USMLE GUIDE

A word on this guide: I just finished my second year at St. Georges University School of Medicine. Figuring out what you are going to do for the oards is a !ain in the ass and gets !eo!le nervous that they do not have a !lan. Many of them sign on to "a!lan or Falcon for this reason. I would li#e to !revent as many !eo!le as !ossi$le from signing u! for those courses for those reasons% as they are e&!ensive and you are !oor. I want you to have a !lan% an idea of what to e&!ect% and all of that free. I ho!e this hel!s. A word on advice: I am wary of most advice. It is often un'ualified% and $y this I mean that I do not #now why I should $elieve in your e&!ertise. (id you score well and are you willing to tell me the score $ehind this advice) Are you li#e me in that we learn% memori*e% and study ali#e) +hat wor#s for ,eter may fail for ,aul and it is good to #ee! this in the $ac# of your mind as everyone $egins to tell you what you should and should not do. -he other !ro$lem that I have with a lot of advice is that I am not told the reason $ehind the conclusion. It is easy to say% ./ust do 'uestions0% $ut it is much harder to give a well thought out argument to su!!ort your advice. -here may $e an e&cellent reason% $ut many !eo!le do not thin# to as# for it or to give it. Also% it ta#es a fair $it of time. If someone says that there is a lot of 1m$ryo on the test% !lease #ic# him in the face. -hat sort of advice 2even if it ends u! $eing true3 is worthless for !lanning. -he most frustrating !art of this whole e&!erience is that n45 and it is hard to draw conclusions from a sam!le si*e that small. 6ou will wonder if you did it correctly% how you would have scored if you changed $lah $lah% and so on. -hat leads us to why I am writing this: Medical school is great $ecause it is the end of decisions. (ecide to go to medical school. -hree and a half years later: decide what #ind of doctor to $e. -hree to five years later: decide which jo$ to ta#e. -hat is three decisions over ten years and medicine is great that way. I was so tired of ma#ing decision a$out how to study that I wished

someone had done it all for me. -his guide is meant to $e a turn7off7your7$rain and do7 as7I7say outline so that you can save yourself from all of that. It is the guide that I wish someone had made for me. A word on irony: I am aware of the irony that I am writing a little guide filled with advice while not offering my score% telling you a$out myself% etc. +hat I can give is my reasons for each decision so that even if you do not end u! following it% you at least see the !ro$lem of !lanning and studying as managea$le. If you are interested% when I get my score I will !ost it and at that !oint% you can decide to continue using this guide or decide to forget everything written here. (eal) 8ow on with the show9 THE SCHEDULE I am assuming that you are ta#ing si& wee#s to study for this test. If it is shorter or longer% I have structured this so that it is easy to change according to your uni'ue schedule. -his schedule is $uilt using the newest edition of the First Aid for the USM:1 Ste! 5 2Systems $ased3 as I thin# it is the $est game in town and damn near everyone seems to own it. +e need a calendar% and we need to divide it into two main sections: cramming and !re7cramming. ;<AMMI8G ;ramming is undervalued. I too# an incredi$ly long time to !re!are 2= wee#s3 so that I would not have to cram $ecause 2cue lame music3 I wanted to really understand the material. Fair enough% $ut the last two wee#s are for cramming. 6ou can realistically cover two to!ics each day. Anything more and you are s#imming. I have good reasons for each of these choices% $ut first you should just ta#e a loo# at what we will call .the cramming0.

-he day $efore the test% you will $e tired of studying 2more so3. -his is when you are most vulnera$le to total mental colla!se. A friend descri$ed it to me: .I o!ened u! Micro to loo# over viruses once more $efore the test and I reali*ed that I had forgotten how to read. It was as if my head had e&!loded onto the ta$le and I could not !ic# it $ac# u! again. I !ost!oned the test a wee# after that.0 -o avoid this% I advocate ta#ing a half7 day and seeing a movie. It was one of the few things that I did that wor#ed. efore you start this final s!rint% ta#e a day off. 6ou have earned it. I thin# you should $egin with iochemistry $ecause the meat of this su$ject is in the under!innings of other diseases. A good loo# in the $eginning will hel! you inter!ret things later on and will reinforce the !athways that actually matter. y !utting this first% you effectively

study it all wee#. It is a $ig to!ic% so it gets two days. Molecular genetics and Immuno cover some similar ground 2signaling3 and this is a nice lead in to Micro. I will ma#e the same argument a$out Micro% that !utting it this early means that you study it with every system to come% reinforcing the !athogens. It is $ig% so also earns two days. ;ardio and >eme?@nc are thrown together $ecause of the !athology. For similar reasons% I have !laced them ne&t to Musculos#eletal. As you will find% the vasculitides are covered in Musculo% not in ;ardio or >eme?@nc% so these three to!ics are overla!!ing in the First Aid which is why I have grou!ed them. ;ardio% >eme?@nc% Gastro% and Musculo are also grou!ed $ecause chances are that one of these to!ics is a strength for you% so going through that su$ject 'uic#ly allows a wea#ness in the others to e&!and into that day. 8eurology and ,sychiatry are ne&t to each other for the association. 8euro% unfortunately% is just too $ig to grou! with a second large to!ic% so this is as good a !lace as any to s!lit u! ehavioral with ,sych 2they !air naturally3 and iostats with 8euro. <enal and <es!iratory are not as $ig as the other sections and this should ma#e for a somewhat easier day. -hese are grou!ed together in ho!es that you finally sit down and learn Acid? ase com!ensation. After two years% it is time. 1m$ryology is tric#y. Most of it $elongs with <e!roduction and 1ndocrine while the rest is s!read out among all the systems. -he $est advice I have is that you study the 1m$ryology for each system in the morning $efore getting into the thic# of each su$ject and save the <e!ro?1ndocrine stuff for the end. -hat it is a hodge!odge also ma#es it a natural move to grou! it with asic ,harmacology and asic ,athology. -hese sections are short and re!resent a little $it of everything. If you give it a good read% it can !ull to!ics from earlier in the wee# together and is not too stressful to $e studying u! to test day. And with that% use the last day $efore the test to !rint out your !ermit% !rint out the directions to your testing center% and loo# over some to!ics that you had to s#i!. -ry to force yourself to sto! studying $y midday and do something non7medical that night li#e watching a new movie with a friend. -he night $efore my test I caught ABB% and it was great to thin# a$out something other than !athways for at least those two hours. ,<17;<AMMI8G -hat was cramming. 8ow% onto !re7cramming. Since we have si& wee#s and I just stole the last two wee#s for cramming% that gives us e&actly AB days to !re!are. <emem$er that you are not !re!aring for the test during this !eriodC you are !re!aring for .the cramming0. If you do not cover everything in a section in the time allotted% it will not $e the end of the world. 6ou will get another crac# at it% at which !oint not getting to it will be the end of the world. <eady for the suc#) Seriously% stay o!timistic. If you are a num$ers !erson% we have AB days to cover AD= !ages of the First Aid% which wor#s out nicely to 55 !ages a day. -his is a la*y way to weight things% $ut who cares) I have gone to the trou$le of counting each !age !er section for you% and arranged the following. >ere is the first two wee#s.

+e start out with something general and familiar: the $asics. Most of the connections in this section went over my head and I did not !ull them together until the end% $ut it is nice to have the early e&!osure and to ease into this whole thing $efore the real su$jects start. -his $rings us to iochemistry. It is $ig and intimidating for a lot of students and three days does not seem li#e enough% $ut it has to $e just three days. First% we give it two full days in the last two wee#s of cramming. Second% the other su$jects need to $e given time and are li#ely higher7yield. It does not let u! as iochemistry feeds into Immunology and Micro$iology. Again% three days is not enough to cover Micro$iology% $ut the other su$jects need to $e covered and we give Micro two full days during cram wee#. ehavioral science and iostatistics are meant to $e your first $rea#. -he ground of ehavioral science will $e touched again during ,sych% and iostatistics is not that $ig. 6ou can either ta#e half the day off or use the e&tra time on Micro. As always% ma#e sure you are not seeing anything for the first time during .the cramming0. 1m$ryology is just not $ig enough to get its own day and should $e learned in !ieces with each system that follows. +hat is im!ortant for now is the develo!mental as!ect. 6ou can com$ine it with the first day of 1ndocrine 2as I have done3 or grou! it with <e!roduction% does not really matter so long as you get to it. I thin# these three to!ics together ma#es each of them stronger% and this might $e the first time you really understand the menstrual cycle.

-he second two wee#s $egin the systems. I was taught su$ject7$ased% $ut for the ty!e of thin#ing that ma#es for good test scores% the integration that comes with doing Anatomy% ,hysiology% ,athology% and ,harmacology together just cannot $e $eat. If your school taught this way then this is old hat for you% $ut for me it was a shoc# to see all the new connections. +e $egin with the ;ardio?>eme?@nc?Musculos#eletal com$ination for the reason I descri$ed earlier. ;ardio loo#s $ig in the First Aid and the !harmacology of >eme?@nc can $e intimidating. /ust remem$er that .screw it% Im just not going to #now that0 is a !erfectly good assessment for some of the material and if you can ma#e !eace with that%

you will $e less stressed. It !ro$a$ly will not $e on your test anyway. @r you fly through these sections and earn a day off. Gastrointestinal is there $ecause where else would you !ut it) <enal and <es!iratory go together with their acids and $ases% and this $rings us to the s#ull. ,sychiatry is a new section with the First Aid and I thin# they have done a good jo$. It may $leed over into 8euro 2as far as <S and other review $oo#s go3 $ut the two of them together get four days now and two more days during .the cramming0. All together now:

If you are ta#ing less time or more time% you sim!ly shave or add a day here and there from one of the $loc#s in the first four wee#s. I do not thin# it is a good idea to steal or add days from .the cramming0 as this is a !eriod favored $y the gods. +hy not add) .-he cramming0 is the !eriod where you reali*e that everything you are reading is the last time you will get to see it $efore the test% and this is a shoc#er if you have not !re!ared for it. ;ramming is also useful in the short term% and once you e&tend that !eriod !ast two wee#s% I thin# it is a hard argument that your short7term memory is still holding onto the lessons in the first days. /ust my advice% $ut then again I could have done !oorly and you should ignore all of this. 6ou can access this calendar online. -he dates used are from May DBth% DBBE F /une ABth. QUESTIONS +hich G an# is the $est) USM:1 +@<:(. ut that would $e shitty advice% right) I could just cut and !ast the whole thing here% $ut I would li#e to #ee! this file managea$le. ,lease read my evaluation of free 'uestions and G$an#s availa$le online.

BOOKS 1veryone is chasing after that magic $ullet: the high7yield $oo#. My e&!erience was that few $oo#s can !ull this off well and that most try to $e miniature te&t$oo#s and are unmanagea$le in the time you have 2>6 ;ell and Molecular $y (ude#% >6 8euroanatomy $y Fi&3 or are $are $ones and do not hel! you ma#e many connections 2 <S ,ath3. After s!ending a good chun# of change on these review $oo#s% I should have just covered the material in the First Aid using my own te&t$oo#s. Most of what you read you will not have to loo# u! 2$ecause you learned it3 and the things you do loo# u! will $e surrounded with full e&!lanations. Anything less than a full answer is annoying and wastes time 2if% li#e me% you tend to dwell3. If you have !layed it correctly% you should also have old review notes from your courses and it is always easier to remem$er what you used to #now instead of starting from scratch with everything. y the end% I was using Golans ,rinci!les of ,harmacology% <o$$ins asic ,athology% and the Merc# Manual. -he ,athology <S $y Schneider and S*anto was useful as an outline 2which I used to focus on <o$$ins3 $ut the 'uestions for each cha!ter are a$solute cra!. ;ostan*as ,hysiology <S was good in !arts and her 'uestions were reasona$le% $ut there are a few uncovered to!ics.

FIRST AID I ti! my hat to Graham A*on of @verHMyHMedH odyH for this !iece of advice: !ut the First Aid in a $inder. I too# my co!y to an @ffice Ma&% had the s!ine cut off and the $oo# three7hole7!unched% and !ut it into a 5.I0 $inder. est move I ever made. I was a$le to ta#e se!arate notes and include them e&actly where I needed them and I was a$le to ta#e my notes from !revious courses and include them 2my roommate e&!anded the $oo# to fill two 5.I0 $inders3. It is hard to overstate the advantage of having everything you need in one !lace.

THE EXAM ITSELF It is hard to antici!ate the !ace of this test. +hen doing timed 'uestions in !re!aration% there were instances where I would finish with 5B or DB minutes left. I thought to myself% .Self% youre going to have !lenty of time to loo# over 'uestions in each $loc#0. I was wrong. @n test day% I had around 5B 'uestions mar#ed !er $loc# that I wanted to give a second loo# and two minutes to do it. It was une&!ected and unsettling% and for this reason I wished that I had ta#en the 8 M1 !ractice test at the center. It is worth it just to remove the final few un#nowns for test day. -he cloc# counts down for each $loc# while you move u! the list of 'uestions. Unless you are willing to do the calculation 2even su$traction can $e stressful3% it is hard to #now how fast you need to move to finish. For !acing !ur!oses% I ended u! starting each $loc# with 'uestion JIB and ending with J5. -his way I #new e&actly how many e&tra minutes I had to devote to !ro$lems as I went along and it hel!ed me gauge whether I had to come u! with an answer now 2$ecause I was falling $ehind3 or could mar# it for later 2since I had a seven minute cushion3. I would do this again. I am than#ful for the advice I received from a stranger: .6ou are going to wal# out of the test with incredi$le relief that it is over. -his will $e mi&ed with some des!air since you will thin# that you failed. It is over. 6ou did not fail. 1veryone feels that way.0 >e was right% and every one of my friends has echoed it. I went from relief% to defeat% to anger that I had not done $etter. A wee# later% I feel .o#ay0. +hen you go through it% remem$er that you are not the first% not the last% and it is normal.

>o!e it hel!s% ;hristo!her "insella. htt!:??rumorsweretrue.word!ress.com

@ther things I wrote a$out the oards while I was !re!aring General Topi ! o "now 6our 1nemy o Statement of Goals o ;hoosing <eview oo#s o +hy 6ou (ont 8eed a "a!lan ;ourse o Setting a Schedule o +hich G an# is the est) USM:1 +@<:( o >andling the Kolume o -a#ing a rea# o Medical Students :aw o (es!eration% In a <ut o Antiarrhythmials o +hat rings 6ou >ere -oday) o @!eration: Urgent "nowledge o -he Une&!ected Suc# of the :ast +ee# S"b#e $ Spe i%i o +hat Are -hey -eaching Me) o iostatistics o :earning from Mista#es o ;ardiovascular System A%$er $&e E'a( o ,ost ;oitus o (o!amine Error! in Re)iew Boo*! o First Aid for the USM:1 2DBBE3 o >6 ;ell and Molecular iology $y (ude#.