Tag Archives: Boards Pathology
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.
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.
For those interested in making corrections to information in your copy of First Aid for the USMLE Step 1 2012, the official FA errata is now posted to the FirstAidTeam.com website. You can check out the webpage to learn more about the process, or RSS subscribe for updates. If you’d like to bypass the site and just go straight to the errata, the document can be found here (pdf).
Keep in mind that you can send in a correction for any mistake you find by clicking on the “Contribute” button on the right side of their site or this post (both bring you to the same place on their site). While they promise $20 Amazon gift cards for new information, someone else has probably already beaten you to any given correction. Nonetheless, making any submission will get your name printed in the preceding version of Step 1.
The 2011 version of First Aid for the USMLE Step 1 was previously reviewed on this site as the must have gold standard of Step 1 board review, and this only builds on it. Reportedly the “world’s bestselling medical review book,” First Aid 2012 continues its long line of teaching with a noticeable update. As the rainbow bar on the cover suggests, First Aid is now in full color. The company also reports approximately 20% new content across the additional pages.
There are a good number of benefits that come with the color upgrade. Previous versions stored a small section of pages near the back of the book with certain must-see color images. In 2012 however, they are blended seamlessly around the relevant text, allowing users to go directly from text to image without page references. The color also seems to make a number of the images pop a bit more. Drawn diagrams are easier to encode into memory, and line graphs are easier to trace (although this may be difficult to appreciate in the below image). There also appears to simply be more color pictures in general, complementing the text more completely than previous versions.
Pages without images still have subdued hues of blue and red around the border. Bolding is now in a dark blue, which seems to conflict with one of the improvements many people liked between the 2010 and 2011 versions: bolder, darker font. Nevertheless text remains easy to read.
The other noticeable addition to the book is the use of QR codes found at the start and end of every chapter, linking the user to updates, errata, “and more.” They all actually appear to be the same QR code throughout the book, and come with a link to the title’s associated question bank. As an aside, that same link is where students can submit errors or recommendations to improve the subsequent version, and get their name printed in it as well. While it is difficult to see the practical use for this electronic QR connection, board-study-psychosis can produce erratic behavior in medical students, and it certainly isn’t a detracting feature.
In general, First Aid Step 1 2012 also does a better job with spacing and sizing, as seen in the above image, although this comes at the expense of smaller margins. As mentioned in the previous 2011 review, most students annotate the book’s blank space. Because of this, margins have historically been important, although a good amount of white space still remains. In regard to the physical size of the book itself, it is surprising to see the dimensions to be about equivalent to the 2010 version, despite an additional 50 pages. The downside to this is that the pages are very thin and don’t hold certain inks or highlighting as well as prior versions.
Overall, it is highly recommended that every second year medical student has access to a personal copy of First Aid for the USMLE Step 1. Unfortunately, it is generally contraindicated to obtain a used copy of this title due to the annotation produced by most users. The color update with a reported 20% increase in content represents an improvement that should not be overlooked for a new copy of a previous version. Therefore, we strongly recommend picking up a new copy of First Aid for the USMLE Step 1 2012. As we get further into Step 1 season, MedStudentBooks.com will post any discounts or deals on purchasing this title online, and possibly give one away for free. For now, shop around the below links to find the best price, and be sure to look for the color version.
Robbins and Cotran Review of Pathology, 3rd Edition, AKA “Red Robbins,” is the best pathology USMLE style question bank/book for the boards, and a great complement to Goljan’s review books and audio. The true strength is mixing clinical scenarios with pathology concepts, which makes a topic that is easily boring for many medical students into a very relevant and high yield exercise in the thought process necessary for excelling in pre-clinical class exams, USMLE Step 1, USMLE Step 2 CK, and USMLE Step 3 boards.
The pertinent questions is: should this be used with a question bank such as USMLE World or Kaplan? The answer is definitively yes. At some point, you’re going to hit up Goljan (to be reviewed later), and this book is what will lock in that information with an alternate perspective on the same topics. This should not replace or be used as a substitute for a primary question bank. As for using it with “Big Robbins” or “Baby Robbins,” neither are really needed for the boards past Goljan. At times you may want to reference these resources for topics that require a bit more detail, but they are not a necessity, and can usually be borrowed from friends or the library. (Both of these will also be reviewed in more detail later.)
Robbins and Cotran Review of Pathology does a particularly good job of pulling glossy high resolution color microscopic and gross images that are actually representative of the pathology being reviewed. This really is one of the most important aspects of any pathology teaching. Explanations are thorough, including why the wrong answers are wrong, and the questions are representative of what comes up on the boards.
The three major pathology review sections are comprehensive. Unit 1, General Pathology, covers Cellular Path, Acute and Chronic Inflammation, Tissue Renewal and Repair, Regeneration, Healing, Fibrosis, Hemodynamic Disorders, Thromboembolic Disease, Shock, Genetic Disorders, Diseases of Immunity, Neoplasia, Infectious Disease, Environmental and Nutritional Diseases, and Diseases of Infancy and Childhood. Unit 2, Organ Systemic Pathology, has individual chapters on Blood Vessels, the Heart, Diseases of White Blood Cells, Lymph Nodes, the Spleen, the Thymus, Red Blood Cells and Bleeding Disorders, the Lung, Head and Neck Pathology, the Gastrointestinal Tract, Liver and Biliary Tracts, the Pancreas, the Kidney, the male and female lower urinary tract, the Breast, the Endocrine System, the Skin / Bones / Soft Tissue Tumors, Peripheral Nerve and Skeletal Muscle, the Central Nervous System, and the Eye. Clearly, all of these chapters combined hit every organ system from the large to the microscopic, but I listed them as a reference. The final Unit III, Integrative Reviews, has two long chapters on Clinical Pathology and a Final Review and Assessment that combines information from prior chapters. Robbins and Cotran Pathology Review can also be purchased for Kindle as an eBook on Amazon, but that is not recommended.