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Member Profile

David Jho (2006)
Member Type: Student, Junior Member Campus: Chicago
Specialty: Neurosurgery Program: Harvard-MGH
Advice
USMLE STEP 1 ADVICE

Sample USMLE Step 1 Study Schedule A (42 days)
-d1-2 = 1st Diagnostic Test
-d3-5 = Biochemistry
-d6-7 = Anatomy
-d8-9 = Embryology
-d10-11 = Neuroanatomy
-d12 = Catch-up Day
-d13-16 = Microbiology
-d17 = Immunology
-d18 = Histology & Catch-up Day
-d19-22 = Behavioral Science & Biostatistics
-d23-26 = Physiology
-d27 = Catch-up Day
-d28-35 = Pathology
-d36-40 = Pharmacology
-d41-42 = 2nd Diagnostic Test


Sample USMLE Step 1 Study Schedule B (30 days)

-d1-2 = 1st Diagnostic Test
-d3-4 = Behavioral Science & Biostatistics
-d5-7 = Biochemistry
-d8-11 = Physiology
-d12-13 = Anatomy & Neuroanatomy
-d14-15 = Embryology & Histology
-d16 = Catch-up Day
-d17-19 = Pharmacology
-d20-23 = Microbiology & Immunology
-d24-28 = Pathology
-d29-30 = 2nd Diagnostic Test


USMLE STEP 1 GENERAL INFO:

I have provided two sample study schedules above. I personally went through two study schedules then the Board Simulator Series in addition to First Aid so that I saw all of the material at least 3x through before taking the test. I will provide more details on study tactics below.

The test is eight hours long with seven sections of 50 questions each (1 hr per section) for a total of 350 questions. However, only six of the sections are counted towards your score, with one section being a venue for testing future questions. Therefore, there is an assumed theoretical maximum of 300 points (and 99 points on the alternate two-digit scale), but NBME usually curves the scale. The average score is usually 215 with one standard deviation (SD) being around 20 points. The more recent passing score was set at 182. Competitive residencies may require that you beat the mean by 1 or 2 SD. Set a realistic target score based on your goals, and tailor your studying towards achieving this score.

Your must arrange your own testing date by registering for the exam near the beginning of your M2 year (aim for Dec). The Office of Student Affairs will help you with this process. More details about the USMLE can be found in the beginning of the First Aid for the USMLE Step 1 book. I recommend setting aside about 3 months of full-time hardcore preparation for the exam. You can begin light preparation throughout the M2 year and X-mas break, but hardcore preparation does not need to begin until March. Ideally the exam should be taken in June before the starting date for your M3 rotations.

Although it will be tempting to push the exam back as you fall behind your study schedule or when stress swells close to testing time, you should resolutely take the exam on your originally scheduled date. If you do not plan to push your test back, you will be more motivated to stay on study schedule. Also, the extra days or weeks of studying tend not to help; most people agree that the questions they did not know were topics that they would never have studied anyway if they had an extra week or two. The only reason the test should be pushed back is for personal emergencies.

DIAGNOSTIC TESTS:

Many of my friends liked Kaplan, whether they did the full course or just Q-bank. If you have trouble motivating yourself or keeping yourself on a study schedule, the Kaplan course may be the best option for you since it forces you to stay on schedule. As a personal choice, I decided not to take Kaplan because the course trains people en masse to achieve a very good score but not to break the curve to extremes.

But for everyone, I recommend taking the free Kaplan diagnostic test in the Spring. The Kaplan diagnostic test can help set a realistic goal for you depending on your starting point. At the end of your diagnostic test, Kaplan makes you fill out a long questionnaire on your studying style. For this questionnaire, I recommend that you fill-in random bubbles and just turn it in. When you receive the score back a week later, just look at your raw score. As a gauge of what your score means, 61% can be considered a passing score (multiply raw score x3 to get an approximation of the three-digit score). If you are already achieving a passing score on the diagnostic test, you can realistically shoot to break 1 or 2 SD. Ignore the Kaplan evaluation on how many days you should spend on which topic based on the questions you got right or wrong, and ignore their evaluations of what type of student you are based on your questionnaire. Their assessment of how many days you need for each topic is wrong because you haven�t yet finished all your classes at this point in the year. As for their assessment of what type of student you are and how you should tailor your studying style, you should already know yourself after two years of medical school.

In addition, taking the official USMLE practice half-exam a month before the actual exam can assess your progress and reveals any weaknesses you can patch in the final month. You can either do the CD on your own or take the official practice exam (which has the exact same questions as the practice CD) administered at your chosen testing site. If you wish to take the official practice exam, you must register via the NBME USMLE website at least 2-4 wks in advance (costs ~$42). I found the official practice test helpful because I would otherwise never have known to bring a sweatshirt in June since the air conditioning at my site is kept extremely high. Also, I don�t think I would have finished the practice CD in 3 hours on my own. The testing center checks your ID and gives you earplugs, markers, and note pads as if it were a real test. At the end, you immediately receive a printed raw score showing the percentage of questions you answered correctly. You can gauge your progress since the free Kaplan diagnostic test and fine-tune your studying accordingly. You may not want to pay ~$42 for the official practice test, but at the least I would recommend visiting your testing center and walking around inside. You can also scope out nearby places to eat, just in case.

STUDY SOURCES:

Your First Aid for the USMLE Step 1 book will serve as the ultimate study guide for this exam. Although you will need to use other references for forgotten M1 material and for mock questions, everything will eventually refer back to the First Aid book. Do NOT begin to write in your First Aid book until 2-3 months before the exam. Any earlier and you will find that you have filled your book with basic material that you have learned thoroughly since that time. The Board Simulator Series (BSS) is a 5-book question series that simulates USMLE content quite well. It is painful to do but well worth the effort. The BSS should be done at a rapid pace of one book every 2-3 days at about 1-2 months before your scheduled exam. Almost every student I know who has cracked 2 SD's has used the BSS (but of course not every student who does BSS is guaranteed to do well).

In March, set a realistically planned study schedule for the next 3 months. Schedule yourself empty catch-up days as you will inevitably fall behind an ideal schedule. The website (http://www.medschool.com) once contained many excellent USMLE STep 1 training schedules that you could adapt to your own needs, but it has recently been taken over commercially and no longer provides free training schedules. However, I have placed some sample study schedules at the top of this page that can be custom-modified.

As mentioned, it is good to schedule your hardcore studying time beginning Spring Break towards the end of March and to take the test towards the end of June. Spend the most time on Pathology, Physiology, Microbiology, Biochemistry, & Behavioral SCience (and moderate time on Anatomy, Neuroanatomy, Embryology and Pharmacology). Do as many practice questions as you can during the last month of studying.

As for other specific books, the First Aid for the USMLE Step 1 has a book review section in the back, which is pretty accurate. The Ridiculously Simple, BRS, Hi-Yield, and the UCV series are generally excellent, but the individual quality of books in the series differs. I have provided my own personal list below with remarks about which I have found to be the best.

PERSONAL SOURCES:

As a warning, my list of personal book choices was biased by my goals and studying style. My goal was to break 2 SD's, so I started studying very early. I am familiar with my strengths and weaknesses. My main weakness is that I retain only about 60-70% of what I read, thus I don�t feel completely comfortable with a topic until I�ve read at least 2-3 sources. Fortunately, one of my strengths has been speed-reading, and that is why I used so many sources per subject. Using such an excessive number of sources would probably be counterproductive for most people. By now you should know your own studying style, and you should be able to design a proper plan for yourself. In the following lists I have marked my favorites in boldface with an *.

1) GENERAL = First Aid*, Board Simulator Series*, Underground Clinical Vignettes (UCV series; Biochem & Pharm most useful), Gold Standard Review Tapes (some errors; Biochem & Anatomy most useful; good for the car or gym), USMLE Step 1 Recall (just okay)
2) ANATOMY = Hi-Yield Anatomy*, Gross Anatomy Made Ridic Simple (good book but may be too detailed), Radiology Made Ridic Simple (overkill in retrospect b/c there aren't many anatomy Q's on USMLE 1)
3) BEHAVIORAL SCIENCE/PSYCHOPATHOLOGY (often ignored topic but very high yield on USMLE 1) = Hi-Yield Behavioral Science*, Hi-Yield Psychiatry (just a slightly expanded version of Hi-Yield Behav Sci), BRS Behavioral Science (Hi-Yield & BRS Behav Sci are excellent books by the same author that are identical in content, different in format), Clinical Behav Sci Made Ridic Simple (terrible book)
4) BIOCHEMISTRY = Hi-Yield Biochemistry, Biochem Made Ridic Simple, Lippincott's (nothing was great, but it's necessary to pick at least one; the First Aid Biochem section & BSS biochem questions are excellent, but at least one detailed book is needed)
5) EMBRYOLOGY = Hi-Yield Embryology*, Sweeney's Basic Concepts in Embryology (only Hi-Yield is really necessary)
6) HISTOLOGY = Hi-Yield Histology (nothing is necessary; very low yield topic)
7) IMMUNOLOGY = Hi-Yield Immunology (nothing is necessary, but this book is only ~60 pp)
8) NEUROANATOMY = Hi-Yield Neuroanatomy*, Neuroanatomy Made Ridic Simple* (Hi-Yield is more detailed but may be excessive for USMLE 1; BRS by the same author is far too detailed for the USMLE)
9) MICROBIOLOGY = Microbio Made Ridic Simple*, Hi-Yield Microbio, Appleton & Lange Immuno & Microbio (for Appleton & Lange, the 40 pp power review in the back is only recommended)
10) PATHOLOGY = Robbin's Review Book* (a question book ~125 pp), BRS Pathology* (Path & Physio make-up the bulk of USMLE 1)
11) PHARMACOLOGY = Hi-Yield Pharmacology*, Clinical Pharmacology Made Ridic Simple*, Pharmacology Recall* (I liked all 3 books, but it is not necessary to use all 3. Ridic Simple is useful only if you've used it throughout the year & added missing drugs; Hi-Yield is short & fruitful; Pharm Recall is thorough & has a power review in the back but is ~400 pp total length; the First Aid Pharm section is great, as is the BSS pharm Q's; the USMLE often tests cardio/blood pressure and glaucoma drugs)
12) PHYSIOLOGY = Physio Made Ridic Simple* (good renal & CV sections; First Aid's physio section is great)

BREAKING THE CURVE:

There are different study strategies for the USMLE depending on whether you want to pass, do very well (meaning 80-97th percentile), or break the curve (>97th percentile). Of course you want to get the highest score possible, but you may want to customize your studying towards a realistic goal as necessary for your career choice; First Aid has a nice intro section regarding this topic.

My reasoning for this advice is as follows: in order to pass, it is necessary to learn the core high-yield information well. To do well enough to break 1 SD, one must learn the core high-yield material inside-and-out, plus learn enough lower-yield info to snag extra questions to break 1 SD. To break the curve at 2 SD, it is necessary to know both high-yield and lower-yield info extremely well. It is a risk to gear your studying towards breaking the curve if you know you will have trouble remembering just the core high-yield info. The lower-yield info can push some high-yield info out of your brain, resulting in a lower score than if you had just learned the high-yield info really well. So unless you feel really comfortable with the core info presented in First Aid, it is counterproductive to study extra lower-yield info. At this point in your academic studies, you should know yourself well enough to set a realistic goal suitable for you.

For those who are shooting to break 2 SD, I must say that everyone I have known that scored above the 99th percentile studied on their own (no Kaplan courses although some used Kaplan materials) and completed BSS (except for 2 exceptions including one really brilliant friend of mine who had inopportune personal problems and crammed for the exam). I emphasize "completed" BSS because many people start BSS but never finish because it is long and painful to do. For those who choose to do BSS, my advice is to push yourself to get through it as quickly as possible; shoot to complete one book every 3 days and set aside 3 wks during which you do nothing but BSS. One of the strengths of using the BSS is that it is arranged by organ systems. Since most med schools teach classes in a subject-based fashion, seeing the material from a organ system-based manner provides a different angle on the same material and may help enhance understanding of the topics. Also, similar questions to the BSS questions on sensitivity, specificity, and all the different types of mortality rates may be found with surprising frequency on the actual USMLE Step I.

FINAL NOTES:

The advice from First Aid on becoming familiar with your testing site and getting a good night's rest/food are common sense but useful. Spacing regular 5-15 min breaks after each section or two will keep you from burning-out during the exam. Also, resist the strong urge to rush through the last section b/c you are "almost done". Treat the last section like the first; take your time and double-check carefully.

Best of luck on the USMLE Step 1!

David Jho

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USMLE STEP 2 ADVICE

I studied for USMLE Step 2 (CK, written) primarily in Nov-Dec while I was interviewing, then took the exam on Dec 29. I agree with the common aphorism that one should generally take Step 2 early (Aug-Sept) in order to compensate for a sub-optimal Step 1 score, and one should generally take it later otherwise. But unlike Step 1, my opinion is that First Aid is NOT the book to use for Step 2; it's more important to do questions and to just brush-up on weaker core clerkship areas.

It's challenging to study while doing out-of-town interviews, so I reserved the final 2 weeks before the exam for full-time studying and building-up test question endurance/tolerance. My personal goal was to break at least the 90th percentile (by statistical distribution for my specific exam, not 2-digit score), which I was fortunate to attain. The strategy on test day is similar to that for Step 1, except that there are 8 sections (~46 Q's each) instead of 7. And as for Step 1, if you take the tutorial on the NBME Official Practice CD to refresh yourself regarding the computer navigation controls, you can add 15 min to your break by skipping the tutorial on test day. I took a brief break after every 2 sections, which worked out well.

CONTENT BOOKS:
-First Aid for the USMLE Step 2 [not necessary]
-Board & Wards [excellent]

QUESTION BOOKS:
-USMLE Step 2 Mock Exam [decent book]
-Appleton & Lange Step 2 Review [not quite as good as the others listed]
-NMS Review for USMLE Step 2 [excellent]

OTHER:
-NBME Official Practice CD [excellent]
-As for the Clinical Skills (CS) exam, I would recommend NOT studying at all as it would be a further waste of time/money than it already is. Very few people fail the exam, and the internal exam at UIC is more challenging than the CS exam. Just register for the Chicago site early, and show-up on test day with your ID/papers plus a stethescope and otherwise empty white coat. The site provides a light lunch (soup, cold cuts, cookies, drinks), but you may also want to bring additional food/drinks.

Best of luck with Step 2 and the residency match!

David Jho