Board Exam Prep – 2008
USMLE Step 1 Guide
By Brad Fetzer (c/o 2010) and Kiran Venkatesh (c/o 2009)
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?
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?
• 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
• 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.
In order to avoid ‘over-buying’ books, think about having one main resource for each category:
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):
• 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):
Pathology (1 Recommended):
• 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.
• 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):
• 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):
• BRS Micro and Immuno – A good resource which explains this complicated subject relatively well and efficiently.
Biochemistry (1 Recommended):
• 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.
• 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.
Behavioral Science (Optional):
• 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 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.
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).
• Kaplan Qbank
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.
Step 1 Links with useful information:
Sample Study Schedules (Microsoft Excel)