Tag Archives: Biochemistry

USMLE Step 1 Series: The 7 Essentials of a Solid Study Strategy

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.

Figure Out Your ACTUAL Strengths and Weaknesses, with Evidence.

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.

Get a Plan, and Stick To It.

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.

Get a Copy of First Aid for the USMLE Step 1 2012

First Aid USMLE Step 1 2012 reviewIt 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.
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Stock Up on the In-Depth Books NOW

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
Lippincott’s Microcards
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.

Use a Question Bank to Complement Your Studies and Track Progress

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.

USMLE World Step 1 Question Bank

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.
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Learn by Rote Memory Over Time

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.

(Try to) Relax

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.
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What You Need to Know About Lippincott’s Biochemistry

Lippincott Illustrated Reviews BiochemistryBiochemistry 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.

 

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