Author Archives: Study Essentials
It’s application season, and while this takes place every year, we only go through it once (thankfully), and thus the >25,000 participating med students are unfamiliar with the process. There are a TON of considerations on selecting individual residency programs to put on your ERAS application. It can seem daunting to wade through the list of endless programs out there unless you are certain of a smaller specialty from the start. We’re going to start with the basics, for those of you who are really lost.
First, head over to FREIDA Online. It’s a searchable sortable database produced by the American Medical Association with over 9000 residency and fellowship programs. After scrolling to the bottom of and agreeing to their policies, users can select their desired specialty (including sub-specialties and combination residency programs), geographic area, program size, and academic affiliation. Results can be further filtered by benefits, ERAS or NRMP participation, research requirements, or specialty training tracks.
Searches can be saved for later viewing, although this is generally not necessary. For the more popular specialties such as Internal Medicine, paring down the perceived 3 billion possible choices by all of these options still produces a list that still feels like 567,902 programs. In actuality, you should come out with a list of less than 100. It’s still overwhelming, but much better than when you started. Trimming that list down to your “short list” of about 20 total programs to which you will apply. The final push should come from academic advisors in your desired field. If all else fails, post a question to this post, and we’ll have someone look into it.
Hopefully though, FREIDA Online will be a highly useful first step. For those of you wondering, the AMA application name stands for “Fellowship and Residency Electronic Interactive Database.” Sounds about right. Good luck on the application process!
So it’s Wednesday afternoon. After weeks of waiting, you’ve been checking your e-mail today Q3minutes or hitting refresh on the NBME site repeatedly, and finally find what you’ve been seeking: the link to the PDF that you think determines everything.
You hastily open the file to find…. a large block of text. After the second it takes you to realize the date and your USMLE ID number at the top have nothing to do with your actual score, your eye catches a glimpse of the following:
A good sign! You’ve joined the >90% of MD students (and about 80% of DO students trying for an allopathic-residency program) who passed. Congratulations! Chances are though, the page opened up just short of showing the box directly underneath the pass/fail: your score. In your excitement, you struggle with getting the mouse accurately (or was it precisely?) to the scroll bar to find….. two numbers? One of them a three digit score, the other a two digit score. So… you were aiming for some three digit goal, but now that you have passed and your score is permanent, what does it actually mean?!
In med school, the right answer usually starts with “it depends.” Let’s start with the three digit score, as that’s the important one that gets sent to residency programs with your application. As you know by now, certain medical specialties are more competitive than others. We’ll discuss interpreting below expected or failing scores in another post, but for now, you should start by checking out The National Residency Match Program (NRMP) and Association of American Medical Colleges (AAMC) document on charting match results. It comes out around September each year and gives a breakdown of the previous year’s match statistics. Right now, you’ll be most interested in the section that shows the average and distributions of Step 1 scores by specialty.
As for the two digit score, this is the number that is most likely to be misinterpreted. The first thing to know is that this is NOT a percentage nor a percentile. The former refers to the number of questions correct on the test divided by the total, and the latter (percentile) refers to how well you scored in relation to other students. The two digit score is neither. Don’t feel too confused – if you got this far, you already know you’re pretty smart. The two digit score is a near-arbitrary number, whereby the National Board of Medical Examiners deems the number 75 to be the cutoff for passing. This roughly corresponds to a three digit score of 188. Is it useful? Not really. It’s more historic than anything, and the confusion surrounding it is the reason why it is no longer sent with residency applications to program directors.
If you are interested in learning more about USMLE Step 1 percentages and percentiles, we strongly recommend checking out the MedStudentBooks.com USMLE Step 1 Percentile Calculator to help make some more sense of your score.
Congratulations to all those who passed – you’ve quite literally taken your first step to becoming a physician.
Along with the flood of information you’ll receive on how to study, it is important to hear some advice on how to NOT study. Yes, what you do while not studying can affect your sanity and how you study as well. The end goal is to increase studying productivity by reducing all the little stressors and time-sinks in your life that would normally be easily managed, but add up overwhelmingly during Step 1 review.
The biggest tip is the obvious one you haven’t actively enacted yet: stay away from the people who are really stressing out. Haters gonna hate, stressers gonna stress, and both are contagious. That’s not to say you shouldn’t be invested in your studies, but nothing good comes from unproductive flipping-out. Practice safe studying.
Sleep hygeine is important when you have no required structured time in your day. Try to wake up and go to sleep at the same time every day. If you find yourself half-asleep and drooling on First Aid at 2am, trying to just finish that last chapter to stay on schedule, you are better served sleeping and finishing it when you wake up so the information can actually stick. This is precisely why we recommend that your schedule is flexible. Pass this info on to any classmate you see with backwards highlighter writing unknowingly smudged across their forehead. Similarly, if you are burning out and finding yourself going over the same paragraph 5 times but not actually reading/thinking about it, it’s time to step away for a few moments. Sometimes that can actually be switching topics/books, or sometimes you need a short power-break.
Try to keep tabs of your breaks. If you decide to stop studying to let your brain relax a bit, it is exceedingly easy for breaks to become longer than anticipated. Set a time limit to what you think is reasonable and try to stick with it. Some students will actually set a timer. While we don’t recommend down-to-the-second inflexible scheduling, the goal should be to create some semblance of a structure to your day.
Breaks should get you back to being you. Again, this may seem obvious, but it is commonly overlooked. If your brain is turning to mush and micro facts are oozing out of your ears, then staring at facebook for the entirety of your break may seem like a needed respite. However you should actively try to return to the things that you enjoy, not just your usual distractions. If you usually workout, hit the gym. If you enjoy video games, go pwn some noobs. Call your family, catch up on your favorite tv show, or take a walk around the neighborhood. While break activities need not be scheduled like your anatomy block, you should have a go-to list of things to do that require minimal thought when you have time off. Again, minimize brain usage during the middle of your study weeks by planning ahead.
Don’t overlook food. While you may be tempted to resort back to ramen and microwavable dinners every night, and may need to do so on occassion, this should not be the total extent of your nutritional intake. Hit up Costco for bulk granola bars, and try to stock up on fruits. Healthy snacks will especially come in handy for stress-eaters.
Med students who have non-medical partners and friends can really benefit from someone else cooking for them. By now, you should have already told everyone in your life that you are not going to be incredibly fun over the next 2 months. If someone is willing to cook for you, it will save time running to the grocery store and cooking, and provide you (nutritious) meals. If you do not already have someone in mind for this task, this is a time to find the med students who live nearby and take turns cooking for each other. Encourage your cooking group to eat and run, but relax while eating. This means no stressful step 1 conversations!
When all else fails, touch base with an upperclassmen who has already gone through the process. No one will know the specific stresses produced by your school and schedule better than someone who just lived it. Not only is the experience still seared fresh into their mind, but most likely they are happy to help. (It’s why most of us went into medicine in the first place.)
Lange’s Case Files Pathology is a book whose purpose is to integrate our knowledge of pathology for diagnosing realistic scenarios in medicine. There are 50 clinical cases written in clear USMLE-style format. For each clinical case, there are four parts: 1) a summary with straightforward answers and clinical correlations, 2) basic science concepts including objectives and definitions followed by a brief discussion of the topic of interest, 3) a few comprehensive questions that reinforce key points, and 4) “pathology pearls”, which are important take-home points. When going through each case, important information is bolded for emphasis and explanations are concise and precise—eliminating the trivial concepts that should have become second nature by the end of organ systems. This means that this book is not for learning materials, but rather more effectively used as a tool for review, reinforcement, and integration of learnt information to allow for synthesis.
Although all Case Files books may or may not fit the needs of boards review, Case Files Pathology is a book that can only help. With key take-home points and short-and-sweet explanations of case material, you should have little problem learning the essentials—the fundamental architecture of clinical pathology. For example, you may come across a case of ventricular septal defect (VSD), requiring you to utilize your knowledge of epidemiology, embryology, physiology, and the clinical presentations of cardiac defects. Of course, take note that this book is for pathophysiology and not just for lab-based pathology, so a good foundation in second year organ blocks material would make this book much more useful for synthesis of all the loosely connected information.
The downside of Case Files Path includes: 1) lack of pictures and images to allow the medical student to truly appreciate the clinical appearance of certain diseases, 2) lack of explanations for various diagnostic tests that may be useful for understanding the diagnostic and elimination process, and 3) the multiple choice review questions at the end of each case are generally very simple and superficial questions asking more for recall than synthesis, despite the fact that the case itself is pretty good at elucidating the more detailed aspects of disease.
Overall, Case Files Pathology would be great to have for some last minute studying or USMLE Step 1 board review, but definitely not for the initial phase of studying. Get the foundation down solid, and then use this book to cement everything together. As for where to use this book, it is not a useful resource for studying for medical school classes since the cases in the book is written in USMLE format rather than in the format of questions on medical school examinations. However, it is definitely a good book to have at the end of your studies for USMLE Step 1 to get the bigger picture and practice applying medical knowledge to realistic medical cases, uncertainties and all.
Has a scholarship or program been asking for a USMLE Step 1 “percentile” even though no such number can be found on your Step 1 score report? Perhaps you’re simply interested in tracking progress of USMLE World practice tests. Whatever the reason, head over to our new USMLE Percentile Calculator to convert between three digit score and percentile.
It uses some recent national data, but can be customized for your specific needs, and extended for Step 2 percentiles. Have a look, and if you find it useful, be sure to share with friends!
Rao’s Rational Medical Decision Making (MDM): A Case-Based Approach by Lange is a narrative textbook on biostatistics. Chapters include A Brief History Lesson, Biostatistics for Medical Decision Makers, Scientific Approach to Diagnosis, Design of Research to Evaluate Therapies, Understanding the Results of Studies of Therapies, Etiology, Survival, Systematic Reviews, Decision Analysis, and Clinical Practice Guidelines.
Within these chapters is a comprehensive review of biostatistics in an applied fashion. Whether it’s T-tests or ANOVA or Chi-squared tests, you’ll find realistic applications and examples to help you understand and to fortify your learning. Even if you plan to do a masters degree in epidemiology or PhD and need in-depth knowledge of statistics, you would still find this book a good starter or review of the main biostatistics concepts with relevant examples.
This book does not take the traditional “textbook” format. Given that the book takes the narrative format, it does not present information in a bland, isolated manner where synthesis and understanding of the information are secondary to (and seems less important than) information overload. Rather, Rao’s MDM is a narrative and all the relevant information is presented with equally applicable case examples. The major concepts, from T-tests to ANOVA to research design are paired with exemplary cases in which Rao helps med students learn biostatistics through realistic and practical examples.
In the narrative format, Rao’s Rational Medical Decision Making is easy to read, easy to understand, and yet still provide all the information you’ll need as a medical student to succeed in biostatistics. Of course, if you dive below the depth of the main concepts, then you may need help from some supplementary sources. But for the purpose of medical school biostatistics and the USMLE Step 1, this book is perfectly sufficient and is, in fact, quite a comprehensive book for the beginner medical scientist or a great review for the intermediate medical student biostatistician. The practice questions at the end of each chapter can help any reader solidify concepts and practice real problems.
The downside about this book is that it is not a textbook. Since it is much more focused on the application of biostatistics, it is less focused on providing every nit-picky detail (in biostatistics in case you are the person who likes to learn everything about everything). This book also does not go that far in depth for the math genius who wants to learn the theories, derivatives, and fundamental basis of the biostatistics formulas/concepts. Furthermore, because the book is a narrative, it does not present information in a condensed manner, because interspersed between major and minor concepts are examples that are meant to help explain the application of the concepts. So if you are looking for a five page hyper-condensed review booklet, this book is not that.
I would definitely recommend Rational Medical Decision Making as it was well written, concise, and relevant, making it an adequately comprehensive starter or review book for biostatistics.
Biochemistry can be defined as the study of metabolism, and metabolism is the sum of all chemical reactions in the body. That’s a pretty wide field to cover. Even if your professors clearly explain what you’re expected to know, there will always be information beyond your curriculum that could help you solidify your knowledge. With biochemistry in particular, you can go in two directions, ‘down’ to the chemistry and energetics (repressed undergrad memories bubbling up) or ‘up’ to the clinical correlations and differentials which we hope to know by the time rotations start. Faced with a bewildering array of review books at every point on this spectrum, you might ask yourself, what is the best book to help me in my class, for the boards, and for the wards?
A common recommendation from biochem professors and older students alike was Harvey and Ferrier’s Biochemistry, part of the Lippincott’s Illustrated Reviews series, now in its 5th edition. The bulk of the book is a thorough review of proteins, enzymes, and the metabolism of the macronutrients. It describes and comments on important reaction pathways such as glycolysis, the pentose-phosphate pathway, the citric acid cycle, and mechanisms of amino acid synthesis, combination, and degradation. Later in the book, one unit is devoted to integrating these pathways. For example, one chapter looks at the effect on all systems of insulin and glucagon in the fasting and feeding cycle, with chapters covering diabetes, obesity, and nutrition. The last unit covers the special chemistry of genetic information which aims at preserving and expressing information rather than procuring energy or achieving certain concentrations of building block molecules.
My initial look through the book brought an immediate sense of relief. The book seemed organized with a huge number of clear and helpful illustrations. The text itself is succinct but vigorous, like an old-fashioned news anchor might sound if the news of the day for some reason involved the emulsification of dietary lipids. Blocked out in chapters, sections, and subsections, the writing never feels rote or forced but manages to retain a readable, almost “listenable” tone that contrasts favorably to how some other books smother murmur beneath an avalanche of facts. Throughout the text, the authors build on previous topics and indicate points of intersection between pathways, often in the form of strategically placed charts and figures. At the end of every chapter, there is a summary with keywords highlighted, “key concept map” for the chapter, and a few questions and explanations. When that isn’t enough, the thorough index was often handy.
After spending a lot of time with the book, it becomes evident that the editors spent a lot of time designing the reader’s experience. This has the unexpected consequence of making students read more than intended when looking up a particular topic. Often, the next related topic is familiar but not completely solidified. In context, you make a connection you otherwise wouldn’t have, and you can cross one more topic off your list of things to review.
This attention to the reader’s experience is also responsible for what may be the book’s only downside. The details on the diagrams are so focused on making a point that they sometimes have less information than it would appear. In a larger textbook, a chart showing the effect of a drug on blood glucose concentrations over time would probably be large, simple, uncluttered, and accompanied by a lengthy description of the experiment. Here, it is small, marginal, and crowded with word bubbles with arrows overlappingly pointing out features on the graph to which they’re relevant. The effect is that of a comic book: bold, practical, attention-grabbing, but a little bit tiresome all the same.
Nonetheless, this book is very good for its purposes. Though it is an ideal adjuvant to a textbook, it probably is not a substitute for one if you’re being introduced to biochemistry for the first time. Opinions about it for Boards Review are mixed: though it covers all the topics that are likely to come up, some students feel that it is perhaps too thorough for high-yield review. On the other hand, if you use this book during your biochemistry class, you will probably know where to look for what you need to review. Its lucidity and completeness would then be a plus.
Overall, if you’re looking for a book to help you make sense of biochem – to help you know what’s important and give you a sense of how the discipline is used in medicine – Lippincott Biochemistry is highly recommended.
The heart of all medical education is centered around a solid foundation in history and physical exam skills. These are not only learned and critiqued early during the preclinical years, but comprise the basis on which medical students are assessed and evaluated during clinical rotations as they are conveyed through presentations. Due to the strong and constant need for excellent history and physical examination skills in producing superior grades, it is highly recommended that all medical students master these abilities early.
Bates’ Guide to Physical Examination and History Taking, now in its 10th edition, represents the best reference resource for this goal. The book itself is rather extensive as a primer for all things history and physical, which makes it perfect for incoming medical students. The text is detailed and straight-forward, with great complementary pictures, illustrations, and tables. It is important to note that the focus extends behind the basic logistics and mechanics of taking a history and performing a physical. Special attention is placed on normal physiology, as well as the significance of abnormal exam findings. Combined with proper instrument technique and care, this book allows for a deep understanding and mastery of the basic physical exam.
Other benefits of this book include the CD and website access on The Point, which host patient examination and assessment videos, fully searchable text, and cardiopulmonary exam sounds. To a lesser degree, the book is also helpful at providing basic differential diagnosis development. While many medical schools specifically assign chapters in this book as required reading during preclinical years, it remains a fantastic reference source throughout clinical rotations as well, with continued potential for residency.
There are a few drawbacks to this book. First and foremost is the price. At around $100, this “must buy” book is often times considered a “must borrow” from the library. Purchasing the black 9th version of this book will offer nearly all the same content for a slightly lower price, but has issues with page discordance when professors assign specific pages from the latest version. Second, Bates’ strength in providing full explanations to completely inexperienced medical students can sometimes become undesirable later in medical school when trying to obtain a quick concise answer for an understood concept. Along those same lines, the weight of this 992 page book can make constant transport somewhat arduous. It should also be noted that this book does not delve into the depths of specialty exams, but rather focuses strongly on the general history and physical exams needed for core clerkships. For example, the basic eye exam is included, but does not cover the depth that an ophthalmologist might assess. The book does however provide a full and thorough neurologic, pediatric, and gynecologic exam.
The first unit is a general overview, and contains specific book chapters on: Physical Exam and History Taking Overview; Clinical Reasoning, Assessment, and Recording; and Interviewing and the Health History. Unit 2 covers regional examination, with chapters on: General Survey, Vital Signs, and Pain; Behavior and Mental Status; The Skin, Hair, and Nails; Head and Neck; Thorax and Lungs; Cardiovascular System; Breasts and Axillae; Abdomen; Peripheral Vascular System; Male Genitalia and Hernias; Female Genitalia; Anus, Rectum, and Prostate; Musculoskeletal System; and Nervous System. The final unit is dedicated to “special populations,” and includes chapters on: Children – Infancy through Adolescence; The Pregnant Woman; and the Older Adults.
Overall, this is a highly recommended book for incoming medical students to master vital skills. Be sure to use the below links to get a starting price comparison between retailers before making a purchase, as the price can be steep.