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!

  • By not knowing how to focus by practicing multitasking and staying distracted by boyfriends/girlfriends, husbands, wives, kids, other family members etc.
  • By sheer Fear, Anxiety, depression and lack of support and guidance. (Important factor for Failing or low score!)
  • Taking too long to reach perfection by going in depth into everything. Slowing down and going into minute details makes you feel good but actually does not translate into an actual score increase on USMLE Steps. I have had many students who have taken sometimes more than a couple years to barely pass their previous step or in fact longer and yet failed before coming to me. Taking long makes you constantly forget as you learn and it's impossible for most people to tilt the scale in the favor of learning as opposed to forgetting.
  • Medical conditions such as adult ADHD, Dyslexia, Thyroid issues and any other medical conditions that are either undiagnosed or improperly taken care of.
  • Using too many resources and listening to so many self proclaimed experts. What works for one student might not work for the next one even if both students are in the same class.
  • Poor medical school teaching, poorer review programs, lack of funds to afford any help at all.
  • Inability to correctly comprehend any and all USMLE Resources: Review books, text books, qbanks, videos, online articles etc., simply because of “poor medical vocabulary” with respect to Greek and Latin medical word parts, Pharmaceutical vocabulary, Physics and Chemistry vocabulary, Medical Numbers such as age groups and associated disorders, age appropriate vital signs and their interpretations, normal lab values and interpretations of abnormal labs, various physiological and pharmacological formulas, Biostatistics formulas and their proper applications, Image vocabulary with respect to ECGs, Radiology images, Gross and Histology images, dermatology, Ophthalmology or Biochemistry flow diagrams and Medical Sound vocabulary like heart and lung sounds, Bowel sounds, bruits etc.
  • Assuming that they understand the subject matter well enough despite low scores on various Self Assessment or despite failing the actual steps as if it's just some mysterious extraneous factor that's holding them from scoring high! Assuming that one knows and understands something that one actually doesn't is one of the most important factors that prevents one from learning the material correctly.
  • Inability to build adequate Stamina for these extremely long 8-15 hour Exams!
  • Studying the day before the Exam and not getting enough rest the night before.
  • Not taking care of one's health: mental and physical.
  • Getting burnt out.
  • Not understanding Clinical Vignettes: poor dissecting, analyzing and interpreting Skills that leads to debate between mutiple or more commonly 2 answers.
  • Changing their answers due to self doubt: here's what data shows - students who change answer within 10 seconds or less after picking an answer to a question usually are changing an incorrect to correct answer but students who change answer after initial 10 seconds are more likely changing an incorrect to another incorrect answer or a correct to incorrect answer.
  • Inability to keep track of time and being unable to finish each block on time. As it is well known that the length of questions on USMLE Steps as well as length of the Exam itself increases from Step 1 to 2 to 3… inability to finish blocks on Step 1 should be a very big red flag! History has a way of repeating itself.
  • If you're preparing for your USMLE Steps and need proper Individualized Guidance, please don't hesitate to reach out to me as I have and plan to continue to provide Free USMLE Guidance sessions to students who are studying for their USMLE Steps and are interested in cracking USMLE or are interested in getting a better score on a USMLE Retake!
  • Good luck and hopefully you found something that you were doing wrong so far and will reach out for help before taking your USMLE Steps!
  • Thank you for reading, liking, sharing and upvoting this answer to this great question How do I crack USMLE?
  • 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.

Welcome to the Best USMLE Tutor! 

Thanks for reading this article/post,

Dr. Harish Malik