THE ULTIMATE 2 IAN aeBROUGHT TO YOU BY GOTMEDBOOKS.COM TADPOLE TESTINGTHEUSTIMATE STUDENT GUDE TO USMLE STEP 1 TABLE OF CONTENTS CONTRIBUTORS 1 DISCLAIMER / 2 MESSAGE TO STUDENTS / 3 PURPOSE / 4 ‘ABOUT THE USMLE / 5 OFFICIAL WEBSITES 15 WHAT IS THE USMLE? (5 REGISTERING FOR THE USMLE | 6 When to register? Registration Steps Where do Htake the test? Hoxw do reschedule? Can I take the test outside of the 3-month eligibility period? HOW STEP. WORKS 13 WHAT'S ON THE USMLE?/8 ‘THE TEST DAY ITSELF /9 What to take? Test Cantor Tine Management During Exam USMLE SCORES 10 Whom seill I reewive my scare? How is the USMLE scored? What is «good score? Can Irotake the test? What ic the performance profile? What are the tso0 different scores on my score report? NBME RELEASED ITEMS / 12 WHAT'S AVAILABLE 13 SAMPLE ASSESSMENT (13 130 RELEASED QUESTIONS 115 GBSSA ASSESSMENTS /13 Why take the CBSSA tests? When ta take these tests? Form 1 vs, Farm 2 GBI PRACTICE SESSION / 16 HOW TO PREPARE / 17 How long should I study? Should Ihave a schedule? Subject based or organ system approach Comprehension vs. Memorization Word on Q.bank MATERIALS #22 ANATOMY 23 (CELL & MOLECULAR BIOLOGY /24 BEHAVIORAL SCIENCE {24 BIOCHEMISTRY [25 MICROBIOLOGY 125 IMMUNOLOGY /25 PATHOLOGY 1.35, PHARMACOLOGY /28 PHYSIOLOGY /28 QUESTIONS 129 REVIEW BOOKS & COURSES 29 FIMAL WORD / 31THEULTIMATE STUDENT GUDE TO USMLE STEP 1 CONTRIBUTORS ‘Thank you to the following individuats fos ‘heir help with thir guide. Shahrzad Akhtar Keck School of Medicine of USC Las Angeles, CA MD candidate, Class of 2007 Peter Katsufrakis, MD, MBA Keck School of Medicine of USC Las Angeles, CA, Associate Dean for Student Affairs Zaid Rafin Keck School of Medicine of USC Las Angeles, CA, ‘MD candidate, Class of 2007 Katrina Fu Keck School of Medicine of USC Las Angeles, GA ‘MD candidate, Class of 2007 Amy Ta. Keck School of Medicine of USC Las Angeles, GA MD candidate, Class of 2007 Tanmai Saxena Keck School of Medicine of USC Los Angeles, CA MD, PhD candidate, Class of 2007 Mansi Shah California Institute of the Ants Valencia, CA Cover and Layout Design hup://wwwmansishah.com conmautors 1THEULTIMATE STUDENT GUDE TO USMLE STEP 1 DiscLaIveR £2 DISCLAIMER ‘The following guide expresses our opinion and our take on the USMLE, Readers should consult the NMBE and assneiated agencies far official infarmation regarding the USMLE. The information presented here is correct to the best of our knowledge, how- ever errors do occur. Alo, NBME may make changes that we are not aware of and itis impossible for us te keep track of such things. Neither the authors, Gotmedbooks.com, and Tadpole ‘Testing, assume no responsibility for any damages that may eccur from the use of this informa- tion, Please verify all information, This guide is designed to prov only and should not be used for any other purpose than that. Itis not meant to replace jon regarding the USML general guidance official informsTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 MESSAGE TO STIDENTS /3 MESSAGE TO STUDENTS Gust a year age we found oursedves in dhe same place you stand new. We had to start preparing for one of the biggest exams of our lives. The amount of information that you will have to Iearn is tremendous and undoubtedly this will be a very stressful time, On top of this, the logistics of the test and how to study for it are very confusing wl begin, The information is handed down from student to student and mum cent fragmented advice on the topic. Message boards reveal students’ anxiety and the same basic questions are repeated. Therefore, we decided to ereate a guide that will help answer those ques- tions. All of the information is here in one place and we hope that this will help you understand the process a bit easier. This is our way of helping our fellow students out. We also have reviews of many books available for you on our website ~ http:/hwww.gotmedbooks.com. Ako there you can find message boards to help answer other questions you may have andl other fe designed to help you. It is a resource developed for you so we urge you to make use of it, ‘This can be a very stressful time and many of you may question why you are doing this, Re- ‘member itis just a part af becoming a physician, just another hurdle. Mamy have gone before you and got through it. So will you. Just hang in there, work hard, and stay focused. You will feel ansxiousand stressed and that is okays it is a monumental task. Try to not let the stress keep you fiom your goal. Do something to help relax you and keep moving. You will be fine. Call your ‘mom, dad, gitlitiend, boyfriend, ete. for support. Don't forget those people while you study far this exam; remember, they are still more important than any test you will ever face. We ask that you tell your fellow students about this guide so that they may alsa benefit from this information, We also unge each and every user of this guide to contribute. If you see any errars, please point them out immediately and we will fis that. If you feel any information is missing or anything can be better organized, please tell us. This isa guide for students by students, We have started the initial document and will modify this according to your advice so that fiature students may benefit. So please contribute, even if itis just one thing you noticed, let us know: Te may help someone else out and over time we ean ereate the ultimate guide for students, Good luck with the exam! If there is amy way in which we can be of assistance, we are an email away; so don't hesitate to contact us: guide@gotmedbeoks.com, Sumit Dua jun 15, 2008THEULTIMATE STUDENT GUDE TO USMLE STEP 1 FUBROE / PURPOSE ‘There is a lot of disorganized and inconsistent information available reganing the USMLE Step L We know how hard it can be to sift through all these opinions anel countless strategies, wwe did it just a year ago, That's why we're writing this guide; we're here to provide yu with in- formation about how to prepare for this exam. Step Fis worth doing well on. The SXT, MCAT, and even Step II pale in comparison to the significance of this exam. Residency programs use Step I scores to differentiate between applicants, but don't worry, we're here to help, We are not AMCAS personnel, we are med students just like you, We have provided answers to the most frequently askeel questions by students ane! we will direct you to the correct places to get the information you may need. We hope this will make your life a bit easierTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 os ABOUT THE USMLE OFFICIAL WEBSITES http wwwanbme.org http/iwwwausmle.org http Jiwww.prometric.com WHAT IS THE USMLE? Jnited States Medical Licensing exam designed by the NBM of Medical Examiners) and by FSMB (Federation of State Medical Boards) administered at Prometric centers and by some medical schools. There are three portions of the USMLE - Step 1, 2, and 3, You must pass all three portions of the USMLE to he a licensed physician in the U. (National Board The actual test is ‘To learn more basic info about the USMLE, visit here higp:/ Awwseusnale.org/ bulletin /2006/ TOC. him For frequently asked questions about USMLE: http/iwwwausmle.org/FAQs/EAQs.him http://www.nbme.org/programs/usmle.aspTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 ABOUT THEUSMLE (CONT) REGISTERING FOR THE USMLE In order to register, visit the NBME. website he httpsi//externall nbme.org/eiw2/prodijspllogin jsp When to register? ‘Your school should guide you as to when you should register for the exam. However, students usually register about 6 months before taking the USMLE. Schools must verify that a student is registered and cligible to take step | (there is usually a form that must be filled out, signed by the school, and sent along with a passport-type photo to the NBME when registering). Registration Steps Obtain application materials (Complete registration materials Submit Re Schedule test date as soon as you receive permit. scheduling permit When registering, a stuclent must designate a 3 month periad during which he will take the exam, American medical students often choose April — June or June ~ August. ‘The test is of fered year round (except Ist two weeks of January), but most American medical schools require that you take the exam before beginning your third year eletkships. It is possible to change the date and the 3-month eligibility period; thisis discussed below:THEULTIMATE STUDENT GUDE TO USMLE STEP 1 BOUT HELM /7 ABOUT THE USMLE (CONT) Where do I take the test? ‘The test isackministered at Prometric centers (and at some medical school). Once you receive the seheduling permit, you will need| to schedule a date and time with Prometric. Schedul- ing can be done via the Prometric website (www.prometric.com), If a test date needs to be hanged, it must be done through Prometric and not the NBN How do I reschedule? Yau are allowed to reschedule your test date within your three month cligibility period. Accorel- flect when this advice was written, if you reschedule at least 5 business days is no fee. Otherwise, NBME charges a “rescheduling fee” of | est Dates” in the USMLE bulletin to figure out the fee amount, ing to policies prior to your test date, then ther about $50. See “Rescheduling ‘or call the NEME, Can I take the test outside of the 3-month eligibility period? Yau are not allowed ta take the test outside of the $-month eligibility period. However, you can request to change your S-manth eligibility period You can do this once your eligibility period begins and up to 25 days afier your eligibility period expires, ‘There isa $30 fee and a farm ‘must be fillee! out. ‘The form ean be acceswed when you login here « https:/fexternall.nbme. org/eiw 2/prod/jspflogin,jsp and is available by elicking the Ist link under “Documents” on the bottom left hand side: “Step | and step 2 GK Elighility Period Extension Form.”THEULTIMATE STUDENT GUDE TO USMLE STEP 1 ABOU THEUSMLE (8 ABOUT THE USMLE (CONT) HOW STEP-1 WORKS. ‘The USMLE is an 8-hour exam. It is split in the following manner: 15 min tutorial, 60 minutes per black, ‘There are 7 blocks af 50 questions cach. So, 7 hrs for 350 questions. 45-min total break time which can be distributed between the blocks. You decide how much time you want between each block, but you cannot exceed 45 min total, You may skip the 15 min tutorial; if you do, then this time is added to the break time, increasing the total time to 60 min. We suggest you familiarize yourself with the format of the exam before your exam date, and skip the tutorial Aficr you finish a block, you must press a button to start the next block. You are only allowed to take breaks between blocks, you may not pause the timer once you start a newblock. You are responsible for monitoring your own breaks. It is only during breaks that you are allowed to get ‘out from your seat and go outside WHAT'S ON THE USMLE? USMLE.org provides content outlines for whatis covered on Step-1: http:/iwww.usmle.org/stepintro.htm ‘The general consensus is that these content outlines are not helpful. Even the USMLE officials, agree ~ “The Step I content outline describes the scope of the examination in detail but is not intended as a curriculum development orstudy guide.” Our feeling is that a good way to study isto use review books to identify what is important. Review books are discussed later,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 aout ® ABOUT THE USMLE (CONT) THE TEST DAY ITSELF Most students are very ansious on and around their test date (and rightly so). Its good to be aware of what to expect on test day and have a strategy. ‘The first step isto figure aut what you will need to take with you to the test. What to take? Checklist: * Orange ticket * Form of ID (photo, signature, not-expire * Review books * Lunch * Caffeinated drink (if needed} * A sweater (it's a good idea to wear layers, it may be warm/cold at your exam site) “Most testing sites assign you a locker, where you are allowed to put your food and personal items in your locker and access them during breaks. Yes, same students put their review books in their lockers and use them during breaks, Know younslf and knaw what works best for you, but remember your exam is # hours long, and you have at most 60 minutes of total break time to distribute as you choose. Test Center Make sure you know where th thing you want to worry about on your exam date is traffic‘parking/being late. When you arrive at the test center you will check-in. At the center there are usually lockers available far students to use. Students can put food and review books in there est center is and arrive at least half an hour early, The last For use during the exam, cach student is given three dry erase boards, two markers, andl lead phones to use as ear plugs, Some centers may not allow you to use your own earplugs,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 MME JD ABOUT THE USMLE (CONT) Time Management During Exam Breaktime, wntorial, managing time, etc. Some students check review books in between sections and look up what they do not know. OF ten times, the same question or concept may repeat, soit may help to take a look at something you did not remember, But be cautious of hoy cl your limited break time, the last thing you want to dais stress yourself out, or start worrying about questions you may have missed. ‘This isa long cxam; you dan't want to get discouraged, or to lose stamina, Know yourself, and do whatever works best for you. You may be better off using exam time to snack, to stretch, to talk on your cell phone, or if you want, to look things up. USMLE SCORES General FAQ about scares - http:/www.usmle.org/FAQs/faqusmlescores htm. A passing score is 182 (75 on two digit scale) for step-I. ‘There is no highest score, [actual believe $00is the theoretical top score ~ PJK] although most scores fall between 140 and 260. ‘The average is usually around 215-220 with a standard deviation of about 20. Pass rates (2004) were 91% for MD students, 69% for DO students, and 67% for International students, ‘The table here provides more specific numbers ( httpsl/wwwsusmle.org/scores/2004perfibtm) When will [receive my score? ‘Scores are generally sent out 4-6 weeks alter the exam, During the peak times (around June), the results take closer to about 6 weeks. During other times, the wait is more like i weeks. Most eceive their students’ scores before they are mailed out, so, you may be able to call your school and find out your score before itis mailed to you. Schools have access to the NBME web site, where new scores are posted each Wednesday.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 ABOUT THE USMLE (CONT) How is the USMLE scored? It really doesn't matter how NBME scores the test, However, students often waste valuable time debating this topic and worrying about it. So here are our 2 theories on this (both probably wrong and hath partially correct). But please don't waste your time on this any further ‘There are certain experimental questions on the test. Some students believe there are about 50 ‘of them, sa there are 300 “real” questions and your score is just 300 minus how many missed, Sof you got 70-wrong out af thase 300, then your score is about a 230. ‘The problem with this theory isit doesn't differentiate the easy tests from the hard tests. The other theory is that the blocks are adaptive, In ather words, if you do well on the first block, then block 2 is harder. ‘They get progressively harder or easier depending on your performance on the previous block. ‘This explains why sometimes students who found the test ta be impossible still do really well and others who thought the questions w allow seare, However, NBME has indicated that they do not currently use adaptive technology. In other words, we don't knaw how itis scored and that shouldn't really matter, just do your best What is a good score? t. Tt really depends on what residency program astudentis, nncral consensus is that a 230 is a competitive score for most residency programs. Can I retake the test? If you pass a Step exam, then you may not retake the exam. If you fail, you are allowed to retake no sooner than 60 days after the failed exam. You may take the failed or incomplete Step no more than three times within a 12-month period. Although there is no USMLE limit on how many times a person can take a Step, this does vary with each jurisdiction; some schools and some states have limits, ¢.¢, alter three fails, you are dismissed. You can contact the FSMB sttpillwwwausmle.org/bulletin/2005/cligibility.htm for more information and visit here:THEULTIMATE STUDENT GUDE TO USMLE STEP 1 ABOUT THE USE / ABOUT THE USMLE (CONT) What is the performance profile? When you reccive your score, you also get a performance profile with it, ‘The peaformance profile graphically displays your relative strengths and weaknesses in the various topics tested ‘onthe exam. You will also get a performance prafile when you use the self-assessment services (explained later) and you can use this to guide your studying, You can see a sample performance profile by visiting here hétps://external lnbme.org/nsasweb/servletimes: licking “Sample Performance Report” on the bottom Iefi hand side, Choose CBSSA sample perfarmance report. ain and What are the two different scores on my score report? When you recive your scores, you will notice that there are two seores, a two digit score and a three digit scare. Both essentially mean the same thing and are just two different ways to report scores. Most people usually talk about the three digit score. ‘The two digit score is not a per- centile, This isa common misconception, USMLE no longer releases percentiles. If you really to know why (http:/Awww.usmle.org/Scoresfpercentiles. htm)THEULTIMATE STUDENT GUDE TO USMLE STEP 1 NEVE RELERSEDITEME | 19 NBME RELEASED ITEMS WHAT'S AVAILABLE Ibis important to familiarize yourself with what services NBME has made available far students ‘These resources are an invaluable tool because they give students a peek at not only what type of questions are asked, but also how they are asked, the format of the exam, the typical time constraints faced, and other subtle distinctions, There are various assessments available for stu- dents, The chart below has this info and is followed by detailed info about each servic Service Cost Sample Assessment i 150 released questions | Free CBSSA Form 1 $45 ‘CBSSA Form 2 $45 BSSA Form 3 S45 GET practice session [S42 SAMPLE ASSESSMENT ‘The sample assessment has only 10 questions, but it dacs show you the software that the test utilizes. Tt alo has the tutorial so that you can familiarize yourself with it now and skip it om the real exam saving you 15 minutes, The sample assessment is free and you can look at that right now by going here (httpsi/externall.nbme.org/nsasweblservlet/mesa_main) and click- ing “sample assessment” from the left hand menu, No answers are provided for the ten ques- tions. Last year the NEM used Fred and others used the old software, However, we believe that starting this year all USMLE tests will be administered in the Fred format. The sample assessment is not the FREI format, but itis dose to how Fred works, Either way itis a good i yourself with this, 150 RELEASED QUESTIONS: started using a new software program titled Fred, Some of the centers a to quickly familiarize ‘These questions are available for free. They can be downloaded he http:/www-usmle.org/Orientation/2006/2006menu.htm ‘There are answers provided for this assessment.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 NEE RELEASED MEMS NBME RELEASED ITEMS (CONT) CBSSA ASSESSMENTS “These are the most important of all the things available to students. ‘The CBSSA assessments are mini USMLE tests {and are actual questions from previous exams), Each form has 200 questions (4 blocks of 50 questions each), whereas the actual exam has $50 questions (7 blocks of 50 questions each}. We will discuss the value of these assessments ane how to use them alter explaining a bit more about these tests ‘There are three forms available. Form 3 is available starting this year and we do not know much about it yet. The information about these exams being good predictors, etc. is based on form 1 and 2. Hopefully, we will receive feedback from those of you that utilize this test and we will report that information to future test-takers, Upon purchasing an assessme in standard or self-paced mode. '$45 cach), you will be required to select whether to comple Standard mode ~ up to 1 hr to complete each block of 50 questions Self-paced mode ~ up to 4 hrs to complete each block of $0 questions So basically the block will close after | hour or 4 hours depending on which option yau choose. ‘You may not return to-a block once it elases and answers are NOT provided for these questions. ‘Therefore, we suggest that you choase the selfpaced mode, “This will alaw a black to remain ‘open for four hours. If you want to simulate a real exam, finish the block in 1 hour and use the remaining 3 hours to review those 50 questions. Once again, answers to the test are not pro« vided, and once the block closes you cannot sce those questions again, You are provided with a performance profile that will indicate your relative weaknesses and strengths on the various topics; you can use the assessment to focus your studying. ‘The assessment also provides a score, In the performance profile there is a chart shawing what this score would correlate to on the actual USMLE. "This assessment in no way guarantess what you will get on the real test, but it is a strong predictor. The accuracy of the self-assessment in comparison to the score on the USMLE is. hotly debated topic in Internet forums. Don't waste time arguing about this type of stuif. ‘The fact is that most students find this to be a rela~ tively good predictor of their actual score, thus you should use these to judge where you stand. No test can predict how all students will perform on the actual exam, but most students find this to be a good indicator. ‘Therefore you should use these tests at various times eturing your study- ing to gauge how you are progressing.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 NEME RELEASED TEMS J NBME RELEASED ITEMS (CONT) (Once you purchase a self-assessment, you have $0 days to complete it. If you start an assess ment, you have to complete it within 20 days. You may pause the assessment and then restart as many times as you like. You do not have to finish the assessment in one sitting, Essential info - _http://wwwanbme.org/programs/sas/essential.asp ‘Ta purchase the assessments, start here ~ https:/lexternall nbme.org/nsasweb/servletimesa_main You will need to create “New Account” (left hand menu) in arder to purchase services, Why take the CBSSA tests? “These tests are the best predictors that are available, They ako give the student another op- portunity to practice and are the only actual test questions available. IF this is nat convincing enough, students report that some of these questions show up verbatim on the actual exam. In other words, some of these questions are fiec points and that alone is a good reason to become familiar with these questions. When to take these tests? Our suggestion is that you should try to take as many of these assessments as possible. How- ‘ever, we strongly recommend that you do at least one. One strategy is to take one early to assess weaknesses, Then use this to guicle your studying. ‘Take one about 1.5 weeks befare the actual exam to see where you stand. If you are not at your goal, you may want to judge if you can learn what you need to by test day. If you require more time, it may be reasonable to postpone the exam, Realistically speaking, if you get a 200 on the assessment and your goalis 240, then itis highly unlikely that you will hit 246 on the Step Ta week later. If you are planning on tak- ing all three forms, then take one in the middle of your studying to assess your progress. You probably get the idea that you can spread this out any way you like, but-our suggestion is that, you take ane close to exam date to get an idea of where you exactly stand and that way you can redefine your goals if necessary. Form Lvs, Form 2 Form 3 is new starting this year so we cannot evaluate that as of yet, Our understanding is that students have issightly it that form 2 is harder, but more forgiving on the score for that reason, Form | than form 2, but grades much harder. For FAQ to the self assessment services - http:/www.nbme.orgiprograms/sas/SAS_FAQ.aspTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 NEME RELEASED! NBME RELEASED ITEMS (CONT) CBI PRACTICE SESSION https:/external I nbme.org/CBTPSRegistrationWeb/jsp/usmle_CBTPS_registrationsp ‘This allows students to visit a cemter and practice taking the USMLE. ‘There is a $42 fee for thik. It has three I-hour blocks of 50 questions each. These are the 150 questions that you can down it: for those students who are extremely anxious about the test, socing the process may alleviate iad and practice for free, The fee is for you to go through the motions of taking a MILE. We don't recommend that everyone do this as it does take money and time. However, some anxiety, Some students may feel more comfortable going through the motions once before taking the actual exams; these students may find this a valuable service,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 wow TORRERRE JTF HOW TO PREPARE So you are ready to attack studying. ‘This test is unlike any other test you have prabably pre- pared for previously. Just the sheer amount of information is overwhelming. You need to-strat- cegize before you start studying and continuously re-evaluate your strategy on what works and. what doesn't We ask that you do some introspective work on the following topics. This may take a few min- utes or a few hours and your thoughts may change as you progress ‘Tipe of student Toe allated fin school t study Weaknesses /Stenglis of Iudivideal Makers /Strengtis of Schools Teaching Gol. ‘Tipeof student — Are you a morning or nighttime student? Do you study better in short 30 to one-hour period or do you do better when you sit in front of a book for 8 hours at atime? Are you a textbook ar review hook reader? Do you study better in coffee shops or in complete silence ata library? The truth of the matter is that it doesn't matter which way you are, just be honest to yourself and try ta stick with what has worked in the past. We suggest not irying completely new strategies, but rather tweaking old strategies to help you maximize your studying. ‘Fine alloted from school le study ~ This part will vary from institution ta institution, If you have three weeks to study and there are 15 review hooks on your desk, it is probably too much. But then again, if you had 3 months, 15 books might be acceptable. Also remember that you are not at a disadvantage because your school has allotted you less preparation time than another school, You can start early if your schoo! allots less time than you feel you need. Remember planning, preparation, and elficiency are key! During the third year of clerkships, students often have a flexible block. ‘This is basically waca- tion in which some students travel, some da another rotation, some do research, etc, Some students schedule their flex block as the first block, immediately following the second year. This allows them an extra 4-4 weeks te prepare. ‘This can be another option for thase individuals ‘who feel that they require extra time to prepare. If you do choose this option, consult your stuclent affairs office. Usually taking this block for studying is of no consequence, there is often enough time later to explore other rotations of interest Heakneses/Sirengtis of Uudividaal ~ "This subject is similar to what type of student you are, but it goes deeper than that. Suppose you hael an extensive background in molecular biology priar to entering medical school. In this ease, you don’t need to study hard for this subject (but keep in mind that the USMLE tests mostly clinical information and you should brush-up on the sube ject). You need to figure aut your strengths and concentrate on your weaknesses,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 HOW TOPRERICE | HOW TO PREPARE (CONT) Hakneses/Sirengtis of Schools Teaching ~ Schools teach in different manners, Some are subject- based, whereas others are system-based. It may be that your particular institution was strong in ‘one subject and weaker in another. ‘Therefore, it would he wise to spend less time on the strong, subject and dedicate appropriate time to the weaker area. For example, the Pathology Depart- ment at our school did an excellent job teaching and thus we devoted somewhat less time to Pathology even though it is probably the largest topic on the exam, You will have to determine how well you learned a particular topic the first time ane how much you remember, and plan appropriately. High Yield ox Law Vield — USMLE dacs not test all subjects equally. There are certain topics that are high yield and certain ones that are low yield, Even though we have mentioned this in ather places, itis important that you spend more time on high yield than on low yield. Even though you may want to learn everything, this is nat the time to do this. “This time should be used! to prepare for this exam, So use your time wisely Similarly you should select material carefally: Certain books tend to have high yield material and you should select the proper materials. Don't waste time on very comprchensive books Use the right books and prepare properly. We discuss the most popular books below: GOAL — Last but not least, you need ta determine your goals. If you are going for a 260 and a Dermatology residency, then get ready to go to batile. If you are just looking to hit the mean ‘or just pass, then you don't need to go crazy. Be realistic about your goals and then set aside ‘enough time to prepare for the exam in that manner ‘There are some questions that are universal among students and we address them below. How tong should I study? ‘Most students find that 46 weeks is adequate time to prepare, Stuelents usually feel that longer than this is too much —you tend to forget stuff and you get burned-out. So start laoking at ma- tcrial from January, but do hard studying for about 4-5 weeks Some students continuously postpone the test day and this usually docs not help, So our general advice will be to avoid doing this, unless you have a very good reason,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 HOWTO Frenne J HOW TO PREPARE (CONT) Should I have a schedule? Adetail lule for some is an absolute must. For others itisn't necessary. “This will depend ‘on ach individual, but you should have a plan. Sa the question really becomes how to design your schedule and your stuelying. ‘The fact is that there is a lot of material, but not everything is ‘equally important. Keep the following things in mind when designing your schedule: * Concentrate more on high-yield material than low yield material. Medical students by nature ‘want to learn a lot and it is not worth spending too much of valuable time an the low yield ma~ terial, We discuss high yielel vs. low yield material in the next section under each subject. * Determine your strengths and weaknesses, Your schedule should dedicate mare time to work on weak areas, * Decide if you like to do questions everyday: Some students prefer to-do a certain number of questions in the morning, certain number at night, and material in the middle of the day. An other strategy isto study for 4-5 days and do questions for a day or twa. This works for people ‘who hate switching gears throughout the day and would rather concentrate on-one thing at a time, However, either way you shauld concentrate mor: on material earlier on in your studying and more on questions later in your studying, We will discuss more about questions when we discuss Kaplan Q-bank, * Determine how many days a week you will be studying Are you the (ype of person who works 7 days? Are you the type of person who would rather work harder for 6 slays and take 1 day off? Also determine the hours you will stuely and stick to those hours. It is fine to attend so- cal gatherings, but you should tcll frienels and family that you will be busy during this time and you should limit yourself, It is easy to be tired and get distracted but try to stay focused during this important time. * Continuously re-evaluate where you stand and modify your schedule and material you need to study appropriately + Leave one week at the endl to review all material Subject based or organ system approach Another question that stuclents often worry about is how to approach studying. Should they do asubject based approach or a systems-based approach? It doesn't really matter, you should go ‘with what works for you. Most students find the system based approach works best for them, whereas others feel that subject based is easicr for them. Your preference may depend on the ‘way you were taught during the first two years of medical school, Or you may decide to do a combination of both. Perhaps, Physiology and Pathology (and maybe even Pharmacology) can be studied together in an organ systems approach. “Topics such as behavioral science, microbiol- ogy; biochemistry etc. can he studied as subjectsTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 HOWTO BRERERE £20 HOW TO PREPARE (CONT) Comprehension vs. Memorization ents often argue about memorization vs, comprehension of material. ‘The fet is that you need to do beth, If you don’t understand a topic, then memorizing won't be much help as you ‘won't be able to reason through a question, At the same time, if you reason through a question, but you do not have the name of the enzyme memorized, it would be detrimental, So you have to dahoth, ‘Therefore, read books to help you understand material (the pathophysiology and reasoning behind disease processes). Also you should memorize material that is important. First Aid isa great resource to-use to determine what should be memorized. ‘There are lists that you can memorize to consolidate information after you have gone through and understood a given topic. So de spend time with this book and memorize this information as well as understand! it, Word on Q-bank Q-bank is a very popular questions database for the USMLE Step |. You will undoubtedly become familiar with the lagistics of the program on your awn. We will concentrate on the dif ferent ways you can utilize this resource, Some students use q-bank and generate tests based on specific subjects (for example, right after they have studied a particular subject), ‘This helps to reinforce the topic. Others feel that you should generate completely random blocks to give you a better idea of your actual performance. Since students learn in different ways, we recommend doing what works best for you, You will be taking this exam (not the other people) and by now have probably figured out what works for you and what doesn’t, So stick with that, don’t listen to others. With that said, as you get closer to exam time, you should be doing random blocks since that will be more representative of th actual exam. If you have just stucied a particular subject and take a test immediately afterwards ‘on that subject, you are likely to da better. ‘This can provide a false sense of security. ‘Therefore, at some point you should be simulating the real exam.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 HON TO PRERIRE / 21 HOW TO PREPARE (CONT) ‘There are several problems with qrbank, One is that certain questions are very nit-picky, Don't worry about it, USMLE.is usually not this nit-picky. So learn from the questions and mave on. Dont waste ime debating and worrying about your performance on q-bank, Q-bank should be used for practice, it is not the USMEE, You should go back and review the questions you got wrong, «A. good goal to have is to get through all of Q-bank and go through the questions missed a second time Some students save Q-bank until the very end. ‘They dedicate t just doing questions all day long, We feel that thisis not a good strategy. This does give you practice in doing questions and probably does build stamina for the test. However, this allows no time to go back and compensate for any weaknesses and cloes not allow the methodology af answering these type of questions te sink in, Albo this can get very boring and affect your cf ficiency. jast two weeks of their time Lastly, students often wonder how their performance on q-bank correlates with USMLE, “Though there is no real evidence available on this, anecdotal evidence inclicates that if you are getting greater than 70% (on random generated test), you are probably looking in the 230+ range. Greater than 75-80% correct is probably closer to the 250 mark, Most students find that ‘when they start they tend to get around 50% of the questions correct and with studying improve steadily.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 aTERALS #22 MATERIALS We are listing several top resources for cach topic, Our website, http:/www.gotmedbooks.com has reviews available for most of these books and for many other books, Also the website has many other resources list that can help you prepare. We urge you to-visit and look there to see what else is available, here we will limit ourselves to inteo- ducing only several top resources. Kaplan refers to Kaplan lecture books. If resources are listed one alter another {without numbers), it means that we feel them to be equally effective, IF there isa number in front of the resaurce, it implics that itis better than the resource with the higher numb 1 that Kaplan is better than the High-Yield {for example, under neuroanatomy we Neuroanatomy). Subject Resources ‘Neuroanatomy 1. Kaplan 2. HY neuroanatomy mbryolos HY embryology ‘Gros Anatomy HY Gross Anatomy, USMLE Road Map Gross Anatomy Microanatomy//Histalogy Waste off time — we recommend very brief quick review. Do not waste time reading a book on this topic ‘Gell and Molecular biology | HY cell and molecular bioloy Biochemistry 1. Kaplan 2. Lippincott’s Illustrated! Biochemistry Behavioral Science Kaplan, HY behavioral science Pathology 1. BRS Pathology 2. Goljan’s materia Pharmacology LEA 2. Kaplan 3, Lippincow’s Hlustrated Pharmacology BRS Physiology Costanzo’s Physiology 3Kaplan Physiology Microbiology Immunology Kaplan ‘Questions QcbankTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 OTEALS ¢2 MATERIALS (CONT) ANATOMY ‘There are several sections under this heading: Neuroanatomy, Embryology, Gross Anatomy, Microanatomy/Histology. Neuroanatomy Yield - Neuroanatomy isa low yield topic but highe: yield than microanatomy and gross anato- Books - The best book for the tapic is probably the Kaplan white haak. Most students use HY ‘Neuroanatomy; but this book has some errors so you have to bea bit careful, Kiopuntly Tesed - You should know the brainstem nuclei and Cranial Nerves down cald. In the recent years, USMLE has also tested C7T"s of brain and brain artery angiograms. You should look at these briefly and become familiar with them, Also stuely the Circle of Willis and its as- sosiated arterics carefully. Yau should also know spinal tracts and how lesions to certain areas of the spine lead to specific clinical presentations. Embryology Yield ~ Embryology is a low-yield topic Books ~ First aid is good for embryology. HY embryology is worth aread, We would recom- mend skipping obscure chapters in HY embryology: Freguntiy Teed ~ Branchial arch derivatives, deft lip and cleft palate, and congenital abnormali- ties (meckel’s diverticulum, hypospadias, epispadias, ete.) are topics that are usually test. Gross Anatomy Yield + Gross Anatomy is another topic that is low yield, even though there is such an emphasis on this in medical scho«l, Books ~ Most students use HY gross anatomy, USMLE Road Map Gross anatomy is alsa very good and has clinical correlations that are worth reading In the end though, gross anatomy ow-yield topic and you should stucly this topic but do not dedicate too much time to this, Finguently Tested ~ Concentrated heavily on the nerves, ingjuries. specially the brachial plexus and armTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 Maren 24 MATERIALS (CONT) Microanatomy/Histology Vield - Low-yield and you should not spend too much time studying micraanatomy. Books ~There isa bit on microanatomy in First Aid and that should suffice, If you really want to sill study microanatomy, you can glance at HY histology. Foequenlly Tested ~ Study the epithelial cell junctions carefully (Zona oceludens, adherens, gap junctions, ete.) CELL & MOLECULAR BIOLOGY Yield ~ This depends on which version af test you receive. Students report that they either see very few questions on this or sce lots of them. ‘This isa topic that the USMLLE has started to lest more in recent years. Either way'it is good to prepare for this seetion. Books HY cell and molecular biology is a very quick read and should suflice. Finguenty Tested --These questions usually focus on lab techniques and basic molecular biology: BEHAVIORAL SCIENCE ‘There are various topics under this heacling ~ biostatistics, ethics, psychiatry, developmental psychology, etc. Yield ~ Behavioral science is medium yield. Not as high-yield as Pathology for example, but higher yield than topics such as Gross Anatomy: Bask - cither th st Aid is actually very good for behavioral seience. You should supplement this with Kaplan white book or the HY behavioral science. Frequently Tested ~ USMILE likes to test ethics with the stem of the question being “what would you say next?” Best way to answer these is to ask yourself « what would Jesus say? Specificity, sensitivity, and relative risk are also frequently tested.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 MATERA £25) MATERIALS (CONT) BIOCHEMISTRY Vield ~ Biochemistry is a medium yield topic. in the ‘Books Kaplan has an excellent book, perhaps the bes Kaplan books. Lip- pincott’s Illustrated Biochemistry is another book that many students usc, however this book is very detailed, We would recommend using it as a reference far biochemistry and only reading sections that you nced to brash up Fiopuontly Tested — Lysosomal storage discases, receptors, questions regarding rate-limiting & di case associated enzymes, and glycogen storage discases arc offen tested. MICROBIOLOGY Jield ~ Microbiology is a high yield topic. Baoks~ Clinical Microbiology and First Aid should be sufficient for this subject. Lippincott Mi- scrocards are also an excellent resource for microbiology. Frequently Tested - USMLE mostly likes to concentrate on bacteriology. This is followed by vi fungi, and then the rest af the subtopics, So concentrate mostly on bacteriology and Least ‘on protozoa, helminths, ete Other Thoughts - Here is ane strategy for microbiology. Grab “Clinical Microbiology Made Ridiculously Simple” and read through it, Don’t take notes — just read. It should take less than day to just read through it, Now grab First Aid and read through that ~ again no notes, just read. Now you will have a good idea of what you need to know. You should memorize in First Aid for this section and rel things that you need. vverything rence Clinical Microbiology Mace Ridiculously Simple far IMMUNOLOGY Yield ~ Immunology is a low yield topic. Books ~ There are not many good resources available for this topic. "The Kaplan lecture book. isexcellent for this topic. Otherwise there is “How the Immune System Works,” although itis iissing some topics, Overall itis a good book and a very thin one at that, Fioquentiy Tevted — Questions on immune deficieney diseases are often seen,THEULTIMATE STUDENT GUDE TO USMLE STEP 1 MaTERAaLS £26) MATERIALS (CONT) PATHOLOGY Viel ~ Highest yield topic on the USMLE. Books ~ You should use review baalks such as First Aid, Step Up, and Pathophysiology for the Boards & Wards along with a full resource. ‘The review books will guide you the most impor- tant things you should remember about a given disease and the full resource should help you increase your understanding and knowledge base. You should also annotate the review books with info that you need to memorize. ‘The two popular sources for Pathology currently are BRS Pathology and material by Goljan. BRS Pathology is considered “bread and butter” for USMLE. It lists key points for each disease {with a key symbol next to important facts) and organizes topics very wel. For pathology i is important to understand the processes behind the diseases, ‘These books should serve well for that. As you go through these books, yau should use the review books mentioned above. The review books will point out the most essential facts for a given disease and you should annotate these with information that will help you retain the topic, Remember repetition is key and these review books make it easier to go through the material repeatedlly as you won't have time to read the big books aver and over again, Robbins has a questions book available and itis excellent, ‘The questions are not USMLE, style, but each answer choice is clearly explained and why one is correct and why the others are ‘wrong. Student who have used the book fel that itis a great way to learn pathology: ‘Finguently Tested ~ Most topics under pathology arc high-yield. Hematology and Reproductive pathology are the only low-yield topics under this category: (Other thoughts - Most of your time should be dedicated to studying pathology. There is a lot of material under this heading.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 MATERIALS 9 27 MATERIALS (CONT) Who is Goljan? Edward J. Goljan (prounounced Goul-yawn) is a pathology professor fom Oklahoma and he tcaches for Kaplan Live Gaurse. The live course is ofien attended by foreign medical graduates. Goljan is an excellent teacher and his material is highly covet ‘only available to students taking the Kaplan live course, But his material is circulated amongst students and kept very quiet. His notes and lectures are Message boards are usually full of questions regarding Goljan, so we will address them he (One thing students wonder is what exactly is available from Goljan? There are a set of notes divided are several lists ~ high yield lists, pictures list (pictures used on the ecture ‘organ systems, there are about 40 hours worth of lectures (mp3 format}, there al USMLE exam}, high yield questions, actual remembered USMLE questions, ‘There are various versions (different years) of the same material floating around and this is why there is so much confusion, Essene tially all of the ‘are the same notes with minor variations. Goljan’s mp3 lectures are excellent. Goljan explains pathology and the reasoning behind the discase processes, Everything comes together brilliantly and for the first time this stuf starts to ‘make actual sense. Lats of students buy am ipod and listen to the lectures while they drive, while at the gym, buying groceries, or having sex - you get the pictun ‘The bad thing about Goljan is that he gives you everything. Time usually will not allow you to gothrough this much material in this detail, so either start very early or choose topics from his material carefully. Also Goljan throws everything under a topic and sometimes that is not a good thing, BRS Pathology is hetter for pointing out important clinical findings, So try to use both if possible. ‘There is na way to legally buy this material without taking the Kaplan course, We will not debate on the ethical issues involved with using copyrighted material without permission, we are merely reporting on the material itself and how students obtain it. It is your decision to use this material or not. Most students get this material from friends or purchase it anline at web- sites such as cha. However, Goljan docs have several books out and they are essentially almast the same as his notes (although there are no commercially available mp3 lectures). There are two books out by Goljan titled Pathology (published by El Sevier. One is a regular book (para- raph format} and the second is an outline format of thisfirst book. ‘The outline book is slightly weaker than the big book, although it does contain practice questions. However, more students use his other book (and rave about it), titled “Rapid Review" that is sort af the equivalent of BRS Pathology: Itis a much mare manageable hook. You should look at all three books and make your decision according ta your styleTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 aareruans +20 MATERIALS (CONT) PHARMACOLOGY Vield ~ Pharmacology is high yield, 1 this section, just memorize everything in First Aid. Let's repeat that, memorize all of First Aid for this section, Did we mention that you should memorize First id for this section? It wouldn't hurt for us to repeat this over and over again, Really most everything USMLE will test you on is here so please don’t waste time going to other resources. Some students use Lippineott’s Pharmeards for this, We feel that those cards give too much information for the purposes of the USMLE. The only thing missing from first aid is theory be- hinel some of these drugs, like how the autonomic drugs work, etc. so it may be good to consult another text for this information, ‘The Kaplan lecture bak follows exactly along with First Aid andis an excellent adjunct to it. If you don’t own that, there is Lippincott’ Illustrated Pharmae -wor's Pharmacology ~ Examination and Board Review (Trevor is also cology and Kataung & the author of Kaplan textbook). Frequently Tested ~ Autonomic drugs are heavily tested on the USMLE. Other Thoughts - Go through pharmacology once carly on, but it should be the last topic you study. Pharmacology is pure memorization and there is a lot of it. [f'you study this early on, then you are bound to forget some details. If you study it last it will be Fresh andl this strategy may serve you best, However, Ieave ample time to get through all of pharmacology: PHYSIOLOGY Vield ~ Physiology is high yield, Books - This i a topic you should really understand. If you have a strong physiology back- ground, then the recommendation would be to use “BRS Physiology.” It is also considered “bread and butter” along with “BRS Pathology.” If you require detailed explanations, there is anather book by the same author of “BRS physiole ogy,” Linda Costanzo. It is called “Physiology” and is available through El Sevier. This book is in paragraph format and “BRS Physiology” is essentially the outline format of this book. ‘This isan excellent book. Likewise, the Kaplan lecture book for Physiology is also excellent. Finguently Tested - Cardiology isa very high yield topic for USMLE. Be very familiar interpreting cardiology diagrams such as the cardiac eycle, cardiac & vascular function curves, ete.THEULTIMATE STUDENT GUDE TO USMLE STEP 1 areas £28 MATERIALS (CONT) Questions ‘The USMLE is a test of multiple-choice questions, So while it is important to-know the materi al, in the end you have to be able to apply this material to answering questions. So the best way to prepare is to elo questions and do lots of them, One of the better resources available for this isKaplan’s qrbank, Almost all stuclents utilize this in their preparation For the USMLE, One negative factors that Q-bank is rather expensive. “There are several other question databases, available but they are net as good as Q-bank. ‘Therefore, we would recammend that you pay the few extra dollars and go with Kaplan on this one. Q-bank has about 2000+ questions, If you stil require more questions, you can study Kaplan Q-hook, NMS Review for USMIE Step 1, or Appleton & Lange Review for the USMLE Step | Review Books & Courses Review books - ‘There are several books that contain a review of alll the organ systems. ‘The three most popular ones are First Aid, and Pathophysiology for the Boards & Wards, You should pick one or two of these books and become very familiar with everything in the book. A good strategy is to use one book and annotate it with material you are studying. ‘way all the information that you need to review is available in one place. hisWAATERIALS £30 THEULTIMATE STUDENT GUDE TO USMLE: MATERIALS (CONT) First Aid - First Aid has undoubtedly become the most popular review book far Step-1 and Lots of stulents utilize this resource. Therefore, we are giving you a detailed review of First Aid here and we will point out what sections in the book are good and which sections Lack. Section Good [Ok roamatorny x “Embryology x ‘Grow Anatomy Microanatomy/Histology [x Biochemistry x ‘Behavioral Science x Microbiology x Immunology x Pathology x Pharmacology x Physiology x First Aid is good for Pathology, however it leaves out some diseases, so make sure to use other sources. The best and most complete section is probably Pharmacolagy Most students annotate First Aid as they study. This allows all information to be available in ‘one place and the book can be used for review as you get closer te the exam. You should anno- tate the book heavily and then go through it several times during the last week of studying. jew courses available on the market. Kaplan is probably options ranging from live lectures, online courses, and Review Courses There are lots of re the most popular. Kaplan offers sever: home-studly courses. You can visit http:www.kaptest.com and sce the different options :nailable, We highly recommend Qubank. Far the other products offered, itis best to get more details by visiting Kaplan or giving them a call and discussing with other students regarding the specific packages you are consideringTHEULTIMATE STUDENT GUDE TO USMLE STEP 1 FINAL WORD /31 FINAL WORD Hopefully this guide gives you a better idea regarding the USMLE. "This is a very important test and you should always remember that. But more importantly remember that this is still just an exam, Don't ignore your family and friends entirely and don't break up with your significant ‘others just to prepare far this test (some stuclents have done that and are very proud of that fact Remember people are more important than any exam. Yes this is your earcer and you should dedicate yourself to prepare for this exam. But never forget your other priorities. As you prog- il become more limited, even, ress in medicine, life will get busier and busier and your time though it may not seem like it right this moment. You will have to maintain balance and pay attention to life, otherwise it will pass you by Visit our website, httpslwww.gotmedbooks.com, and take advantage of the ather things we have dedicated time to developing for you. Also please provide feedback and your contributions so that others may benefit from your experience, You can always contact us at guide@ gotmedbooks.com. GOOD LUGK!