Tag Archives: question bank

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 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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Family Medicine Question Book Showdown: NMS Q&A vs PreTest

NMS vs PreTest Family Medicine

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

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.

 


NMS Q&A Family MedicineThe 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.

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How to Reset MKSAP Answers

Since reviewing MKSAP 4 for students previously, we have received a question and several lost googlers trying to ascertain how to reset or restart MKSAP for Students 3, MKSAP for Students 4, and even MKSAP 14 for residents digital question banks.

Resetting these qbanks is straight-forward if you know where to look.  Regardless of whether you are using MKSAP 3, MKSAP 4, or MKSAP 14, the process is generally the same. Just click on Answer Sheet, followed by the Clear Answers button.  That’s it!  You’re all set to restart and reuse your MKSAP question bank.  For the visual learners out there, large purple arrows always help:

How to Reset MKSAP for Students 3 and MKSAP for Students 4

How to Reset MKSAP for Students 3 and MKSAP for Students 4

For the wayward residents who stumbled onto this med student resource site, we’ve also uploaded a visual on how to reset MKSAP 14 as well.

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USMLE World QBank Group Discount!

USMLE World Question Bank (Qbank) group discounts for the USMLE Step 1 and Step 2 exams have historically not worked out.

Here’s the typical scenario: Someone from your med school tries to organize a group of at least 50 students to band together and take advantage of a group discount from USMLE World. 70 people express uncertain interest because they don’t know the timing or what they want. 30 sign up, and despite the majority of your class eventually gets USMLE World QBanks, everyone pays full price.  Meanwhile, individuals chase down google searches for USMLE World discounts and coupon pages, none of which are legit. At this point, the only way to pay less for USMLE World subscriptions is in group discounts.

In line with this site’s collaborative mission, this page was previously dedicated to providing a sign-up whereby medical students from different schools could come together as a larger group.  We unfortunately found out  that this too is not allowed. The minimum of 50 students must come from the same school and have the same domain in their e-mail address (yourmedschool.edu).  USMLE World representatives have also confirmed that no other discount exists anywhere for any reason outside of a minimum of 50 students from the same school. Sorry everyone.

 

Don’t forget to check out these other resources from the USMLE Step 1 Series:

How to Choose USMLE Step 1 Question Banks
Sorting Through Confusion: Making a Withdrawal at the Question Bank The 7 Essentials of a Solid Step 1 Study Strategy

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Must Buy: Goljan Rapid Review Pathology

Goljan Rapid Review Pathology: a Must Have Pathology book for the USMLE boards

Goljan Rapid Review Pathology: a Must Have book for the USMLE boards

It is finally time to review Goljan: Epic King of Pathology.  All of the legends and rumors you heard were true.  He’s an arm wrestling champion, rides a white stallion around his massive pathology fun house, and can break a man’s finger clean off during rectal exam.  Indeed, some believe that the mere act of saying his name aloud increases their board score by one point every time. If you don’t understand these things, it is simply because you are not yet enlightened.

Edward Goljan is a world class Pathology Chair from Oklahoma State University.  Back in the day, he began doing pathology review courses for his medical students, which have been condensed over the years into the most comprehensive yet concise pathology review available.  More importantly, it is perfectly tailored to the USMLE Step 1, USMLE Step 2 CK, and even USMLE Step 3 boards exams, as Dr. Goljan has further refined his teachings based on constant feedback he receives from students after they take the boards.  As he states:

These notes took 25 years to put together over time.  And it dwindled down to the absolute quintessence. It’s like espresso.  You just have a little drop and you’re already fixed.

At some point, one of his students recorded his epic lecture series, which continues to float around the internet and med school back-alleys to this day, obtained and abused like crack for the boards.  To complement his lectures, he handed out his condensed notes, mentioned above.  Over time, these notes coalesced into Edward Goljan’s Rapid Review Pathology book.

The book itself is newer than the audio and has undergone further revisions, whereas the audio remains in its temporally frozen preservation. 

Edward Goljan, Pathology Review Expert and Arm Wrestler

Edward Goljan: Pure Pathology Intimidation

Specific chapters of Goljan’s Rapid Review Pathology include: Cell Injury, Inflammation and Repair, Immunopathology, Hemodynamic Disorders (Acid, Base, Electrolytes, Water), Genetic and Developmental Disorders, Environmental Pathology, Nutritional Disorders, Neoplasia, Vascular, Heart, Red Blood Cells, White Blood Cells, Lymphoid Tissue, Hemostasis, Immunohematology, Upper and Lower Respiratory, Gastrointestinal, Hepatobilliary and Pancreatic, Kidneys, Lower Urinary Tract and Male Reproductive Disorders, Female Reproductive Tract and Breast Disorders, Endocrine, Musculoskeletal and Soft Tissue, Skin, Nervous System, and Special Sensory Disorders.

Goljan’s Rapid Review Pathology also comes with Student Consult, the online portal and electronic copy of the book, giving you access to all of the text remotely, as well as the images (which come in handy for powerpoint presentations).  Student Consult for Rapid Review Pathology also comes with a little over 400 USMLE style pathology questions related to the book itself.  However, to truly lock in the information with a fantastic complementary USMLE style pathology question bank, Robbins and Cotran’s Review of Pathology (reviewed here) is the recommended book of choice.

For more information on Goljan and to view his other books, see his publisher profile, or download the Pathology Rapid Review Errata (word doc).

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Robbins and Cotran Review of Pathology, AKA Red Robbins

Robbins and Cotran Pathology Review, AKA Red Robbins

Robbins and Cotran Pathology Review, AKA Red Robbins

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.

 

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Must Buy: ACP MKSAP For Students 4

American College of Physicians' Medical Knowledge Self Assessment Program (MKSAP) 4

American College of Physicians' Medical Knowledge Self Assessment Program (MKSAP) 4

The American College of Physicians (ACP) produces a number of resources, but MKSAP For Students 4 is one of the best things they have to offer medical students on inpatient internal medicine or outpatient primary care medicine clerkships. There are a number of USMLE style question banks and books out there, but this one really covers all the bases in these fields.  In case you were wondering, it stands for the “Medical Knowledge Self Assessment Program”.

More valuable than the physical text itself is the CD that comes with every copy.  Questions can be loaded directly onto a computer, which comes in handy if you like to study around town with a laptop. Your progress and answer choices are tracked and can easily be reset at any time. My personal favorite use is loading the question bank onto my smart phone so I can listen to music and answer questions while waiting for the bus.  Keep in mind that certain Android browsers do not support linking through websites that are on the phone itself.  All this means is that you will need to hit the back button and load a new question from the browser instead of just hitting “Next” on the question page itself.

There are a number of different MKSAP question sets, which gets confusing. Bottom line: As a medical student searching for a good book, get MKSAP 4, followed by MKSAP 3 if desired.  An article will be posted soon regarding all the differences, including the higher numbered books.

As for MKSAP 4, it covers all the expected topics, complete with dermatology images and EKG interpretations. Specific chapters include Cardiovascular Medicine, Endocrinology and Metabolism, Gastroenterology and Hepatology, General Internal Medicine, Hematology, Infectious Disease, Nephrology, Neurology, Oncology, Pulmonary Medicine, Rheumatology.  By the end of the book, you will know every etiology of common presentations such as cough, chest pain, abdominal pain, etc. It really is a great tool for inpatient Internal Medicine, outpatient Internal Medicine, a large portion of Family Medicine, shelf exams, and the USMLE Step 2 CK exam.

 

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