Longtime readers know that I don’t do ads, guest posts, or push products. I do however share a coupon or referral code or two for something people might actually want if it results in someone saving money (and not just me making a few bucks).

Which brings us to SmashUSMLE. The bottom line is that if you’re interested, the coupon code BW10 saves you 10%.

I don’t think most people need to be interested at this point.

While SmashUSMLE has Step 1 and Step 2 CK qbanks, it’s essentially billed as a curriculum-replacement tool with hundreds of hours of video lectures. It’s got all the trappings: It has the FRED qbank software. It has accelerated video playback options. It has a phone app.

It’s competing with pricey options like DIT and Kaplan. And while it’s cheaper than both of those, it still costs a fortune ($395 for 1 month, $795 for 3 months). There is a 15-day free trial, however, so if you were planning on doing an expensive course, you wouldn’t lose anything by trying. 15 days is actually a really generous trial; you could get a lot of value for free if you remember to cancel it if you don’t think it’s worth the dough. The solo qbank product option is cheap ($59.99 for a month), but the competition on that front is really stiff.

From my brief review sampling, the qbank lacks polish. Questions use the clinical vignette format but do not ape the USMLE house-style particularly well. A UWorld replacement it’s not.

As for the videos, I would never ever personally be interested in buying a video course, so my intrinsic bias probably precludes a fair assessment. Like DIT, they follow First Aid. The style is pure casual whiteboard—like a friend trying to teach you in a room in the back of the library—which I imagine is nice and approachable for students feeling overwhelmed. But, again, these felt a bit on the unpolished side of the spectrum. I’m not sure I could imagine spending the 100+ hours it would take to watch them all even at 2x speed. The free sample online is representative, so you can make your own decisions.



Renewed ExamGuru Code

ExamGuru, the original qbank dedicated to the shelf exams, has just released a new emergency medicine product (currently clocking in at 302 questions). So EG now covers all the core shelf exams + EM (but not, say, neurology), and you can still buy the same total package organized for Step 2 CK (2600+ questions) for dedicated prep. While there have always been plenty of resources for most shelf exams, family medicine and non-core rotations can sometimes be a bit harder to approach. Peds, for example, was also little thin on UW (at least back in my day).

Everyone still needs UW as far as I’m concerned. But for those who enjoy question-based learning and need more review, EG remains a viable adjunct. Code BW15 takes 15% off your purchase, as well as earns me a few bucks.


Medscape resident survey, embarrassingly interpreted, again

Medscape’s newest resident compensations survey is out and discussed in “Most Residents Say They Deserve Big Raise, Survey Shows.”

The main thrust is fine, discussing that today’s residents feel more underpaid than generations past, which is no surprise given the proliferation of mid-levels who work alongside them making considerably more (and likely combined with the envy caused by their better-off friends parading happily on social media [when #YOLO, #FOMO can be devastating]).

But then this:

Resident salaries in 2017 vary considerably by specialty. Trainees in hematology lead the pack, at $69,000, while family medicine residents bring up the rear, at $54,000.

The gender gap in resident pay is negligible. Men averaged $57,400 or 1.2% more than women, who received $56,700.

Ugh. Who writes up these Medscape survey articles? I even wrote about the same misleading fake resident gender pay gap back in 2014.

To summarize:

All trainee salaries are based on PGY year and location. There are absolutely no differences between specialties or genders of trainees of the same seniority. Any differences are related to the differing duration of training between specialties as well as the geographic spread of the relatively small sample.

Ultimately, any attempt to differentiate annual salaries by specialty is intrinsically misleading. Any differences that can be created between genders or specialties are simply reflective of different numbers of respondents at different levels of seniority within the PGY scale. The difference between a family practice resident and a “hematology resident” is that almost every family medicine resident finishes in three years while any hematology fellow will be at least a PGY4 or higher. The fact that hematology “led the pack” and not—let’s say—cardiology or gastroenterology just means of the respondents of the survey, slightly more senior hematology fellows answered compared to their other IM-fellowship peers.

There is a real gender wage gap in medicine, but it does not apply to residency. As I discussed almost exactly three years ago, any differences in gender pay during training are related to the known disparities in gender representation among certain fields, particularly surgical specialties (which have longer training lengths and thus get “paid more”). Now, if we want to talk about the “gender surgeon gap,” that would be a different and worthy story. Because there are fields in which women are underrepresented—that’s the story when it comes to residency. Not a misinterpretation of the statistics.

This sort of willfully misleading interpretation has no place on a website that caters to physicians. Medscape should know better. And, reading some of the comments suggests that some readers (primarily the nonphysicians) do latch on to these “differences” despite simply being a distraction from the real issues at play.

Explanations for the 2017-2018 Official Step 2 CK Practice Questions

The updated 2017-18 official “USMLE Step 2 CK Sample Test Questions” PDF, released in May and available here.

The PDF set is completely unchanged from last year. You can read the complete explanations for last year’s set here.


As for the updated multimedia questions found only in the online version:

Block 1

7. A – Classic Moro reflex, entirely expected and normal until it disappears around age 4 months. If you have never seen a newborn before, also note that the mom is concerned about delayed milestones at two weeks of age, which is a red flag for BS: babies aren’t even smiling socially yet by two weeks.

Block 2

3. D – Pill-rolling resting tremor of Parkinson’s disease secondary to loss of dopamine neurons in the substantia nigra.

18. A – I’m going to point out that a normal healthy kid with no cardiac history or symptoms and no family history of sudden cardiac death for a pre-sports physical is probably going to have a benign exam no matter what you think you hear. HOCM is what you want to exclude theoretically, but here we don’t have a real systolic murmur, just a little vibratory flow murmur at LLSB.

33. E – This one is a bit silly. The lung exam is normal outside of the super common basilar crackles. Everything except for PE you would expect to hear a more impressive auscultation abnormality. But for this question: B and C take longer than 3 days. D we would expect fever, productive cough etc. Bronchitis would be possible, but still more often to have at least productive cough if not fever. PE, on the other hand, classically has a nonproductive cough, hypoxemia, and tachycardia. All three are present. And then they mention her med: OCPs, which are an important predisposing factor for PE in young women for whom it is otherwise a rare entity. Young lady on OCPs is a classic set-up for an STD question (who needs condoms?) or a PE question, one of the two.

Block 3

12.1 D – Statistical significance (a low p-value) does not equal clinical significance. A favorite teaching point when it comes to interpreting literature.

12.2 C –A & D are conjectures: the kind of statements people drop inappropriately in the conclusion of a weak paper to make it sound important. E is an exclusion criterion. B is the opposite: including 0 is equivalent to something not being significantly different.

Your ERAS application photo

You may not have thought about it, but a lot of people are going to be looking at your glamour shot. The program director and any application reader will see it before you’re chosen for an interview.

  • Your interviewers will see it.
  • It’ll probably make it into a big interview day composite along everyone else visiting that day.
  • The residency selection committee will usually blow it up and put it up on the big screen when they discuss you.

So, for better or worse, people are basically going to see it whenever they think about you. While the people who meet you may form additional images, not everyone who has a role in your selection is going to meet you in person.

Once you land a residency, the photo will almost certainly make more appearances in the “meet our new interns” flyer, get plastered around the department, and may even be accessible online. Rarely, it could even be on your badge.

This is all to say, it might as well not be a terrible photo.

And, like your personal statement, it’s also probably best for you to not stand out.

Not that you can’t be incredibly good looking, of course, but rather that the format of your photo should be the usual bland applicant kind where you’re wearing something you’d wear to the interview while sitting angled slightly in front of a miscellaneous grayish or bluish pseudo-cloud background. Please don’t wear your white coat; you’ll look like a tool.

Stands out in a bad way? How about in front of a random white wall in your apartment under harsh lighting taken by your roommate with your phone where you’re too far away like a B-grade passport photo. The instagram-worthy pic of you in a park with your hair in the breeze and a beautiful bokeh background—while better to look at—also doesn’t scream, “I will answer pages promptly at 3 am and like it.”

Just google something like “residency photo ERAS” and see which examples spark joy for you.

Every interview day we’ll get a big pdf emailed to all the residents and faculty with a composite of everyone who’s visiting. Inevitably, there will be one person who stands out with a blurry poorly lit photo. Does it really matter? I very much doubt it (unless it dovetails with other more serious mistakes/poor judgment calls), but I can’t think of any meaningful benefit to choosing this moment to pinch pennies.

If you have the option of paying an extra 20 or 30 bucks to have the photo professionally retouched, frankly, I encourage you to do so. While this is an irritating expense, again, this photo is used everywhere. Even if you do have it retouched, I still recommend taking steps personally to improve it if you have the skills and desire. Photoshop, its free alternative GIMP, or one of the many free or paid photo retouching apps (including the very nice and very free Adobe Photoshop Fix for iOS) will all do the trick to remove stray hairs, razor burn, leftover blemishes or even whiten teeth. In other words, you want to take reasonable steps to ensure that the photo is a good one.

And, of course, #NoFilter.