Category Archives: Boards
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.
High Yield Histopathology (2nd Ed), High Yield Cell and Molecular Biology (3rd Ed), and High Yield Embryology (4th Ed) are three books in a series whose purpose is to provide high yield topic and content review to prepare us for the boards.
Histopathology topics are covered in 30 chapters and about 300 pages, some of which cover nucleus, cell membrane, bone, blood, muscle, blood, thymus, small intestine, large intestine, respiratory system, eye, and ears.Cell and Molecular Biology topics are covered in about 140 pages consisting of 16 chapters, including, but not exclusively: chromosomal replication, meiosis, mitochondrial genome, mutations, proto-oncogenes, cell cycle, molecular biology techniques, and identification of human disease genes. Finally, the book on Embryology, consisting of about 140 pages, includes topics on overview of fertilization, development of organ systems, and teratology resulting from various external factors such as drug side effects.
These books are fairly comprehensive as far as review books go, but may not be the best books of choice for learning the material for the very first time. Certain topics may require reference or background information from a more comprehensive textbook. The range of topics covered in these books can be described as having more breadth than depth, although depth is generally sufficient for review purposes. Note that these books are in gray scale, which means if you need colorful pictures to keep you entertained, then you probably shouldn’t use these books since they are condensed material with black and white images. However, the inclusion and highlighting of clinically relevant concepts in the “Clinical Considerations” makes these books good sources for review, and helpful for the wards.
Perhaps one of the larger benefits is that these books are much shorter than their corresponding texts. Although many med students will tell you they are too dense or too much to read, other people will tell you that they are perfect for studying. The reason for this disagreement is that people tend to use these books in different ways, for different reasons, and with different backgrounds or expectations. These High Yield books do contain quite a bit of information, which may be considered too dense for those people who are simply looking for a flashcard style review book. However, people who use the High Yield series for learning the material for the first time may find that the information contained in it is insufficient to fully explain the concepts (which is an obvious feature with review books). Few review books are perfect, since there are so many possible topics to be covered, and any topic that one person studied but didn’t get tested on (either in class or on the boards) becomes “excessive material” even though another student may hit questions requiring that knowledge on their Step 1 exam. It’s important to disregard single outlier reports from other med students who took the boards before you. The boards can’t test everything every time.
The fact that these books are black and white makes them a less appealing to study from, but the material included are condensed and easily accessible. Again, they sometimes require some reference/background books from time to time, which is reasonable given that they are review books and not textbooks.
This subset of the High Yield series is good to use for a comprehensive review of the corresponding topics that are likely to be tested on the USMLE and preclinical med school classes. Using these titles by themselves for medical school curriculum may be insufficient, although using them as a “big picture” review for medical school exams is probably fine. Since medical schools rarely teach to the USMLE, it is prudent to keep in mind that these books may not necessarily produce the Honors that you may be aiming for. Use this book when studying for the USMLE, but in conjunction with First Aid and in ways mentioned elsewhere on this site. That way, you can better gauge the highest of High Yield topics and prioritize material to optimize learning for the boards.
For those of you who have not yet found a good source for quick free online pathology review, we recommend checking out the University of Utah WebPath site.
The site breaks down major path areas and provides images with specific gross images and histological slides of most major pathology items that come up on Step 1 and Step 2. We don’t recommend this as a sole pathology study suite, but there’s no better place that helps with image pattern recognition. The site is easy enough to navigate without an explanation here. Check it out.
You’ve heard whispers around your medical school of a variety of question banks to use during boards, and there are a lot. To be specific, this article is going to hit on the main points of question banks only, not to be confused with the variety of coaching or training programs out there.
As mentioned in the opening article of the USMLE Step 1 Series, choosing a question bank has little dependence on your individual learning style. Before we get into the individual options, it’s important to note that this can be one of the largest detriments to your student loans for the Step 1 exam, outside of the exam itself. While we always encourage smart purchases, this is not a time to be frugal. You should purchase a question bank, and round up on the time compared to your exam (e.g. if you exam is 1.5 months away, get a 2 or 3 month subscription). Never try to “exact fit” a question bank with your pre-determined study time. Overestimate slightly.
This is our top recommendation, without question. When groups of medical students are surveyed about resources, this is consistently rated the highest of the question banks, with around 95% of students who used it rating it “Very Good” or “Excellent” after taking the Step 1. (Evidence for the win!) Buy it.
Review: The interface and question types are the closest approximation to the actual FRED2 format you will find on the actual Step 1 exam. More importantly, the question stems and content are in a similar style. Difficulty overall is slightly higher than the real deal, but at an appropriate level that doesn’t feel ridiculous like some of the other question banks. Answers are comprehensive, high yield, and fulfilling. Performance is tracked by subject and topic, but overall analytics leave something to be desired at times as improvement-graphing is not a feature. While tracking progress can be reassuring during this stressful time, it’s not why students should purchase a question bank. This is a large cost, so as a (repeated) point of disclosure, MedStudentBooks receives absolutely no benefit or compensation from USMLE World.
Usage: You should do questions every day you study, with a heavy focus on the topic you just reviewed. Some questions every day should be general (randomly chosen) questions. This number should increase as you get closer to the exam date. Number of questions should be tailored to individual learning style. However, if you find yourself burning through the question bank quickly and expect to finish it early, we recommend saving approximately 300 for the very last week of studying. Purchasing a second question bank (see below) is only recommended for this scenario for those who really excel by doing questions.
USMLERx comes from the group that makes First Aid for the USMLE Step 1. Questions are true to the exam in content and difficulty, with great answer breakdowns. This corresponding question bank to First Aid does extend past the book’s knowledge and can be used as a true supplement (not just rehashing the exact same content), which is why it represents our runner-up question bank recommendation. When surveyed, about 60% of students who used this question bank rated it as Very Good or Excellent. One money-saving tip is to use the corresponding book First Aid Q & A for the USMLE Step 1 (often referred to as “paper USMLERx”) and/or First Aid Cases for the USMLE Step 1. This last title is actually not a question book, but rather goes over cases with multiple questions that could come up for any given question stem. Unlike question banks, this is usually self-selected by those whose learning style works well. Furthermore, either of these titles can be picked up used or borrowed from friends. Keep a lookout for your medical school hosting a USMLERx “Scholarship” which is code-word for “promotional free qbank subscription that coincidentally creates free advertising.”
Kaplan tends to get extreme opinions. People either love it or hate it. When a class of med students were surveyed, 30% of those who used Kaplan Qbank rated it as Very Good or Excellent. As opposed to the above two options, Kaplan takes a different approach, by asking questions that do NOT approximate the Step 1 exam in style. Questions usually focus on specific factoids, and are sometimes perceived as being detailed minutia. Nevertheless, some people swear this is a helpful method of studying. If you are curious about this option, you can use the above link or below banner ad to check a free trial before purchasing it. Either way, it shouldn’t be your first choice.
What about the NBME?! As we mentioned in the opening article in the Step 1 series, everyone should take an initial Comprehensive Basic Science Self-Assessment (CBSSA) exam to get some hard evidence of performance. While these are great at providing a big picture of strengths and weaknesses, these exams unfortunately do not provide great answer descriptions or aid in learning. The NBME has started rolling out exams with “Enhanced Feedback” but they still don’t match up to any of the above as learning tools, and wind up being more expensive per question.
USMLE Consult: This is the question bank famous for being backed by the Great Goljan. We love Goljan’s teaching, but we don’t have enough evidence on USMLE Consult to say it’s necessarily a strong choice. Without the Goljan stamp of approval, this option would probably fade into the background with many other countless banks.
Exam Master: Many med schools provide this to students for free. The price tag reflects the quality. This has a lot of negative reviews and responses associated with it. Questions are unfocused, unclear, and often times have poor answer explanations. Learn from med students who came before, and avoid dedicating time to this option. If you are interested in free questions, hit up the question banks that come with many new books (check for scratch-off areas on the inside cover) or use the Lippincott free 350 question set.
USMLE Weapon: This Pittsburgh startup gets a curious honorable mention as a rising question bank gaining popularity. While USMLE Weapon has not yet stood the test of time or produced a lot of evidence regarding its perceived value, it has impressive analytics and may yet give USMLE World a run for their money one day. At this point though, MedStudentBooks cannot endorse this option, but we will be following it for future years.
There comes that point, usually midway through first year, when every medical student hears about First Aid as the magical end-all Step 1 study book. “Everything I could possibly need to know for the largest exam of my life in one book?! Sounds too good to be true!” It is.
First Aid for the USMLE Step 1, reviewed here previously, is absolutely essential for the first board exam experienced by medical students. However, it is incomplete. Before discussing the manner in which it can be fortified, let’s address the first question that usually arises: When do I actually buy a copy of First Aid and start studying from it?
You will likely encounter several gunners in your class who bought their copy of First Aid as soon as they finished the MCAT. This is not recommended. In fact, going through all of first year med school without ever seeing First Aid is probably a good thing. The summer between first and second year is the gray zone, and depends on your personal learning style. No medical student should start studying for boards at this point. However, some people find it helpful to begin familiarizing themselves with the layout and teaching style of the book. It can be especially helpful to students taking organ system based courses to skim through corresponding chapters of First Aid. However, study time should be dedicated to medical school classes, not the boards at that point. If you decide to use this method, try to find an older copy of First Aid that costs little or no money. If you purchase the latest version during the summer after first year, a newer version will come out by time you take the boards.
Regardless of whether you “pre-skim” or not, purchase a new copy of the latest edition for the start of your dedicated USMLE Step 1 study period. Your job, over the subsequent 6-8 weeks, is to fill in all the information left out of First Aid. How do you know what you don’t know? Other resources, namely question banks. As you begin to read through the list of in-depth support books we previously mentioned and take Step 1 styled questions, you’ll find the factoids and concepts First Aid missed. While the tradition has historically been to write these high yield ideas in the margins, each revision of First Aid has produced less and less white-space on a page.
This has been addressed in a few ways. The simplest is to simply shove extra loose pieces of paper between pages of the book. Unfortunately, dropping the book once produces a disorganized mess of notes. The recommended option is disassembling the book. While harming the Step 1 bible may seem sacrilegious, it has many benefits. First and foremost, it makes transportation much easier, as grabbing an individual chapter is a lot easier than lugging around the entire book along with all your other study materials. More importantly, it can keep things very well organized.
As seen above, a standard three ring binder allows for easy organization and insertion of extra pages. Some people prefer spiral binding or similar plastic ends that have easy open and close mechanisms. It’s up to you. As for getting your copy of First Aid into these states, we don’t recommend doing it yourself. You can usually get anything you’d like done at your local Kinkos or Staples for less than $5.
There are a lot of opinions on what should be placed on extra pages, without much consensus. Some people insist on putting sources to their facts for later reference, others don’t care. All we advise is to use your usual study practices, with one exception. There are a few of us who never take notes. You know who you are. Step 1 does not afford you that luxury, regardless of how amazing your short term memory is. There’s just too much information. Bottom line: annotate First Aid.
Alright, you’re all set to get the most out of your copy of First Aid. Don’t forget to check out the back of the book for common buzzword associations. You should have all of them down by time you hit the exam. Happy studies!
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.)
We’ve been collaborating with Lippincott to create a giveaway that addresses some of the major aspects of USMLE Step 1 Studying. Along with several books, the Step 1 Exam Survival Sweepstakes includes some gift cards to keep you entertained and caffeinated, and an extra shirt so you can put off laundry day just a little more. Head over to Lippincott’s facebook page and sign up for a chance to win:
Q&A Review of Microbiology and Immunology
Lippincott’s Microcards, Third Edition
Lippincott’s Illustrated Reviews: Biochemistry
Board Review Series (BRS) Physiology
$25 iTunes gift card
$25 Starbucks gift card
Lippincott water bottle
As with all other giveaways on this site, this contest is similarly limited to US residents. End date is May 7, 2012, just in time for the start of most med school’s Step 1 break. Good luck!
To kick off the USMLE Step 1 advice, we present the big picture overview of studying. Some of the below are well known strategies, but we hope to present some clever caveats that have been compiled by a number of med students along the way. Over the next few weeks, in depth articles will detail more of the little tricks that offer that competitive test taking edge. For now, let’s stick to the basics.
Early in the study process, you will be bombarded with different strategies and study practices. The problem will always come back to figuring out what works best for your specific learning style and knowledge base. Before you even decide where to start, you should have a basic idea of big-picture learning goals. After all, it would be silly to dedicate the same amount of time to a topic you despise as one you already know really well. Don’t guess. That’s an easy and common mistake. Get evidence.
The National Board of Medical Examiners (NBME), the same guys who bring you the Step 1 exam, have created a number of helpful exams for this goal called the Comprehensive Basic Science Self-Assessment (CBSSA). They use Step 1 style questions and provide performance profiles (above) similar to that found on your actual Step 1 assessment. It lays out a visual representation of strengths and weaknesses. Hopefully your med school provides them to you for free (if they don’t, petition for it).
It is recommended that you take an untimed enhanced CBSSA exam early on or even before you start studying. Assessing your Step 1 knowledge before studying, and seeing the score and performance profile early on will definitely sting, but the purpose is to push you in the right direction. It can serve as a strong motivator, and has been shown to increase board scores at certain med schools by 1/4 of a standard deviation. If desired, take another one about 10 days before the actual exam for comparison and reevaluation of focus. Using a question bank to accomplish this goal is an alternate option, but they are focused on teaching topics, and nothing is as authentic and insightful as an exam coming directly from the NBME.
Once you figure out strengths and weaknesses, creating a study schedule is the next essential step. We’ll cover the various types of plans more extensively in future posts, as there are many out there. The big picture point is that it should keep you focused but remain flexible. This can be a large stress-inducing topic for med students, as gunner plans will require no sleep and IV hydration. Construct something right for you that also maintains sanity.
It has been reviewed and highly recommended on this site, and even given away in a contest. This should be at the core of every med student’s study plan, and can be purchased confidently, regardless of your individual study strengths. However, this absolutely cannot be the sole source of information for Step 1 studies. Every commercial question bank and review course will cite some arbitrary number that suggests First Aid doesn’t hold 100% of the needed knowledge. They’re right.
The proper way to use First Aid for the USMLE Step 1 is as a guide. The sections corresponding to the subject of your focus should be lightly overviewed first. This should then be followed by in-depth learning from a dedicated resource. Some students like returning to review First Aid after that, and/or in the days just before the exam. Either way, it should be used as your starting marker to point you in the right direction, not your end point. Furthermore, it should be annotated thoroughly, which will be discussed with tips in an upcoming post.
Now that we convinced you that First Aid won’t make you a Step 1 superstar by itself, let’s look at what else to consider. You will find that there are about three million medical books out there. After narrowing down the list to those designed specifically for med students studying for the USMLE Step 1, you will find yourself left with about 43,943 books. Pro-tip: you can’t read them all.
Feuds have started over which books present the highest of yields. You could sink a lot of time into researching every title, and fall prey to the gunners and trolls of the SDN forums, never wanting to hear the term “high yield” ever again. Here at MedStudentBooks, we like to keep things simple. Below is a list of recommended titles to support various Step 1 topics. As always, we highly recommend using the titles you already know and love to jog your memory. But if you don’t have a favorite, the following is a list of highly recommended titles from the MedStudentBooks team, surveyed med students, and med school administrators that you should consider first:
|MedStudentBooks Recommended Step 1 Resources|
|Lippincott’s Biochemistry||(full review here)|
|Q&A Review of Biochemistry|
|Clinical Microbiology Made Ridiculously Simple||(full review here)|
|Q&A Review of Microbiology and Immunology|
|BRS Physiology||(full review here)|
|BRS Behavioral Science|
|BRS Pathology or Goljan’s Rapid Review Pathology||(full review here)|
|Robbins and Cotran Review of Pathology (question book)||(full review here)|
|MedMaps for Pathophysiology||for true visual learners|
|Lilly’s Pathophysiology of Heart Disease||(full review here)|
|High-Yield Gross Anatomy with your favorite atlas for reminders|
|High-Yield Neuroanatomy||with this gem|
Clearly you should not seek out every book on this list. In fact, purchasing too many books can stress you out if you have a large pile of materials you feel you must get through, without the time to actually do it. These are just top recommendations for the subjects with which med students tend to need extra help. The key is to figure out what topics need to be strengthened as mentioned above, and focus on them from the above list appropriately. We’ll go over general question and case books in another post.
Do not be that med student who waits until the day before they are scheduled to start reviewing a topic to buy the associated book. You should not dedicate any brain power on bookstore trips or figuring out why the postal service didn’t deliver your Amazon order in the middle of your studying. Added stress is not welcomed. Figure out what books you need from your self-assessment, and purchase them early.
Your med school may host an obligatory Kaplan lunch talk, or notify you of a USMLERx “scholarship” (?). Maybe you’ve heard some rumors about a new and upcoming question bank weapon for gunners. Like books, there are several options out there, but this choice is even simpler than books: use USMLE World.
Much like First Aid, this is not a question of learning style. If you’re a visual learner, use UWorld. If you’re an auditory learner, use UWorld. If you work for Kaplan… use UWorld. We’ve previously mentioned that we’re not a fan of their company policies or prices, but the high quality of their question bank is undeniable, which is why they are the gold standard. Unless your exam is scheduled within the next 8 weeks, get a 3 month subscription. We’ll discuss question bank strategies and alternatives in upcoming posts, but for now rest assured that you don’t need to worry about other companies unless you’ve blown through UWorld and come out hungry for more. Again, the price is unfortunately high, but it is an absolute necessity.
So far we’ve covered basic science subjects that are largely conceptual. Unfortunately, Step 1 (and the rest of your career) will require straight up no-thinking-through-it memorization. By this point in med school, you’ve probably created lists that you’ve stared at for so long that you not only remember the factoid, but the irregularities of the paper as well. This will most likely come up for Step 1 in pharmacology and microbiology. It is an unfortunate necessity, however it can be improved slightly. Just remember that large amounts of rote memorization are best retained with spaced repetition. In other words, you should identify the long lists somewhat early, and continue to review them in short bursts throughout your study schedule instead of dedicating large chunks of time without returning to the information.
A lot of us really neglect this one, and it can have devastating effects on productivity and exam scores. We’ll be discussing burnout in greater detail soon, but you should start thinking of things that keep you sane now. Step 1 sucks, but you are awesome.