https://altiustestprep.com/

ii

© 2019 by Altius Test Prep

All Rights Reserved MCAT® is a registered trademark of the Association of American Medical Colleges

iii

You may not share, photocopy, scan, distribute, email, text, upload to a server, upload to the

internet or an intranet, photograph, screen capture, display, or otherwise digitally reproduce or

transmit this information by any means whatsoever, or knowingly allow others to do so. The

entire contents of this work is protected by U.S. and international copyright law. A small number

of images or articles used herein are reproduced under a Creative Commons license. Materials

marked with a Creative Commons citation may be reproduced only if the user distributes the

copy or derivative work under the same terms as the existing Creative Commons license.

AUTHORIZED USE ONLY

Use of this manual and its contents is authorized for Altius students currently enrolled in a

qualifying Altius MCAT program only. Use by any non-Altius student under any circumstance

whatsoever is a violation of Altius’ intellectual property rights.

DIGITAL RIGHTS MANAGEMENT (DRM)

The pdf version of this manual uses DRM technology to track and restrict use. Authorized

student users are granted one year of access from the date the pdf is first opened. The pdf will

become password locked upon expiration. You are pre-authorized to access this pdf from five (5)

different devices. IP addresses and other information may be gathered by our software to

protect our intellectual property rights.

Altius takes violations of its intellectual property rights seriously and will pursue violators to

the fullest extent of applicable law.

By using the Altius Student Study Manual, you agree to abide by these terms.

iv

v

Chapter Page Number

Introduction....................................... vii

SMRM ................................................. 1

CAR 1 ............................................... 49

Psychology 1 ..................................... 87

Physics 1 ......................................... 117

General Chemistry 1 ......................... 151

General Chemistry 2 ......................... 177

Biology 1 ......................................... 199

Biology 2 ......................................... 227

CAR 2 ............................................. 253

Organic Chemistry 1 ......................... 281

Biochemistry 1 ................................. 311

Sociology 1 ...................................... 339

Psychology 2 ................................... 359

Physics 2 ......................................... 385

General Chemistry 3 ......................... 427

CAR 3 ............................................. 451

Biology 3 ......................................... 469

Organic Chemistry 2 ......................... 493

Biochemistry 2 ................................. 523

Sociology 2 ...................................... 549

Psychology 3 ................................... 571

vi

vii

THE ALTIUS MCAT PROGRAM Welcome to the Altius MCAT Program. We could not be more excited to have you join the Altius family. Together, we can do incredible things. We can achieve what others consider “impossible.” In fact, at Altius, we help our clients achieve the “impossible” every. single. day. Do you want to earn a 520+ MCAT score, along with all the life-changing benefits that will accompany it? Have you taken the MCAT before and need to improve by 10, 20, perhaps even 30 points? Are your sights set on an elite medical school to which it is insanely difficult to gain admission? We hope so. Small dreams won’t do. If you think you have signed up for a typical MCAT course designed to prepare you “adequately” for an upcoming exam—you

are mistaken. We don’t do small. We don’t get excited by 507s…and we absolutely, unequivocally, H-A-T-E mediocrity. We are fueled by that addictive feeling of jubilation that can only come when together we accomplish something that is truly G-R-E-A-T. Start dreaming big, plan to work your tail off, and expect to accomplish your goals. That is the Altius way. A word to those of you who may think of yourselves as merely average. You might be reading all this talk about huge goals and massive expectations and thinking to yourself, “I’ve never accomplished anything like that before.” That may be true, perhaps you have not. But that was before; this is now. The key to achieving life-changing outcomes through Altius is humble, disciplined W-O-R-K. You don’t have to figure out how to transform yourself, that’s our job. You just need to be humble enough to trust the process…and disciplined enough to do all the work required of you. You don’t have to have an elite IQ or a private-school education to be humble. None of those things are required to work hard either. That is why anyone can succeed through Altius.

We use a simple, proven formula:

You are the first ingredient. You must do your part. You must come with faith and determination. You must be humble and be willing to work hard. That hard work will require sacrifices, and you must be willing to make them. The second ingredient is science. The Altius system is built upon 100+ years of peer-reviewed research in the fields of neuroscience, memory, and learning. We augment those principles with proven concepts from the behavioral sciences. When you complete an assignment in the Altius program, you will probably recognize only a tiny portion of all that is going on behind the scenes. Each activity takes advantage of multiple scientific principles demonstrated to improve learning and/or performance. Often, these principles build upon one another over time, or interact with other aspects of the program in an intentional manner, creating a powerful additive form of educational inertia that continually drives improvement. Trust the system. If you follow it exactly, whatever sacrifice that commitment

requires, it will always produce the results you desire. The final ingredient is mentoring. Private 1-on-1 MCAT Mentoring is the linchpin of the Altius MCAT system. Private tutoring is the most effective method of instruction ever tested by researchers. Compared to the two most commonly used forms of instruction in higher education, attending lectures and reading textbooks, 1-on-1 tutoring has been shown to improve performance on standardized tests by 2.0 standard deviations (Bloom, 1984). On the MCAT, that translates into a score jump of approximately 20 points.

Introduction Altius

viii

The mathematical sum of combining your effort, our scientifically backed system, and the 1-on-1 guidance of a caring MCAT Mentor is Y-O-U achieving something extraordinary. Not something merely good, or above average, but an achievement that is truly exceptional in every way. The average score increase for students who complete 100% of the Altius MCAT System is 15 points. That equates to an increase from the 50th percentile to the 92nd percentile! That is exceptional. What’s even more exceptional is the fact that half of the Altius graduates improve by more than 15 points…some by as many as 30 points! This same simple formula has helped thousands upon thousands of Altius students achieve elite 90th-percentile scores. Students like Jayden Garcia, who came to Altius after having struggled severely with standardized tests in the past. Jayden trusted the Altius system. Jayden worked hard—very hard—making sacrifices his peers weren’t willing to make. The road was long, but the destination was already assured. In the end, Jayden achieved a 95th percentile MCAT score. In his own words, “I never thought I’d be able to do this. Altius taught me that I

can do hard things.” The photo below is of Jayden and his wife celebrating their “Harvard Dream Come True.”

Jayden followed the same formula that helped Arnulfo Garza, a student from a severely economically-depressed community on the Texas-Mexico border set a new all-time school record of 518 (96th %-tile) on the MCAT. The following year, Arnulfo's record was shattered by Jayson Vel, another Altius client who set a new school record of 521 (99th %-tile). It was the same formula again that helped Emily Kahoud, a non-traditional student from New Jersey who had tried unsuccessfully for six years to get into medical school. After working with an Altius mentor for only a few short months, Emily improved her MCAT from a 496 (45th %-tile) to a 514 (92nd %-tile). This incredible news was soon followed by multiple acceptance offers from top-tier medical schools.

You are the next success story. Decide this very moment that you will follow the formula. Commit to yourself to complete 100% of the program assignments, to humbly accept our advice, and to work hard—whatever sacrifices that may require. If you do so, and follow it through to the end, you have already guaranteed yourself an extraordinary MCAT score. In conclusion, we have a final word for those of you who think of yourself as “above average.” Confidence can be a powerful ally, or a pernicious enemy. Many straight-A students assume they can easily earn a 90th-percentile MCAT score, but less than one out of five actually do. Don’t become the tragic Altius student who believes that his or her aptitude can make up for completing only 80 or 90 percent of the program requirements. Such students usually peter out around a 510 or 5-teens MCAT score when a complete effort would have delivered a 520+.

Introduction Altius

ix

WELCOME TO THE FAMILY From this point forward, you are one of our dearest friends. If you need something, call us. If you are frustrated, tell us. If you aren’t 100% on-track to accomplish your goals, speak up—we are all here to help you. From the newest intern to the Founder & CEO, every member of the Altius team is committed to helping you achieve your maximum potential. As a member of our family, we want you to have the very best. We work hard to hire and train only the best, most passionate, most caring team of MCAT Mentors. We provide the most accurate, predictive, test-day-realistic practice materials available anywhere. Our programs utilize teaching methods scientifically proven to be superior to standard classroom lectures. We combine those superior teaching methods with constant one-on-one mentoring and support to drive student achievement in a way no other program or method can approach.

Superior Teaching Methods:

• Private one-on-one tutoring instead of one-size-fits-all classroom instruction.

• Interactive small group seminars instead of monotonous lectures.

• Curriculum that emphasizes critical thinking and conceptual mastery instead of rote memorization or plug-n-chug calculation.

• Multiple learning environments instead of relying solely on classroom lectures.

• Regularly-scheduled review of each topic instead of assigning each topic to a single class.

• Frequent experience attempting and analyzing real AAMC MCAT questions under proctored conditions instead of relying only on sporadic practice exams.

Constant Mentoring & Support:

• Each student in a Silver, Gold or Platinum program is assigned to an elite 1-on-1 MCAT Mentor.

• 24-hour access to your assigned tutor-mentor via phone, text, or email.

• Regular Proctored Study Halls for additional instruction and support.

• Proctored Mastery Sessions to increase long-term retention.

• Detailed monitoring and feedback with extra help as needed to keep you on track.

• Proprietary tools that constantly track your progress and can accurately predict your eventual MCAT score at any point during the program.

PLAN NOW TO MAKE YOUR MCAT SCORE COUNT

At Altius, a terrific MCAT score is only the beginning. We also help our clients take full advantage of their elite score by leveraging it into acceptance to multiple top-tier medical schools. While the nationwide acceptance rate hovers around 40%, our paid admissions clients achieve a nearly 100% acceptance rate, with most applicants receiving multiple offers. Best of all, we provide these premium admissions services at a fraction of the normal market rate. More importantly, our team of actual admissions officers provide advice you can trust. The admissions advice students receive from other sources is often inaccurate. Following such advice can do more harm than good when it is given by those without actual experience on an admissions committee. Our team of experts includes current and former members of actual admissions committees at U.S. and Canadian medical schools, medical students accepted at some of the top medical schools in the country, and both MDs and PhDs with extensive

admissions experience. For more information on these services, visit: http://AltiusTestPrep.com/admissions.

• SILVER ADMISSIONS PACKAGE: $499* FREE with any Platinum MCAT Program

▪ AMCAS Personal Statement Review: Thorough review of your AMCAS Personal Statement by our highly-trained team of admissions and expository writing experts. Your 100% personalized edit will include detailed feedback, specific suggestions for improvement, and an evaluation of the competitiveness of your essay compared to other applicants.

Introduction Altius

x

• GOLD ADMISSIONS PACKAGE: $899*

Everything in the Silver package, plus: ▪ Additional Personal Statement Revisions and Edits: In addition to the comprehensive initial

evaluation of your personal statement included in the Silver Admissions Package, you can resubmit additional essay revisions for further editing and feedback—up to a total of four (4) hours of editing.

▪ AMCAS Activities Review: Thorough review of your AMCAS Activities section, including evaluation of the competitiveness of your activities compared to other applicants and editing of the mini-essay descriptions for each activity.

• PLATINUM ADMISSIONS PACKAGE: $2,299*

Over fifteen (15) total hours of editing and consultation by our expert team of current and former admissions officers, a $4,500 value. You’ll also have 24/7 access to your own 1-on-1 Admissions Mentor. The Platinum Admission Package includes everything in the Silver and Gold packages, plus: ▪ Personal 1-on-1 Admissions Mentor: Each platinum admissions student is assigned to his or her

own one-on-one admissions coach. Our coaches are current medical students or recently-graduated MDs who received multiple medical school acceptances. You can call or email your mentor at any time with questions. Each mentor has direct access to our current and former admissions committee members to get expert feedback on any element of your admissions profile.

▪ Complete Review of the Full AMCAS Application: Our team will thoroughly examine your grades,

personal statement, the activities section, and crucial-but-often-overlooked considerations such as the disadvantaged status designation, or how to explain an institutional action. Receive multiple back-and-forth edits up to a total of fifteen (15) hours.

▪ Help targeting the right list of schools

▪ Editing and feedback on up to three (3) secondary essays

▪ A copy of the Altius Admissions Workbook

▪ Proven Admissions Results: Our Platinum Admissions clients have experienced a nearly-perfect acceptance rate over the past ten years. Our students not only get into the best medical schools, they also collect hundreds of thousands of dollars in scholarships. One recent admissions client, Trevor Hodson, received zero acceptances after applying on his own. The next year, with help from Altius, Trevor was accepted to multiple schools and claimed over $300,000 in scholarships!

• ULTIMATE PLATINUM ADMISSIONS PACKAGE: $4,497*

Everything included in the Platinum Admissions Package, plus exclusive direct access to the Altius Admissions Committee. The Altius ADCOM is composed 100% of former U.S. medical school admissions officers. These former ADCOM members will review your complete application exactly as they would if you were applying to their medical school. You will then receive a full report, including:

• The ADCOM Committee's overall impressions, with their acceptance or rejection votes.

• Competitiveness Ranking Score of 1-10 for GPA, MCAT, 15 Activities, Secondary and four core applicant characteristics.

• Specific suggestions and recommendations to improve your application.

The Ultimate Platinum Admissions Package also includes our popular Mock Interview Package:

• Two separate 30-minute interviews with ADCOM members from different medical schools.

• A complete Mock Interview Report highlighting your strengths, weaknesses, and specific suggestions for improvement.

• All interviewers have documented previous experience conducting formal applicant interviews for U.S. or Canadian medical schools.

*Compare Altius admissions pricing to that found at other major providers, such as Accepted.com or Kaplan Test Prep and Admissions. Accepted.com charges $290 per hour and Kaplan charges over $240/hour.

Introduction Altius

xi

AN ENTHUSIASTIC BEGINNING We hope you are genuinely excited to be involved in the revolutionary Altius MCAT program. For us, there is tremendous satisfaction in offering this unprecedented suite of services at a cost that is a small fraction of what our competitor’s charge. For decades, premed students like you have paid thousands of dollars for ineffective lecture-based MCAT courses. Now, Altius has made 1-on-1 MCAT mentoring and expert admissions assistance available at a price the average student can actually afford. We know the Altius system works. Our greatest joy comes from watching our students succeed. What a pleasure it has been to be a part of so many amazing success stories! Students who had taken multiple MCAT prep courses, spent several thousand dollars, and were about to give up on their dreams, have frequently realized double-digit score improvements after taking Altius. Seeing students like these embrace the Altius system and use it to finally

earn impressive 95th-percentile MCAT scores is intoxicating. Just as exciting, are the stories we see time and time again of students who entered the Altius program thinking they would have been happy with an “adequate” MCAT score, but who months later sit for their exam expecting nothing less than the 99th percentile. We want you to be our next inspiring success story. If you have struggled with standardized tests in the past, don’t worry—we can help you change the way you think and develop an entirely new sense of confidence. If you are already confident in your abilities, good—Altius will raise your sights even higher, channel your efforts into the most effective activities, and push you to the absolute limit of your capabilities. Most students come to our program because they have heard rave reviews from their friends. Many of you are looking forward to meeting or exceeding our average MCAT score, which has been at or near the 90th percentile for more than a decade. Other students join Altius eyeing one of those coveted 99th-percentile MCAT scores—something

our students earn at a per capita rate that is approximately ten times the national average. At Altius, as long as you complete everything the program asks of you, a score in the 99th percentile isn’t a long shot; it is a relatively common achievement. The mere fact that students enter our program with higher expectations than they would have in another program is a tremendous benefit. We hope you will not only elevate your own expectations, but that you will also appreciate the blessing it is to be studying with other students who share those high expectations. It is time to leave mediocrity behind. The word Altius is Latin for “Higher.” We chose this name to reflect our organizational philosophy. We help students earn significantly higher MCAT scores. Our mentorship drives students toward higher levels of achievement than they ever thought possible. Pushing the limits of achievement is who we are, and it is what we do. We reject the idea that any student is incapable of greatness. As long as you are humble and willing to work, our scientifically-proven system can help you can accomplish anything.

Our results back up our philosophies. Every year, our students as a whole exceed national averages by a large margin. Every, single, year we take supposedly “underachieving students” and help them reach the pinnacle of premedical performance—with 15, 20, and even 30-point score improvements being commonplace. All of that being said, do not be confused: simply paying for the Altius program and showing up to class will NOT earn you one of these coveted scores. Research has shown that, for Altius students, the greatest predictor of eventual MCAT score is program adherence. Those who work hard and give a sincere effort—from the very beginning—to do everything asked of them by this program, usually score in the 95th percentile or above. Students who do not take our advice to heart, resist applying the strategies, procrastinate studying, or study less than we ask them to, should expect to score below historical Altius averages.

Finally, consider how remarkable it is that the students who have gone before you have averaged in the 90th percentile or above on the MCAT. Premed students are a very elite group compared to the students you’ll find in your average undergraduate science course. Scoring better than 90% of all premeds nationwide is a tremendous accomplishment—one that obviously cannot be realized without a truly intense effort. You should expect to work much harder than your friends taking other status quo MCAT programs. This will not be easy. However, if you will decide this very moment to trust in the Altius system and do everything we ask of you, you should expect to accomplish amazing things. You should expect to learn a new, more conceptual way to study and to think. You should expect to attain heights that you previously considered impossible. In the sections that follow, we will discuss several important topics. First, we will give you a few succinct hints from former students on how to get the most out of the Altius program. Second, we’ll discuss a recommended study

plan. Finally, we’ll review in detail the major scientific principles of learning and memory that form the foundation of the Altius system. It is extremely valuable for each student to study and understand these principles. These principles constitute the core guiding principles that underpin every activity we will ask you to engage in over the next five to nine months.

Introduction Altius

xii

HOW TO GET THE MOST OUT OF THE ALTIUS MCAT PROGRAM We asked a group of our most successful former students (99th-100th percentile MCAT scorers) what advice they would offer to new students to help them get the most out of the Altius program. We have condensed those comments into the following excerpts. In their own words, here’s what they had to say:

1) Start Early. “Those of us who waited until December or January to begin the program really noticed the difference, compared to students who started earlier [e.g., September or October]. Start early and study hard from the very beginning. If you must start in January [or do the summer course] make sure you actually learn and retain the material conceptually as you go—you can’t cram for the MCAT. Really, you can’t cram for it or it will eat you alive. And yes, this is coming from straight-A students. No matter how smart you are, you can’t cram for this exam!”

2) Focus on the Altius Strategies & Mantras. They Work! “Trust us, the strategies work. Sometimes it is easy to resist them because we all have our own test-taking habits. But, if you don’t buy into them now, you’ll eventually be humbled when you start taking the practice tests and make the exact same dumb mistakes and errors the strategies are designed to prevent. At that point, unfortunately, it’s almost too late to internalize those strategies and make them a habit.”

3) Study Together. “We found the Student Review Sessions [SRS] to be one of the most effective ways to study outside of class. Even if you’re used to studying on your own, form a reliable SRS and attend and participate regularly. It will make a difference. The power of SRS is that you are forced to learn the material to the level required to teach it back to someone else. At the end of each SRS meeting, we would always split up the next lesson into sections and assign a member of the group to teach each section. At our next SRS meeting, we would take turns teaching each other our assigned section. We always tried to figure out how the MCAT would test those subjects conceptually. Each member would also write several of their own

AAMC-style questions and we would share, attempt and discuss them together. It is vital that you get into a good, productive SRS group. Prepare diligently to teach your assigned section. Believe us when we say that it is obvious (and annoying) when someone hasn’t prepared well to teach their part. Teaching things to someone else is completely different than studying on your own. These groups also help a ton with discipline; they help everyone stay motivated. They make studying a little less tedious and a lot more fun.”

4) Private Tutoring is Your Responsibility. “We were all happy with our tutors—they were all amazing teachers. However, in the end, we learned that it is you who must take personal responsibility for your own learning. We all know people who came to their one-on-one sessions without putting in their best effort to master the materials on their own first. They expected their tutor to somehow download all the information into their brain in one hour. As you might guess, that’s not going to work. We all agree that it is best to go to your tutor with a solid outline of what you know well and what is still unclear.

Then you can utilize your time most efficiently. Also, ask your tutor frequently to help you see how the MCAT will test a particular subject, and what types of questions to expect. This is definitely something they understand and grasp in a way you don’t. Most tutors will quiz you hard on the subjects you claim to know well. Don’t take it personally. They are just trying to make sure you don’t have any holes in your armor. It’s your test and this will be your score, so you should welcome careful examination!”

5) Take Group Sessions Seriously. “We all had some people in our Group Sessions that seemed to want to run through the practice questions as fast as possible so they could go home. There were also a lot of students who almost refused to follow the strategies Altius suggests while analyzing the practice questions. Other students were constantly zoned out on their phone or tablet. From students who wanted to work hard and get a good score, we want to tell you that this attitude isn’t appreciated. If you don’t want to learn, analyze, and gain insights from your tutor, then why did you pay for the Altius program in the first place? If you have students like these in your group (and you probably will) don’t be afraid to put a little

positive peer pressure on them to step up and have a better attitude. The best Group Sessions happen when everyone is seriously trying to learn and contribute. Finally, the science topics tested during Group Sessions are NOT the most important thing. The most important thing is to master the exam itself. Study how the questions are being asked. Keep track of how the questions are requiring you to think. Look for trends. Decide why you are missing questions and fix those problems.”

Introduction Altius

xiii

6) Write Your Own MCAT Questions. “Many of us were struggling to perform at the high level we wanted to until we followed the Altius advice to focus on ‘Becoming an MCAT Author’ [one of the Altius strategies you’ll learn about later]. This strategy teaches you to author your own AAMC-style MCAT questions for each chapter or topic. It may seem tedious at first, but it is an incredibly effective way to see if you truly understand the material and how the MCAT tests each subject. During our Student Review Sessions, we would attempt each other’s questions and then discuss how closely they did or did not match the real AAMC questions we had been attempting in Group Session. This process helped us learn how to analyze MCAT questions and think “bigger-picture” about questions the MCAT authors might ask in the future.”

7) Smile and Enjoy Yourself! “Seriously, you do need to work really hard, but you also need to be happy and keep a smile on your face. This program is getting you so much better prepared for the MCAT than you would be otherwise; try to get a little excited about that opportunity. A lot of us, about half way through the program, started to feel seriously bad for our friends taking other MCAT courses. If you put in

the time, and do what Altius asks you to do…Y-O-U are going to get a great MCAT score! So keep a positive attitude and be happy! You’re surrounded by people working just as hard as you are, and everyone is making huge sacrifices. Lean on each other for support. You can do this!”

Introduction Altius

xiv

PRIORITIZE THE MCAT Weekly Student Study Calendar: Every student enrolled in any Altius MCAT course is expected to create a formal study plan and a weekly study calendar. Under the “My Account” section of the Altius website you have access to your own digital study calendar. You may use this resource, or you may choose to use another planning tool with which you are already familiar, such as Google Calendar or a phone app. Whichever resource you choose, you must create and follow a weekly study calendar. Your tutor will ask regularly to see your study calendar and will follow-up to make sure you are using your scheduled study time effectively. You should also track your school and personal commitments to ensure that they do not encroach on your MCAT preparations. Later in this section, we will outline fifteen (15) specific activities you will be expected to complete once for each chapter of this manual. These constitute the core of the

proven Altius MCAT system. You must designate an exact time on your Student Study Calendar when you will complete each activity. When you formalize your commitment to complete each program activity by assigning it to a specific date and time on your study calendar, you are actually formalizing your future MCAT score. What you will score then, is a function of what you do now. We have provided you with the proven system. We have paired you with an elite 95th-percentile MCAT tutor who will offer you 24/7 one-on-one mentoring. Finally, we have provided you with the most accurate MCAT practice materials ever created, including practice exams that are indistinguishable from real AAMC exams. Y-O-U are the final ingredient.

Your choices and behaviors over the next few months are the only factor Altius cannot control.

Do not let yourself down. Decide now to complete 100% of the Altius MCAT program! A Proven System: The Altius MCAT program is a carefully structured, step-wise system that utilizes proven principles of memory and learning. Everything we ask you to do has a specific purpose and a scientific basis. All you need to do is follow the steps outlined for you. Doing so will NOT be easy. Between school, work, and extracurricular activities, many of you are already over-committed. You may find it very challenging to do everything you need to do for the MCAT and continue all of your other commitments at the same time. If that is the case, it is time to re-prioritize your

current commitments. The MCAT is a harsh taskmaster. It does not care. It is an inanimate testing instrument. It does not care if you are volunteering ten hours per week at the hospital, working twenty-five hours per week, or taking a heavy course load. There will be no adjustment to your final MCAT score to account for the number or size of your extracurricular activities (…other than the downward adjustment to your score that will happen automatically if you are too busy to dedicate to the MCAT the time it requires). Admissions Committees will NOT care either. That may sound harsh, but it is an important reality. Yes, ADCOMS will look positively on students who maintained serious, demanding extracurricular commitments. However, such commitments will only be viewed positively for students who were able to simultaneously maintain excellent grades and earn a high MCAT score. If you have a low MCAT score and lots of extracurricular activities,

the extracurricular commitments themselves will NOT compensate for the low MCAT score. Any idea that your GPA or low MCAT score will be overlooked because you were “busy”, amounts to nothing more than wishful thinking. The admissions data back this up, as do the personal experiences of members of the Altius ADCOM on actual medical school admissions committees. In case you were considering it, the worst thing you can do is try to parlay your “busyness” into special consideration during an interview, or in your personal statement. This is nearly impossible to do without sounding like you are whining or making excuses. As Benjamin Franklin said so aptly, “Those who are good at making excuses are seldom good for anything else.” Remember this: athough you may have been genuinely busy, there are most likely several applicants in the same stack of files who were equally busy and yet they still managed to earn a great MCAT score. Synthesizing those two concepts, 1) Scoring well on the MCAT requires a serious time commitment, and 2) There

is no way to explain away a poor MCAT score, leads us to only one logical conclusion:

You must prioritize your life in whatever way necessary to create ample time for MCAT preparation.

Introduction Altius

xv

This may require you to make tough decisions, such as reducing your course load at school, taking a temporary hiatus from volunteer commitments, or quitting your part-time job. We recognize that some of you may be supporting a family and are therefore in serious need of continued employment, while others are on scholarships you would lose if you reduced your course load. If this describes your situation, the first thing you must do is check yourself. Is the status quo really your only possible option? Would quitting that volunteer position really cause the sky to fall? Could you ask for a hiatus from your job and live for a few months on savings? Don’t forget that most coaches, volunteer coordinators, or lab supervisors are understanding and supportive of your goal to attend medical school. In many cases, such individuals would be open to a student taking a short hiatus, or reducing their weekly time commitment, but the student doesn’t know this option is available because he or she never asks. Some students occasionally insist that there is absolutely nothing in their schedule that can be adjusted. If that is how you feel, you may want to ask yourself if becoming a physician is really your number one priority. If it is, why

do so many other things take priority over the MCAT? Furthermore, even if it were actually true that you are insanely busy and can do “nothing” to remedy that situation, that by no means prevents you from completing the Altius program correctly. There is no pre-written rule stating that you must take the MCAT in exactly four, six, or any other set number of months. Completing the Altius program in full requires about 20-30 hours per chapter, a few Saturdays for practice exams, and one month for the Final Preparations Checklist. If you cannot find 20-30 hours in one week, complete those same activities across two weeks. Forty years from now, it won’t matter one iota if you took the MCAT a few months later than originally planned. In fact, ADCOMS around the country are looking with increasing favor on those who take a gap year between college graduation and medical school. That means you can take the MCAT when you are ready, even if that postpones your application cycle. This flexibility leaves you with no excuse for not giving the MCAT all the time and attention it requires. Others who were busier than you are have done this before. You can too.

Introduction Altius

xvi

THE FIFTEEN (15) WEEKLY ACTIVITIES During the Altius program, you will complete the same fifteen (15) activities in connection with each chapter of the Student Study Manual. These fifteen activities are listed on your Student Accountability Tracking Sheet (SATS). You and your tutor will review your SATS checklist, and your overall progress, at the beginning of each one-on-one tutoring session. Let’s review each of the fifteen activities in detail.

1) Lesson Preparation: Study and annotate the current chapter outline prior to your one-on-one tutoring session [Estimated Time = 6-10 hours]. Review the current chapter of the Student Study Manual thoroughly, line by line. Each chapter is an outline that sets clear parameters as to exactly what you do and do NOT need to know for the MCAT. However, if

one simply memorized every line of the Student Study Manual the resulting knowledge would be grossly insufficient. The lesson outline sets the boundaries, but you must study and research that topic until you have developed a solid conceptual mastery of the why, how, when, and where behind each topic. At Altius, we shun memorization whenever and however possible. You’ll hear the following mantra throughout your time in this course:

Don’t Memorize, Conceptualize! Memorization is a bad habit. You’ve likely been over-reliant on this pseudo form of learning for most of your lifetime. It isn’t your fault. Memorization is perpetuated and rewarded by a broken educational system. As an Altius student, you will finally move beyond memorization to embrace conceptual mastery—a more rewarding, more effective, and infinitely more durable form of learning. As you prepare for your one-on-

one tutoring session, avoid the temptation to focus on memorized knowledge, definitions, or other simplistic facts. Instead, try to learn why things happen, how they happen, and how each new concept relates to the other basic science concepts you already know well. Look for opportunities to expand text or written descriptions into something more visual. Draw pictures, diagrams, graphs, and mechanisms whenever possible. Another oft-repeated Altius mantra is:

Write it Down and Draw it Out! This mantra reminds you that on every question you attempt, and for every passage you read, you should always have scratch paper handy. Write down and draw out everything you possibly can. Write out equations; draw diagrams, mechanisms, or pictures; list key concepts as bullet points; draw arrows or

symbols to relate concepts; or simply annotate your thoughts. This process is a proven method for adding a visual component to your thinking. This process will very frequently allow you to make a connection, or to recognize a relationship, that you otherwise would not. As you prepare for your tutoring session, you may choose to take notes and draw pictures directly in the margins of your Student Study Manual, or you can do so on a separate sheet of paper. Either way, you should have copious notes that represent many hours of careful study and annotation. This is an important part of the program that you alone must do. Because it is so important, we have instructed your tutors to postpone the current tutoring session if a student arrives for their one-on-one session with a poorly prepared lesson outline. While you study and annotate the current chapter, you will also need to answer all of the Italicized Questions interspersed within the lesson outline. Use online resources, particularly the “Expensive Memory Principle Study Links” provided on the Altius website, to develop a deep, conceptual mastery of each topic.

In the upcoming Strategy, Math & Research Methods chapter we will introduce you to “The Four Conceptual Questions.” These questions are a tool that prompts you to think more critically. Most of these questions cannot be answered from memorized knowledge alone, which will force you to conceptualize the information you are studying. Write down the Four Conceptual Questions at the beginning of each study session. Do NOT consider your study of any chapter complete until you can confidently answer each of the four questions for every line of the assigned chapter. During your lesson preparation, carefully note those topics you find most difficult so that you can review them later with your tutor.

Introduction Altius

xvii

The lessons in the Student Study Manual are intentionally presented in outline form. We expect that you will need to do a little searching on most topics in order to gain a full, broad, conceptual understanding. Reading a description out of a textbook is a very ineffective way to learn. Had this type of learning proven effective, we would have formatted the lessons to be more textbook-like. Trust us. Our methods work—as third-party-documented score results have clearly proven. Memory science has demonstrated that if you will invest the effort required to explore each topic yourself (rather than simply reading a summary of it out of a book), you will understand and remember the material far more easily. The goal of this lesson preparation process is to master the concepts in the assigned chapter to the best of your abilities before you meet with your tutor. You have ample resources at your disposal to accomplish this goal. These include: The Expensive Memory Principle Study Links, the in-chapter Italicized Questions, the Answers to the Italicized Questions, and—one you should never forget or neglect—the assistance of

fellow members of your SRS group. Finally, you have a dedicated tutor-mentor who is ready and excited to help. You will not want to use up your valuable one-on-one tutoring time to cover topics that you could have easily figured out on your own, or with the help of your SRS group. Save for your tutor the most challenging topics—perhaps those concepts you and your SRS group struggled to clarify. Also look to your tutor to help you take your concept mastery to a deeper level. Ask him or her to help you find potential weaknesses in concepts you think you have already mastered. Finally, rely on your tutor to help you understand the unique ways in which the MCAT is going to test you on these basic science principles. We very strongly discourage you from utilizing prep books from other MCAT companies as reference material. First of all, they are NOT reference material. They are themselves a review book. Second, one of the greatest benefits of the Altius program is our proven ability to give you a laser-like focus on only those topics you need to know, ignoring those that are superfluous. If you venture into these

other books, you will be negating that benefit and are likely to be confused by conflicting messages and strategies. If for any reason you feel another prep company is a more trusted resource for what you do or do not need to know for the MCAT, please ask for a refund so you can go take their course instead.

2) Weekly Strategy Session: Read and ponder the Weekly Strategy Session [½ hour].

Read the Weekly Strategy Session on the website. Take careful notes and focus on applying that particular strategy on every MCAT question you attempt this week. Come back from time to time and engage in careful self-analysis. Are you taking each suggestion seriously? Are you applying these strategies on every question you attempt? If any strategy seems unimportant to you, or if you fail to catch the vision of its effectiveness in improving your MCAT score, please discuss these questions with your tutor.

3) Group Session Attendance: Attend this week’s Group Session(s) [2.5-5 hours].

Attend Group Session, participate actively, and record your performance on the Student Accountability Tracking Sheet (SATS). Report the percentage of questions answered correctly on both the science content and the CARS content. During the Fall Long Track, you should attend Group Session either once every other week, or once every week, depending on your study schedule and test date. Between January and May, the Long Track and Short Track students meet together for Group Sessions and both should be attending two Group Sessions per week. Students enrolled in the Fall Accelerated Track will attend Group Sessions twice per week, while those in the Summer Full-Immersion Program will attend three times per week. In order to get everything you need out of the Group Sessions, you must be an avid student of the exam itself. Study the structure and content of the exam. Constantly evaluate your test-taking skills,

especially as they apply to the AAMC’s unique way of asking questions conceptually. You should be searching for exam trends—not necessarily right and wrong answers. Make note of common passage types, question styles, and answer choices. As you look for and deduce commonalities and tendencies in the exam, you will gain both a psychological and academic advantage. The MCAT is quickly “demystified” when you begin to see the repeatable and predictable patterns used by the MCAT authors. A major pitfall encountered by most students is the bad habit of over-emphasizing the questions themselves. Each question you attempt in class is a tool. There is almost no chance whatsoever that this exact question will appear on your exam, so knowing the right answer to that particular question is nearly worthless. The only way you can use that question to improve your MCAT score is to learn something from it that you can apply to similar questions in the future. To accomplish this, try asking yourself

question such as these: “What does this question reveal about how or what the AAMC authors are testing? Which critical thinking skills were required to answer this question correctly and how can I strengthen those to perform better on similar questions in the future?”

Introduction Altius

xviii

This important caveat about the importance of learning from questions rather than memorizing their answers is captured by this important Altius mantra:

Master the Exam, NOT the Question. Finally, let us emphasize one more important strategy relevant to Group Sessions. Whenever you miss a question during Group Session, you should always ask yourself, “Why did I miss this question?” Answers such as, “I didn’t know the answer,” or “I hadn’t covered that material yet in the manual,” are cop-outs that will not improve your score. Other than having more content knowledge, what would have been necessary for you to have answered that question correctly? Most of the time, this has more to do with how you approached the question than what you knew. This is an example of another Altius mantra we will reference frequently: (NOTE: The ≫ symbol stands for “Much Greater Than”).

How You Think ≫ What You Know

No statement about the MCAT is more true. How you think is infinitely more important than what you know. In those rare cases where it was indeed a gap in content knowledge that caused you to miss a question, you should still ask yourself: “Why didn’t I know that?” “Should I have known that science concept by this point in the program? Is it a weakness in my prerequisite background? Was it covered in previous class and I overlooked it? Was it a topic covered in an earlier chapter and I’ve already forgotten it?” Based on the answers to these questions, take active steps to prevent a similar problem in the future.

4) Review Group Session Science Topics: Review all basic science topics encountered during Group

Session [1-2 hours]. Undoubtedly, topics and questions will arise during Group Session for which you do not have a strong, pre-existing conceptual mastery. It is vital that you allocate time after each Group Session to review

and master the topics covered. We instruct the tutors to create a running list on the board of basic science concepts covered during that Group Session. Approach your study of these topics in the same way you prepare for a tutoring session. Begin by looking up that topic in your Student Study Manual. Review all relevant tutorials from the Expensive Memory Principle Study Links. Research the topic until you have a solid conceptual mastery—as indicated by your ability to confidently answer The Four Conceptual Questions. As the mantra “Master the Exam, NOT the Question” suggests, the specifics of any one particular question from Group Session are not very important; because there is almost no chance you will see that exact question on your actual MCAT. You will often hear Altius students saying:

Nice question…but I will never see it again!

This phrase begs the obvious question: “What could I see again?” The answer is this: you will see something related, something on the same topic, or something requiring the same form of critical thinking…but you won’t see that exact same question. These facts drive home the importance of developing a deep, broad, concept-based understanding. This type of learning prepares you to not only answer a similar question should it appear on your MCAT, but also allows you to answer any number of related questions on the same topic. Each year, a few students question why we cover some science topics during Group Session that students have not covered yet in the Student Study Manual. First, understand that this approach is intentional. The Altius system is designed such that approximately half of the topics will be seen for the first time in the Student Study Manual, and the other half will be seen for the first time during Group Session. Second, this delivery method is a tremendous benefit to the student over the traditional, linear, one-time-only approach

employed by most curriculums. The Altius system is designed to automatically expose each student to approximately ten (10) spaced repetitions of each key MCAT science topic. Further, it is designed to present each repetition in a unique learning environment. Multiple repetitions in varying learning environments create a powerful, scientifically-proven system that maximizes both long-term retention and conceptual mastery. If the Group Session topics were chronologically correlated with the Student Study Manual, you would be focusing on only one topic at a time and would miss out on the power of these spaced repetitions. Finally, on test day you will be required to answer questions on a variety of topics, which will appear in an almost random order. For example, on the Chemical and Physical Foundations of Living Systems section (CP), you could be presented with a question from physics, general chemistry, organic chemistry, biology,

Introduction Altius

xix

or biochemistry, in that order, or in any order. The unique design of the Altius system will make it more comfortable for you to deal with this test-day challenge, moving more fluidly from one topic to another. It is worth noting that you should have covered all these basic science topics during your prerequisite courses—so nothing should be entirely foreign. Furthermore, prior background knowledge is rarely the key to answering highly-conceptual, critical-thinking-based MCAT questions. That point is so important we will say it again: Prior background knowledge is rarely the key to answering MCAT questions. Being in a situation where you have limited recent experience with a topic helps you practice the use of logic, application of passage information, and critical thinking—the very skills the MCAT actually tests!

5) SRS Preparation: Prepare for your Spaced Repetition Session [1-2 hours].

Each student must be a participating member of a regular Spaced Repetition Session study group (a.k.a., SRS Group). Each SRS Group consists of three to five members. MCAT Everywhere students will meet with their SRS groups via webinar. SRS meetings are held at least weekly (but more often two or three times each week). Spaced Repetition Sessions are designed to take advantage of spaced repetition and the accelerated learning that takes place when you teach someone else what you have learned. We have referenced “The Four Conceptual Questions” a few times already, and will be discussing them in detail in the next chapter. One of those four questions is this: “Can I teach this concept to someone else in Layman’s Terms?” SRS meetings are the perfect time to validate that you can confidently reteach these core science concepts to others. These meetings are far more than an informal study group. SRS Meetings should be highly-structured review sessions that require each member to prepare their own miniature lesson plan and deliver it to the other members of the group. You will learn both by

preparing your own content, and by discussing the content presented by your fellow group members. Spaced Repetition Sessions should be structured as follows:

1) Break each lesson apart into equal segments. 2) Assign each section to one of the members of the SRS group. 3) Prepare to teach your assigned section. During the upcoming week, each member will

thoroughly dissect his or her assigned section, attempting to bring to light every possible conceptual avenue the MCAT might use to test those subjects. This should include preparing several conceptual AAMC-style questions to present to the other members of your group.

4) Take turns teaching each other. At the subsequent SRS meeting, usually held one week after

the assignments were made, take turns teaching each other your assigned topics.

To be fair to the others in your group, take the necessary time to be well-prepared for your assigned part. Write a minimum of five (5) of your own AAMC-style MCAT questions on your assigned topics and bring them to the SRS meeting. As a group, attempt and discuss each question. Focus not only on the principles tested, but on the accuracy of the format and delivery. Is the question similar to those you have been attempting during Group Session? Does it match one of the 40 MCAT Question Blueprints? Does it require you to think in the same way AAMC questions do? Your ultimate goal is to become as proficient at writing AAMC-style MCAT questions as are those who author the actual exam. This is all part of another important Altius mantra, which is also the basis for #8 of the 15 Weekly Activities:

Become an MCAT Author

We will also discuss this mantra in more detail in the upcoming Strategy, Math & Research Methods chapter.

6) SRS Attendance: Attend at least one Student Review Session (SRS) [2 hours]. At a bare minimum, your SRS Group should meet once each week for a few hours. Most SRS Groups, however, meet more frequently. Summer Full-Immersion Students should study together, as an SRS Group, at all times—separating only when necessary for private tutoring. One meeting each week will be specifically reserved for teaching each other topics from a previous chapter of the Student Study Manual. We refer to this as the Primary SRS meeting. Outside of these formal SRS meetings, students in the same SRS Group are strongly encouraged to meet and study together as often as possible. We sometimes

refer to these informal “group study” meetings as Secondary SRS meetings. During the Primary SRS meeting, you will be studying a previous chapter from the manual—ideally one that was covered approximately two or three weeks prior. This is the meeting where you will be teaching one another your assigned sections. During Secondary SRS meetings, you are simply meeting to study together.

Introduction Altius

xx

There are proven benefits to group study that cannot be realized when studying alone. Learning to study in groups will be a tremendous advantage to you in medical school. At times, the medical school curriculum is almost impossible to cover on one’s own. Often, the assigned content is so large, and the available study time is so short, that you do not have enough hours available to even read through the assigned material a single time. For this reason, it is common for medical students to take the SRS approach of divide and conquer. Instead of trying to study everything yourself, you study a small portion and report back to your study group on what you think is most important, or most likely to be tested. Other members of the group do the same, and in this way you can process enormous amounts of information in a short period of time. The Altius SRS system is modeled after the obvious success of this approach observed by Altius Founder, Lauren Curtis, during his time in medical school: “The benefits of the ‘divide and conquer’ group study approach were undeniable, especially when the

volume of material to review was large. This tactic was always most effective when genuine ‘teaching back’ of the material occurred. No reinforcement is more powerful than the one realized when we teach someone else what we have learned.” -Lauren Curtis, Altius Founder & CEO If you are struggling to meet the program indicators, consider joining two or more different Primary Student Review Sessions. This will give you both increased repetition of previous topics, and a variety of insights from different people.

7) CAR Study Block: Study Critical Analysis & Reasoning (CAR) exclusively for at least three hours each week [3 hours minimum].

Spend a minimum of three (3) full hours each week studying exclusively for the Critical Analysis & Reasoning section. The CAR section is—without question—the most underestimated section on the MCAT. CAR notoriously destroys composite MCAT scores. It is alarmingly common for a student to earn 95th percentile scaled scores on the science sections, but drop precipitously on the CAR section. This is of particular importance because many medical schools apply strict minimum criteria to section scores. At many schools, by rule, you must score a minimum of 124, 125, or even as high as 127, on each section. The CAR section is most often the section score that causes one of these automated rejections. Altius has developed a particularly effective CAR strategy and a program that makes it difficult for students to NOT dedicate the necessary study time. You will attempt real AAMC CAR questions under timed conditions at all thirty-two Group Sessions. You will log a minimum of three (3) hours of CAR study each

week, even when you are spending the rest of that week focused on one of the science chapters. You will also be expected to author a minimum of five (5) of your own AAMC-matched CAR questions each week, and report this task as completed on your Student Accountability Tracking Sheet. As long as you are doing everything the program asks of you in this regard, you should earn a solid CAR score on par with your other section scores. During your weekly CAR study block, please complete all the activities outlined below. o Weekly CAR Activities:

Read at least ten (10) CAR passages from the Altius CAR Workbooks.

Complete five (5) CAR Comprehension Drills and five (5) CAR Speed Drills based upon those ten passages. Show each drill to your tutor. The method for completing both drills will be explained in further detail in an upcoming chapter.

Author five (5) AAMC-style CAR questions each week. Share them with the members of your

SRS group and your tutor. Work hard to make your CAR questions indistinguishable in every way from real AAMC CAR questions.

Attend Group Session. Timed CAR passages are always attempted and analyzed at each Group

Session. Always attending Group Session will therefore give you consistent, realistic practice with the CAR section.

The time you spend attempting CAR questions during Group Sessions does NOT count toward

your weekly three-hour CAR study block. However, we mention it here because Group Session CAR practice is vitally important. Always have very high expectations of yourself on the CAR

Introduction Altius

xxi

problems you attempt during the Group Sessions. Early in the program, demand of yourself that you miss no more than 2-3 questions per session. A few weeks into the program, raise this expectation to no more than 1-2 per session. By the mid-point of the program, demand of yourself that you miss no more than one question per session. If you repeatedly struggle to meet these expectations, you must take measurable action. In coordination with your tutor, adjust your weekly study calendar to include more CAR study time. Pair up with a study buddy who excels at CAR. Many students also find it helpful to purchase a few hours of additional tutoring to dedicate solely to working through CAR passages with their tutor. Finally, don’t forget that Proctored Study Hall Sessions are an ideal time to get extra help with CAR.

8) Becoming an MCAT Author: Author ten (10) AAMC-matched MCAT questions [1-2 hours].

Practice Becoming an MCAT Author by creating ten of your own AAMC-style MCAT questions. Author five (5) CAR questions as well as five (5) science questions. The science questions should test the topics you are currently studying in the Student Study Manual. Make a serious, concerted effort to understand and define those characteristics that make an AAMC MCAT question different from the questions you have encountered on other college-level examinations. Carefully match the AAMC question stems, answer choices, and critical thinking requirements of the questions you are attempting in Group Session and on full-length practice exams.

9) Notecard Mastery: Master all new notecards made this week, and review all the notecards served to you by Anki each day [2+ hours]. The time required for this task will vary greatly depending on how diligent you have been in reviewing your

notecards. All Altius students should use a free notecard software program called Anki. This software program allows you to create your own digital notecards and then delivers them to you using a computerized delivery method which automatically shows you previously-mastered notecards at about the time you will begin to forget them. The principle of spaced repetition, on which much of the Altius program is based, is integrated directly into the Anki delivery system. You can download a free copy for your computer that will run on Windows, Apple, Linux or about any other operating system. Mobile apps can be purchased for iPads, iPhones and Android devices. Visit www.ankisrs.net to access the free versions, or search for “Anki” in your mobile device app store.

10) Question Set Completion: Attempt the Question Set at the end of the chapter [1 hour].

Complete the Question Set that accompanies the current chapter, allowing yourself approximately one minute per question. Many students are tempted to give themselves unlimited time to complete the Question Set. This is unrealistic and counterproductive. By doing so, you give yourself a misleading experience with the speed and timing of the MCAT and develop bad habits that will be difficult to overcome. Always practice under timed conditions: one minute per question for stand-alone questions, and eight minutes per passage to both read the passage and answer the questions.

Because the Question Sets are almost exclusively stand-alone questions, they are most representative of what you might see on the free-standing questions found on the MCAT. They work well for testing content mastery, but do not represent the passage-associated questions which account for 85% of all questions on test day. The passages you are attempting during Group Sessions, and on the Altius Full-Length Exams, are exact replicas of the question type and distribution you will see on test day.

o Your score on the Question Set is a direct indication of two things:

▪ Your mastery of the principles covered in that chapter ▪ Your understanding and implementation of the Altius strategies

If you have done a serious, thorough job of completing SATS Weekly Activities #1 through #8, expect to score 85% or above on the Question Set. If you score below 85%, this is an indication of one of two things: 1) You did not master the topics in that chapter sufficiently before attempting the Question Set, or 2) You have not yet developed the skills necessary to effectively answer MCAT-style questions. Often, it is a combination of the two. To deal with the first problem, increase the amount of time you are investing into

the other Fifteen (15) Weekly Activities prior to attempting the Question Set. To deal with the second problem, invest some of your tutoring hours into working problems together with your tutor. During these extra sessions, work through some of the practice problems you have missed recently. Work the problem

Introduction Altius

xxii

out loud for your tutor, demonstrating your reasoning at each step. Also have your tutor work a few problems out loud for you, so that you can see and mimic the approach he or she is taking. Finally, be sure to employ all of the Altius strategies and mantras on every single question. If you score below 80% on any Question Set, do NOT continue immediately on to the next lesson. Before studying the next chapter, sit down with your tutor and brainstorm specific interventions you can take to reach this indicator (e.g., logging more study time prior to taking the Question Set, spending additional time with your tutor working problems together, or studying with a student who is already scoring above 85% on the Question Sets). We have given tutors strict instructions NOT to continue progressing a student through the program if they are repeatedly scoring poorly on the Question Sets. Every single lesson is vital to your MCAT score. To continue forward without meeting this indicator is to march forward into inevitable disaster. We have devised multiple indicators and criteria that monitor and

evaluate your current progress and reliably predict your future performance. When you struggle to meet any of these indicators, you should always STOP to find a solution. Only after you have realized noticeable improvement should you proceed to the next chapter. When students do otherwise, their weaknesses, bad habits, and frustrations accumulate over time, eventually resulting in a low MCAT score.

11) Question Set Review: Carefully review your completed Question Set using the KEY [1 hour]. Score and review each question on the accompanying Question Set. Do not focus solely on the questions you missed. With any multiple-choice test there is always a chance you have answered correctly by sheer luck. Often the answer keys point out principles or MCAT trends you will want to understand. Look up and restudy any subject area on which you missed a question.

12) Mastery Sessions and Proctored Study Hall: Attend all Mastery Sessions and Proctored Study Hall Sessions available at your program level [variable time commitment]. Attending Mastery Sessions provides each student with organized, guaranteed repetition of each key science topic. Anywhere from a few weeks, up to a few months, after you have covered a science topic in the Student Study Manual, you will be exposed to it again during a Mastery Session. These small-group sessions are proctored by our best tutors and provide an invaluable opportunity to work with a high-scoring instructor as you attempt to deepen your conceptual mastery. Mastery Sessions help ensure that the basic science concepts most commonly tested by the MCAT are safely stored in your long-term memory. Proctored Study Hall Sessions are open office hours staffed by our best instructors. The tutor staffing the

Proctored Study Hall will generally move from one student to another, working one-on-one with each student on any needs or questions that student may have. Although you may not have exclusive access to the tutor during this time, it is relatively easy to get an additional hour or more of one-on-one attention via this resource. As topics arise that are of interest to everyone in the room, the tutor may take time to provide brief instruction to the group as a whole. Even at Altius, where one-on-one tutoring is affordable and attainable for nearly every student, private tutoring hours are still a limited resource. Proctored Study Hall is the ideal time to get additional help from a tutor with items you may not have time to review during regular tutoring sessions. For students in our Bronze Classroom-Only Program, this is your only formal opportunity to receive personalized attention, so show up early, and never miss a session.

Here are a few examples of effective activities you could do with a tutor during one of the Proctored Study Hall Sessions: o Complete a Speed or Comprehension Drill together.

▪ How does the tutor use CAR drills effectively? Does the tutor do things differently than you do?

o Review your recent notecards. ▪ Are they conceptual in nature? Are you making enough of them?

o Work practice problems out loud together.

▪ Identify the root problems that cause you to miss questions.

o Prepare a section of the Student Study Manual for your next tutoring session.

▪ How does a high-scorer prepare and annotate a lesson outline prior to individual tutoring?

Introduction Altius

xxiii

o Analyze the AAMC-style questions you’ve authored recently. ▪ Are your MCAT questions accurately matched to real AAMC MCAT questions?

o Review one of your recent full-length exams. ▪ Work with the tutor to find common trends among the questions you missed. How can you prevent

these same issues on the next full-length exam?

13) Private Tutoring: Attend your 1-on-1 private tutoring session [1 hour]. The hours of one-on-one tutoring to which you have access vary by program level. Platinum students have forty-five (45) hours of tutoring, Gold students have twenty-five (25) hours of tutoring, and Silver students have fifteen (15) hours of tutoring. The Classroom Program does not include one-on-one tutoring.

However, Classroom-Only students can purchase tutoring a la carte for $75 per session. Please consult your Course Outline for full details on how to use your one-on-one tutoring most effectively. During your one-on-one tutoring sessions, focus your tutor immediately on those topics you have been struggling with most. After these topics have been addressed, move on to topics you think you know well. On these topics, have your tutor quiz you to test your true level of mastery. For all topics, consistently ask your tutor to help you catch the vision of how the MCAT will test that subject conceptually. We encourage every Altius student to regularly ask their tutor questions such as: “How will the MCAT test me on this subject?” or “What MCAT questions have you seen on this topic?”

14) Tutoring Session Review: Review the chapter outline and your notes from the associated

tutoring session within 24 hours [1-2 hours].

Repetition is an absolute must if you are to excel on the MCAT. This should be the third time you have reviewed the current chapter: once before your tutoring session, during your tutoring session, and now a third time, within 24 hours of that tutoring session. This time around, you should be attempting to retain basic information in your long-term memory and to reach the level of Teaching Mastery. Teaching Mastery means that you can explain or teach every concept in the lesson confidently to someone else in layman’s terms (which, not coincidentally, is an application of one of the Four Conceptual Questions).

15) Final Review and Mastery: Re-visit everything you’ve learned while studying this chapter until

you’ve achieved a “Tutor-Level of Mastery” for each concept [variable time commitment].

Finish the week by reviewing all your notecards until fully mastered. Read through the lesson outline one last time and ensure that you are confident in your mastery of every single line of the current lesson. To consider a topic “mastered,” you should be able to answer each of The Four Conceptual Questions for that topic confidently, from memory, without consulting notes or other resources. Call, email, or meet with your tutor face-to-face if necessary, to tie up any nagging loose ends. Your goal during this Final Review & Mastery phase is to obtain Teaching Mastery of each topic to the point that you know these topics as well or better than your assigned tutor. You should feel confident that you could step into his or her place and confidently tutor another student on these subjects. If you are not yet at that level, plan to spend one more week on this chapter.

Introduction Altius

xxiv

Summary of The Fifteen (15) Weekly Activities:

1) Lesson Preparation: Study and annotate the current chapter outline prior to your one-on-one tutoring session.

2) Weekly Strategy Session: Read, ponder, and apply the Weekly Strategy Session.

3) Group Session Attendance: Attend this week’s Group Session(s).

4) Review Group Session Science Topics: Review the list of science topics covered during this week’s Group Session(s) until fully mastered.

5) SRS Preparation: Prepare to teach your assignment at the Spaced Repetition Session (SRS) meeting.

6) SRS Attendance: Attend at least one Spaced Repetition Session.

7) CAR Study Block: Study the CAR section exclusively for a minimum of three hours each week.

8) Becoming an MCAT Author: Author ten (10) AAMC-matched MCAT questions.

9) Notecard Mastery: Master all notecards made this week and review all pending cards in your Anki deck.

10) Question Set Completion: Attempt the Question Set at the end of the chapter.

11) Question Set Review: Carefully review your completed Question Set using the KEY provided.

12) Mastery Sessions and Proctored Study Hall: Attend all Mastery Sessions and Proctored Study Hall Sessions available at your program level.

13) Private Tutoring: Attend a 1-on-1 private tutoring session.

14) Tutoring Session Review: Review the chapter outline and your notes from the associated tutoring session within 24 hours.

15) Final Review and Mastery: Re-visit everything you’ve learned while studying this chapter until you’ve achieved a “Tutor-Level of Mastery” for each concept.

There you have it. Now you know exactly what you will be doing for the next five to nine months. It’s a simple process, with a proven outcome. Complete the Fifteen (15) Weekly Activities for Chapter 1, then repeat. Complete each activity to the absolute best of your ability, and in such a way that you accomplish the intended purpose of the assigned activity. Remain consistent and before you know it, you will be celebrating an amazing MCAT score.

Time Required to Complete the Fifteen (15) Weekly Activities:

You may notice the expected time commitment for many of the Fifteen (15) Weekly Activities is given as a variable. Altogether, the time required to complete all fifteen activities ranges between 20 and 30+ hours. At an absolute minimum, plan to invest 20 hours per chapter of the Student Study Manual. If you are enrolled in the

January Short Track Program, this will mean a minimum of 20 hours per week, period. Students in the Fall Long Track Program can spread their study time out over 6 to 9 months, and may therefore invest as little as 10 to 15 hours per week. Students in the Fall Accelerated Track or the Summer Full-Immersion Program will need to treat MCAT study like a full-time endeavor. Twenty hours per lesson is the minimum. This amount of time will usually suffice for a student of above-average intellect, with a strong pre-requisite background, self-discipline, and solid study habits. Even for a student with a history of high achievement, MCAT preparation should be at least as time-consuming as a part-time job.

That being said, if you have historically struggled with standardized exams, if these MCAT science subjects were difficult for you when you took the prerequisite courses, if you took these classes more than two years ago, or if your early Altius performance indicators are below average, you may need to spend 30+ hours on most chapters.

In such cases, it may be wise to spread out the study schedule described above across two weeks, rather than one. Some students have spent as much as three or four weeks mastering a chapter that is particularly difficult.

Introduction Altius

xxv

There is no shame whatsoever in taking the time you need to do things the right way. Altius can help anyone earn an amazing MCAT score, but it may take some students more time than others. If you need to, postpone your exam to a later test date. Students in this situation should also give serious consideration to upgrading to the Platinum version of the program, giving them significantly more instructional time with their assigned tutor. Finally, keep in mind that everyone will have particular subjects that are more difficult for them personally. Some students will loath the upcoming biochemistry chapter, while others will be excited to see their favorite subject. During a week when you face a particularly challenging subject area, you will need to find a way to put in the extra time necessary to master that content. The one thing you absolutely cannot do is proceed forward to the next chapter if you have not mastered the material from the current chapter. We have all had those “crazy” weeks when we just can’t get anything done. In such a case, it is much better to take one extra week to master the material

than it is to move forward in the program and hope to make up for it later.

Introduction Altius

xxvi

THE TEN INDICATORS OF SUCCESS After tracking student performance for more than a decade, we have found a consistent, reliable correlation between ten categories of program adherence and a student’s eventual MCAT score. We call these ten measures of program adherence “The 10 Indicators of Success.” We have never known of a student who fully completed all ten of these key indicators and still scored below a 508 on the MCAT. In fact, most students who complete all ten indicators score in the 95th percentile or above.

1. Followed the Suggested Timeline: o I took a minimum of five (5) months to complete the January Short Track, six (6) or more months

to complete the Fall Long Track, four (4) months or more to complete the Fall Accelerated Track, or no less than ten (10) weeks to complete the Summer Full-Immersion Program.

o I allowed at least one week of study time to cover each chapter (two chapters per week for summer students) and finished all lessons in the Student Study Manual at least 30 days before my test date.

o I precisely followed the Course Outline for my suggested study track.

2. Attended All Group Sessions, Mastery Sessions, and Proctored Study Halls: o I attended all of the Group Sessions, Mastery Sessions, and Proctored Study Halls available to me

at my program level. o During Group Sessions, I studied and analyzed every practice question, studied and analyzed the

exam itself (layout, trends, question types, etc.), made notecards, applied the Altius strategies, and reviewed and mastered all the Group Session science topics.

3. Completed the Final Preparations Checklist:

o I allowed a minimum of four (4) weeks between my last content lesson and my actual exam date. o I completed the Final Preparations Checklist in its entirety as outlined.

4. Used and Mastered Anki Notecards:

o I made a notecard for every question missed or new concept learned. o I focused on making my notecards conceptual in nature rather than memorization-based. o I mastered all the notecards in my Anki deck on a weekly basis.

5. Mastered Every Line of Every Lesson:

o I mastered each concept from the current chapter of the Student Study Manual to a “Tutor Level of Mastery” before moving on to the next chapter.

6. Completed and Analyzed the Question Sets:

o I completed all of the Question Sets under timed conditions. o I reviewed the Question Set KEY for every question I attempted, both those I answered correctly

and those I missed. o For any Question Set scores below 80%, I consulted with my tutor and implemented his or her

recommendations before proceeding to the next lesson.

7. Critical Analysis & Reasoning: o I attended all 32 Group Sessions and focused intently on improving my CAR performance. o I logged a minimum of three (3) study hours per week dedicated exclusively to CAR. o I read a minimum of ten (10) CAR passages each week.

o I completed five (5) CAR Speed Drills and five (5) CAR Comprehension Drills each week. o I tracked my CAR Speed Drill time and decreased it gradually to four (4) minutes or less. o I wrote five (5) of my own AAMC-style CAR questions each week and shared them with both my

tutor and my SRS group.

8. Application of Strategy: o I read the Weekly Strategy Sessions multiple times and worked diligently to apply them. o I was familiar with, and regularly applied, every strategy in the Strategy, Math & Research Methods

chapter of the Altius Student Study Manual.

9. Attended Spaced Repetition Sessions Regularly:

o I was a member of a reliable SRS group and attended SRS meetings regularly. o I always came well prepared to teach my assigned portion of the previous lesson.

Introduction Altius

xxvii

10. Communicated and Sought Help: o I sought help early and often on anything I struggled with, or did not understand. o Whenever I was unable to meet one of the Altius progress indicators I sought extra help from my

tutor and/or Altius management. o I was candid with my tutor and Altius staff about my progress and satisfaction level. o I agreed to and implemented all advice given to me by my tutor and/or Altius management.

Over a decade of data from former Altius students has proven that program adherence is the single best predictor of high MCAT scores. The following graph depicts the mean MCAT score among Altius students as a function of their level of program adherence.

This graph demonstrates that students who complete 100% of the Altius MCAT Program requirements eventually earn very high MCAT scores. Among students who completed all 10 of the Ten Indicators of Success, the average score was slightly above a 515. Please note the precipitous drop in MCAT score when only 80 or 90 percent

of the program is completed. Students in this scenario often believe they have “almost” completed the entire program, so they should “almost” reach the 95th-percentile. To the contrary, completing 8 of the 10 Indicators of Success is associated with a significantly lower MCAT score.

500

502

504

506

508

510

512

514

516

0 2 4 6 8 10

Mea

n M

CA

T Sc

ore

Indicators of Success Completed

Introduction Altius

xxviii

HOW TO USE NOTECARDS Notecards play an important role within the Altius MCAT System. Some of you may not have used notecards in the past. However, for the Altius MCAT Program they are an absolute imperative. Later in this chapter, we will provide you with a brief overview of the key principles of memory and learning science. At that time, we’ll demonstrate for you how notecards utilize several of the proven principles of long-term memory retention. For now, however, we’ll focus on how to create an effective notecard. The notecards most people make and use are ineffective, nothing more than front-and-back drills of rote facts. Although such memorization is rarely rewarded on the MCAT, you may need to have a few of these memorization-based cards in your Anki deck. If, for example, you come across common formulas, figures, or values that you do not know by heart (e.g., PV = nRT, speed of light = 3.0 x 108 m/s, the specific heat of water = 4.18 J/gC, etc.),

such a notecard could be appropriate. For most of you, however, a handful of these cards will be sufficient to cover everything you need to memorize for the entire exam. Effective notecards focus on concepts and critical thinking, NOT memorization. The overwhelming majority

of the cards in your Anki deck should test your understanding of the principles you are learning in a conceptual manner. An effective notecard features a prompt and an answer, but requires the user to think in a fashion similar to the MCAT’s testing style. As soon as you revert to merely copying text, facts, or formulas directly from the Student Study Manual onto a notecard, you’ve undercut the intended benefit of this process. Any notecards you do create in this way will ultimately prove ineffective. Such notecards do more harm than good. When you encounter something new, instead of copying information directly onto a notecard, ponder a few questions in your mind: “What is the crux of this new concept?” or “What is the most challenging or counterintuitive aspect of this science principle?” Once you have those key concepts crystallized in your mind, author a notecard that will force you to think in that same way. Try to design a question that will require you to both think and reason; one that cannot be answered using memorization alone.

The primary purpose of notecards is accountability, NOT memorization. Notecards help you account for, organize, track, and retain newly mastered concepts. If you encounter a concept you did not understand previously, it should go onto a notecard. If you encounter a concept you have seen before, but for which there is still room for improvement, that concept should also go onto a notecard. Of course, you aren’t simply going to write down a concept and its definition. You are going to design a conceptual question or prompt that will require you (when you are reviewing this notecard days, weeks or months from now) to use and apply your newly-mastered way of thinking. In other words, the notecards you will make as part of the Altius program are NOT the same as the notecards you may have used in the past. Rather, think of notecards as a formal documentation of potential chinks in your MCAT armor—areas that, for you personally, hold the most opportunity for growth and score improvement. As a natural consequence of how the brain processes, prioritizes, and stores information, students learn things all

the time only to forget them later. On almost innumerable occasions during this course, you will invest anywhere from minutes to hours studying a concept before you finally “grasp it.” You’ll have one of those proverbial “Aha” moments.”. If you were able to take your actual MCAT exam that instant, and answer only questions on that exact topic, you would do quite well. Unfortunately, it may be many months before you are sitting in front of a computer taking your real MCAT. Without regular repetition of this new concept, you will forget it. The precious minutes or hours you invested in reaching that insight will be worthless. This very fact is why notecards are such a pivotal part of the Altius MCAT System. You are NOT making notecards to memorize something. You are making notecards to keep track of something you value. You will spend a lot of effort over the coming months figuring things out. Once you have finally wrapped your mind around a challenging concept, making and reviewing a notecard will ensure that you don’t lose what you’ve fought so hard to obtain.

Throughout this Student Study Manual, we have emphasized counterintuitive or difficult science concepts in bold and italics. Similarly, when we offer you advice or counsel that has proven to have a particularly dramatic impact on student performance in the past, we will also use bold and italic font. It is usually a good idea to formulate a notecard for each of these important points. Please take all of the information presented in bold and italics seriously. It is incredibly disappointing when, near the end of the program, some students are still missing questions on subjects highlighted in bold and italics throughout the Student Study Manual. They are emphasized for a reason—so make learning them a priority! Finally, remember that notecards are not reserved for science concepts only. You can and should use notecards to keep important strategies, best practices, and test-taking skills at the forefront of your mind. For example, if you and your tutor have determined that you tend to miss questions when you read too fast, or when you are not sufficiently critical of the proposed answer choice, those are reminders worth putting on a notecard. You will see

Introduction Altius

xxix

those reminders every so often as you study your Anki deck, and as a result you’ll be more likely to remember and apply those best practices in the future. You will create and review hundreds of notecards in the coming months. As you do, remember the Altius mantra cited earlier:

Don’t Memorize, Conceptualize!

If you have been in the habit of memorizing content for your undergraduate exams, you need to break that habit as quickly as possible. The MCAT tests conceptual understanding. Therefore, to be effective, your notecards must do the same thing. Think of notecards as a tool for identifying and systematically eliminating all your weaknesses. Each notecard made and regularly reviewed via the Anki method is one chink in your armor identified and repaired. Once you’ve found a weakness, struggled through to that “Aha moment,” and then created an effective notecard, you will never have to worry about that issue again. As long as you keep up to date with your

Anki notecard deck, you can have confidence that what was formerly a weakness will be solidly banked in your long-term memory come test day. Replicate this process thousands of times over a period of months and you will end up with an almost impenetrable defense.

Introduction Altius

xxx

UNDERSTANDING THE EXAM The most important characteristic of the MCAT, the one aspect of this exam that is most valuable for premed students to understand, is this:

Nearly 90% of MCAT questions are conceptual, analytical, or entirely passage-based. The remaining ten percent of the questions will be the question type most students expect to encounter on the MCAT: questions that reward content knowledge. We call this The 90/10 Rule, and will refer to it regularly throughout the course. This simple fact should constantly guide how and what you study. Most students who prepare for the MCAT spend their time exclusively studying content and attempting calculation-based practice problems. Every MCAT preparation book currently available follows this same trend, with very few questions that

test conceptual thinking or analysis and thousands of questions that test knowledge, calculation, or memorization. A quick analogy may help emphasize the importance of keeping The 90/10 Rule at the forefront of your mind as you study. In the sport of American football, there is a unique, rarely-used offensive scheme referred to as “The Option.” Some college football teams occasionally run one or two option plays in a game, but most teams rely upon more traditional offensive approaches. There are a few teams, however, that run the option offense exclusively. This is significant because the type of defense necessary to counteract an option offense is quite different from the defense used against traditional offensive schemes. Imagine that you are a coach and your football team is scheduled to play in ten games this coming season. Nine of those games will be against teams that run traditional offenses, and one game will be against an option team. During all your camps and practices you decide to practice only option defense. Would this be a wise decision?

Unfortunately, this is exactly what most MCAT students do—they spend all or most of their study time focused on that which makes up only 10% of the exam (content knowledge) and spend little or no time focused on that which makes up 90% of the exam (critical thinking and application). One of the reasons students, by default, ignore the 90% conceptual content of the exam is that they are unsure how to prepare for these question types. Most students are used to studying for a college-level exam by reviewing notes and lecture slides, memorizing equations, and so forth. The conceptual questions that dominate the MCAT test your ability to reason, conceptualize, analyze, and synthesize. In other words, they test not so much what you know, but how you think. This important fact is the basis of the mantra we mentioned once before:

How You Think ≫ What You Know

How do you prepare for these types of questions? First and foremost, follow the Altius program. We have designed

several repetitive, reinforcing aspects of this program that will develop and gradually improve your critical thinking skills. If you follow our system with exactness, you will improve greatly in these areas. However, merely showing up and doing the minimum won’t suffice. When we say “follow the program,” we mean that you must take every suggestion, strategy, and mantra seriously. You must do your genuine best to understand each strategy and to get the most you possibly can out of each activity. Those who always maintain a positive, forward-thinking attitude will gain many insights and show measurable growth from everything they do as part of the Altius program. Those who have critical, negative attitudes rarely learn anything and their negativity becomes a self-fulfilling prophecy. They decide rather flippantly that they don’t like something, say they aren’t “getting much out of it,” or proclaim “That’s not how I learn.” Eventually—no matter how effective that activity may be for other students—these “naysayer” students prove themselves right.

This initial mention of The 90/10 Rule is intended to get you thinking in the correct frame of mind regarding the reality of the challenge that lies before you. Later, in the Strategy, Math & Research Methods chapter, we will address several specific things you can do to master the 90% question type. Before we proceed, however, we must mention that as important as that 90% of the exam is, one cannot neglect the 10% completely. Would it be wise for the football coach in our analogy to go in the complete opposite direction and never practice option defense? When test day arrives, you will need to have memorized certain facts, formulas, and vocabulary. In fact, you could never expect to do well on the MCAT without some fact-based knowledge. For example, even if you were to answer 100% of the conceptual questions correctly, but you missed most or all of the 10% question types, your total score would drop by several points. Fortunately, at Altius we have worked diligently to isolate only that content absolutely necessary for the MCAT. Our lessons are greatly condensed compared to what most other MCAT programs present—so mastering all of the content knowledge in the lessons is well within reason. As long as you commit yourself to

doing this, the 10% question type shouldn’t be a concern for you.

Introduction Altius

xxxi

ENSURING YOUR OWN SUCCESS At Altius, we give you a large array of tools to help you monitor your progress and thereby guarantee your eventual success. The greatest of all the resources available to you is your personal 1-on-1 tutor. He or she is an invaluable resource to help you know where you are at in relation to your goals. Talk to him or her frequently and seek honest, candid feedback. The Student Accountability Tracking Sheet (SATS) contains all the measurable weekly activities that must be accomplished if you hope to earn at or near our very lofty averages. Please take this seriously. If you are flippantly checking off boxes, trust us, your tutor will know. From time to time, your tutor will ask you to bring in examples of your completed notecards, show them questions you missed on the Question Set, or report to them on your performance at last week’s Group Session.

In addition, we have created an easy-to-remember set of three criteria that will allow you to quickly evaluate your performance throughout the program. The first criterion is: 90 Based on historical data tracking thousands of students, this is the approximate percent correct you will need to earn on the proctored Group Session questions in order to confidently score in the 95th percentile on exam day. As a result, you should ALWAYS be intently focused on reaching this level of performance during Group Sessions. Early in the program this may not be plausible, and may even feel like an insurmountable task. Given time and continued diligence, however, most students can approach this criterion before their exam day arrives.

The second criterion is: 85 This refers to the percentage of questions answered correctly on each Question Set. If you are on track for a 95th percentile score you should be answering around 85% of these items correctly on your first attempt of each Question Set. If you are targeting a score in the 99th percentile (which we strongly encourage; Altius students have historically earned 99th percentile scores at about 10 times the national per capita average), your goal should be 90% or above on each Question Set. Many students seem to throw up their hands after grading their question set, as if to say “That’s what I got. There’s nothing I can do about it.” That is ridiculous. Any student that works hard enough and long enough to 1) master the material in the given chapter, and 2) regularly improve their strategy and test-taking skills, will eventually be

capable of answering most of the practice questions correctly. It may mean you need to study longer, maybe even twice or three times as long as the student next to you, in order to reach that bar. If that is the case, so be it. This is not a contest between you and your neighbor; it is a challenge between you and yourself. If you score below 85%, it means you either a) did not master the material sufficiently before attempting the Question Set, or b) you have not yet mastered the skills necessary to deal with AAMC MCAT-style questions. Both of those problems can be fixed…but only if you are willing to do the necessary work. The third and final criterion is: 514 This is the total MCAT score students need to average on their first attempt of the last three Altius full-length practice exams (FLEs) in order to have reasonable confidence they will score at least a 513 (90th percentile) on their actual exam. Many Altius students have been earning real MCAT scores equal to their average score on the

last few FLEs, or even a few points higher. However, a few students always go down on test day and you’ll need to take that possibility into account. Suppose you are scoring around a 510 on the last few FLEs and decide this is “close enough.” There is a serious risk that you could go down by a few points on test day, which would put you below a 510—the score that has become an unofficial “breaking point” between competitive and non-competitive applicants. If you are mid-way through the program and are still struggling to earn a 514 on a practice test, seek additional help from your tutor. STOP your normal progression through the Student Study Manual. With your tutor’s help, identify stopgaps and solutions, then implement them before proceeding. We assure you that viable solutions are within your reach. You may need to upgrade. You may need to extend your test date. You may need to significantly increase your time commitment to the MCAT. Whatever it takes to get the score you need, do it.

Introduction Altius

xxxii

Making significant changes mid-course may slightly alter your application timeline, but that is an inconsequential consideration compared to getting the MCAT score you need. Do NOT keep burning through practice tests repeatedly earning low scores. Stop, re-evaluate, review, and take full advantage of your tutor and all other resources provided to you by Altius.

If you are nearing the end of the program and your average score on the last few Altius FLEs is still below 514, do NOT take the exam.

You are not ready. That is to say, you are not ready right now...but you can be ready soon. As long as you are headed in the right direction, and are willing to keep on fighting, you will always reach your destination eventually. Meet immediately with your tutor and make a game plan for how to get your practice scores up to where they need to be. In the grand scheme of things, postponing your exam a few weeks, or even a few months, will have no

impact on your “life as a physician” twenty years from now; scoring poorly on the MCAT will. It could prevent you from even having a “life as a physician” twenty years from now. Remember these three criteria and use them regularly throughout the program to self-diagnose your progress. The Three Criteria:

90 │ 85 │ 514

Introduction Altius

xxxiii

THE SCIENTIFIC BASIS FOR THE ALTIUS MCAT PROGRAM We ask that all new students entering the program take a few minutes to read the following article written by our founder, Lauren Curtis. Understanding the science and reasoning behind our program will make it easier for you to wholeheartedly accept and apply our study suggestions.

The First-Ever Evidence-Based MCAT Program Memory and learning research has been an interest of mine for many years. I first became interested in this subject when taking courses in Educational Psychology during undergrad. The principles I learned then, and in my studies since, have dramatically changed my life. My love for learning and—perhaps more importantly—the speed with which I actually learn, have increased many-fold as a result. In creating the Altius MCAT Program, I have attempted to create a system that maximizes the use of those learning methods shown by science to be most effective. The Science of Memory

The process by which the human brain stores, condenses, and retrieves information is still only partially understood. Researchers have established with some certainty, however, that the key processes occur at neuronal synapses. As we learn, these synapses undergo physiological changes that account for memory storage and retrieval. These processes include changes in the way neurons interconnect with one another as well as changes in the actual cell membranes themselves at the synapse. Although the exact details of this process are still scant, the science of memory on a macroscopic scale is among the most well investigated topics in modern science. Peer-reviewed studies demonstrating how humans learn most efficiently (or inefficiently) began appearing regularly in the literature as early as the turn of the century. Since then, investigations into memory and learning have continued in earnest. We now know with relative certainty which approaches to learning are most effective, those that are moderately effective, and those that are abysmally

ineffective. Heading up that last category, or should we say “bottoming it out,” is the ubiquitous lecture. In fact, lecturing has been found to be so ineffective that two researchers, McLaughlin and Mandin, coined a new scientific term to describe the negative impact of lecturing: Lecturalgia. Lecturalgia—sometimes referred to as simply “painful lecture,” is a measurable physiological response experienced by the disengaged members of a lecture audience. This response shares many similarities with the physiological responses seen in persons experiencing chronic pain. Lectures, it seems, are not only ineffective, they are painful to endure. How in the world then, one might ask, is it that every major institution of higher learning in this country still seems to base their entire educational experience on lectures? That is a perplexing question indeed. However, more important for you, as a future MCAT examinee, is to ask yourself how science is or is not being applied to your learning processes in preparing for the MCAT. All the status quo test prep providers appear to have entirely disregarded the science and blindly trudged forward with lecture-only formats.

Short-Term vs. Long-Term Memory There is a pervasive misunderstanding of what constitutes “short-term” vs. “long-term” memory. The brain’s short-term memory storage system can hold information for only a few seconds to just under one minute. This is what would allow you to glance at a few words written on a chalkboard, quickly turn away, and be able to recall what you saw. Long-term memory storage, on the other hand, accounts for everything you learn and remember for more than a few minutes. Even “cramming” for a test, therefore, utilizes long-term memory storage. The difference between this kind of memory and memories that you retain for years is simply the “strength” of the memory. Several factors—which we will discuss below—determine the strength of the memory and therefore the length of time the memory is available for recall.

Spaced Repetition Based on what I’ve described thus far, whenever you learn some new piece of MCAT information you will need to store that information in your long-term memory. Whether or not it will still be there on test day will depend on the “strength” of that memory. The first (and by far the most important) way to increase the strength of your MCAT memories is via repetition. After your first attempt to learn something, each time you review the information again, or attempt to recall it from your long-term memory, your brain interprets this as a clue regarding the information’s importance. It is quite accurate to think that your brain gives this information a higher place in the “pecking order,” protecting it from housecleaning removal for a longer period of time.

Introduction Altius

xxxiv

Don’t be fooled, however, such a memory is still on a timer to be removed; the timer has merely been extended. As time passes, if you continue to review the information regularly, your brain will be convinced to expend the neuronal energy necessary to keep this information not only available, but “cached” at the forefront of your memory system for easier retrieval. Not surprisingly, your brain is an excellent economist. It will not spend more energy than absolutely necessary. Because of this, you can review the information too much, especially at first. If you review something, say 100 times during the first hour you learn it, your brain appears to actual de-prioritize that memory. It is as if the brain decides, “This information is presented so frequently, there really is no need to remember it.” You will experience what seems to be a strong memory of such items at first, but this will be followed by rapid deterioration. To avoid this, repetition should be regular, but with sufficient time intervals between recitations. It is generally

accepted that during your first exposure to new information, you should review it the minimum number of times necessary to achieve good understanding and recall. Then leave it alone for one to twenty-four hours. When you come back to it the second time, attempt to recall it only once, then leave it alone for three to seven days. After that, review the information once every week or so. You can gradually expand the spacing to two weeks or more after several successful recalls, but you must never stop reviewing it entirely. Several researchers (Crowder et al, 1976; Green 1989; and others) have demonstrated the increased efficiency of this method over other approaches and have referred to it as the “spacing effect.” The 3-7 days of distance between review sessions seems to be the ideal amount of time for convincing the brain to give information the highest “strength” rating possible. Of course, if you fail to complete that pivotal first or second review, or fail to complete regular review thereafter, you will lose the benefit of the spacing effect. If you do not remember anything else from this article, remember the spacing effect. You must engage in regular

review of new information to make all of the effort you’ve put into learning it in the first place pay off. I recommend having all your notecards on a schedule to be reviewed once each week, gradually moving them to two or three week intervals once you know them well. If you use the Anki program we have recommended to you, the proper timing and spacing will be orchestrated for you automatically by the software. Active Recall Many people like to study by reading through their notes, re-reading books, reviewing lecture slides, etc. These individuals will tell you “It works for me,” but this laughs in the face of hard science. The main problem with this approach is that the questions and answers are presented to the brain together. Your brain will NOT give a memory a high strength rating if it is never actually forced to recall it. Can you blame your brain? Think

about it. Would you invest any effort studying for the MCAT if on test day all MCAT questions were always presented with their respective answers? The term “active recall” refers to any situation where the question and answer are separated, and the brain is forced to actively “look up” the information. This is accomplished quite well by notecards. The two absolute requirements are as follows:

1) The answers must be obscured. 2) Your brain must attempt to retrieve the answer.

This means you cannot just read the front of the card and then flip it over. You must attempt to answer each card to the best of your ability before checking your answer. Whatever you do in your studying, never waste your time reading through question-answer sets together!

Simplifying and Chunking Try to memorize this number: 50246775635023683392. Don’t read on until you have seriously attempted this memorization exercise multiple times. Now try it again using the principles of “simplifying” and “chunking.” That long string of numbers is actually two phone numbers smashed together: (502) 467-7563 and (502) 368-3392. Without actually memorizing these phone numbers, can you sense that it would be much easier to do so now that they are “chunked” into simplified sets? Whenever you study for the MCAT, you should attempt to simplify and chunk. This is yet another scientific basis for the use of notecards. The process of making your own notecards should involve reviewing the lesson material and consolidating it into greatly simplified, “chunked” details. Your brain gives higher priority to chunked material

because it perceives it as being able to be retained with relatively little effort. If information is too complex and unorganized, your brain will resist your efforts to retain it.

Introduction Altius

xxxv

The Expensive Information Principle One type of memory to which the brain usually assigns extremely high strength ratings is information that was “expensive” to obtain. By “expensive” we mean information which you had to invest significant and/or repeated effort to capture. In the literature, it is sometimes referred to as “desirable difficulty.” In other words, EASY learning is not effective. The easier something is to obtain, the less important your brain assumes it to be. By contrast, if an answer requires substantial effort to obtain, the brain gives it a much higher strength rating. Don’t confuse this with repetition. The Expensive Memory Principle refers not to the number of attempts needed to memorize the information, but to the amount of energy and effort used to get the information into your brain for the first time. Suppose you are studying and find a missing piece of information. You spend a half-hour on the internet finding the answer. This information will receive a very high strength rating. By contrast, suppose you are

reading the “Big Status Quo MCAT Book” and read a fact directly off the page. This memory will receive an extremely small strength rating. This is the exact reason we present the Student Study Manual in outline form and include italicized questions that require research outside of the text. We know that if students spend more effort finding some of the information themselves, they will automatically remember that information better. Rote vs. Semantic Memory The Altius mantra, Don’t Memorize, Conceptualize, pays homage to the next principle of memory and learning we will discuss. Rote memory is a term used to refer to information that is memorized without being fully understood first. This type of learning predominates on college campuses (and in medical schools too). In physics, every premed student memorizes the equations for falling bodies, but perhaps 1 in 1,000 truly understands the concepts and relationships these equations illustrate. Professors exacerbate this problem because they lecture and test in a

manner that allows this type of learning to continue. Truth be known, there are even a few professors who don’t really understand the “why and how” behind what they are teaching. If you can put this behind you and begin demanding a conceptual understanding from all your educators, you’ll be well on your way to marvelous accomplishments—including a top-notch score on the MCAT. This is more than a mantra, however; there is scientific evidence supporting this particular soap box. You see, the brain treats rote information as flippantly as the giant number I asked you to memorize earlier in this article. Your brain knows that it will require enormous energy to retain long-term. It also knows, from experience, that almost every time in the past when you have tried to cram this kind of information into it, you’ve rarely ever used that information again. Such information is assigned a very low strength rating and therefore becomes very difficult to retain.

By contrast, memories that are based upon understanding—especially broad, conceptual understanding—receive the highest strength ratings. These memories have been labeled “Semantic Memory” by scientists. “Semantic,” in Greek, translates as “meaning.” In other words, semantic memories are those memories accompanied by contextual meaning. Your brain finds this information relatively easy to retain because it can create relevant neuronal connections with pre-existing memories. The memory comes with “context,” a spider-web-like attachment that allows neuronal interlacing. Not only is conceptual understanding many times easier to apply to MCAT questions, it is easier to remember and retain in the first place! Episodic Memory (Visual, Olfactory, Emotional) Just as meaning increases the strength of a memory, so do several other key attributes of the memory. In increasing order of strength, these are visual cues, olfactory cues, and emotional cues. These cues are all examples

of “episodic memory,” a memory tied to an experience rather than an abstract attempt at rote memorization. Memories that are tied to visual cues, such as pictures, flash cards, symbols, graphs, etc., are automatically given higher strength ratings than those associated with text only. Those memories associated with smells tend to be particularly strong and long-lasting. Finally, those memories associated with emotional states such as excitement, moderate stress, embarrassment, anger, etc. receive the highest relative strength ratings. With the exception of a few “scratch-n-sniff” notecards we tried to make once, the olfactory cue has been the one principle we’ve been unable to effectively integrate into the Altius MCAT system. Visual cues, however, are integrated into several aspects of the Altius program. It is because of visual cues that we emphasize the following mantra:

Write it Down and Draw it Out!

Introduction Altius

xxxvi

In fact, three of the Four Conceptual Questions, which we instruct our students to answer for every science topic they study, take advantage of the powerful impact of visual cues:

#1: Can I visualize it? #2: Can I draw a picture, graph, or diagram of it? #3: Can I teach it to someone else in layman’s terms? #4: Can I think of and describe real-life examples?

As a student, you should always study a subject until you can accurately picture in your mind the actual process, whether it be macroscopic or microscopic. If you can do that, you ought to also be able to represent that process or phenomenon in some visual way. This would include such things as drawing and labeling structures, graphing relationships, or diagramming processes schematically. Finally, if you can recall a real-life illustration of a science

concept, you will immediately gain not only contextual experience (which will allow for neuronal interlacing), but you will also automatically recall visual cues. To illustrate, try thinking of a real-life illustration of any science concept you know well… Was your mind blank as you thought about the real-life experience? Of course not. You had a visual memory associated with that experience and you could see that in your mind’s eye as you thought about the real-life illustration. By definition, a real-life example is something with which you have some level of previous experience, and whenever you think of such an example some visual will immediately come to mind. Thus, when we ask our students to visualize how processes actually occur, when we ask them to write down and draw out everything they are studying, and when we ask them to constantly graph, diagram and label, we are helping them establish visual cues. Focusing on The Four Conceptual Questions guides student thinking in a way

that will maximize the positive impact of visual cues on long-term memory storage. Visual cues are also integral to the advantage of using notecards over other note-taking methods. When the information on a notecard is properly “chunked,” the brain will associate a visual “snapshot” of each notecard with the information it is presenting. I have used notecards religiously for many years. On almost innumerable occasions, I have sat in an exam and been able to recall a “photographic picture” stored in my mind of the notecard I had used to master a given concept. Had that same information been listed on line thirteen of a page full notes, no effective visual cue would have been available to me. As effective as visual and olfactory cues are, research indicates that emotional cues are even more powerful. Some of our strongest, longest-lived memories are those first learned during heightened emotional states. Ironically, if

MCAT studying makes you cry, that may be a good thing. It is known that one of the most effective emotional cues for learning is moderate levels of anxiety. Some degree of public anxiety, such as having to produce an answer in front of an audience, has been shown to dramatically increase the strength of learning associated with such an experience. Researchers Tony and Helga Noice published a paper in 2006 demonstrating how this principle helps account for the above-average ability of professional actors and actresses to accurately memorize the thousands of lines of text found in a movie script. Such findings support the interactive design of the Altius Group Sessions. The opportunity for a student to lead the group in analyzing an MCAT problem gives the student involved a moderate level of anxiety which will assist them in storing that information in their long-term memory. Bringing it All Together: The Altius MCAT System The principles of learning and memory I have just reviewed are powerful tools you can use to succeed—not only at

the MCAT, but in the many educational endeavors that lay ahead of you. They are the basis for the design and construction of the various aspects of the Altius MCAT Program. For these reasons, we believe that no other MCAT program anywhere can give you a better chance at achieving a top score. The proven science is simply behind us. The conceptual focus of our program taps into the principle of “semantic memory.” The outline form of the lessons and the in-chapter italicized questions tap into the “desirable difficulty” principle. The chronology of a pre-tutoring session review, followed by a tutoring session review, post-tutoring session review, Group Session review, Mastery Session review, Proctored Study Hall review, and regular notecard review, build appropriate spaced repetition directly into the program. That is significant, and worth repeating. The program itself automatically builds spaced repetition. Simply follow the systems we provide and you will automatically receive spaced repetition of each MCAT topic sufficient to ensure long-term retention. The Group Sessions and Mastery Sessions utilize multiple principles of memory, including expensive information, semantic memory, active recall,

and emotional episodic memory. In summary, the things we ask of you are not just heart-burn inspirations I dreamed up on some sleepless night—they are evidence-based and will almost certainly improve your MCAT results to the extent that you follow them.