Despite the rave reviews from family, friends, and readers on Amazon, I thought David Larson’s Medical School 2.0: An Unconventional Guide to Learn Faster, Ace the USMLE, and Get into Your Top Choice Residency overall falls prey to the common trap of the self-help genre: overpromise and underdeliver.

It’s unapologetically the approach to medical school as if written by Tim Ferriss (of the 4-Hour Workweek fame), which is fine I suppose, but therefore it harkens from the same spiritual family of life hackers that purport to teach you how to make six figures while banging the best-looking people in every city as you travel the world with two pairs of pants and some merino wool socks in a small Tom Bihn backpack. Even though the content is usually fine, the constant hyper-selling (you too can be like me!) sort of makes your eyeballs feel cheap.

On the whole, the book is clearly self-published. The first 13% is all introductory fluff. Larson repeatedly and irritatingly uses ALL CAPS to signify emphasis. There are a lot of grammatical, typographic, and miscellaneous errors (e.g. using “deep-seeded” instead of “deep-seated,” using “I.E.” when he meant “E.G.,” “your” vs. “you’re” etc). But most of all, it just needs an editor. It’s too long and fluffy. It plays the typical self-help book game of giving you a few pages of information with ten times more verbiage in an attempt to convince you of how great and revolutionary the plan is and how it will benefit you.

Much of the self-help/life-hacking genre is a silly follow the leader game, whereby an individual makes money by trying to sell their success methods to other people (a fraction of which then try to do the same). The real problem is that while success may be sexy, achieving it almost never is. Anyone who purports to teach you the secret to achieving your dreams is mostly selling snake oil (or a book or a pricey online e-course). The good thing is that many of these books, this particular book included, actually have reasonable advice buried beneath the hype. It’s not earth-shattering, but it is solid. The bottom line is something I used to tell my students all the time: You can’t learn everything. No matter what, you will have to pick and choose what to learn, and it might as will be the stuff that matters. Limit your resources. Don’t let your overachieving peers drag you down. If it’s not high yield for step one and you don’t otherwise know that it’s going to be on your unit exams, then you probably don’t need to know it. How Larson thinks you should study finally makes an appearance at the 48% mark (hint: it’s flashcards and spaced repetition, such as many students do with Anki). In catchphrase parlance, that’s “study smarter, not harder.”

So, other than discussing how to study, the book includes exactly 0% of the other parts of medical school: any real specifics about study resources, what to do with the summer after first year, anything specific to the boards, anything about clerkships, anything about applying for residency, etc etc. This is just about how to study, which means in many ways it’s not really about medical school at all. If you want to know about medical school itself, you’ll have to look elsewhere.

There’s also a bunch nutritional pseudoscience and wellness stuff, which is +/-. Maybe I’m too cynical.

If you need someone to help you orient your mindset as you begin medical school, then this book will do the trick. The study methods are fine. Although, while the “typical” med student Larson refers to does exist (the “gunner”), it’s a bit of a straw man to compare his method against. Most people I knew in med school where nothing like what he describes.

All that griping aside, I do think Larson genuinely thinks medical students are making themselves miserable and is trying to offer his perspective of a reasonable approach to prevent throwing four years of your life away, and for that, I do applaud him. The mindset aspect of the book may very well be the most helpful thing about it.

Overall: If you want an in-depth discussion of how to stay sane making flashcards, go for it.

Newly minted orthopod Daniel Paull MD’s So You Got Into Medical School….Now What? came out last year. The book attempts to be a one-stop shop of medical school advice with a big focus on how to study. I bet the idea of a detailed how-to guide for medical school seems compelling to a lot of people (particularly the anxious type A variety), but I find it odd how specific authors and various internet people attempt to be for study advice given how variable the coursework and grading are for the basic sciences nationwide.

Chapter 1 (“Conceptual Learning and Detail Worrying”) is 7% of the book, extremely dry, and could be summarized by saying medical school is hard, there is a lot of information to learn, and given that, you should try to really understand material and not cram. I’d argue that the argument that studying over time leads to better long-term retention over cramming requires no argument at all. It’s self-evident. Even people who cram (and I’m one of them) know that it is a test taking strategy of procrastination/weakness and not a good method for truly learning the material or preventing self-hatred and sabotage.

Paull also advocates strongly for reviewing the material before lecture. Conversely, many students would argue that avoiding lectures altogether when possible is a more time-efficient solution. His discussion of anatomy is pretty old school without any discussion of how anatomy instruction has changed at many institutions around the country (with many schools placing a greater emphasis on prosections, virtual dissections, etc instead of lots and lots of hours in the lab).

I did really like one bit of counterintuitive advice: keeping a study schedule can help you prevent the feeling that you should always be studying more. The schedule as a means to say “you’ve done enough” sounds like a great idea! Everyone needs balance.1This would be for the “gunner” – I would have needed a schedule to actually study and not mess around on the internet.

When it comes to specific test advice like Step 1, he again focuses on the idea of the magical schedule (without supplying an example himself). He doesn’t mention anything specific about book recommendations, question banks, or any recommendations on how to structure your review. I wonder if he avoids mentioning any books by name so that his book doesn’t become outdated? Either way, all the conceptual writing about studying then falls short without any specific advice when it might count. Paull falls prey to thinking his own specific experiences and school set-up are totally generalizable (because they’re not). His take:

Review books and question banks are equally important in preparing for the Step 1, and just about every study schedule will dictate the use of both.

Again, the best approach is to ask upperclass students which materials they found most helpful. Usually you’ll get a consensus on this.

Which is a huge cop-out! You’re the upper classman in this context! People are reading the book because they want your thoughts! If there is really a “consensus,” then give it. You ask enough people, especially completionists, and you won’t get a consensus. In reality, ask enough people and you’ll eventually get a list of more good/reasonable resources than you can handle. (I’d also personally argue that the question banks are generally more important than books in preparing for Step 1, but that’s just my take.)

Regarding shelf exams:

Another mistake students make is not reading the books they select in their entirety; too often students rely entirely on practice questions. Despite their usefulness, practice questions often do not cover all the necessary details of a topic and are designed simply to test the base of knowledge you will gain from books.

Agree that you need to read the entire book, but I’ve never met anyone who really relied too much on practice questions; I have however met a lot of people who haven’t done enough.

Regarding clerkship evaluations:

The subjective component can comprise up to 50 percent of your clerkship grade.

Up to but not more than? Really? 50% of your grade from evaluations is the maximum cut off nationwide?

Regarding Step 2 CK:

In fact, most medical schools simply require students to take this test before graduation.
On average, students study for two to three weeks for the Step 2 CK
Second, find someone who did well on the Step 2 CK and ask how that person studied.

The appeal to authority fallacy is really a terrible way to live your life. Many (most? who knows?) schools require Step 2 CK long before graduation, and more importantly, a growing number of programs require passage before ranking.

Regarding Step 2 CS:

Most nonnative English speakers will have a more-than-sufficient clinical skill set to pass those aspects of the test, but the spoken English proficiency section can be a challenge.

The data don’t necessarily demonstrate that. Spoken English Proficiency (SEP) is the least likely cause of failure in all groups (US and IMG). International students (which doesn’t distinguish between native and non-native English speakers) fail ICE > CIS > SEP, the same order as US students. I wrote about this here (with actual data).

Regarding The Match:

A personal statement won’t make or break your application.

A great personal statement can only “make” an application in extreme circumstances, but truly terrible personal statements absolutely can and do break applications.

Either way, if an institution doesn’t have a majority of residency positions filled by people who rotated there (this includes students from the program’s home institution), consider that a bad sign.

This is highly field-dependent. Small surgical subspecialities like Ortho and Urology differ greatly from typically larger residencies like Medicine or even Radiology.

Anyway, you get the idea.

Ultimately, the book falls prey to the obvious limitation: Paull is a single author who hasn’t made a huge effort to see how his medical school experience might differ from other students across the country.2It’d actually be really hard to do that well; I don’t fault him a bit for this. The real fault is in not anticipating which parts of your personal experience may or may not be broadly generalizable. The general advice is reasonable but not mandatable. Study hard but not too hard, over time instead of overtime. The specific advice is occasionally way too narrow,. and of course, the whole thing is mostly common sense. That’s the nature of these things.

Overall: If it would make you feel better to have a solid road-map of medical school to keep you grounded, give it a spin (especially if you have a free trial or subscription to Kindle Unlimited, making it free to read). I know that during med school I was always wanting to know more about what happened next and felt that the class meeting that discussed it was inevitably further away than I wanted. If you want specific advice though, you’ll still have to (and should) look elsewhere.

Updated 5/16/2016 to reflect new prices, new discount code, and some additional changes. Updated since then to reflect new discount codes. 

ExamGuru is the brand new and currently only question bank geared specifically for the third year NBME shelf exams. While the product itself is new, the company is not: it’s a new brand of the COMQUEST family, one of the two big players in the osteopathic question bank market (for the COMLEX exams, which are analogous to the USMLEs). It was released to the general public this week, but I had early access in order to write this review. I was also able to secure a discount for readers, so if you sign up using the code BWBW2022 , you’ll get 15% off whatever package you get, and I’ll get a few bucks.

Before we get started with the actual review, full disclosure: I wrote a small number of questions for this question bank as a freelancer several years ago. These were sold on a per-question basis; they are no longer my intellectual property, and I have no financial stake in the company or its success outside of the time-limited coupon above.

Size and Cost

The ExamGuru question bank is divided into separate shelf exam products, each with a goodly number of questions (as of the time of this post): family medicine (375), internal medicine (412), ob/gyn (369), pediatrics (406), psychiatry (395), and surgery (399). Each question comes with the detailed explanations we’ve come to expect from medical school question banks: 1) Concept/question explanation 2) Detailed answer choice explanations, including explanations of the incorrect options, and 3) Take home point.

You can buy a subscription for a single shelf product at a time: 1 month for $49 $37 and 3 months for $99 $79. Alternatively, you can buy all six products for a length of time ($129 for 1 month up to $379 for the year). Given that buying a month of each product would add up to almost $300, it would seem that the product is priced to encourage you to either buy a few products for a month each or just shell out for the whole year, which would allow you to the use the bank both as a shelf study resource and as an alternative/secondary Step 2 CK qbank.

Software

The website imitates the FRED software you’re intimately familiar with (and also has an option to change the layout to the one used on Osteopathic examinations for DO students). Everything is accessed via the website itself (no downloads or creepy UW spying/tracking), and the site is responsive: it works appropriately on your computer or your smartphone.

Peer percentage correct for each question is provided a la other competitors. Questions are also rated by difficulty, though I’m not sure how this was calculated; oddly, it seemed like most of questions I did were graded as “hard” in their software. I wasn’t sure if this was simply chance or reflects how they’ve self-graded the difficulty and the relative proportions of each within the qbank. Additionally, EG does provide good actionable data about your performance, including a breakdown by question task (establishing a diagnosis, management, etc), which may be a nice way to pick apart areas of weakness you didn’t know you had. If you’re getting the diagnosis questions but missing the management ones, then presumably it’s time to focus on the “next best step” and drugs of choice.

Question Quality

The question quality is good for its first iteration, but it’s not yet at the UW level of polish. This isn’t surprising: I remember using USMLERx back when it was a newer product, and it was awful and a total waste of time and money. The EG house style in particular a bit spotty and could use more homogenization: Multiple question writers and their particular quirks remain surfaced, and occasional aspects, particularly when it comes to the final stem and answer choices, sometimes stray a bit from what you’d actually see on game day. Buzzwords are over-employed and are even sometimes “in quotation marks” whereas nowadays these terms are more likely to described rather than simply called out. Explanations range from relatively short to long & fluffy, sometimes casual “Don’t forget XYZ on test day” and sometimes stiff.

Topics and narratives are fine overall, but some of the questions slipped through without matching the official question writing guide (which I’ve discussed before). A random example: a question about cirrhosis with blatant over the top SBP contained unbalanced answer choices (1 antibiotic choice versus multiple diuretics). That’s probably too easy and not reflective of the standards. I’d argue the question should have been a bunch of antibiotics asking you to know which type is used to treat SBP, or an even combination of both. One answer choice that stands out from the list is to be avoided. On the flip side, the family medicine section has some really great rash/skin questions, which are high yield and not well represented elsewhere.

EG also still needs a copy editor. Shelf questions are often long but almost never because of fluffy prose (only extraneous details!), and comma errors remain (inappropriate comma use before a coordinating conjunction used in a phrase will always be my pet peeve). Again, not necessarily substantive criticism but certainly one that signifies a lack of polish in its first iteration. The material is there, but these little differences do detract a little from question experience, which otherwise is well designed to approximate the real deal. As above, the software is solid.

Update: The EG CEO informs me that they brought on a copy-editor to deal the issues I raised in this review. He also tells me they’ve updated a lot of questions from user feedback. I haven’t personally taken a look again, but if nothing else, most question-banks generally get better over time, not worse.

On the whole, these are mostly nitpicks. But to me, the level of polish of a product is really important if you’re going to spend a lot of time with it. Errors and inconsistently can detract from the experience and distract from your education. 2If you harp on that kind of stuff like I do. That said, ExamGuru is probably one of the best things to come around for the Shelf exams for a while and breathes some new life into the static review lineup. The mistakes I found during my review were nearly all ones of style, consistency, and grammar. These are the things that are easiest to fix gradually. The core content I saw was just fine.

So my overall impression is that this a supplemental product, not a UWorld replacement. While the important topics are covered and the explanations are generally thorough (sometimes a bit lengthy, I’d argue), the overall quality is not yet up to the consistent quality of UW. The main benefit of EG is that it adds some meat to the UW bones, which are nearly ideal for Step 2 CK but a bit thin for several shelf exams. UW is still I think a critical component of shelf review, but there’s definitely space for another question source. And on the whole, I think ExamGuru is a better question source than the usual alternatives (e.g. PreTest) in terms of depth, ease of use, powers of software, etc. I’d much rather do dedicated shelf questions in a simulated USMLE environment on my computer or phone (yes, EG is mobile-enabled) than thumbing through a book or shelling out for another Step 2 qbank.

Conclusion

So should someone use or buy this product? Depends. If I were a third year again, I would for family (maybe peds and ob/gyn as well). Certainly not internal medicine, UW had plenty of that for me to chug through. Ultimately, as readers of this site are well aware, I believe strongly in doing questions, even as a core study method. UW just doesn’t have a very satisfying number of questions for several of the shelf exams (it’s well-pruned for Step 2 CK). Financially, it either makes sense to buy 1-3 of the shelves for the one-month period to use during a dedicated review push or, if you want more, just get the whole set for the year (ouch). I don’t think the quality or consistency is at the UW level but it’s a tailored source of questions in a friendly NBME style package that you can use on your computer or on your phone. And that’s a great start.

If you do end up using the EG product, shoot me an email or comment and let me know how it holds up to thorough use.

There’s a new residency guidebook on the scene, Medical School and the Residency Match, and the reviews on Amazon are great. So I’m reviewing it.

This time, instead of being written by a residency consultant (like this or this), the book is written by a group of post-match medical students. As such, it’s a refreshingly honest take and not full of the usual spiels. On one hand, books written by program directors (this is probably the best) may be more authoritative, but they are sometimes over the top and not relatable or easily actionable. For one, what people say they want and what they actually want aren’t necessarily the same thing. Secondly, there isn’t a single path to success. Sometimes it’s nice to be reminded that people like you have been doing just fine, thank you. (more…)