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USMLE Test-Taking Strategies Part 1: Archetyping

Picture this: two students are preparing for Step 1. One decides to only memorize First Aid from cover to cover, while the other student just uses UWorld. In this thought experiment, which student will do better on Step 1?

Undoubtedly, the student who simulates the test as it’s supposed to be  i.e. the one doing UWorld will be more successful. Obviously this is purely hypothetical, as the perfect combination is a balance between studying material and applying it in question form, but it’s important to appreciate the value that question banks offer during a student’s preparation.

The USMLE has some of the best question writers out there, people whose sole job is to construct complex passages that assess the competence not only of extremely intelligent people, but of future doctors. Looking at the exam through this lens, you can appreciate that USMLE question writers highly reward critical thinking and a methodical approach to unfamiliar problems, instead of simply rewarding how much one can memorize obscure information. Following that reasoning, students who score 240+ on board exams don’t necessarily possess more information; rather, they are more apt at applying their knowledge by mastering test-taking strategy. Yet no one is born a good test-taker. It takes diligent practice to train to that level.

In a series beginning with this post, I’ll combine evidence-based practice with personal experience to highlight the most important elements of test-taking, as well as how to implement them so you’re as prepared as possible to crush your exam. This article will focus on using archetypes to effectively classify pathologies.

For example, take this question:

A 24-year-old white female comes in complaining of blurry vision and weakness in her right arm for three days. She previously has experienced left leg sensory loss six months ago. The cell type affected predominantly in this disorder mainly consists of _____?

From this data, you have all of the information you need to diagnose this patient with multiple sclerosis. How did I know that from such a short stem when most are two to three times longer? Simple: I have an archetype for MS.

1: Make archetypes

An archetype, for the purposes of test-taking, is a detailed example or mental image you can use as shorthand to reach answers more quickly. To make one for MS, imagine a typical patient of the disorder. Do this for as many disorders as you can, factoring in as much information as you can. This includes epidemiology, specific presentations with buzzwords, imaging findings, treatments, etc.

For example, my archetype for MS is a 20-30-year old white female with changing neurological symptoms which also involving the eyes. With this archetype, I’ve captured the high yield information necessary to answer any question about MS:

Epidemiology  A 20-30-year-old, white female with no obvious genetic predominance. This is my go-to person when thinking about autoimmune disorders.

Clinical presentation  Intermittent motor and sensory defects commonly with optic neuritis and internuclear ophthalmoplegia.

Pathology  Since it involves the CNS, there is oligodendrocyte damage furthered by the evidence of cranial nerve problems such as vision loss, which is specific for MS.

Diagnosis  Again, with CNS involvement the specific imaging we use is MRI. For MS, the image will show periventricular plaques. Also, to investigate CNS pathologies, you can do a lumbar puncture looking for elevated IgG in the CSF (think autoimmune).

Treatment Since it’s an autoimmune mediated pathology, specific immune modulators such as steroids are required. Because of its continued progression, you’ll need to treat the symptoms too.

2: Apply your archetypes

Compare the evidence in the question with your archetypes using the most likely differential diagnoses, then stick with the one that has the most evidence towards it. In this case, we can compare MS, Guillian-Barre, Cerebrovascular accidents, and Myasthenia Gravis. Having a well-formed archetype for each to compare to the data given in the stem makes it easy to select the correct diagnosis.

3: Modify your archetypes

Throughout your studies, continue to change your archetypes to better differentiate them from each other. Be sure to note the differences between closely related pathologies. For example, you can use similar archetypes for polymyositis and dermatomyositis, but the key difference is that dermatomyositis involves the skin. This relatively simple distinction is a pattern that can be found when comparing multiple similar pathologies, and your job is to highlight that contrast when applying them to question stems.

I hope you leave this post understanding how valuable archetypes can be. Using them will allow you to compartmentalize information more efficiently and aid your recall when presented with scenarios like the one above during your actual exam. Stay tuned for the next post in my series, and of course, happy studying!