Tag Archives: step 1

Recommended Preclinical Pulmonology: Respiratory Physiology

West's 9th edition of Respiratory Physiology, great for medical studentsRespiratory Physisology: The Essentials 9th Edition (2011) by John B. West is a beautifully constructed book for understanding the fundamentals of respiratory physiology in about 1 to 2 weeks.  Initially opening the book may bring a bout of anxiety due to the seemingly dense text and black-and-white (or rather red-and-gray) visual aids and illustrations.  However, when you actually begin to read this book, it is quite easy to follow and learn the essentials of respiratory physiology. Only a few sections seem slightly more difficult to understand despite the explanations provided.  In each chapter, the content is provided in a narrative manner, interjected by diagrams, charts, equations, summaries of main points, and finishes up with a summary of important pulmonary concepts and some relevant review questions for the chapter.  Although the presentation is not colorful, the material is presented clearly and concisely.  All the fundamentals medical students need to know are contained within, and there is very little digression or extraneous material.

The table of contents reveals the comprehensive nature of this book:  structure and function, ventilation, diffusion, blood flow and metabolism, ventilation-perfusion relationships, gas transport by the blood, mechanics of breathing, control of ventilation, respiratory system under stress, and tests of pulmonary function. As you can see, Respiratory Physiology talks about everything from structure to function to regulation of respiration, so it does not skip on the important topics.  However, it is important to note that this resource is more focused on physiology than pathophysiology: a needed fundamental for any system. This book can be used either for a comprehensive review of pulmology for pre-clinical medical school exams and for the USMLE boards.  It is 200 pages of good information, but may take several days to read if you are studying pulmonology and other courses at the same time.

when you actually begin to read this book, it is quite easy to follow and learn the essentials of respiratory physiology

This book is recommended to medical students who really want a comprehensive basis in respiratory physiology fundaments, those who want to have a solid foundation for clerkship in pulmonology, and pulmonology residents who may want to brush up on the important basics of respiration.  It However, it is certainly not necessary for students looking only to pass. Although West’s Respiratory Physiology is not wordy beyond necessity, it is still quite a detailed and complete book on the physiology of respiration.


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USMLE Step 1 Series: What Does My Step 1 Score Mean?!

Navigating Step 1 Scores

So it’s Wednesday afternoon. After weeks of waiting, you’ve been checking your e-mail today Q3minutes or hitting refresh on the NBME site repeatedly, and finally find what you’ve been seeking: the link to the PDF that you think determines everything.

You hastily open the file to find….   a large block of text. After the second it takes you to realize the date and your USMLE ID number at the top have nothing to do with your actual score, your eye catches a glimpse of the following:

Passing the USMLE Step 1 Exam

A good sign! You’ve joined the >90% of MD students (and about 80% of DO students trying for an allopathic-residency program) who passed. Congratulations! Chances are though, the page opened up just short of showing the box directly underneath the pass/fail: your score. In your excitement, you struggle with getting the mouse accurately (or was it precisely?) to the scroll bar to find…..  two numbers?  One of them a three digit score, the other a two digit score.  So…  you were aiming for some three digit goal, but now that you have passed and your score is permanent, what does it actually mean?!

In med school, the right answer usually starts with “it depends.” Let’s start with the three digit score, as that’s the important one that gets sent to residency programs with your application. As you know by now, certain medical specialties are more competitive than others. We’ll discuss interpreting below expected or failing scores in another post, but for now, you should start by checking out The National Residency Match Program (NRMP) and Association of American Medical Colleges (AAMC) document on charting match results.  It comes out around September each year and gives a breakdown of the previous year’s match statistics.  Right now, you’ll be most interested in the section that shows the average and distributions of Step 1 scores by specialty.

Is my Step 1 Score good?As for the two digit score, this is the number that is most likely to be misinterpreted. The first thing to know is that this is NOT a percentage nor a percentile. The former refers to the number of questions correct on the test divided by the total, and the latter (percentile) refers to how well you scored in relation to other students. The two digit score is neither. Don’t feel too confused – if you got this far, you already know you’re pretty smart. The two digit score is a near-arbitrary number, whereby the National Board of Medical Examiners deems the number 75 to be the cutoff for passing. This roughly corresponds to a three digit score of 188. Is it useful?  Not really.  It’s more historic than anything, and the confusion surrounding it is the reason why it is no longer sent with residency applications to program directors.

If you are interested in learning more about USMLE Step 1 percentages and percentiles, we strongly recommend checking out the MedStudentBooks.com USMLE Step 1 Percentile Calculator to help make some more sense of your score.

Congratulations to all those who passed – you’ve quite literally taken your first step to becoming a physician.

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USMLE Step 1 and 2 Studies on the Go: Utah Web Path

University of Utah Web PathologyFor those of you who have not yet found a good source for quick free online pathology review, we recommend checking out the University of Utah WebPath site.

The site breaks down major path areas and provides images with specific gross images and histological slides of most major pathology items that come up on Step 1 and Step 2. Utah WebPath QR CodeWe don’t recommend this as a sole pathology study suite, but there’s no better place that helps with image pattern recognition. The site is easy enough to navigate without an explanation here. Check it out.

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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 Right Way to Use First Aid for the USMLE Step 1

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.

First Aid for the USMLE Step 1 Remove the CoverRegardless 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!


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USMLE Step 1 Series: The Exam Survival Sweepstakes is Now Open

Lippincott Williams & Wilkins Medical Education LogoWe’ve been collaborating with Lippincott to create a giveaway that addresses some of the major aspects of USMLE Step 1 Studying. Along with several books, the Step 1 Exam Survival Sweepstakes includes some gift cards to keep you entertained and caffeinated, and an extra shirt so you can put off laundry day just a little more. Head over to Lippincott’s facebook page and sign up for a chance to win:

Q&A Review of Microbiology and Immunology
Lippincott’s Microcards, Third Edition
Lippincott’s Illustrated Reviews: Biochemistry
Board Review Series (BRS) Physiology
$25 iTunes gift card
$25 Starbucks gift card
Lippincott t-shirt
Lippincott water bottle

As with all other giveaways on this site, this contest is similarly limited to US residents. End date is May 7, 2012, just in time for the start of most med school’s Step 1 break. Good luck!

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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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Lange Case Files Pathology: For Your Review

Lange Case Files: PathologyLange’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.


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