USMLE Tutoring: Who, What, When, Where, Why and How of Answering USMLE/ NBME Clinical Vignettes for USMLE Step 1, 2CK & 3.
USMLE Tutoring: Best USMLE Tutor answers the most Basic questions which are absolutely necessary to understand, interpret and accurately answer USMLE/ NBME Clinical Vignettes!
Who of Answering USMLE/ NBME Clinical Vignettes:
Who is your patient? Were they brought or came themselves? Their age (yr/mo/days/hours)? Their sex (M/F)? Their Race and Ethnicity (Caucasian/African American)? A new patient or a follow up visit?
What of Answering USMLE/ NBME Clinical Vignettes:
What is the purpose of their visit? Sick visit vs Chief Concern/ Complaint vs Pre-Op vs Post-Op? What are the Vitals/Labs/Image/Physical Exam findings/Video/Drug Ad or Abstarct findings? Also, MUST ANSWER WHAT IS BEING ASKED by the Question writer.
When of Answering USMLE/ NBME Clinical Vignettes:
When did the problem begin? Must understand the timeline correctly and correlate any relevant changes such as medication dosage changes or addition of a new drug or deletion of any old one? Did the problem begin after a visit to an endemic area or after an injury such as a fall or is the problem insiduous in nature? Is the problem episodic (is it currently happening or the episode/episodes were happening in the past) or intermittant, acute, acute on chronic or gradually worsening?Where of Answering USMLE/ NBME Clinical Vignettes:
Where is the patient located? Came by themselves or brought by family member or Police or Paramedics to the Physician usually means Doctor's Office or Clinic or Out-patient setting. Comes or brought to the Emergency Room / Department or is it a Home or Nursing home visit? Is the patient already an In-patient and if so where are they? PACU, ICU, CCU, NICU, Floor/Ward? Where is the problem located? Focal, multi-focal, diffuse, systemic and which side of their body?
Why of Answering USMLE/ NBME Clinical Vignettes:
Why are they having the said concern/complaint or problems (Symptoms/Signs/Vitals/labs/Images/Specific test results)? Or What is the underlying theme? VINDICATE ME mneumonic: Vascular, Infectious, Neoplastic (Paraneoplastic/Spread), Dietary/Drugs, Idiopathic/Iatrogenic, Congenital, Traumatic, Endocrine Metabolic, Eating Disorders/Exertional or lack of Exercise/Exposures. Keep in mind their Age/Sex/Location/Stability/Timelime/Risk Factors including Family History, Personal Smoking Status, Alcohol intake, Drugs (Rx, abuse and Herbal and OTC medications), Allergies, DM, Asthma and Atopy, COPD, Cancer, HTN, Sexual orientation and contraception, Ob-Gyn History, prior occurances, aggravating and aleviating factors etc., among others.
How of Answering USMLE/ NBME Clinical Vignettes:
How is perhaps the MOST IMPORTANT QUESTION that needs to be answered while reading the Clinical Vignette and heavily depends upon your Medical Knowlege and Integration Skill set. How do all the Signs and Symptoms in the question develop over the said timeline to our patient? You will require requisite Sensitivity as well as Specificity to be able to answer each question Reflexly rather than debate. Students who are used to debating tend to have harder time finishing their Blocks on time. You will have to focus on Vocabulary when pertaing to Symbols, Pharmaceutical words and Greek and Latin Word-parts, Numbers (age, vitals, formulae, Biostats, Labs), Images (EKG, EEG, Echo, Ventriculogram, V/Q Scan, USG, CT, MRI, Bone Scan, Meckel Scan, Gross Anatomy, Histology, Pathology, Flowcharts, Diagrams, Tables, Graphs etc.,) and Sounds (Heart, lung, Bowel sounds, BP or Korotkoff sounds and Bruits).
In order to answer all these questions, you will be developing intense Focus, Improve Specific Medical Knowledge, Visualize the clinical vignette as if you were watching it like a movie and all the roles were played by you and you alone! This will allow you to stay a few steps ahead of the question writer and help build confidence in picking your answers reflexly or instinctively.
- What I am about to share is a “Goldmine of Information” that I have come to understand through one on one Online and In person teaching/tutoring hundreds of medical students and doctors from around the world and guiding a few thousand from US schools as well as IMGs for their USMLE Steps and many Residents for USMLE Step 3 on why and how someone is able to mess up on their USMLE Steps. My recommendation to the reader “you” is to avoid these common mistakes while preparing for your USMLE Steps 1, 2 or 3 in order to Ace or Crack your USMLE Steps!
- PS: Just the proper mix of adequate Focus, Hard work, Dedication, Positive attitude, Stamina, Skills, Knowledge and timely Guidance will help you crack USMLE. Just Remember that Human Resource “YOU” are the most important resource that shouldn't be neglected by you and must be developed so that all other resources can be utilized to the max! Don't waste a ton of precious time and energy picking out extraneous resources such as which books, which qbanks, which videos, which review programs and which tutor can help “YOU” CRACK or ACE USMLE Steps 1, 2CK and 3. Just Remember it's only YOU who is allowed to take your exam and therefore you must spend a lot of time, energy and money in building your ability to Crack USMLE.