Wiki Doc Board Review Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gonzalo Romero, M.D.[2]

Overview

Steps to Build a Question Stem

1. Read and understand the tested material to grasp the basic principles, diagnosis, management and therapeutics according to the BOARD level.

2. Be familiar with the format, content and high Yield material frequently asked. Try to take many exams through the NBME website [[[3]]], the actual exam and other Qbanks. Respect Copy Rights sources.

3. Pick a specific content

4. Use the WBR Checklist

5. Use Wiki Doc to obtain information,links, pictures, videos, and promote their use on the explanations.

Goal of Building a Good Question Stem

The goal of building these questions is to recreate a Board Scenario that serves both to:

Develop test-taking strategies by managing time correctly
Test high yield knowledge in a typical Board presentation

Do Not Give Away the Answer

Avoid using proper or specific signs. Describe signs and symptoms in simple terms to give the hints without giving away the answer. Example: “marfanoid” use instead: long extremities, skinny, tall. Do not ask negatively like which one is incorrect, not correct, false.

Stems Length

Long stems: are extremely helpful! They create challenge for the test taker who has to read quickly, yet carefully to pick up the important info.
Short and moderate stems: test specific facts. It is useful to add pictures/videos/sounds/tables/graph.

Multi-step Questions

Test the process, not the content including 2 ot 3 Step questions.

Process

Symptoms or clinical presentation
Physical exam findings
Laboratory findings
Diagnosis
Treatment of Choice
Mechanism of action of treatment of choice
Most common adverse effect

Example

Micro questions require the reader to make a diagnosis, know the correct drug and then the mechanism of action of the drug (3 steps). An equally difficult but less elegant question would ask what HLA-subtype is associated with some rare rheumatological disease.

Sequential Item Questions

The format remains the same as above, but it tests two or three different concepts on separate questions having the same clinical vignette.

Matching Sets

The question begins with answer options followed by multiple questions. The answers to these questions are in the options at the beginning.

Answer Explanations

Overall explanation

Connect all the puzzle pieces. Explain the pertinent positive findings (symptoms, signs) as a clinician, not just list the topic. (i.e. the patient has … which is a typical presentation of…). Also explain the negative pertinent. Justify why that choice is correct. Only ONE answer is the best or most appropriate one

Answer choice explanation

Include concise, yet thorough explanation providing a high yield chunk of info.
Concisely explain the right answer.
Add info missing on the overall explanation to the right answer choice and explain the wrong choices and why they are not correct.
Explain the wrong choices

Educational objective

Include short high yield fact at the end of the explanation (1 or 2 take-home sentences/phrases)

Internal Resources and References

Use the Wikidoc.org content
Promote Wikidoc use inserting internal links into the explanations

External Resources and References

Mention external sources used only if necessary Respect Copy Rights

Books

First Aid latest edition for STEP 1

-For Step 1: updated yearly by students who aced the exam -For Step 2CK: updated biyearly

Master The Boards for Step 2CK and Step3
Med-Essentials For Step1
Kaplan Review Series
Falcon Review Series

Websites

www.usmle-forums.com recent test takers give feedback about their experience and commonly tested facts. Updated hourly.

USMLE STEP 1 Question Design

Vary the method Test the basic principles using graphs, diagrams, pictures, calculations, clinical scenarios/cases, and multimedia Reuse vignettes and ask in a different way Use both long and short vignettes

USMLE STEP 2CK (Clinical Knowledge) Question Design

Follow the most recent Algorithms/Guidelines from the Wiki.
Useful Resources MTB and FA
Include basic STEP 1 questions; 50-60% of the knowledge from STEP 2CK comes from STEP 1
Include Labs
Long stems
Accommodate information within the vignette that will benefit the test taker to identify the proper answer choice
Include extra information that is not necessary leading towards the correct answer
Audio and video questions would be ideal also

Case Scenarios

Age of patient
Sex
Chief complaint
Vitals
Describe the chief complaint
Physical examination findings
Significant past history if any
Laboratory findings
Image or video (if applicable)

Commonly Asked Questions

What is the most likely diagnosis?
What is the most likely cause for this condition?
What is the next best step in management?
What is the best initial treatment?
What is the best treatment for this condition?
What is the best/ most accurate laboratory test to confirm diagnosis?
What is the drug of choice to treat this condition?
What is the most likely physical exam finding? (eg. On auscultation, abdominal examination, etc.)
Which of the following is the most likely underlying mechanism?
What is the most common risk factor for this condition?
What is the most common complication of this condition?
What is the best drug/ drug of choice used to treat this condition?

USMLE STEP 3 Question Design

Testing mainly on management of case, covering the following fields:

Application of Concepts

What is the most likely cause for this condition?
What is the most likely underlying mechanism?
What is the cause of (sign/ physical exam finding)?
Questions related to research studies

History and Physical examination

What is the most likely physical exam finding?
What facts from the past history are important for diagnosis?
What is the most common risk factor for this condition?

Laboratory and Diagnostic Studies

What is the most appropriate/accurate laboratory test to evaluate this patient?
What is the most appropriate laboratory test to evaluate the efficacy of current treatment?
What is the best initial laboratory test to order?
What is the most likely result of this laboratory test seen in this condition?
What is the most likely laboratory finding seen in this condition?

Diagnosis

What is the most likely diagnosis?
Which condition is most commonly associated with ____?

Prognosis

Which of the following factors influences prognosis (good or bad)?
Which of the following is the best/ worst prognostic indicator?
Which of the following laboratory finding indicates best/ worst prognosis?
After follow-up, which of the following is the most common factor that indicates favorable prognosis?
What is the most appropriate counseling advice?
What is the most common complication of this condition?
What is the most likely outcome of this condition?