioral sciences
• Biochemistry
• Microbiology
• Pathology
• Pharmacology
• Physiology
• Interdisciplinary topics, such as nutrition,
  genetics, and aging.

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Step 1 Content

• Classifies test items along two dimensions,
  system and process
• System
• 4050 General principles
• 5060 Individual organ systems
• Process
• 3050 Normal structure and function
• 3050 Abnormal processes
• 1525 Principles of therapeutics
• 1020 Psychosocial, cultural, occupational and
  environmental considerations

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Step 1 Format

• Step 1 has approximately 350 multiple-choice test
  items, divided into seven 60-minute blocks,
  administered in one eight-hour testing session.
• Step 1 consists of multiple-choice questions
  designed to measure basic science knowledge.

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Step 1 Format

• Some questions test the examinee's fund of
  knowledge
• The majority of questions require the examinee
  to
• interpret graphic and tabular
• material
• to identify gross and microscopic
• pathologic and normal specimens,
• to solve problems through
• application of basic science
• principles

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Step 1 Format

• Step 1 includes only single one best answer test
  questions.
• Items consist of a statement or question followed
  by three to eleven response options arranged in
  alphabetical or logical order.
• Some questions involve interpretation of graphic
  or pictorial materials.
• Examinees are required to select the best answer
  to the question.
• Other options may be partially correct, but there
  is only ONE BEST answer.

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Step 1 Reporting

• The number of test items you answer correctly is
  converted to two equivalent scores.
• The three-digit score
• The minimum passing score is 185.
• The mean score for first-time examinees from
  accredited U.S medical schools is in the range of
  200 to 220 (SD /- 20)
• The two-digit score
• Is derived from the three-digit score and is not
  a percentage score.
• Is used in score reporting because some medical
  licensing authorities require a "passing score of
  75."
• A score of 75 always corresponds to the minimum
  passing score.

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Application Process

• Review the 2009 USMLE Bulletin
• http//www.usmle.org/General_Information/bulletin/
  2009.html
• Complete your application materials and submit
  them online at www.nbme.org
• Request a 3 month eligibility period
• Receive a Scheduling Permit verifying your
  eligibility and authorizing you to schedule the
  examination

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Application Process

• Follow the instructions on your Scheduling Permit
  to schedule your test date at a Prometric Test
  Center at www.prometric.com
• On the scheduled test date and at the scheduled
  time, bring to the test center your Scheduling
  Permit and the required identification.
• Take the test

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Strategies for Success
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Strategies for SuccessGame Plan

• Time Management
• Resource Management
• Study Strategy
• Test-Taking Skills

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Strategies for SuccessGame Plan Recommendations

• Read all info on the USMLE website
• Familiarize yourself with content of exam
• Once you develop a schedule and study strategy
  stick to it!
• Dont procrastinate
• Most of all

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Strategies for SuccessGame Plan Recommendations

• Dont distress De-stress!!!

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Strategies for SuccessTime Management

• Prolonged study ? better retention
• Develop daily schedule
• Keep reasonable study periods
• Set aside time to decompress
• Dont forget fundamentals of maintaining health
  and wellness

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Strategies for SuccessResource Management

• You cant review it all so stick with what has
  worked for you!
• Class notes
• Videos
• Textbooks
• Board Review Books
• On-line materials
• Tutors

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Strategies for SuccessResource Management

• USMLE Prep Courses
• Kaplan
• Princeton Review
• Falcon Review
• USMLE World
• UMKC Institute for Professional Preparation

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Strategies for SuccessResource Management

• USMLE Study Guides
• First Aid USMLE Step 1
• USMLE Step 1 Secrets
• High-Yield Comprehensive USMLE Step 1 Review
• Underground Clinical Vignettes USMLE Step 1
• BSS Body Systems Review I
• USMLE Step 1 Recall Buzzwords for Boards
• Rypins' Basic Sciences Review
• Kaplan USMLE Step 1 Home Study Program
• Rapid Review Series USMLE Step 1
• Deja Review USMLE Step 1 Essentials
• Cracking the Boards USMLE Step 1
• Board Simulator Normal and Abnormal Processes
• Laughing Your Way to Passing the USMLE
• Step-Up
• BSS General Principles in the Basic Sciences
• Rypins' QA for Basic Sciences Review
• Blueprints QA USMLE Step 1
• PreTest Clinical Vignettes USMLE Step 1

Laughing Your Way to Passing the USMLE
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Strategies for SuccessStudy Strategy Study
Smart, Not Hard

• You cant know everything!
• Ask yourself, at this point in your career
• What is vital information?
• What is recall information?
• What is forget it information?

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Strategies for Success Study Strategy Study
Smart, Not Hard

• Be an active learner
• Use visual elements where possible
• Pick out relevant information
• Look for overlaps between subject areas
• Write questions rather than notes
• Use study groups wisely!
• Assess study reassess

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Strategies for SuccessTest-Taking Skills
Practice Exams

• NBME Comprehensive Basic Science Exams (free)
  this spring, before and after the Transition Block

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Strategies for SuccessTest-Taking Skills
Practice Exams

• USMLE Step 1 Orientation and Practice Materials
• http//www.usmle.org/Orientation/2009/menu.html
• The software has over 100 practice test items and
  a software tutorial
• Cost Free

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Strategies for SuccessTest-Taking Skills
Practice Exams

• USMLE Computer Based Testing (CBT) practice
  session at the Prometric Test Center
• https//apps.nbme.org/CBTPSRegistrationWeb/jsp/usm
  le_CBTPS_registration.jsp
• The Practice Session is a maximum of 3.5 hours
  and is divided into three 1-hour blocks of 50
  multiple-choice test items each.
• When you complete the session, you will receive a
  printed percent correct score
• Cost 42

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Strategies for SuccessTest-Taking Skills
Practice Exams

• University of Missouri - Kansas City (UMKC)
  Computer Based Tests
• http//www.umkc.edu/ipp/cbt.asp
• Diagnostic Exams (2) 45 each
• The output from this test will assist in
  pinpointing weaknesses and strengths as you
  prepare for the exam
• Mock Board Cost 45
• Seven blocks, 50 questions per block, timed exam
• Provides a realistic day of testing. The test,
  once begun, requires up to eight hours for
  completion, just like the USMLE
• A comprehensive diagnostic report is produced to
  help the student focus his or her study time for
  maximum effectiveness

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Strategies for SuccessTest-Taking Skills
Practice Exams

• NBME - Comprehensive Basic Science
  Self-Assessment
• http//www.nbme.org/programs-services/medical-stud
  ents/sas/index.html
• Standard-Paced four sections, 50 items each, up
  to one hour to complete each section
• Self-Paced four sections, 50 items each, up to
  four hours to complete each section
• Immediate feedback, profiles indicate relative
  strengths and weaknesses
• Profiles similar to those Step 1 candidates
  receive
• Score interpretation guide provides approximate
  Step 1 corresponding total score to assessment
  score
• Cost 45

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Strategies for SuccessHandling One best answer
questions

• Read each question carefully and understand what
  is being asked.
• Try to answer the question first, then look at
  the option list.
• alternatively, read each option carefully and
  eliminate those that are clearly incorrect.
• of the remaining options, select the one that is
  most correct.
• If unsure about an answer guess!!!
• unanswered questions are automatically counted as
  wrong answers.

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Strategies for SuccessHandling One best answer
questions

• DONT SKIP questions. If you dont know it when
  you see it, youre probably not going to get it
  later.
• DONT spend too much time on an individual
  question.
• NEVER CHANGE your answer.
• SCAN for trigger phrases or words.
• GUESS consistently.

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Strategies for SuccessPreparing for the Day of
the Test

• Decompress a few days before the exam
• Check out the test center / confirm your test
  date
• Get all of your papers in order
• Get a good nights rest

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Risks for Failure

• Consistently marginal / poor academic performance
  during the first two years of medical school
• Prior history of problems with board type exams
  (MCAT, SAT).
• Performing poorly on mock exams
• Thinking you cant fail
• Thinking you cant pass
• Not putting in the time / effort to prepare.

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Special Issues

• The Seven Year rule
• Testing accommodations
• http//www.usmle.org/Test_Accommodations/test_acco
  mmodations.html
• Irregular behavior
• When things go wrong

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Summary Strategies for Success

• Game Plan
• Manage Time Wisely
• Study smart, not hard!
• Manage resources
• Practice, practice, practice
• Take care of yourself

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USMLE Step 1 Mean Scores 2004 - 2008
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USMLE Step 1 Pass Rates 2004 - 2008
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YOU CAN DO IT!