Deans Tips Feb 2007

8/13/2019 Deans Tips Feb 2007

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To: Class of 2009From: Dr. ORe: Tips for USMLE 1Below are tips from students in the class of 2007, as well as a study schedule from one of the students (attached). All theClass of 2007 passed!

NOTE: there are comments at the bottom specifically 'to those in the bottom 10% of the class' from a medical student. ____________________________________________________

1. Books you usedFirst Aid, BRS Path and Phys, Step Up systems review, then High Yield2. On-line materials you used- Q-bank is necessary, but not until the study period starts3. Whether or not you studied in groups & did it help? Find partner to study next to and have discussion/questionssessions but do NOT try to study together and stay on track/schedule. No one studies at exactly the same pace and it iscrucial to stay on your schedule.4. How much you studied - per day & how many days8-14 hrs/day with one day of catch-up and questions each week for 28 days5. How you organized your studyingTake all books and make a spreadsheet of systems, then fill in page numbers for each book. I would go through systemsas follows: Overview section in Step Up, Anatomy, Embryology, Histology, Physiology, Pathology, Pharmacology, Sectionin First Aid, Q-bank questions. I did Biochem and Micro by themselves.6. How you dealt with your anxiety... (or not)...EXERCISE, EAT WELL, SLEEP WELL, schedule breaks with friends or family in the "real world." Most importantly: remindyourself that you WILL pass and that this in only a short period of time.

____________________________________________________________________________What books I used and schedule:Step Up and First Aid were essential. For the first 2 weeks, I did a chapter of Step Up (one organ system) every day andsupplemented with either BRS or High Yield. BRS was good for pathology and physiology. High Yield was good forembryology and neuroscience. After this I did a week of Qbank, some questions on the above organ systems, but mostlyon microbiology. I supplemented with Microbiology Made Ridiculously Simple. For the last few weeks I read andmemorized portions of First Aid. Especially the pharmacology section. I regret purchasing larger texts like LippincotsBiochemistry. I spent most of my time with Step up and First Aid and didn't have time or mental space for probingdeeper.Did you study in groups?I did not study in groups because I felt I could focus better on my own. If I had started earlier on in the year, it would'vebeen nice to study on the weekends with a group. I never managed that.Hours spent studying:I studied a little bit on the weekends (got through a few first aid books) starting around January. Started studying inearnest after school ended. I studied for about 5 weeks which was about the max I could've studied. I think it wasimportant to take some time off before third year. I studied 6-8 hours a day, sometimes 10 hours.What did you do for stress-relief?Was better for me not to overdo it on a given day. I tried to continue to exercize, sleep, and eat normally. I didn'tsocialize very much, but tried to study outside and enjoy the weather.Other advice?Only other advice I have is not to worry about it too much before the study period begins. It's best to spend most of yourstudy time on the med school classes, which are relevant for the boards. One very good idea was to use the board reviewbooks as study aids for the med school classes. This helped focus med school study and get acquainted with board stylequestions. Some did q bank in this manner too. Nobody ever believes it, but the 4-6 weeks you have to study is definitelyenough, especially if you focus on First Aid/Step up.

_____________________________________________________________________1. Books you used: first aid for the boards, BRS physiology, BRS pathology, Robbins (book with questions), Micro MadeSimple, other High Yield Books just a bit for stuff the other books didn't go into2. On-line materials you used: Kaplan Q-bank3. Whether or not you studied in groups & did it help? I studied by myself, but with other students around to take lunchwith4. How much you studied - per day & how many days 7-8 hours a day for about 25 days

5. How you organized your studying: broke it into topics and systems and did about one a day (ie cardiology,biochemistry, anatomy, pulm, renal, etc) There is generally a chapter in BRS path and phys on each system andinformation in First Aid. If you read all that stuff and then answer some questions, it's pretty good.6. How you dealt with your anxiety... (or not)...eating junk food

_______________________________________________________________________1. Books you usedBRS Pathology, Physiology, Neuroanatomy and Embyology. First Aid. Robbins Path review book. Katzung Pharm.Clinically Oriented Micro. Question book that Keenan recommended. Various notes and charts from class.2. On-line materials you usedQbank and the USMLE practice exam3. Whether or not you studied in groups & did it help?



Yes I studied in a group and I would not have been able to do it otherwise. The group kept me focused. We sharedbooks and went over topics together. We diagrammed things out. If someone needed more info on a topic, someoneelse in the group could usually help clarify things since we each had strengths and weaknesses in different areas. Wewould also help quiz each other. The danger you run is that you are together a lot in a stressful environment. Make sureto take some "alone" time.4. How much you studied - per day & how many daysI guess about 3 weeks. Started off about 12 hours/day, with some breaks. Started tapering off after 2 hard core weeks.Would sometimes throw in a "rest" day.

5. How you organized your studyingStarted with anatomy and embryology. Then we studied by system, including pathology. Studied immunology separately.Usually did self-tests at night, since the group was usually not helpful for that. Though we would go over odd testquestions together.6. How you dealt with your anxiety... (or not)...Take breaks!!! We went to the nearby park to play or out to dinner. The swing set was great fun. We cooked. We hadtons of food.and any other comments you think would be helpful.The FRED software was much better than using that Qbank format. It was much easier to navigate and it was nice to beable to cross things out. Don't get bogged down during the exam. Keep moving. Don't spend too much time on onequestion. Some blocks will seem harder than others. There will be questions where you just have to guess, don't dwellon them. Be aware that there will be people at the testing site that are not taking the boards and they may be tappingaway on an essay at the computer next to you. Bring ear plugs if you need quiet. Some computers have vents rightunder them so you may be cold while everyone else is hot. Be prepared for all temp conditions. Figure out how youwant to do your breaks early. The first few blocks aren't so bad, but you really start dragging toward the end.

_______________________________________________________________________1. I used a combination of First Aid and Step-up. Step-up was great for systems based review, and then the last fewdays when I concentrated on microbio/pharm, First Aid was great. I supplemented these with MANY other books, but theboard review series was notably good.2. Qbank was invaluable.3. No group studying, but I never study in groups, so this was not a change.4. I studied about 8 hrs a day/6 days a week for 5 weeks. THIS WAS TOO LONG. I'm not one who crams for tests, butI came to the conclusion that this is one test in which cramming would be useful. I would not study longer than 3-4weeks if I was to do it again.5. I organized my studying by system, then the last few days concentrated on pharm/microbio. This worked well.6. With an extended study period, and only studying 8 hrs/day, the stress level was "low" (relatively). I had time forexercise, relaxing, time with wife, etc

________________________________________________________________________Step 1 study info:1. Books you used: First Aid, Step Up (systems based...more detailed info than some of first aid), flash cards for drugsand micro--very helpful!, BRS path and physio--didn't really like physio book, and because they're basically all outlinedwords (no diagrams), it is easier to get bogged down in them. Used Robbins pathophys question book which was morehelpful and a great testing tool. Also neuroanatomy and embryo high yield--both of which were very helpful. I like thisseries much better than the BRS.2. On-line materials you used: Qbank. Didn't really start using it until the 4 weeks of studying. Utilized it individually in theevenings and shared with 3 other people. worked okay, but you can't track your progress very well. Might be worth themoney to purchase your own if you feel you need the instantaneous feedback.3. Whether or not you studied in groups & did it help? Studied in my regular 4 person study group, 6 days/week, 8 amuntil 3-5 pm as it was useful. We also split into pairs for drug flashcard quizzing (much better than 4 people).4. How much you studied - per day & how many days: 8am - 3pm scheduled topic studying, 3-5 pm flashcards of drugsper day. Scheduled 3 weeks of covering topics with the last week (3-4 days) of review or time to pick up stuff we didn'tquite understand the first time. We sat down and made a calendar together with # of days spent on each topic. Tookevery Sunday off. Also each of us spent the evenings doing Qbank or individual studying or spending time with SO/kidsetc...as needed. I think it worked really well, but that was because we'd been studying together for 2 years already--wedidn't change our study technique for the boards, really just extended the regular routine.5. How you organized your studying: as above--we picked out the books we were going to use to make sure everyonehad a copy and supplemented as needed. 3 weeks of scheduled plus a few days of review. In retrospect, would have cut

off the last few days because you're so burned out by that time, you should just take the test and stop waiting around forit to come. 4 weeks is to long. 3 weeks probably about right.6. How you dealt with your anxiety... (or not)... Lots of group therapy amongst the four of us. Phone calls to otherclassmates to check in on each other's mental health. Go to the gym. Taking Sundays off was the best decision.

______________________________________________________________________1. Best book & should be read multiple times - First aid for step 1 (can use supplemental text if you need more info)2. Used Kaptest.com and completed nearly all the questions.3. left 28 days to study and took about 1 day off per week. studies about 8 hours a day. only think I would say is toleave yourself at least 1 day off to recoup (or two half-days, whatever. set a time to start and stop and stick by it...andwhen your time is up for the day, go home and don't try to sneak in study time!4. organization is key - I had a schedule passed down to me and I adapted it for my study days, etc. it is also importantto keep to the schedule. if you don't finish a topic in the time allotted, leave it and move on. however, I also scheduled



review days at the end where I made up any missed material. then the last 2 days before the exam I just re-read firstaid all the way through.5. anxiety - well, getting enough sleep is key. I don't sleep well so I started taking 0.5mg melatonin several weeks priorto the onset of studying 8 hours after I wanted to wake up and was in a good sleep schedule during study time. also,exercise is good - even if it is just a walk at lunch (which I did daily). eat well, don't snack on too much junk food. oh,and it is important to tell people that they will feel terrible during the exam - feel like they know nothing and don't belongin medicine, etc. I cried for 30 minutes at lunch time and was sure that I had failed the exam, could only think of a fewquestions that I was confident I answered correctly, and was incredibly disappointed in myself and depressed. however,

I did okay on the exam.6. Lastly - if 2nd years want someone to chat with RE the exam, let them know they can e-mail me.Jessyka Lighthall" <[email protected]

_______________________________________________________________________1. Books you used: BRS Phys, BRS Path, Robbins Path question book, First Aid, Step Up, NMS question book2. On-line materials you used: Q-Bank every night (30 day sufficient, you will never use it before then)3. Whether or not you studied in groups & did it help? I studied with two other people I studied with most of the year, weknew we worked well together and studied at the same pace4. How much you studied - per day & how many days: 24 days straight, 8-5 group study, 5-7 break, 7-11 Q bank andreview5. How you organized your studying: made calendar ahead of time, studied by system, followed BRS path and physsupplemented with other materials, did questions together as group related to topic of the day (in BRS path, phys,Robbins)6. How you dealt with your anxiety... (or not)...I have never been so stressed in my life. Just know that it will be okay.Everyone gets through it. And you actually end up learning a lot, things really come together. Bring lots of healthysnacks to the test. Take walks outside between blocks.

_______________________________________________________________________> 1. Books you usedRobbins Pathology and Robbins Review -- excellent (often more than you need to know, but good for gunners)Katzung & Trevor's Pharmacology Examination & Board Review -- same as RobbinsFirst Aid for the USMLE -- mediocre (not adequate, but good to make sure you've at least covered everythingonce)PreTest (various) -- poor (too minutia-oriented)> 2. On-line materials you usedKaplan Qbank -- Indispensable!NBME/USMLE online exams (all of them) -- Very useful, but do them EARLY.> 3. Whether or not you studied in groups & did it help?Nope.> 4. How much you studied - per day & how many days> 5. How you organized your studyingIn my opinion, the best way to do well on the Step I is to have done well in classes the first two years. I studied mygluteus megamus off for the end-of-year shelf exams (i.e., 10 hours/day for almost a month), which helped a lot. Iwas way too stressed out after final exams to cram for another two weeks, so I postponed my Step I until about 3days before 3rd year rotations started, and took two weeks off to go to New Mexico and go bicycle touring. About 1/3of the time I was riding, I listened to the "Gold Standard" USMLE prep materials on my iPod. The other 2/3, I justtook in the sights. After a day's ride, I either camped or stayed in youth hostels, and I did one of three things: 1) readthrough First Aid and made flash cards; 2) listened to more Gold Standard lectures (most common); 3) tried not tothink about it, and went out for a beer.

As far as audio materials, I tried listening to the infamous "Goljan lectures," and I was not nearly as impressed with Dr.Goljan as Dr. Goljan obviously is. I gave up and went back to Gold Standard, which are excellent. They're expensive,but I highly recommend them as a passive study tool. I also listened to the Gold Standard lectures while I wascommuting to school and back for the last couple months before the exam. They were even useful for preparing for theshelf exams.When I came back from New Mexico, I had another two weeks to cram like mad, during which time I went throughevery single question in the Kaplan Qbank. First I just went through "new questions only," then I went back andretried all the questions I'd missed. Any time I missed a question (or guessed correctly but wasn't sure I'd get it right ifit were asked differently), I typed the salient points of the answers into a Word document. That document ended upbeing something like 60-70 pages long, but it made a great review of important details in ALL disciplines.

After I finished the Kaplan, I tried taking the official NBME practice exams. They were useful, but I shouldn't havewaited so long to take them. I would recommend taking one of them as a baseline gauge when you START studying,and the other at least two weeks (preferably a month) before you take the Step I.> 6. How you dealt with your anxiety... (or not)...Green chili beer and live music in Taos, New Mexico, after riding my bike across the desert. Unbeatable.> and any other comments you think would be helpful.

Anybody who tells you how to study for the Step I, ask them what they got. I talked to dozens of people who said thatFirst Aid was the only thing you needed, and I don't think any of them did very well (they passed, but I think at least90% of them scored sub-210). If you really want to do well, especially if you're going into a competitive specialty,don't just nod your head to everybody who says they did "fine." Ask what "fine" means. (I'm not going to post minepublicly, but I'll be happy to tell you if you ask.)

______________________________________________________________________



1. Books you usedStep Up, First Aid, High Yield Embryo, HY Neuro, BRS Path, BRS Phys2. On-line materials you usedKaplan q bank -very helpful3. Whether or not you studied in groups & did it help?I studied with a partner and it was the best way to study for me. Reading and talking about the material would help meto remember it. Sometimes we did q bank together and would share things we learned doing questions. And its just alot more fun.

4. How much you studied - per day & how many days23 days, for 11-12 hours with a lunch break, dinner break, and exercise break5. How you organized your studyingBy systems, giving more time to big systems. Then had a few extra days built in to review and cover things missed.6. How you dealt with your anxiety... (or not)...Laughed with other people studying. Even though it was anxiety provoking, it was kind of nice to review everything wehad learned.

________________________________________________________________Board Review Schedule 2005Starting in March, and continuing over 7-8 weeks during Blood and HGD, I tried to read the following 4 textbooks forreview:Lippencott's Pharmacology (March 28-April 10)BRS Pathology (April 11-April 24)Microbiology Made Ridiculously Simple (April 25-May 9)Lippencott's BiochemI got through pharm and most of BRS path. If I had to do it all over again, which thank God I don't, I would try harder

just get through these. I'd probably do it in the order listed.Thursday*final HGD testSaturday May 21*Biochemistry

7:00-11:00 Q bank12:30-6:30 BRS Biochem (I might recommend Lippencott's instead)8:00-10:00 Appleton & Lange (107-166)

Sunday May 22*Immunology7:00-11:00 Q bank12:30-6:30 High Yield Immunology8:00-10:00 Robbins question book (ch. 2, 6)

Monday May 23*First Aid General Info7:00-11:00 Q bank

12:30-6:30 Step Up (First Aid-organ systems based) ch. 1, First Aid (Phys,Path, Pharm)Evening*movieTuesday May 24*GI

7:00-11:00 Q bank12:30-6:30 Step Up (111-133), BRS phys (205-240), BRS path (237-282),Lippencott's Pharm (207-216; 230s?)

8:00-10:00 Robbins (ch. 17,19)Wednesday May 25*Endocrine

7:00-11:00 Q bank12:30-6:30 Step Up (158-179), BRS Phys (241-272), BRS Path (339-362),Pharm (247-278)8:00-10:00 Robbins (ch. 24), Clinical VignettesThursday May 26*Reproductive

7:00-11:00 Q bank12:30-6:30 Step Up (180-208), BRS phys (273-281), BRS path (307-338),Pharm (263-278)8:00-10:00 Robbins (ch. 21-23)Friday May 27*Anatomy/Embryology

7:00-11:00 Q bank12:30-6:30 Step Up (209-234), First Aid (75-118), High Yield Embryology8:00-10:00 Appleton & Lange (p. 1)

Saturday May 28 Play Day JSunday May 29*Cardiology

7:00-11:00 Q bank12:30-6:30 Step Up (65-92), BRS Phys (71-123), BRS Path (133-168), Pharm (151-216)8:00-10:00 Robbins (ch. 4, 11, 12)Monday May 30*Cardiology, cont.

7:00-11:00 Q bank12:30-6:30 Same as 5/29Evening*movie



Tuesday May 31*Renal7:00-11:00 Q bank12:30-6:30 Step UP (134-157), BRS phys (153-204), BRS path (283-306),

Pharm (179-192; 220s)8:00-10:00 Robbins (ch.20), Clinical Vignette

Wednesday June 1*Renal7:00-11:00 Q bank12:30-6:30 Same as 5/31

Evening*night offThursday June 2*Behavioral Sciences

7:00-11:00 Q bank12:30-6:30 First Aid (119-139); High Yield Behavioral Sciences8:00-10:00 Appleton & Lange (p. 327)

Friday June 3*Pulmonology7:00-11:00 Q bank

12:30-6:30 Step Up (93-110), BRS phys (127-160), BRS path (213-236),Pharm (217-222)8:00-10:00 Robbins (ch. 15), Clinical VignettesSaturday June 4*Pulmonology

7:00-11:00 Q bank12:30-6:30 Same as 6/3Evening*movie

Sunday June 5*Hem/Onc7:00-11:00 Q bank12:30-6:30 Step Up (235-256), BRS path (169-212), Pharm (193-206)8:00-10:00 Robbins (ch. 13, 14)

Monday June 6*Neurology7:00-11:00 Q bank12:30-6:30 Step Up (28-64), High Yield Neuroanatomy8:00-10:00 Robbins (ch. 27-29)

Tuesday June 7*Neurology7:00-11:00 Q bank12:30-6:30 Same as 6/6

Evening*night off/movieWednesday June 8*Microbiology

7:00-11:00 Q bank12:30-6:30 First Aid (175-218), Pharm (279-372), Step UP bug list8:00-10:00 Appleton & Lange (p. 167)

Thursday June 9*Review Day7:00-11:00 Q bank

12:30-6:30 Robbins (ch. 16, 25), BRS path (skin), Pharm(adrenergic/cholinergic drugs)8:00-10:00 Clinical VignettesFriday June 10

I had worked out other things that I wanted/needed to reviewSaturday June 11

Read Step UP front to coverSunday June 12

9:00-1:00 Q bank2:00 Drive by test center; take rest of day off

Monday June 13*Test dayTuesday June 14-Day to rest and packWednesday June 15-Costa Rica!! (Highly recommended)

Dear Dr. O,

Here's what our group of four came up with:1. Books used:First Aid for the USMLE - used constantly, daily, religiouslyBRS Pathology (read cover-to-cover)High Yield Embryology - good review of all those pharyngeal arch/pouch thingiesHigh Yield Behavioral ScienceRose and Renke Renal Pathophysiology (review of acid-base dx especially)Robbins (skimmed relevant chapters for review)Kaplan's PharmacologyI also re-read all of my written objectives for the last two years. Which, considering that I'd manage to misplace most ofmy first-year objectives, was not as daunting a task as it sounds. The 2nd year curriculum objectives were generally well-worth the re-read.



2. On-line materials you usedKaplan's Q-bank. Only used it intensively for about the last 6 weeks3. Whether or not you studied in groups & did it help?Studied in a group daily from the last day of school to two days before the boards. It definitely helped because we had avery controlled environment, the discipline of the others to keep each of us on track (when our own discipline gotwobbly), and got to enjoy each other's company every day.4. How much you studied - per day & how many daysI studied in the group 8 to 12 hours a day with one half day off per week from the first day after school let out until two

days before the boards (approx 4 weeks). Then I came home and did Q-bank questions for an additional 1-4 hours,depending on the length of the day. In total, probably 12-14 hours every day.5. How you organized your studyingWe very tightly organized our studying and (for the most part) stuck to it:Week 1 - Anatomy, embryology, biochemistry, some physiologyWeekend - "half boards" (4x60 min blocks on Q-bank)Week 2 - Physiology, behavioral science, biostatisticsWeekend - "half boards" (4x60 min blocks on Q-bank)Week 3 - Pathology, microbiology, pharmacologyWeekend - "half boards" (4x60 min blocks on Q-bank) - Saturday

- USMLE-provided online exam in FRED formatWeek 4 - Review, skim through more low-yield topics, do lots of Q-bank & quizzingTypically we'd spend an hour or two studying quietly on our own and then another hour quizzing each other or doing Q-bank questions; repeat as possible and then sleep. We made sure we had plenty of food around while studying.6. How you dealt with your anxiety... (or not)...One day off of total rest and relaxation the day before the boardsOne extremely well-deserved beer on Sunday evening

A 15 minute walk around the blockPromising myself a whole body massage afterwards

_____________________________________________________________________To those in the bottom 10% of the class....The standard board study schedule does not work as well. I would recommend taking more than 5 weeks. I took 5weeks the first time. My second time around I took 2 months - yes, 2 months. I studied 10 hours/day. It sounds like along time, but is what some of us need.The first time I got "bogged down" in too many books. Everyone is telling you that you need this book or that book.Know your goals. If you are hoping to excel in Step 1, then you might need all those books. If you are hoping to pass orget average, those books can be overwhelming. The first time around I purchased the entire Board Review Series inaddition to about 10 other texts. I was very overwhelmed and was always learning "new" material, rather than reallyknowing the basics cold. The second time around I focused on First Aid and Q-bank. I passed. This method will only getone passing or average - I got a 200 and was quite pleased. If you are shooting for higher than that, I wouldrecommend the Kaplan Home Study Series ($500). Go through them from beginning to end - very comprehensive. Imight have done that if I had discovered this earlier. Take notes as you study.Use Q-bank daily to test what you studied that day. Before the actual test, make sure you are getting at least a 65% on3 out of 4 timed tests. If you are getting 60-65%, it will be close. If you are getting less than 60%, don't take the test.Bottom line - this is what the Kaplan staff states. The first time I took the test, my Q-bank was 55% and I decided to gofor it - didn't pass. This time my Q-bank was 64% and I got a 200. Take notes on Q-bank material as you go along.1-2 weeks prior to test, take the USMLE practice test ($45). It will give you an estimated score. One week prior it told meI would get a 190 - I got a 200. They are usually within 15 points either direction. It also helps to tell you where yourweak points are. If it predicts "fail" - then postpone. There are worst things than postponing. My second time around, Ipostponed twice - I wanted to be REALLY sure that I would pass.Use the ENTIRE last week for reviewing all your notes and tidying up areas that are weak. The first time I only used 2days for review - not enough. The day before the test, don't do any Q-bank. But I would review quick word associations- buzzwords. Don't study the entire day.

Also, I think it is important for those who didn't pass to be connected with others who did not pass as well - one just feelsso alone when they get the "FAIL" on their results. Please feel free to give my name and email to any of the studentswho did not make it this year.

If you have further questions, don't hesitate to contact me either at my office: tel: 503/ 494-0751 or on my pager 503/423-5961 or by email: [email protected]

Sincerely,Molly Osborne, MD PhD

Associate Dean for Student AffairsProfessor Pulmonary & Critical Care

Department of Medicinemail code: L102Oregon Health & Science University3181 SW Sam Jackson Park RdPortland, OR 97239-3098



tel: 503/ 494-5260, FAX: 503/ [email protected] pager: 503-423-5961http://www.ohsu.edu/som/dean/md/sa/index.shtml

If you have further questions, don't hesitate to contact me either at my office: tel: 503/ 494-0751 or on my pager 503/423-5961 or by email: [email protected]

Sincerely,Molly Osborne, MD PhD

Associate Dean for Student AffairsProfessor Pulmonary & Critical Care

Department of Medicinemail code: L102Oregon Health & Science University3181 SW Sam Jackson Park RdPortland, OR 97239-3098tel: 503/ 494-5260, FAX: 503/ [email protected] pager: 503-423-5961http://www.ohsu.edu/som/dean/md/sa/index.shtml



Page 1 of 9 September 2006

A Student’s Experience with USMLE Step 1

What is Step 1 and why is it important?

It is a 350 question 1-day 8 hour long exam. It is divided into 7 hour-long blocks of 50questions. There is also 1 hour of total allotted break time. However, break can seemshorter during the exam because you need to check in and out each time you leave theroom. Step 1 is entirely on a computer that keeps track of time for you. You can useyour break time any way you choose, and the break timer keeps track. You can’t pausein the middle of a block. First Aid for USMLE has a great explanation of the exam. Ifyou want to become a doctor (and that’s why you’re here!), it is one of many exams youmust pass to become a licensed practicing physician in the U.S. Residency directors alsouse your Step 1 score as a screening tool for residency selection

How should I study?

The info below is only one student’s view on how to study for Step 1. There is no oneright way to study for Step 1. Everyone will have a difficult style, strategy, and plan.Decide what score you are aiming for: pass, average, very high, or somewhere in between. This can determine your study plan. Talk to people and find a way that works best for you. The biggest mistakes I think are:

• Not starting soon enough

• Using too many resources

• Using books during the study period that you have never seen before

• Adopting a study strategy that isn’t a good fit with your leaning style. (i.e. youare a visual learner but use books without pictures)

The “study period” for Step 1 is not the 3-4 weeks allotted at the end of year 2. It isduring the entire 1st and 2nd years, with particular emphasis on year 2. It’s a mistake tothink that if you didn’t learn something well the first time, that you can learn it wellduring the study period. Studying well for your classes will prepare you for Step 1 and beyond, and preparing for Step 1 can supplement your coursework. I never viewed themas separate. Both were complementary.

Know Yourself. I personally am a horrible memorizer. I have to see/hear/write

something several times using many different resources before I understand and retain. Istarted thinking about Step 1 at the beginning of the 2

nd year and set small but realistic

goals for myself. I am a procrastinator. I can’t sit down and read Lippincott’s in oneweekend. I needed to break it up in manageable chunks, such as reading a chapter aweek to make sure I stay motivated and on track.




Studying with others vs. by yourself . I had a study partner while studying for Step 1. Ithelped me stay motivated because we had the same study styles and I knew someonewould be waiting for me if I didn’t get up and around. It was also great having someone

to chat with during study breaks. We would read a few pages at a time and then quizeach other verbally on the material until we both learned it. I also studied with the same partner throughout the first two years and it worked well for us. A lot of people studiedfor Step 1 by themselves and this worked great for them too. Do what is best for you.

Where to begin?

First, I started reading discussions boards on Studentdoctor.net and see what other people said about their study plans and books they used. I hated to see when people hadthis huge list of books. It was too overwhelming. I poked around Amazon.com and readthe reviews on First Aid, BRS Phys, BRS Phys. I came across a Listmania! List by alias

“steveo” entitled “Rock the USMLE Step 1 Using Only 5 Books”. That was intriguing tome, so I emailed him and he sent me a document he wrote entited : “A Student’sPerspective On How To Study For Step I”, which I have attached to the end of thisdocument. I found his notes very helpful.

What about Kaplan Q-bank?

A tool most people use is Q-bank by Kaplan. It is a 2100+ question database withsample test questions and answer explanations that are excellent for knowledgeassessment. It is organized by topic (i.e. physiology, microbiology, pathology) and organsystem (cardiology, neuro, renal), etc. It allows you to create 50-question exams basedon those parameters and also on questions that you have missed or not done yet, e.g anexam of missed questions of respiratory microbiology. You can also take the blocks intimed or tutor mode. Timed mode simulates a real exam. Tutor mode lets you review theanswers as you go and is good for learning. Read the answer explanations. The Kaplanfolks came and talked to us at the beginning of the year, and offered 9-month subscriptionto 2nd years at a discount. My manageable goal was to do the organ system relevantquestions during the school year as we were covering them in our classes. So afterfinishing the Cardiology section in Circulation course, I did the 250-some Cardiologyquestions and read the answers and took notes on what I had missed.

Other practice questions

The other tool that was very useful was the NBME practice exams. Available onnbme.org > “Self-Assessment Services” >”NBME Interactive Website for Self-Assessment Services”. Create an account, and then choose “Comprehensive BasicScience Self-Assessment (CBSSA)”. There are 4 forms, each costing $45. Each of the 4forms has four 50-questions block, so 200 questions per form, 800 questions total. Youcan choose Standard-Paced (1 hour for each 50-question block, 4 hours per form) or Self-




Paced (4 hours for each 50 question block, 16 hours per form). Solutions are not provided. If you choose the Self-paced version, you can answer the question block in anhour, and then have 3 hours to look up the answers on the web. You can’t review the

exam once submitted, and you must submit it to get a score. It gives you a score that canreasonably predict your Step 1 score. The questions are different than Kaplan and verymuch worth doing. Since this costs money, it may be worthwhile to do them during thestudy period. For more info:http://www.nbme.org/programs/sas/sas.asphttp://www.nbme.org/programs/sas/essential.asp

What could I do during the year?

Remember this is only one students perspective. There are many different ways to study.Ask around what worked for other people and figure out what would work best for you.

Here was sort of my plan:

Prior to study period, beginning September:

• Used comprehensive review books to supplement studying for classes, i.e. mostlyFirst Aid, BRS Path, BRS Phys, Lange and Lippincott Flashcards, and also Step-Up, Hi-Yield, and took notes in them. Goal of getting through the content-relatedchapters in these books while studying the subjects in class.

• Did the content-relevant Q-bank as I studied the topics during the class (I hadcompleted about 75% by the time the study period began)

• Used High-Yields as needed to supplement course work.

• Listened to Goljan lectures during commute to and from school

•

Read Clinical Micro Made Simple in January/February

March

• Took the practice assessment offered at OHSU. Realized how little BiochemistryI knew.

• Read Lippincott’s Biochemistry starting around March, only ½ to 1 chapter perday

Starting around beginning of May

• Started going through First-Aid in detail with study partner. Went over each pagemethodically and tried to memorize as much as possible. Created a study

schedule, using First-Aid chapters as a guide

During Study Period

• Finished going through First Aid. Memorized as much as possible. Made sure Iunderstood as much as possible. Finished a section at a time using First-Aid as aanchor and then supplemented




• Used other review books and class text books as necessary to further explainthings I didn’t understand in first aid

• Finished Qbank

•

Went through High-Yield Embryo, a good aid for embryology and reviewingorgan system anatomy and pathology.

• Memorized the virus table in Clinical Micro Ridiculously Simple.

• Did the 4 NBME forms, 1 per week (200 questions per week)

• Did the Kaplan full-length practice exam

• Did 150 Released questions from NBME and reviewed answers (Free)

Time Committment

To get an estimate of how much time this took me (remember, I am a slow memorizer).Qbank: For me, 2100 questions / 25 questions/hour (including reading answers) = 84

hours, or roughly 100 hours total to go through Qbank, (I completed 75% of this before June)High-Yield Embryo: 10 hours First Aid: It took me roughly about 150 hours going through it in tremendous detail NBME: 4 forms * 4 blocks/form * 4 hours/block = 64 hours TOTAL: 325+ hours for Qbank, First Aid, and NBME. Studying 60 hours/week

= 5 ½ weeks

Other, not included in above, as were done throughout the year before May:Goljan Lectures 40 hoursClinical Micro Made Ridiculously Simple 20 hours

Lippincott’s Biochemistry 30 hoursLippincott’s Pharmacology 30 hours

(only finished 1/3 of this, 30hoursan estimate for the whole book)

BRS Path 20 hoursLange Medical Microbiology and Immunology (Levinson) 10 hoursADDITIONAL TIME TOTAL: 150 hours

Starting early helps. To get through the 150 hours, studying 1 hour per day is about 22weeks, or 5 to 6 months. I tried to be creative and find less monotonous way to study. I put the Goljan lectures on my iPod and listened to then on my commute to and from

school (40 minutes total) and then would try to read for ½ hour before I went to bed. Imade small goals, and only tried to read ½ to 1 chapter per night, so I would finish a bookin about 6 weeks. I would only do questions blocks of 25 question or so at a time. Iretained more and it was easier to stay focused.




Our study period was 5 weeks long. If you want to take a vacation, like many of us did,and I highly recommend, that leaves about 4 weeks, which was how long I studied. Sothat required me to study before the study period started. I probably ended up studying

60 hours/week for 3 ½ weeks during the studying period and then took a ½ week toreview and relax. You may take more of less time. Figure out how much time you willneed and plan accordingly.

Balance

Yes, Step 1 is important. But your health, well-being, happiness, and family cannot beneglected. No score or amount of studying is worth it if you lose the things in your lifethat are most important to you. Remember to get enough sleep, eat well, exercise, spendtime with your friends and family, and continue to pursue outside activities and intereststhat are important to you.

Books

This book lists reflects where my weaknesses were. For example, I know biochemistry,microbiology, and immunology were weak for me, so I studied that more. Books that Iused:

• First Aid

• BRS Path

• Lippincott’s Biochemistryo Read after Circulation and Metabolism

• Goljan’s Pathology Audio lectures (available on ebay)

o 40 hours of Pathology lectures. Very funny and entertaining! I put theseon my iPod and listened to them on my commute to and from school.

• Lange Pathology Flashcardso Used these throughout the school year. Very helpful for classes.o Clinical Microbiology made Ridiculously Simple

Re-read this around mid-year. Made a lot more sense after Circulationand Metabolism.

• Hi-Yield - I used an assortment of these, specifically High-Yield Embryo. Good,easy reads.

• Step-Up

• Medical Microbiology & Immunology, Warren Levinson

Some Useful Websites:http://www2.uic.edu/stud_orgs/hon/aoa/usmle1-15.shtmlhttp://www2.uic.edu/stud_orgs/hon/aoa/usmle.shtmlhttp://medinfo.ufl.edu/~med2007/year2/boards.ppt




A Student ’s Perspective On How To Study For Step I

Basically, take my advice for what it is worth...I did well on Step I but I could probably take thattest again ten times and not get the same score. If you study hard and know the material, you willprobably break 240, but the difference between 240 and 265 is luck.That being said, preparing for this exam is not a six week endeavor (well it is if your only goal is topass) and it should technically start at the beginning of second year. That doesn’t mean youshould be putting in time studying for any of the first year subjects during second year, rather youneed to learn the second material really well and in a clinical context so that you aren’t learningany new information or associating a disease with its symptoms for the first time when the sixweeks of hell rolls around. 70-80% of the material on this exam is from the second year, so thisis where your money is. I believe the single biggest reason I did well was because when boardsstudy time came around, I didn’t even have to look at the two biggest subjects the exam (Micro &Path) because I already knew them cold (don’t get me wrong I still looked at these subjects, I justwasn’t relearning material or learning material for the first time…it was all just reinforcing thematerial I already knew). The reason I feel I was able to do this was because I used very goodresources to study during the second year that approached these subjects from a clinical

perspective. This way when it came time for boards I was (1) using resources that I already knewwere good and (2) I had been using these resources the whole year so I was already familiar withthem (ie they were already full of my own notes and highlighting). Hopefully this makes sense butyou wouldn’t believe how many people start purchasing new books right before studying forboards and then spend half of their time learning how to use the book and/or making your ownnotes in the margin. All boards studying is supposed to be review, and I wouldn’t even botherusing a book that you haven’t already read at least once if you are in the hardcore boards studyperiod.Finally, this exam is not like other standardized exams that you’ve taken up to this point (SAT orMCAT) because your score is not predetermined before you walk in the door. There are a lot ofpeople in my class much smarter than I, and I did better than all of them on this exam. This is aknowledge-based exam and there really aren’t any tricks…if you know the information well, youwill do well (as opposed to the MCAT where you could study your ass off and still come in at an 8

on the verbal). Resources are listed in the order of how useful I felt they were in preparing forStep I. Remember, this is all just my take on how things are; each person needs to find out whatworks for them. Good luck.

-C.SClass of 2007

First A id for the USMLE Step IThe absolute best book for Step I. Get it early and use it w/ your second year courses. Everyline printed in this book (even the ones that seem like random facts) is high yield. It is updatedevery year to reflect the changes on the exam; 2006 version to be released in December. Thereis a reason this book is universally used by all med students…it’s that good. This is the only bookI used for Pharm, Biochem, Embryo, Anatomy, Neuro, and Behavioral Science/Biostats.

Basically 90% of the questions you could or will be asked on these subjects are in this book;there are additional books out there that are more thorough and probably contain the extra 10%of material not in First Aid, but in my opinion it would be much more beneficial to know First Aidinside and out than to know 70% of First Aid and use an additional book on the same subject.Probably the biggest reason why everyone uses First Aid and not everyone does well on thisexam is that the key to using this book is UNDERSTANDING (and not just memorizing) the factsin it. It will have facts like “an associated finding in patient’s with Conn’s syndrome is aconcurrent metabolic alkalosis.” And sure you can memorize this little fact but boards doesn’t




want to know the what (ie metabolic alkalosis finding) they want to know the why (aldosteronestimulates a proton pump in the collecting ducts to pump hydrogen ions from the plasma into theurine, so excess aldosterone results in more acidic urine and more alkalotic plasma).

Also, someone gave me the 2004 version of First Aid put to notecards on MS Word documents,

so if you want the docs let me know; I found them pretty useful.http://www.amazon.com/exec/obidos/tg/detail/-/0071440674/ref=cm_bg_f_1/002-7066749-0432026?v=glance ISBN #0071440674

Goljan Lecture Series For The USMLE Step IFive days of multidisciplinary lecture with most emphasis on pathology. Unbelievable how muchDr. Goljan knows about Step I and how right on he is. Worth listening to at least two to threetimes…just hard to find the time unless you want to listen to path lectures while at the gym orwhile driving (which would probably accelerate the course to insanity rather than bump up yourscore). I have these lectures on mp3, so drop me an email and I’ll make you a copy. Theselectures are very valuable.

MicrocardsBest resource out there for microbiology for both Step I and the second year course. Very highrecall value (the information sticks with you) especially if you use the clinical scenarios written onthe front of every card. Everything you could want or be expected to know about the bugs andtheir respective diseases is on these cards. Don’t get these for Step I if you haven’t been usingthem all year, it would be a waste of your time…they need to be bought in the beginning ofsecond year and used with the course. The flow charts on the front of each section alone makethese cards high yield enough to buy (by the way, you should memorize and commit these flowcharts to memory when you study the respective bugs….it is unbelievable how much time this willsave you when you starts studying and how many attending you will impress third year when asputum gram stain shows gram positive rods and the attending asks you which bugs it could beand you rattle off 10 species like it was nothing).http://www.amazon.com/exec/obidos/ASIN/0781722004/qid=1123430567/sr=2-1/ref=pd_bbs_b_ur_2_1/002-7066749-0432026

ISBN # 0781722004

Pathology Flash CardsEveryone raves about BRS Path but these cards are where I felt the money was for path. Everycard has a clinical scenario on the front and all the major pathology on the back (etiology andepidemiology, gross and micro pathology, clinical manifestations, treatment, and extra randomfacts about the disease). My step one exam had very few obscure diseases/syndromes and Iwould say 95% of the path questions I was asked were covered on these cards. Very goodresource but only if bought in the beginning of second year, otherwise they would take too muchtime to use. These cards are fairly new so they haven’t gotten the publicity that BRS Path has yetbut eventually they will be considered a necessity for all taking path.http://www.amazon.com/exec/obidos/tg/detail/-/0071436901/qid=1123430612/sr=1-1/ref=sr_1_1/002-7066749-0432026?v=glance&s=books

ISBN #0071436901

BRS PathologyEveryone knows about this book and everyone uses it for good reason. Clear, concise, and allthe info you need for path. More comprehensive than the path cards (but path cards have higheryield/recall value). Questions and comprehensive exam are also very good.




http://www.amazon.com/exec/obidos/ASIN/0683302655/qid=1123430137/sr=2-3/ref=pd_bbs_b_ur_2_3/002-7066749-0432026 ISBN #0683302655

BRS PhysiologyBRS Physiology is the gold standard for studying phys. This is the only first year subject reallytested in depth on Step I; good to know it cold. The way the questions on physio are asked onStep I is in the context of diseases; for example, they would give a scenario of a person who hasa small cell carcinoma of the lung and is experiencing signs and symptoms of hyponatremia(headache, dizziness, altered mental status, ect.) and at the end of the scenario they may or maynot tell you that this person was diagnosed with SIADH (if they don’t you are supposed to assumesince the scenario is classic). Then, they’ll ask something about renal phys and fluid shiftingbetween compartments (serum osmolality would be decreased and both the ICF and ECFexpanded) or how hyponatremia causes cerebral edema (water movement from ECF into cells ofthe brain causing swelling). It is very rare to have a physio question that doesn’t ask about thepathophysiology of disease, so while it’s important to know the normal, most of the questions willbe on how deviations from normal physiology manifest as signs and symptoms of a disease.

http://www.amazon.com/exec/obidos/ASIN/0781739195/qid=1123430137/sr=2-1/ref=pd_bbs_b_ur_2_1/002-7066749-0432026 ISBN #0781739195

Other Stuff You Can Buy If You Have The Cash And/OrTime

Micro & Immuno ReviewGood book but too much writing and so you should probably only use it to study for theimmunology section of your microbiology course. Otherwise, this book is most useful for theassload of questions it has on each subject (virology, immunology, ect.). I did use this book forboards but only to study immunology and I only reread the sections on hypersensitivity reactionsand immune deficiencies (which covers over 80% of all the immuno questions they’ll ask onboards).http://www.amazon.com/exec/obidos/tg/detail/-/0071382178/qid=1123430486/sr=1-1/ref=sr_1_1/002-7066749-0432026?v=glance&s=books ISBN #0071431993

USMLE Step I SecretsThe way the boards are written is that they write a case scenario and then write five or sixquestions that could be asked about the case (anything from what is the diagnosis to what is themechanism of virulence of the bug that causes this disease to what drug would you give to treatthis disease); you and the person next to you might get the same case scenario but be askedtotally different questions about that case. This book is set up just like that; there is a casefollowed by six or seven questions on the case and their answers. It is most useful because you

can see how they could ask multidiscipline questions on the same case (so it helps you see howthey could ask pharm, phys, biochem, and path questions on the same case). This book isdivided into systems and so its perfect for boards studying.http://www.amazon.com/exec/obidos/tg/detail/-/1560535709/qid=1123571949/sr=8-2/ref=pd_bbs_sbs_2/002-7066749-0432026?v=glance&s=books&n=507846 ISBN #1560535709




Platinum VignettesMuch better than the Underground Clinical Vignettes series (which if you use the UCVs you’ll findout just how much they suck within the first day). These books give ‘classic’ presentations fordiseases and bugs causing disease which is what they expect you to know on Step I. Also,

unlike the UCVs the answers are not printed on the same page as the case so you can actuallythink about the case and come up with a diagnosis rather than having it given to you. Thebehavioral science book in this series was especially useful. Dr. Brochert is the king of USMLEexams; his books for step II and step III are to these exams what First Aid is to the step I exam(he doesn’t have a step I book out, so these are as close as it comes).http://www.amazon.com/exec/obidos/tg/detail/-/1560535741/qid=1123430769/sr=1-3/ref=sr_1_3/002-7066749-0432026?v=glance&s=books ISBN #1560535741http://www.amazon.com/exec/obidos/tg/detail/-/1560535725/qid=1123430769/sr=1-5/ref=sr_1_5/002-7066749-0432026?v=glance&s=books ISBN #1560535725http://www.amazon.com/exec/obidos/tg/detail/-/1560535695/qid=1123430769/sr=1-6/ref=sr_1_6/002-7066749-0432026?v=glance&s=books

ISBN #1560535695http://www.amazon.com/exec/obidos/tg/detail/-/1560535814/qid=1123430769/sr=1-10/ref=sr_1_10/002-7066749-0432026?v=glance&s=books ISBN #1560535814http://www.amazon.com/exec/obidos/tg/detail/-/1560535768/qid=1123430879/sr=1-12/ref=sr_1_12/002-7066749-0432026?v=glance&s=books ISBN #1560535768



Last updated 2/12/2007

Board Prep Advice

You are in training for test day— your studying should mimic the actual test day.

• Study in one-hour blocks, take 5-8 minute breaks between study blocks.•

Do not drink, eat or take bathroom breaks during your one-hour study blocks—you won’t be allowed to do so on test day.• Do not listen to music or TV while studying. You may even consider wearing ear plugs

or headphones (most test centers do not allow you to wear ear plugs, but will provide youwith headphones).

• Exercise—at least once a day• Eat healthy—avoid sugars and simple carbs. Get in the habit of eating snacks every hour,

rather than a mid-day meal—you will not be eating lunch on the day of the exam.• Do one full-length practice test the week before the exam. Assimilate the practice day to

be as close to the real day as possible.• Use the “method” for answering multiple choice questions (Q, S, P

o Read the Question stem FIRST

o Then read/skim the paragraph and summarize the Sceneo Identify Normals (normal labs, PE, etc.)o Formulate a Predictiono Then do “ABC’s”

• Whenever you do questions, use your laminated sheet and whatever question method youhave devised.

• Question sourceso Kaplan Q-bank

Do sets of 50 questions across all disciplines and topics (unused questionsonly)

Set your goal to score at least 65% on blocks of unused questions (200questions average) one week before the test. Some blocks will be higher,others lower, just be sure to average your percentage over 200 questions.

o NMS booko Kumar & Klatt Pathology Review (do all of the questions!)o Lange’s Katzung Pharmacology Review—the questions at end of chapters are

good.• NBME Self-Assessment Services—4 blocks of 50 questions (200 questions total) for

$50. USMLE score report provided immediately upon completion. There is also a free50 question sample test provided through NBME.https://external1.nbme.org/nsasweb/servlet/mesa_main Recommend doing at least one

of these 200 question tests no less than one week before your exam—if you get a passing

score (> 182), the next week of studying is icing on the cake; if you do not get a passing

score, consider postponing your exam. You may post-pone without a fee one week before

your exam date.

• Familiarize yourself with the NBME test tutorial before exam day. This will allow you toskip though the tutorial (15 minutes) during the board. That time will be added to your break time, so you will now have 60 minutes of break, rather than 45 minutes.



Last updated 2/12/2007

• Study with other students. Quiz and teach one another. If you are unable to study withother medical students, teach your family/friends concepts. It takes time, but if youunderstand material and can teach it, you can be assured you know it. Again, you are better off know less material really well, rather than trying to master it all, and failing atit!

o Meet with 2-3 students once or twice daily for an hour (no more). Provides agood break from solo studying, rejuvenates your energy, and provides a goodforum for covering key topics, e.g. teach each other heart murmurs, draw &explain the cardiac cycle, quiz on bugs & drugs.

• Pace yourself. The day before the boards, do 50 questions beginning at 8:00am, reviewthose questions, and relax. Do not study any more that day—see a movie, go shopping,go for a hike.

• Do not nap during the day during your study month—you need to train your brain to beawake and alert from 8am to 5pm!

• Visit the test center in advance. Ask/assess the following:o Allowed to use ear plugs? (most likely not, headphones provided)o

How many pens and dry erase boards provided? (usually 2 pens, 3 boards anderaser)o Locker provided? (usually, yes)o Refrigerator or microwave available (most likely not)o Number of test stationso Other tests offered at site—some sites offer typing tests—try to avoid that!o How noisy is the neighborhood, building, etc.

• Have fun on test day! Really.

Documents

Deans Tips Feb 2007