Tag Archives: question and answer
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.
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.
Family medicine can be a tricky clerkship in many medical schools due to the vastly different experiences based on location. Some are heavily procedure driven, while others are very hands-off. Some experiences are well balanced, while others exclusively focus on family medicine subspecialization such as dermatology, sports medicine, or ob/gyn clinics. Regardless of whether you experience an urban or completely middle-of-nowhere rural practice, all students at a given med school take the same final exam, and often times that exam is an NBME shelf.
It is not uncommon for students to feel that clinical experiences on a family medicine rotation do not comprehensively prepare them for the exam, especially when the specialty has such a wide breadth and oftentimes unknown depth. For students who know they learn best with practice questions, the below two titles tend to come up for comparison.
PreTest Family Medicine by Doug Knutson continues on in the same style as other titles in the series, providing high yield questions and helpful answers that are geared specifically towards medical students. As each book is written by a different author, there is some variability within the series, but Family Medicine is one of the stronger PreTest titles.
The book is about 5.5 inches wide, which allows it to easily slip into a white coat pocket. This really came in handy during canceled patient appointments that created a good amount of downtime. The 500 USMLE styled questions in the book specifically focus on preventive medicine, doctor-patient issues, acute conditions, and chronic conditions. Question explanations generally go into both right and wrong answers, which helps solidify learning.
The National Medical Series for Independent Study (NMS) produced their own Q&A for Family Medicine, written by David Rudy. The book is full sized, meaning there’s no way it can fit within a white coat pocket. However, it does come with a scratch-off on the inside cover, and every owner is a winner! The prize? Online searchable access to every question and answer in the book, making it easy to use from any computer (if your Family Medicine practice happens to have available computers).
It is important to note that the “nearly 500 exam-style questions” advertised on the cover is actually over 900 questions. This brings up one of the larger complaints of the book. Previous editions had a number of spelling errors and even outdated content. While the content appears accurate, some of the typo issues have remained.
Answers in the NMS question book similarly overview all of the right and wrong answers, allowing for a full learning experience. However, the feel of the questions doesn’t parallel USMLE format as much as PreTest. Content seems to be more advanced overall, with more detail. It can probably serve as an effective learning tool well into residency.
The winner: This round goes to PreTest Family Medicine.
Overall, PreTest provides questions that are more geared towards the NBME Family Medicine shelf exam, in both format and content. For a third year medical student who benefits from practice questions and wants a white coat resource, PreTest is the way to go. For those who anticipate blowing through all of the PreTest questions and coming up hungry for more, try out NMS Q&A Family Medicine for more in-depth content as a subsequent resource. Special consideration should be taken by those who plan to enter family medicine as their chosen specialty, in which case the breadth and depth of NMS Q&A may provide a larger challenge with greater long term benefits. Keep in mind that neither of these titles is recommended for USMLE Step 2 CK study, despite both of them advertising it.
Students preparing to study for the USMLE Step 2 CK should be well accustomed to the type of question encountered on the boards and shelf exams, and should have a decent sense of their own study habits and strengths. This is immensely important when deciding on a study plan for Step 2. The seemingly infinite clinical knowledge can be overwhelming, and a structured study plan truly helps.
Deja Review USMLE Step 2 CK, now in its second edition, continues to get mixed reviews by students studying for the boards. The format of the book is very straight forward: alternating sections of clinical vignettes, and rapid-fire two-column recall question and answers. The book goes through each of the core clerkship specializations that will be found on the USMLE Step 2 exam, starting with Internal Medicine, and progressing through Surgery, Neurology, Psychiatry, Obstetrics and Gynecology, Pediatrics, and finally Emergency Medicine. It is not a text book, or even a comprehensive review book such as First Aid, and as such should not be relied upon to learn new concepts. Its strength is purely in aiding with recall and making buzz word connections, and it does that very well.
However, the lack of teaching can be frustrating for students who do not already know or remember the material. DejaReview Step 2 CK shouldn’t replace question banks either. There are no answer explanations or experience in testing. Furthermore, the book is often times seen as unhelpful to students who do not learn well with recall type resources.
It is due to these reasons that there exists a split in outlook about this book. People who excel at rapid recall questions can easily carry this in a wide white coat pocket during the months preceding the USMLE Step 2 CK exam, for high yield on-the-go studying. It is a very strong review text that complements First Aid and USMLE World question banks, but it is not for everyone. Learning style really matters with this book, which is why there are such mixed feelings about it. If you are unsure of your learning style, it is recommended that you check out the format of the book before purchase. Try to browse through a copy at your medical library, or if you want to decide sooner, head over to Amazon, which gives a few of the question type pages found in the book. As far as price, Deja Review USMLE Step 2 CK gives a lot of bang in its 300+ pages for a low cost, so finding out it is not for you won’t set you back too far. Check out the links below to see what I mean.
Surgical Recall is one of those third year med student books that can be your secret phone-a-friend ace up your sleeve, and concurrently your downfall. There are a number of books you will encounter throughout medical school where the outcome of that class or clerkship is dependent on how the book is used. Just as you wouldn’t use Netter’s or Rohen’s to replace an anatomy text, Surgical Recall must be used properly.
As the title implies, Surgical Recall is your guide to all things pimping on surgery. Unless surgery is your first rotation, you should already be aware that the pimping starts on the very first day. Accordingly, you should ideally grab a copy of this during the weekend before your surgery clerkship starts and dig in quite a bit by time you hit the first day. This is the book that’s going to help you avoid looking like a total newbie, because common surgical etiquette and culture is not taught in preclinical classes. This is the book that’s going to tell you all the usual abbreviations, the names of all the different scissors you enounter, why you should NEVER touch the mayo tray (and what that is), and all of the common pimp questions you will commonly encounter.
Like other books in the Recall series, Surgical Recall uses a split page question and answer format that quizzes the reader on all the common things seen in surgery. The book does a good job in its use of pictures, especially on sections dedicated to surgical instruments and consumables. This is important as most third year med students don’t know what a JP drain is, what JP stands for, what they look like, and how they are different from other drains. You could responsively google “JP drain” right now, but you won’t know the names of all the other commonly used tools, which is why this book is helpful.
The latest edition (as seen above) has taken on a somewhat retro look. Perhaps market research has shown med students go for books that are already on fire to quell the need to later set them ablaze in frustration, or perhaps this just allows for the subsequent edition to look modernized in comparison. Nonetheless, we can’t judge a book by its cover, else the BRS series of books would have gone extinct long ago. The first section of Surgical Recall is going to touch on the big picture and background of surgery, including abbreviations, surgical signs, syndromes, cutting, suturing, tying, instruments, preoperative requirements, wound care, hemostasis, nutrition, shock, complications, and surgical anatomy pearls. Section II goes over the main general surgery areas, including GI hormones, GI bleeds, hernias, laparoscopy, trauma, burns, bariatric surgery, appendicitis, ostomies, fistulas, IBD, portal hypertension, other hepatobiliary diseases, the breast, endocrine, melanoma, vascular, and intensive care unit knowledge. The third and final section hits the surgical subspecialties, including pediatrics, plastics, hand, otolaryngology, thoracic, cardiovascular, transplant, orthopedics, neurosurgery, and urology. This book is around 800 pages long, and while the question and answer format allows for a faster read, you should generally focus on the general surgery knowledge and the topics that specifically correspond to your surgical service.
Included with this latest version is the promise of free “Mobile Access.” As of now, the jury is still out as to whether this is legitimate, as a number of students have had a hard time actually accessing it through their phones without paying the additional ~$45 app price through Android or Apple. It may be fixed in the future, but don’t purchase this book thinking it will instantly be on your phone.
Surgical Recall can be the downfall for the occasional medical student who believes this is the only book needed during surgery. Indeed it will seem like a cheat sheet, whereby memorizing this book will produce superstar results in the operating room and floors (and it will). However, the NBME Surgery Shelf Exam doesn’t care about the things that make awesome operating room medical students that get all the obscure attending questions. There is no Surgery Shelf question on one-handed ties, no Surgery Shelf question on drain choices, and no Surgery Shelf question on how your attending likes their coffee. Make the distinction: there is OR / floor knowledge, and there is NBME Surgery Shelf exam knowledge, with a minority of overlap. You need both to go for the gold on your surgery clerkship, and Surgical recall is the tool to help with the former.