Tag Archives: MS-II
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.)
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.
Congratulations on finishing second year of medical school! Now what? The dreaded USMLE Step 1 exam.
Discussing all the aspects of Step 1 is easily overwhelming and exhausting. It’s not unusual for medical schools to host stress-inducing class-wide meetings to throw loads of information at med students at one time. It can be a bit much. As we head into boards season, MedStudentBooks.com will provide bite sized posts on how to tackle all the tough topics, through the USMLE Step 1 Series of posts.
In addition to helpful information from senior med students, we will continue to bring you free book giveaways. Earlier in the season, we gave away a free copy of First Aid for the USMLE Step 1 2012. Tomorrow, however, is our largest contest to date. We have collaborated with the fine folks at Lippincott to bring you the 2012 Exam Survival Sweepstakes. Full contest details will be posted tomorrow, but we can’t help but hint that it contains the majority of MedStudentBooks.com recommended titles for Step 1 studying, and some gift cards.
To get all the latest tips and tricks to tackling the boards and getting that extra edge on Step 1, be sure to check back to the site frequently, or follow us on Twitter.
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.
Has a scholarship or program been asking for a USMLE Step 1 “percentile” even though no such number can be found on your Step 1 score report? Perhaps you’re simply interested in tracking progress of USMLE World practice tests. Whatever the reason, head over to our new USMLE Percentile Calculator to convert between three digit score and percentile.
It uses some recent national data, but can be customized for your specific needs, and extended for Step 2 percentiles. Have a look, and if you find it useful, be sure to share with friends!
After graduating from the Albert Einstein College of Medicine in 1967, I practiced neurology, ophthalmology, and family medicine at one time or another. I also did research and taught at the University of Miami School of Medicine for 25 years in the Cell Biology/Anatomy department, where I taught neuroanatomy, and was an attending in the Family Medicine department.
In 1979, I formed the MedMaster publishing company after my first book, Clinical Neuroanatomy Made Ridiculously Simple, was rejected by multiple publishers for making a serious topic funny and being too brief. Strangely, the aspects of the book that were criticized were the same ones that my students appreciated. The book went on to become a best-seller in the U.S. My students awarded me the George Paff Award for Most Outstanding Professor eleven times.
Other authors of like mind, including my students Mark Gladwin and Bill Trattler, who wrote Clinical Microbiology Made Ridiculously Simple, submitted books that went on to become the MedMaster “Made Ridiculously Simple” series. I was invited to give the commencement address at the Washington University at St. Louis School of Medicine in 2004 in appreciation of the MedMaster contribution to medical student education.
It occurred to me that when a publisher receives a book, it is often sent for review to someone who may be expert in the field, but not necessarily expert in understanding the needs of a student learning the topic for the first time. Such experts often feel a book is “incomplete.” Hence, the student is often left with very large texts with a lot of clinically irrelevant information, and has difficulty grasping the subject as a whole. One study indicated that the leading cause of stress in medical school is that there is so much to learn and so little time to learn it. Another study showed that if a first year medical student actually did all the reading that was assigned, this would entail reading more than 24 hours a day. So MedMaster embarked on publishing books that are brief, clinically relevant, enjoyable to read, and promote understanding.
The medical student needs 3 kinds of books:
- The reference text. While such large books provide essential reference information, the student can get lost and not achieve an overall understanding of the subject. Understanding is very important. The human brain is better at understanding than at memorizing huge numbers of esoteric facts. Computers are better at facts; humans are better at understanding. Understanding not only helps in dealing with the many variations on patient problems, but also facilitates the learning of facts.
- The Board review book. I’ve noticed that many of the student forums focus on study for the USMLE. Passing the Boards is necessary; indeed, MedMaster publishes its own review books for USMLE Step 1, 2, and 3. But simply relying on the rote facts in Board review books is insufficient for practicing medicine, because Board review books do not promote understanding, which is vital in dealing with patients.
- The small conceptual book, which provides understanding in addition to key information useful not only for exams but for practical application throughout one’s career. MedMaster emphasizes such books, which can be found at www.medmaster.net. MedMaster’s blog, the Goldberg Files, deals with methods to promote rapid learning and other ways to deal with the stress of medical school.