USMLE Step 1 Series: What Does My Step 1 Score Mean?!

Navigating Step 1 Scores

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:

Passing the USMLE Step 1 Exam

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.

Is my Step 1 Score good?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.

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Success in Medical School: for a push in the right direction

Success in Medical School: Insider Advice for the Preclinical Years is the latest title from the MD2B publishers.  The book is laid out across 17 chapters, and explains the basics of how to excel in the first and second year of medical school. Notable chapters specifically include History and Physical Exam techniques, the importance of research, community service, extracurricular activities as they relate to residency applications, professionalism, what to do in the summer between first and second years, and tackling the USMLE Step 1 or COMLEX Level 1 exams.  The book is laid out in list format, making it a particularly easy read, as topics are concisely broken into the most important take away points. These lists are generally composed of three types of information: anecdotal evidence, data-driven concepts, and general good advice.

Success in Medical School - Insider Advice for the Preclinical Years

The data-driven points tend to vary. Some can be incredibly insightful for someone new to a particular topic. They can range from subjective surveys of medical students, course directors, and residency program directors, to more objective histories and statistics. These last two categories are useful when referencing chapters on the USMLE Step 1 and COMLEX Level 1 exams, as they address many of the common questions this site receives through our contact form about them. What is average? Why are there two reported scores for Step 1? However, a small minority of the fact-driven points can be underwhelmingly simplistic. One point, for example, quoted the Merriam Webster definition of the word plagiarism as its take home message. These types of low-yield facts almost suggest that there is a fact-quota, and makes the book feel fluffy every so often.  For most of the book though, the thorough references are insightful, and incredibly helpful on topics that involve describing different specialties or best practices in medical school.

Anecdotal experience can be a huge benefit for rising medical students. This website is largely built around that very idea. However, a lot of the med student comments in Success in Medical School tend to be unhelpful, and focus on the personal opinions of the cited med student on a particular seemingly-trivial question (e.g. “my favorite course in medical school was…”). While these types of opinion-comments are scattered throughout the book, they are thankfully not a large majority, and don’t detract from the surrounding value.

Lastly, the book offers some general advice which isn’t necessarily reference or backed by data. Often times these can be a good starting point for med school success, but they can be rather vague for someone seeking specific means of improvement.  However, there’s no way for any single book to offer specific methods of studying that would work for all students, let alone up to date, so this generalization is somewhat understandable.

Much like MD2B’s other titles, the goals of this book are quite similar to this site: giving rising medical students an edge. However, the target audience is clearly different, as Success in Medical School: Insider Advice for the Preclinical Years is really geared towards students who have absolutely no understanding of the basic med school concepts.

So how should one reconcile this mixed review?  Well, the book isn’t for everyone, and can’t be endorsed accordingly. However, there are a few key audience types that would benefit from reading Success in Medical School, and almost all of them are self-selecting:

  • pre-medical students who are nervous or unsure about what is expected in medical school (especially those about to matriculate)
  • students entering a medical school that does not provide a lot of orientation, support, or guidance on expectations or succeeding
  • medical students who find they are consistently not able to excel or who consistently produce lower than average grades and evaluations in the first semester of medical school
  • students who want some extra reassurance that their interpretation of academic expectations is accurate before entering situations that are evaluated
  • the nervous-gunner types who are doing fine but feel compelled to find any and all resources they perceive may be of help

Based on the content type of the book, we would normally recommending renting/borrowing it. However, as it really does cover all areas of the preclinical years, we instead recommend having it on hand and referencing sections that are relevant to a student’s stage in medical school as they arise. After all, there’s really no reason a pre-med student should be reading about Step 1, but that section could be helpful during the summer after first year. Purchasing the book used would save some money without losing value, but since it is so new, that may be difficult to do.

For those who feel they may benefit from Success in Medical School, check back on the site over the next week, as we will be giving away a free copy of this title.

 

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Deja Review Emergency Medicine: A Great Quick Reminder

DejaReview Emergency MedicineDeja Review’s second edition of Emergency Medicine promises maximum retention with minimum time.  Using a ‘flashcard in a book’ question and answer format followed by a series of clinical vignettes designed to mimic classical presentations of the disorders presented therein, this copy of Deja Review “helps you remember a large amount of pertinent information in the least amount of time possible.”  So how much of this self-promotion is hype and how much is fact?

Emergency Medicine is divided into 18 chapters, each focusing on a particular overarching organ system or concept such as Cardiovascular and Vascular Emergencies or Toxicological Emergencies Each chapter is further subdivided into specific emergencies or presentations within these broader topics.  The subsections cover the most pertinent information regarding a specific presentation, such as etiology, exam findings and management.   It should be noted that the answers to the questions posed are very specific and typically not explanatory.  Following each chapter is a series of clinical vignettes which highlight key concepts of the diseases  or emergencies presented within the chapter.  A ‘Stimulus’ section found at the end of the book features 7 expanded clinical vignettes that include expanded presentations, images pertinent to the topic (MR, EEG, X-ray) and lengthy explanations regarding the answer choice.

emergency-reviewDespite being very bare bones, Deja Review Emergency Medicine, if used exactly as it is intended—as a last minute review solution—will probably serve those who choose to invest.  This is not a book for those who wish to explore the in depth intricacies Emergency Medicine has to offer.  Other comprehensive resources would likely benefit those looking for great detail regarding various case presentations and how to diagnose and treat cases seen in the emergency department.  But for someone who is looking for a quick and effective review of what Emergency Medicine has to offer in the week or so leading up to an exam or for rapid EM review, look no further.

 

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The High Yield Series: Histopathology, Cell and Molecular Biology, & Embryology

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.

 

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USMLE Step 1 and 2 Studies on the Go: Utah Web Path

University of Utah Web PathologyFor 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. Utah WebPath QR CodeWe 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.

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USMLE Step 1 Series: Making a Withdrawal at the Question Bank

How to Choose USMLE Step 1 Question BanksYou’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.

USMLE World Step 1 Question Bank

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.

NEW Step 1 QBank- Only $99-$199!

Other Questions Banks to Mention

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.

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USMLE Step 1 Series: The Right Way to Use First Aid for the USMLE Step 1

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.

Power-Annotatation
First Aid for the USMLE Step 1 Remove the CoverRegardless 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!

 

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USMLE Step 1 Series: 6 Tips on NOT Studying

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.

Asleep on First Aid

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.

USMLE Step 1 Break TimerTry 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.

balance studying with breaksMed 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.)

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