02(04): Take learning in medical school to the next level with AMBOSS

In this post, I will be introducing the question bank of AMBOSS. Before diving straight into that, I think it helps to establish some essential background information so that we can at least understand slightly better AMBOSS’s role in medical education today.

My earliest encounter with AMBOSS was probably late in 2018, where I chanced upon a few advertisements on AMBOSS on my Facebook News Feed. At the time, I was quite curious because I had not heard of it. An introduction of AMBOSS’s global expansion beyond the borders of Germany in relatively recent times would be incomplete without introducing the USMLE and why it is a significant issue of most discussions regarding medical school online (hint: a lot of content on the Internet focuses on issues pertaining to the US).

Back then, I was only familiar with UWorld, Rx, and Kaplan’s Qbank. These three question banks were and still remain pretty well-known among the medical student community online for allowing students to consolidate preclinical knowledge (apply their knowledge to solve questions which often require multiple orders of thinking). Many online resources for medical school focus on preparation for the USMLE, a series of high-stakes examinations which dictate whether and how exam candidates can practise medicine in the US.

For those unfamiliar, the USMLE consists of a series of “step” exams: Step 1 (preclinical knowledge), Step 2 CK (clinical knowledge), Step 2 CS (clinical skills), and Step 3. With these high-stakes examinations that are mandatory in order to be licensed to practise medicine in the US, an entire “Step-prep” industry spawned over the years to cater to the needs of students who wish to prepare for these exams. In addition to the three question banks i have listed, there are comprehensive and highly innovative video resources such as Dr Jason Ryan’s Boards and Beyond, Dr Hussain Sattar’s Pathoma, SketchyMedical (SketchyMicro, SketchyPharm, SketchyPath), Physeo, Pixorize, and Dr Najeeb Lectures.

Anki (Japanese for ‘memorize’), an open-source flashcard platform which originally catered to learners of the Japanese language, has also become highly popular in recent times for medical students around the world. In fact, an entire subreddit “r/medicalschoolanki” even emerged. Students on that platform share premade medical school decks (eg Zanki, LY, Duke, and Dope) based on various resources (including the ones I have listed and more).

If you are reading this post, and do not intend to take the USMLE, you might be thinking: “What has this got to do with me? How will these resources even be relevant to what my medical school requires of me?”

Fret not. The good thing about medicine is that the curriculum is roughly the same wherever you learn it in the world. I think medical students nowadays are very blessed. Although the three question banks and various resources I have listed above have largely been designed to help students prepare for the USMLE (particularly the USMLE step 1), I would argue that the required content knowledge for the USMLE Step 1 has a pretty substantial overlap with preclinical curriculum in medical schools all around the world to the extent that even students who do not intend to sit the USMLE can benefit immensely from using USMLE-prep resources in their medical studies.

NB: I am putting a focus on preclinical knowledge because that is largely what I am involved in right now. All of what I say is also largely applicable to clinical knowledge and skills as AMBOSS and many question banks also have questions regarding those.

In my experience, USMLE-step prep requires not just breadth, but also depth. I think that the nature of USMLE-step prep resources will allow you to understand medicine at a greater depth than what is required by many medical schools. While some may think that deeper knowledge is just a waste of time and has little clinical relevance, I would argue that it can allow you to understand many concepts more fundamentally. This can enable you to explain why certain things are the way there are, while your peers may be unable to.

Now that I have established some context regarding the USMLE, I will now talk about how medical students can use AMBOSS to take their learning to the next level. AMBOSS has entered the Step-prep market recently (previously, it was only largely used by medical students in Germany; it has since expanded worldwide), positioning itself as a highly competitive alternative to the other question banks/resources that have been in the Step-prep industry for a longer period of time. It is becoming more popular with each passing day with its far-reaching promotional efforts. If you were to visit its website at amboss.com, you would be greeted with this:

AMBOSS prides itself as ushering in a “new era of medical education”, That’s sounds like a pretty bold claim, doesn’t it? Well, I think they are fairly justified to say that though. In recent years, AMBOSS has been expanding rapidly. More students and clinicians have begun to see the utility of AMBOSS. It has a nice ecosystem which reminds me of how Apple also its own ecosystem for its products. Most notably, AMBOSS has its renowned question bank, AMBOSS library, and its AMBOSS addon. As I have mentioned earlier, I will proceed to talk about these aspects of AMBOSS in separate posts. In this post, I will focus on the AMBOSS Qbank. Here is a video I would highly recommend to get a broad overview of AMBOSS:

Introducing: AMBOSS Question bank

Although the video that I have embedded above is nine months old, I think that it is still largely relevant. When you first login to AMBOSS, you will be greeted with a sleek interface:

The sidebar allows you a variety of options: from creating a study plan, to studying from the AMBOSS library, and setting up a question session. You can also opt to review past question sessions. In particular for the question bank, it is rather customizable. When you click “Qbank” on the left sidebar, you are taken to this page:

You can essentially tailor the question bank to your specific needs. The slider at the bottom allows you to choose how many questions you wish to do for your created question session. You can filter the question selection by system (eg cardiovascular, endocrine, reproductive, nervous system), by discipline (eg biochemistry, embryology, reproductive), by symptoms, by learning cards (which demonstrates the integration between the AMBOSS Qbank and its learning library).

You can also filter questions by difficulty (ranging from 1 ‘hammer’ questions to 5 ‘hammer’ questions). The more ‘hammers’ a particular question is tagged with, the more difficult the question is deemed (probably judged by the percentage of people who chose the correct answer, and the overall option selection distribution).

Most importantly, you are able to filter questions by status (include/exclude unseen questions, incorrect questions, correct questions, and questions answered correctly with “Attending Tip”). Such incredible flexibility allows your specific needs to be met! Let’s move on to the interface once you have begun a Qbank session.

Study mode means that you are presented with this interface during the Qbank session:

Clicking Key Info would automatically highlight relevant information in the question stem. Clicking Labs would allow standard lab values to pop up on the right, which you can consult while attempting questions. Clicking Attending Tip gives a hint, which makes you more likely to arrive at the correct answer.

After clicking on an answer, you would automatically be told whether you got it correct or wrong since this is Study Mode. Note that in Exam mode, this feature is absent. This is what it looks like after selecting an option for the above question in Study mode:

I think this question is great because it requires the student to possess strong fundamentals in biochemistry regarding how mRNA interacts tRNA in the context of protein translation. To solve this question, one needs to know the sequence for methionine’s mRNA codon (i.e. AUG) and stop codons (UGA, UAA, UAG). What medical students can use to learn what the stop codons are is the following:

U Go Away, U Are Away, U Are Gone.

Logical reasoning is required. The kind of question cannot be tackled by just memorizing one’s way through. This demands critical thinking: something that I think all patients expect their doctors to be able to engage in. In my opinion, it is these questions that truly make AMBOSS shine as a QBank, and provide abundant learning opportunity for medical students. It doesn’t take long to find out that AMBOSS’s question bank is arguably the most challenging of the question banks.

I have done nearly 1k questions on AMBOSS and what I can tell you is that for many questions, you have to really understand how something works to get full credit for the question. Both factual recall and critical reasoning are necessary. Sure, some of the questions can be quite picky but that’s how some tough questions are. For this reason, I have personally found AMBOSS quite challenging, more challenging than other question bank I have attempted. Don’t expect questions in AMBOSS to explicitly and frequently mention buzzwords such as “Auer rods” or “hair-like projections” in the context of AML or hairy cell leukemia respectively. Expect instead creative phrasing such as perhaps “large crystalline cytoplasmic inclusion bodies” or “radial cytoplasmic projections”.

Note that clicking on the underlined words within the explanation would cause a popup of the relevant learning card in the AMBOSS library, allowing you to see both the question and the library on the same screen simultaneously. Here is the new view after clicking the underlined ‘tRNA in the explanation for option C:

On a lighter note, I was joking with a friend and I told him how I thought this question would have even be more brutal (maybe even a 6 ‘hammer’ question if such a classification existed) if the answer options presented with just letters and without the 3′ and 5′ markers (because by convention the 5′ end is on the left). As you might have guessed based on the answer statistics, this was a pretty tough question. Only 29% selected the correct answer. Not the worst I have seen though. I think I saw one AMBOSS question with only 18% correct. Really tough. It just makes the success sweeter when you know that a question you get correct was quite tough. On the other hand, if you get such questions wrong, you can take comfort in the fact that many people also got it wrong.

Takeaway: Treat every question as a learning opportunity and do not get discouraged if you get questions wrong.

This following question is an example of that. I incorrectly chose option E but the correct answer was option B!

Well, that is what I have for this post. I hope you have found it useful. AMBOSS offers a 5-day free trial, which you can make use of to test the waters without any financial commitment. There are also many useful videos on YouTube which you can view to learn more about AMBOSS. Please do not hesitate to contact me should you wish to find out more about AMBOSS or need any help.

5 May 2020

I am ethically obliged to divulge that I am affiliated with AMBOSS GmBH, and that I am compensated for my role as a representative and promoter for AMBOSS. Nevertheless, I decided to become a part of its AMBOSSador programme because I have genuinely found it helpful for my learning. I had used AMBOSS a fair bit before deciding to join its student ambassador programme.

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