Board Exam Prep – 2008

Overview

The STEP 1 is the last hoop you’ve got to jump through before you get to clinicals. Make no mistake, it’s a long, comprehensive and difficult test. To help you get started thinking about how to prepare for it, we’ve compiled advice from years past and added some book recommendations that we think will help.

Here’s some basic tips:

How long to study?
Most people take anywhere between 4-6 weeks to study. You can take longer if your schedule affords it (i.e. if the first month of your third year is a free month, etc.), but after several weeks of reading you’ll realize that you approach the law of diminishing returns – you can only cram so much in that head of yours before you start forgetting stuff. Study like it’s your job – wake up at 8 and study until the evening, do some questions, sleep, rinse and repeat this routine for the next day. Each day should be focused, and schedule in days off because you’ll need them to unwind a bit and to catch up in case you find that it took longer than 1 day to cover a certain topic.

If you prefer studying less hours a day than most…you will need more days…and vice versa. Mixed in with this, you will need to try to anticipate how much of a break you will need before MS3. We recommend taking a break of some sort…how long is up to you. Most people needed about a week. Honestly, many of us had a little over 5 weeks to study and there’s plenty of us that by week 4 crashed and wanted to take the test the next day – and then started to lose the information we had learned at the beginning of my study month – which is a key reason to NOT schedule your test too late. Also, some people needed a break after the MSK/Clinical Cases blocks – so don’t forget to give yourself a few days to chill if you think you need it. There is no perfect exam day – each person needs to schedule what they feel is best for them. Again, if you need people to process this decision feel free to contact the chief mentors.

For those that anticipate significant difficulty with studying for/taking/passing Step 1 (honestly, this will be VERY few of you): Likely you are already connected with resources that have helped you to improve your performance throughout medical school – I suggest you talk with those who have helped you thus far in deciding upon a strategy for taking Step 1 – these folks LOVE helping students and I know they would be delighted to help you craft a plan that works best for your learning style/time-table needs.

When to take the test?
When scheduling your test date, schedule an activity that you will not be able reschedule, i.e.non-refundable plane ticket. This will limit the temptation to postpone your testing due to panic. For those that have “summer plans” like getting married or other travel plans – do what seems best to you. I have seen students take their exam quite early (two-three weeks or so after MSK ends) and do quite well, as well as students who chose to get married/travel first…then return and begin their study plans and take the exam late (the week before 3rd year begins). This is a very personal decision that requires you to ask….can I relax during my time off if I haven’t taken Step 1 yet? or do I need to get it out of the way? or can I focus on studying if I have these marriage/travel plans over my head? Only you can figure these things out – but feel free to contact any of us personally if you need a sounding board as you try to make up your mind.

• Plan ahead for traveling to the test site – i.e. stay in a hotel close to your testing site, so as not to be caught in traffic on exam day – eliminate possible stressors.

• Try to do questions everyday – doing questions helps to reinforce what you learned and helps you get used to pacing yourself, and reinforce your test taking strategies so you’ll be ready on test day. Also, don’t underestimate how long it takes to do questions. For example, if you do 50 questions per day and simulate the real testing situation, it will take you an hour to do those questions, and maybe an hour or more to review them, that’s 2 hours minimum right there just for questions per day.

• Most importantly – try not to panic!

How to Study
• You’ll hear the phrase “high-yield” so many times when looking at review books you’ll want to shoot the next person that says it. This phrase basically encompasses most of the study strategy for the Step 1 (and others for that matter), meaning that you want to use resources/study aids that contain very useful information in a compact and quick format – the opposite of a textbook.

• Don’t put off lengthy topics or topics that you’re weak at towards the end of your studying – make sure you get practice and are comfortable with those topics earlier than later. However, stuff like embryology which is not a huge portion of the test and is always a tricky subject can be studied towards the end. Thus, everyone needs a different amount of time to study for different materials.

• The big topics covered are: pathology, pharmacology, microbiology, and physiology. Note that this means that things like anatomy and biochemistry will be on the boards but in much smaller proportion and more clinically relevant (unlike some of your exams perhaps).

• You can organize your studying by organ systems or by subjects. Either way works, and most question books are organized in both manners.

• It is not necessary to do every single question in any given question resource. Concentrate on the things you are doing worse on.

• Keep in mind that things happen. Schedule in a cushion in case of an emergency. The best way to do this is to keep one or two days free each week for either catching up or relaxing.

• Studying with friends is a great way to stay motivated and ensures that you show up to study. Plus you never know what crazy mnemonics will result! But if this doesn’t work for you, no worries. You can use your med school friends to make sure you take study breaks also.

• Most people found it helpful to have a consistent place to study. You can reserve lab study desks if you’d like. You can also reserve cubicles/study rooms at most UNC libraries. And some people make a rotating schedule of their favorite coffee shops.

• At the end of the day, it’s another standardized, full day test like the MCAT. Being a great standardized test taker helps on tests like these, as they might have on the SAT, and MCAT. So, in a way your performance on the MCAT from a test taking standpoint can give you a guide to your performance on this test. Also, how well you grasped the material from the first two years of school is another determinant and simply how much you can cram inside your head ~ some of us are better at that than others. Nonetheless, having a sound plan and being honest with yourself about your strengths and weaknesses and approaching this test with a good attitude all helps in the end.

BOOKS
Pick your books carefully, or you could easily spend way too much money. Nothing is worse than realizing you’re low on funds from buying 20 different books for the boards. Also, don’t try to read every single word in each book. Utilize one book as your main study tool and use others as a reference or to supplement. You also don’t need to buy everything new. Ask older friends. Buy used online – you can find some very good deals here. MS3s and MS4s will probably start posting in March and later trying to sell their old books.

In order to avoid ‘over-buying’ books, think about having one main resource for each category:
1) Physiology
2) Pathology
3) Pharmacology
4) Micro
5) Immunology
6) Biochemistry
7) Anatomy
8) Embryology
9) Behavioral Science
10) A Question bank with good explanations

PLUS an overall resource book, such as First Aid, which includes the essentials of all these

Caveat: There are obviously a ton of other resources one could use. These are just some of the more common ones. These opinions may vary, but this is a general sense of what our classmates have thought. There are numerous sites online which review books. In addition, the back section of FA reviewed study sources for different subjects.

Overall Recourses (1-2 recommended):
• First Aid for Step 1 – A MUST HAVE (2006 and newer editions are organized by organ system while previous ones are organized by subject; get the latest edition since each successive one has corrections and updates based on the prior editions). Will need to use this as a basic resource. Many people found it helpful to scribble notes and additional high yield info in the margins so that most everything high yield they needed to know was here – ie using this as a Step 1 ‘Bible’ of sorts. This will be useful to read back over in the days before the test. It is an organ system based approach, but also has biochem, genetics, micro, imunno, and nutrition sections.

• Step-Up to USMLE Step 1 – Like FA, this is a systems based review. It is probably even more concise than FA in many areas and offers some additional information. For example, step up reviews the anatomy, embryology, physio, and path of each major system. It has a lot of good tables as well. It does not have as many ‘facts’ as FA and does not cover Micro, Biochem, Nutrition, very well, but it is a good additional resource

• High-Yield Comprehensive USMLE Step 1 Review – Don’t know many people who used this. Unlikely to need over the above two for an overall resource.

• Deja Review USMLE Step 1 & USMLE Step 1 Secrets – These two books are both systems/subject based, however not stand alone books. They are essentially books completely full of high yield facts – ie quick question and one word answers plus word association type questions (not multiple choice questions like the test). The advantage to these is that they are easy to pick up and read for a couple of minutes, however they don’t have any explanations. Step 1 Secrets is a little more comprehensive. They are both very dense however and it can be overwhelming to read fact after fact. They could be good for reviewing the week or so before the test, especially for focusing on your weak subjects.

Physiology (1 Recommended):
• BRS Physiology – A quick and succinct summary of the important physiology for the exam. Probably the most comprehensive physiology review, without going into way too much detail. Expect a number of pure physio questions on the test, but it’s helpful to review this material before delving back into pathology. This books is systems based. All BRS books have Q & A at the end of each chapter, which is helpful.

Pathology (1 Recommended):
• BRS Pathology – This is a very good resource that covers MOST of the pathology you’ll need to know for the boards. It’s succinct and easy to read and follow. Most people liked using this. Downside is perhaps it’s lacking illustrations, lacks questions in clinical vignette format, and lacks some important details with emphasis on low yield subjects. However not to worry, you will pick these details up elsewhere with good review using your Q-bank.

• Goljan’s Rapid Review Pathology – This is a very comprehensive pathology review book with more information than BRS. Overall people really liked this book, but many found it almost too dense to get through. Does have some nice really tables with color pictures and illustrations. Has Q&A at the back, but not by chapter as with BRS. Though it has more details than BRS, keep in mind time is limited. This can be used as your primary resource if you willing to put in the time to get through it, but if bought, it may better be used as a supplement to BRS in areas where you want more detail, or used as a reference.

Pharmacology (Optional):
*The vast majority of the pharmacology you need to know will be in FA or in Step-up. Using this, plus any resources you used throughout your MS2 year (flash cards/excel spreadsheet, etc.) should be sufficient. There are a ton of other options, but not wholly necessary. Other options include:

• BRS Pharm Cards – quick and simple, if you like flash cards (premade). Provides high yield facts about the most common drugs, however is not comprehensive. Good for memorizing.

• Katzung & Trevor’s Pharmacology – great if you want to shell out $$ for a reference book. Helpful to fill in some details not well explained by the overall review books. Unrealistic as a primary resource to read through.

• High Yield Pharm – Not very comprehensive, but provides a good quick review. Useful for getting the essentials down quickly.

Microbiology (1 Recommended):
• Clinical Microbiology Made Ridiculously Simple – Big, but an easy, fairly quick read. It is well organized and has good illustrations, mnemonics, and tables (especially in the new 4th edition). If you knew this book cold you would probably know everything for the boards. The 3rd edition (or earlier editions) are a bit outdated.

• BRS Microbiology and Immunology (one book) – Not as comprehensive or easy to read asClinical Micro. However it does have a lot of good information plus Q&A’s. If you are a fan of the BRS series, then this may be a good alternative.

• Bug Cards or other set of micro flash cards – Most people found these useful for quick high yield recall of this information

Immunology (1 Recommended):
* Like pharm, much of the immuno you will need to know is in FA. However, it is very helpful to have a resource which explains this complicated subject a little better.

• BRS Micro and Immuno – A good resource which explains this complicated subject relatively well and efficiently.

Biochemistry (1 Recommended):
* Again, FA will have a lot of high yield biochem, but an additional resource is probably necessary here.

• BRS Biochem – Mixed reviews on this one. It is comprehensive and explains some of the detailed mechanisms well. Has good figures. Does have a number of errors in it. Also, it is dense and would be difficult to get through in less than 3 days. Need to have the time budgeted to make good use of this.

• Lippincott’s Illustrated Reviews: Biochemistry – A very highly rated resource. More useful as a course textbook, however highly visual review in an easy-to-use outline format. USMLE-type questions and detailed explanations included with each chapter. This book is too long however to read entirely through while studying for boards. You will have to devote a couple of days to biochem, then pick and choose which parts of the book to focus on.

• High Yield Biochemistry – A very quick and dirty review of biochemistry. Offers more information than FA, but not a whole lot more. Good for those who don’t plan on spending more than a day or so on boichem.

Anatomy (Optional):
* A consistent anatomy resource would be very helpful. Referring back to Moore’s or Netter’s Atlas from MS1 year could serve as useful resources. However, some people found it helpful to have a quick anatomy review presented in Step 1 high yield format.

• BRS Anatomy or High Yield Anatomy – Depending on whether you like the High Yield format or BRS format. Both are useful and probably contain more information than you need to know. Again, with a limited amount of time, it will be difficult to fully utilize these.

• High Yield Neuroanatomy – A good all around review book for neuroanatomy complete with MRI/CT scans, tracts (DC-ML, etc), and some pathology. It’s a quick read and you’ll probably want to brush up on this more than you will get with FA. You will definitely see a few questions on Neuroanatomy, but if crunched for study time, this can be avoided as it will not likely be heavily emphasized.

Embryology (Optional):
• High Yield Embryology – You will need more Embryo than you’ll get with FA if you want to master this for the test. HY is the general consensus to get your recommended dose of embryo for the Step 1. Systems based.

Behavioral Science (Optional):
* Not totally necessary to review this beyond FA since we have a pretty good Clin Epi class, but this is an area that is quick to review. Most people don’t spend much time on this, so if you do have the time it’s a great way to pick up some points on the exam that folks from other schools will likely be missing.

• High Yield Behavioral Sciences or BRS Behavioral Science – Again depending on which style you like best, these are both pretty quick and good review books of psychiatry and clinical-epi related topics.

Kaplan:
• Kaplan Lecture Notes Book Sets – These are a organ-system based set of books that are comprehensive and updated every year. They are expensive brand new, but sometimes you can find upperclassmen selling old editions or find them on eBay. If you are someone who really feels like they need to have a consistent format for all the information you’re covering for the boards, this is a great option. It really boils down to your studying style and what suits you best. Don’t be intimidated by the size – they have massive margins and questions within each book. Be forewarned that they cover much more detail than the other books and than what is necessary to pass the boards.

Kaplan Courses – Those who enjoy having lectures and a very structured learning environment do really well with this option. Needless to say they are also expensive.

NBME Resources:
• NBME practice tests (4): 200 questions each, $45 each. You can buy access to 4 electronic NBME, 200 question practice tests, officially known as the Comprehensive Basic Science Self-Assessment or CBSSA. Each test, or form as they call them, is completely electronic, allows you to start and stop the test when you like, and gives you a score in the end that correlates to a rough USMLE score – i.e. 206, 230, etc. Most say that the last two forms, Form 3 and 4, mirror more recently used old Step 1 questions and will give you a better idea of what the real test is like versus forms 1 and 2. The only disadvantage to these tests is that they DO NOT provide answers or explanations, only a score report for each major subject area (neurology, cardiovascular, etc), hence they are only designed to measure your performance in each subject, nothing else.

To get the tests, you need to create an account at the NBME website, then pick which test you want. Keep in mind, these tests take a while to take, so make sure when you organize your calender, you set aside enough time to go through the tests. Most folks who used the service took anywhere between 1 and 2 tests. Taking more is possible, but also time consuming. Take them after you’ve done some substantial studying or early on to gauge where you need to study.

Also, when you register for Step 1, you get access to practice content. The 3 blocks of content are easier than the real exam, but they are a good confidence booster and are worth running through if only to know that you have covered the “official” material. The Kaplan Qbank subscription also comes with a .pdf file of explanations (an answer key without explanations comes with the content).

Q-Banks:
You have 3 Qbanks to choose from, the old and venerable Qbank, the newer (and cheaper) USMLEworld, and USMLErx by the same folks that make the First Aid series of books. In the end, choose one and you should be fine. (side note: when doing questions, try to always include all subject manner in each practice test, so you’re not just doing a micro-only test one day, and a biochem-only test another day. The real test is not like that so get in the habit of doing a wide variety of questions fromt the start)

• Kaplan Qbank
The majority of people choose Kaplan Qbank because it has been the mostly widely used resource for a number of years. Kaplan boasts over 2000 questions, and most are thorough with explanations, and like most Qbanks, the testing service has features to track your progress and design tests to suit your studying habits and goals. The test formatting itself is Kaplan’s own design, whereas USMLEworld’s layout is designed much like that of the actual Step 1 to give you that same look and feel.

When you purchase access, you can purchase the qbank service in a one ($199) or three month block ($279). You can also purchase an add-on qbank called Integrated Vignettes Qbank aka IVQbank. The IVQbank is not very useful because for one thing, it is tough to get through the standard 2000 questions in the regular Qbank, much less an additional pack of 1000 questions that the IVQbank provides. So keep that in mind if they try to sell you that as well. Watch out for specials from Kaplan for qbank pricing and sometimes right before the end of the MS2 year, Kaplan works out a group rate to bring down the price per person, so you don’t have to necessarily buy the service very early.

• USMLEWorld
This is one of the newer qbanks and has quickly gained popularity because of the depth and variety of questions, the layout which mirrors that of the actual Step 1 (as well as Step 2, and 3), and the price which is cheaper than Kaplan (about half the price ~ $90), and it has 2000 questions, close to that of Kaplan. We’ve been noticing that year by year more and more people are going for USMLE world, and that’s been the trend for the upperclassmen when studying for the Step 2 as well.

• USMLErx
USMLErx is the newest qbank and is marketed by the authors of the First Aid series of books, and you may have seen ads in First Aid books or other McGraw-Hill medical review books. This is the cheapest of the qbanks right now ($69 for one month – it’s even cheaper if you’re an AMSA member) and has more question than either Kaplan or USMLEworld with over 2600 questions. However, being so new, there’s not a lot of people who can offer advice on how good it is.

Step 1 Links with useful information:

http://spreadsheets.google.com/pub?key=pJ_4c9-dlTiGSs7UyS4_MbA&gid=0
(Massive excel file with tons of drugs, bacteria, viruses, fungi, etc all laid out in one resource – good as a reference)

http://library.med.utah.edu/WebPath/ORGAN.html
(Great free histology/pathology review)

http://library.med.utah.edu/WebPath/EXAM/EXAMIDX.html
(same site as above, but linked directly to quizzes on the pathology)

http://en.wikibooks.org/wiki/Test_Prep_for_USMLE_Step_1
(Yes Wikipedia actually has a quick and dirty USMLE review – has some useful high yield facts, some useful infor for 3rd year as well)

http://www.medfriends.org/step1_estimator/
(A step 1 score estimator. Don’t take this one too terribly seriously, but decent as a broad estimate)

http://www.nrmp.org/data/resultsanddata2009.pdf
(Gives you the average Step 1 scores as per specialty, again don’t stress yourself out here)

http://syllabus.med.unc.edu/yr1/grosanat/iha/app/bodyregions.htm
(Online anatomy reference, if you need it)

http://www.nbme.org/programs-services/medical-students/index.html
(NBME resources)

The Rumours were true Step 1 Blog

Sample Study Schedules (Microsoft Excel)

• Sample schedule 1
• Sample schedule 2
• Sample schedule 3