INTRODUCTION – PREPARING FOR STEP 1



Alpert Medical School Step 1 Handbook

INTRODUCTION

The purpose of this handbook is to provide you with the background information you need to successfully prepare for the USMLE Step 1 examination. In addition to the material in this handbook, you will find a variety of other resources posted on Canvas in the USMLE Step 1 Materials section. There, you will find a self assessment tool, planning calendar, sample study plans, content related material, etc.

You have every reason to feel positive about Step 1. Alpert Medical School students perform very well on this test, as indicated by our students’ success in the residency match. Our curriculum and examinations provide excellent preparation for this test, and we have a robust system in place to provide students who need additional help with that assistance in preparing for the exam.

We wish you all the best as you tackle this challenge and progress towards becoming a licensed physician.

Emily Green, MA Paul George, MD

Assistant Director of Student Affairs Director, Year II Curriculum

A QUICK OVERVIEW

USMLE Step 1 is the first of three examinations students must pass to become a licensed physician in the United States. Step 1 is designed to measure basic science knowledge. It does so through a case‐based, multiple‐choice question approach. A Step 1 score of 188 is considered passing. The national mean for first time test takers in 2010 was 222.

TEST QUESTION FORMAT

The exam is an eight‐hour computer‐based test consisting of seven 60 minute blocks of questions. There are a total of approximately 330 questions with 48 questions per block. Most Step 1 questions begin with a description of a patient. Three to eleven possible answers (usually five) are provided for each question. Although answer choices may be very similar, or partially correct, there is only one best answer. There are also some non-case-based questions that focus primarily on the basic sciences.

Some questions include media clips (audio and/or video) and some include sequential questions embedded in the question base. Sequential questions necessitate a wider range of knowledge around particular cases. Once you have answered the first question, your answer will be locked in as you complete the second question. Some questions embedded in the exam are experimental and non-graded.

REGISTERING FOR STEP 1

It is suggested that students register through the NBME 3-6 months before the date they wish to take the exam. For specific guidelines, and to apply for the Step 1 exam, please review and follow the application instructions at the NBME website (). Students can also reference the section “How do I register to take the exam?” in First Aid. Starting in November, 2011 the registration fee for the exam is $535.

As you register through , one of the steps involves completing a Certification of Identification and Authorization Form. This form must be completed and submitted to Janice Viticonte of AMS student affairs (be sure to attach a photo).

Please note that registering for the USMLE Step 1 exam is different than scheduling your USMLE Step 1 exam. When you register for the USMLE Step 1 exam you will be asked to select a 90 day eligibility period in which to take the exam. After registration, NBME will issue you a scheduling permit by email. Once you receive this permit, you will schedule a specific test date through the testing center where you plan on taking the exam.

SCHEDULING OF EXAM RETAKES (excerpt from )

The USMLE Program sets rules on how quickly examinees can repeat the same Step or Step Component. These rules will change for exam applications submitted on or after January 1, 2012.

For exam applications submitted on or after January 1, 2012, the following rules apply to all Steps and Step Components:

• You may take the same examination no more than three times within a 12-month period.

• Your fourth and subsequent attempts must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam. Attempts at that examination (complete and incomplete) prior to January 1, 2012 will be counted in determining whether these rules apply.

When you reapply, your exam eligibility period will be adjusted, if necessary, to comply with these rules.

CHANGING YOUR ELIGIBILITY PERIOD

Students may request a one‐time three month extension using a “Step 1 and Step 2 CK Eligibility Period Extension Form” available on the NBME web site.

Important Reminder!!! Rescheduling your 90 day eligibility period does not automatically move or cancel any tests or practice tests you may have scheduled with the testing center.

SCHEDULING YOUR EXAM

The USMLE Step 1 exam is offered at Prometric testing centers (). In the Providence area, the closest Prometric center is located in Warwick, RI. There are also reasonably close centers in Cumberland, RI and in Worcester, MA. The telephone number to register for exams is 1‐800‐MED EXAM or 1‐800‐633‐3926. Should you need to call the facility in Warwick, the telephone is 1‐401‐738‐9172. The facility is located in a plaza at 2346 Post Road, Suite 104, Warwick, RI.

Directions: Take the T. F. Green Airport exit (Exit 13) to the Airport Connector. Take the second exit, which will be Post Road (Route 1). Turn right onto Post Road (South). Continue 3/10 of a mile to the Airport Professional Park on the left‐hand side of the road; first building on left, last door. The complex is surrounded by a red brick wall. The Prometric Testing Center is located in the professional park across from Dave’s Bar and Grill. Enter the center by the last door in the first building.

AVAILABILITY OF TEST DATES AND TIMES:

Students must select a date with Prometric which falls between the start and end dates of their 90-day eligibility period. Test scheduling is on a first come, first served basis so it is important to call and schedule an exam date soon after you receive your scheduling permit. Please note that a scheduling number (obtained from NBME as part of the boards registration process) is required to schedule an exam with Prometric. Please check with individual testing centers for the days/times they offer USMLE Step 1. Once scheduled, changes to your test date may incur Prometric fees.

DEVELOPING AN EFFECTIVE PREPARATION PLAN

The best preparation for Step 1 is mastering the material in your preclinical courses. That said, it is not unreasonable to begin thinking about Step 1 before that time. By the time the 6 week prep period begins in March, you should have

1. Purchased your prep books and other materials and become familiar with the way in which they are organized.

2. Attended the content presentations organized by the Office of Medical Education.

3. Developed a fairly detailed study plan for the prep period.

|Suggested Step 1 Timeline |

|Summer before Year II |No preparation necessary (low yield for content retention) |

|August – October |Focus on mastering Year II course material |

| |Purchase and become familiar with First Aid (optional) |

| |Annotate sections of First Aid that correlate with Year II courses (optional) |

|November - December |Focus on mastering Year II course material |

| |Purchase and become familiar with First Aid (optional) |

| |Annotate sections of First Aid that correlate with Year II courses (optional) |

| |Attend administration’s “Intro to Step 1” presentation |

| |Register for the exam via |

| |Apply for exam accommodations if necessary |

|January - February |Focus on mastering Year II course material |

| |Review Step 1 materials in Canvas |

| |Review and purchase Step 1 resources |

| |Become familiar with the format of q-bank questions |

| |Attend content review sessions |

| |Sign up for tutoring if necessary |

| |Develop a prep calendar |

| |Sign up for prep calendar review by Emily Green and Paul George |

|March - April |6 week prep time followed by 1 week vacation |

TEST ACCOMMODATIONS

Students with disabilities requiring test accommodations should consult Test Accommodations at the USMLE website (). However, please note that it is very difficult to get accommodations for Step 1 and it usually takes several months to receive a decision from the organization. Please plan accordingly. Contact your Academy Director with any questions about this process.

Study PLANs

Once your preclinical courses have ended, you will implement a study plan for your exam preparation. Study plans should be individualized. We have provided several plans that have proven effective for students from previous years in the Canvas USMLE Step 1 Materials folder. Most students use these plans as a starting point, then modify them as they work through the preparation process.

Study plan overview:

• Prep time is usually 6 weeks in length followed by 1 week vacation

• Study plan should include days off and flex days

• Study plan should include time for practice exam(s)

• Daily schedule should include 6-8 hours of studying spread out over 10-12 hours

• Daily schedule should include a balance of content-specific studying and q-bank questions

We recommend sitting down with an actual calendar and mapping out your study plan so that you have a clear idea of what you will be doing on any given day during your prep period.

STEP 1 CONTENT PRESENTATIONS

During the spring semester of Year II we offer content presentations focusing on the primary basic science areas from first and second year. These presentations focus on identifying what is generally covered from those areas on Step 1, materials to support studying in those areas and several hints for learning and recalling such content. These presentations are delivered by third and fourth year students who have taken Step 1. Handouts are available on Canvas.

TUTORING

Students can arrange for tutoring through the Office of Medical Education. Tutors can help with preparation strategies and/or with content.

STUDY GROUPS

Many students choose to be part of a study group. Working in a group can help you focus your effort on specific content areas, stay on task, and helps develop test‐taking skills based on your colleagues’ various approaches. Other students find it more beneficial to study independently- either alone or in the same general area as a peer.

PRACTICE EXAMS

Students often have questions about the number and type of practice exams to take. Factors such as content recall, observing clues within cases, and timing within individual questions and within blocks can be self-assessed through the use of practice exams. Generally speaking we recommend that students take 2-3 practice exams during their board preparation time. There are at least five companies offering practice exams, NBME, WORLD, CONSULT, Thomson Prometric, and Kaplan, among others. However, it is also possible to create your own practice “exam” by doing a block of questions from your q-bank in a timed manner.

Commonly Used Practice Exams

|Type of Practice Exam |Description |

|NBME/CBSSA |The NBME Comprehensive Basic Science Self‐Assessments (CBSSA) are 200‐question practice exams (“forms”) that |

| |can be taken in two different timing modes. Standard Paced allows 1 hour for each block and Self‐Paced allows 4|

| |hours for each block. Several of the forms come with enhanced feedback- incorrect answers are identified, |

| |however correct answers are not provided. |

| | |

| |After each form, NBME provides a performance summary with a breakdown across 19 content and organ system areas,|

| |and a three‐digit score in the range of 200‐800. This score can be converted to an approximate USMLE score. An|

| |unconverted score of 340 indicates a 95% probability of passing the actual Step 1 exam (Morrison, 2010). |

|Q-Bank |You can create your own practice exam by generating approximately 330 q-bank questions and taking them in a |

| |timed manner. |

|Prometric Practice Sessions |Prometric administers a three and a half‐hour long practice exam offered by USMLE in the actual exam setting. |

| |This is the same 150 question exam that can be downloaded free of charge at the USMLE website (). |

| |Scores on this exam are not predictive- the usefulness of the exam concerns logistical familiarity with the |

| |test site. Prometric practice exams must fall within your 90-day eligibility period. |

| | |

| |Prometric also offers a “test drive” that allows you to visit the Prometric test site for a 30 minute |

| |orientation to the site, including lockers, restrooms and computer area. In addition, they will confirm that |

| |your documentation and registration materials will be accepted on the day of the actual test. You will also |

| |experience ID confirmation, biometric identity capture, image capture and a sample generic test (not using Step|

| |1 questions), where you can practice with the headsets. |

|USMLE-Sponsored Tutorial |USMLE provides a 15‐minute tutorial on their website []. This same |

| |tutorial is provided on your test day at the beginning of your exam; by looking at the tutorial online, you can|

| |usually skip the tutorial during the actual Step 1 exam, and therefore receive an extra fifteen minutes of |

| |break time. |

The real question is not how many practice exams to take, but how to approach them in a strategic manner. Thinking through why you are taking them and what you will learn from them will help you decide how many to take and where to place them in your schedule. Practice exams can be helpful tools in the following array of ways:

• Diagnostic tool- Taking a practice exam at the beginning of your study period can help identify particular areas of strength and weakness. This can be especially helpful if you are taking the exam “off schedule” and further away from your preclinical courses.

• Timing- Exams completed at the standard pace allow you to practice getting through the exam in the time allotted.

• Content review- Seeing material repeatedly through questions can consolidate information and help with retention.

• Schedule adjustment- Practice exams can help identify areas of strength and weakness and help you make any necessary adjustments to the rest of your study period accordingly.

• Study tool- Reviewing material that you got incorrect on a practice exam can be the basis of at least part of your study plan.

• Score prediction- The data shows that a single NBME/CBSSA exam form is generally predictive of actual Step 1 scores.

• Stamina building- An eight hour exam is a marathon. Sitting and concentrating for that amount of time at least once prior to the actual test is good practice. A “double” NBME/CBSSA exam (2 forms taken together during an 8 hour period) 7-10 days prior to your test date is good practice for the actual exam.

• Logistical familiarity- The 3-hour practice exam at the Prometric site offers the opportunity for you to become familiar with the environment and practices of the testing site and prevents any last minute “unknowns” from causing anxiety on the day of your test.

Be strategic. Before you start putting practice exams into your final boards prep calendar, be sure you know why you are including them and what you plan on doing with the data they generate.

|Time of Exam |Type of Exam |Purpose of Exam |

|Week 1 |Single NBME/CBSSA form (particularly one |Diagnostic- identify content knowledge areas of strength and weakness |

| |with expanded feedback) |to better refine study plan |

|Week 3 |Single NBME/CBSSA form Or |Timing- practice getting through questions in the time allotted |

| |~330 randomly-generated Q-bank questions )| |

| | |Study tool- Review any questions missed and study related material |

|Week 5 |“Double” NBME/CBSSA exam (2 forms) |Score prediction- Assess any risk of not passing exam |

| | | |

| | |Stamina building- practice focusing for eight hour period |

|Week 6 |Prometric Practice Exam |Logistical familiarity- Become familiar with the test site and |

| | |eliminate need to complete the system intro on your actual test date |

Possible Practice Exam Schedule A

Possible Practice Exam Schedule B

|Time of Exam |Type of Exam |Purpose of Exam |

|Spring Semester Year II |Prometric Practice Exam |Logistical familiarity- Become familiar with the test site and |

|(prior to 6 week prep | |eliminate need to complete the system intro on your actual test date |

|period) | | |

|Week 4 |Single NBME/CBSSA form |Study tool- Review any questions missed and study related material |

| |Or | |

| |~330 randomly-generated Q-bank questions |Schedule adjustment- Use the results to make any necessary changes to |

| | |your study schedule |

|Week 5 |“Double” NBME/CBSSA exam (2 forms) |Score prediction- Assess any risk of not passing exam |

| | | |

| | |Stamina building- practice focusing for eight hour period |

| | | |

| | |Schedule adjustment- Use the results to plan your “review period” just|

| | |prior to your exam |

Important Reminder!!! Moving or canceling any appointments you have made with Prometric does not automatically reschedule your eligibility period. Remember, you cannot schedule a test or practice test with Prometric until you have scheduled your eligibility period.

THE DAY OF THE EXAM

The scheduling permit you received in an email from NBME must be printed out and brought with you to the Prometric testing site on the day of the exam. DO NOT JUST PRINT THE EMAIL ITSELF. BE SURE TO OPEN THE LINK AND PRINT THE ACTUAL SCHEDULING PERMIT! Students will not be allowed to take the boards unless they present this permit along with an unexpired, government‐issued photo identification with their signature (such as a current driver’s license, passport, national identity card or ECFMG‐issued ID). If your ID does not contain your signature, you must present another form of unexpired ID showing your signature. Students must make sure that the name on their photo ID exactly matches the name appearing on their scheduling permit.

In Warwick there is often heavy traffic early in the morning, and the testing center requests that all applicants arrive one half hour prior to their designated start time. If you arrive after your testing time, you may be denied admittance to your exam. Please plan accordingly.

RULES OF CONDUCT

The entire testing session, including orientation and breaks, is considered a closed and secure testing session, and the entire test center, including the orientation room and the rest rooms, is a secure testing area. Therefore, the rules regarding unauthorized possession of materials during Step 1 extend to the orientation room and to all breaks.

When you apply to take USMLE Step 1, you are agreeing to follow the Rules of Conduct outlined by the testing center. Please be aware that there are strict rules regarding materials allowed including electronic devices, outerwear, books, food, etc. The center will also inform you about current rules regarding earplugs, headphones, breaks, etc.

The exam day is long. Plan ahead so that you have food, beverages and rest periods. Practice exams can help with this preparation.

OTHER STEP 1 POLICIES

Students in MD2013 are required to take the USMLE Step 1 examination prior to graduation. Students in MD2014 and in subsequent classes are required to pass the USMLE Step 1 examination prior to graduation, and will be allowed to take the examination as many as three times. If a student in MD2014 or a subsequent class does not pass Step 1 within these three attempts, s/he will be considered for dismissal from the medical program by the Medical Committee on Academic Standing (MCAS). The MCAS and the appeal process will adhere to current guidelines for students with other academic issues (see Student Policy Handbook; ). The Associate Dean for Medical Education will have the discretion to waive the requirement of a passing grade on Step 1 for students who are opting for careers that do not involve patient care or whose circumstances otherwise justify a reconsideration of the requirement. Students will be held to the Step 1 policies in place at the time of their matriculation to medical school.

Students are encouraged to check the state licensing requirements in the state in which they hope to practice, as some states may require students to complete their licensing exams within a particular number of years and may require them to pass particular steps within a prescribed number of attempts.

STRUCTURED SUPPORT PROGRAMS

Some students require a more structured preparation program in order to be as successful as possible on Step 1. Below are a number of residential and on-line programs designed to support students studying for Step 1. At this time the administration has only anecdotal evidence to support program claims to help students pass the exam. Please rely on your own knowledge of your study style and skills to help assess the usefulness of these programs. (The administration welcomes any feedback on these programs from students who do end up utilizing them.) Info on these programs below was updated in 2011.

Physician Assisted Student Success (PASS) Program



• Classroom and one-on-one instruction for USMLE Step 1, 2 and 3.

• Offer 4, 6 and 8 week sessions that run throughout the year

• Locations: Champaign, Illinois (PASS Program Champaign) and St. Augustine, Florida (PASS Program South).

• Tuition: between $3,900 - $7,800 depending on program; housing not included in tuition costs

• 4 week program offers classroom lectures, two one-on-one sessions/week, simulated exams and practice questions.

Tuition $3,900 (housing is additional $700+ security deposit)

• 6 week program (offered at PASS South only) offers classroom lectures, two one-on-one sessions/week (five in the last two weeks), simulated exams and practice questions.

Tuition $5,850 (housing not included)

• 8 week program offers classroom lectures, four one-on-one sessions, 60 day subscription to USMLEworld, Qbank or COMBANK, simulated exams and practice questions. Tuition $7,800 (housing is additional $1,400+ security deposit)

• Guarantee: If you attend the 8 week program and do not pass the USMLE exam, you may return for 4 weeks for free.

Falcon Reviews



• Classroom instruction for USMLE Step 1 and 2

• Offers a seven-week intensive course that runs from spring to fall.

• Locations: Holiday Inn, North Dallas, Texas and Holiday Inn, Pittsburgh, Pennsylvania.

• Tuition: Between $4,950 - $6,350; cost includes lodging, shuttle service and complimentary breakfast and lunch.

• Course offers classroom lectures, a 3-month subscription to USMLE World

Tuition: $4,950 (for a double occupancy room) and $6,350 (for a single occupancy room).

• Also offer online and phone app programs.

• Guarantee: If you attend 90% of the sessions and use the FALCON study method and do not pass you will receive free tuition waiver on the next regularly scheduled review.

Doctors in Training



• Two-part course available for USMLE Step 1 and 2

• Location: Part I is web-based learning; Part II is in Galveston, Texas from May 9 – 27, 2011

• Tuition: Part I and II is $770 total. You can choose to receive Part I without participating or paying for Part II; you cannot select Part II without paying for Part I

• Part I is a series of emails every Monday-Thursday with 15 questions (total of 510 questions) of First Aid. Emails begin in January 2011 and continue until May 2011. If you register after January, a word document with the list of previous questions will be sent to you.

• Part II is a 15 day course that is a fast-paced review with explanation of difficult topics.

• Part II Live takes place in Galveston, Texas from May 9 – May 27, 2011. Food and board are not included in tuition costs.

• Part II Online offers you access to online lectures beginning on the date you specify in March. These lectures may be viewed up to 3 times over a 30-day period.

Finch Program – Cognitive Processing-Based Review for Step 1 (CPR-1)

• Classroom instruction for USMLE Step 1 and 2

• Location: Rosalind Franklin Medical School in North Chicago, Illinois from January 21 – April 22, 2011 (14-week course).

• Tuition: $6,000 (housing not included). Student housing is available for an additional fee on a first come, first serve basis.

• Course is designed for students who have been unsuccessful in passing Step 1; especially students with multiple attempts. Not intended for students who have not taken the exam.

USMLE Tutor



• Online one-on-one tutoring available for USMLE Step 1 and 2

• Location: web-based learning and Skype tutoring sessions

• Tuition: $75/hour

• 3 packages available for one-on-one skyping tutoring sessions with Dr. Mickey

• Custom package: One-hour session at $75/hour

• 10-hour package: 10 one-hour sessions, $750

• 20-hour package: 20 one-hour sessions, $1500

• Students must have a webcam and be able to use Skype

Med School Tutors



• One-on-one tutoring available for USMLE Step 1, 2, and 3

• Tuition: Rates start between $150/ and $215/hour, depending on subject, test and tutor.

• Location: Students in the New York City area can meet with tutors from top medical schools with high schools on the USMLE exams.

• Students not in the NYC area can arrange for tutoring over the phone, availability may be available in Boston, Philadelphia, Miami, and Washington DC (additional fees will apply), or may pay for the tutor to travel to you for intensive weekend, week or a month of study (additional fees will apply).

• Program dates and timeline is based on student’s need and a diagnostic test undertaken by the student to assess strengths, weaknesses and goals.

Fox Tutors



• One-on-one tutoring available for USMLE Step 1 and 2

• Location: Students can arrange for tutoring across the country with availability in Boston and a various other cities.

• Tuition: Rate information not available

• Offer medical tutors, medical school tutors, medicine tutors, surgery tutors, and test-taking tutors.

Kaplan Live + Center + Online



• Offers three featured programs with varying weeks of Live preparation course, continued tutoring at a local center and online access to Qbank Plus

• Location: For the Live portion, students can arrange for tutoring across the country with closest availability in New York City. Center locations also across the country with closest availability in Boston.

• Customizing plans also available with varying weeks, LivePrep (7, 14 or 16 weeks), CenterPrep (3, 6, or 9 month), and Qbank Plus access (1-12 month).

• Tuition: Between $4,400 - $9,900. Does not include housing.

ADVICE FROM YOUR PEERS

These words of wisdom are from your peers in previous classes who have successfully surmounted the challenge of Step 1:

From MD14

1. Stick to your schedule. Everything could always use more time, but the more you keep with what the schedule says, the calmer you will be and the greater chance you will feel prepared for the date you

planned.

2. Do more NBME exams. World was fine, but I wish I had spent less time trying to get through that Q- bank and more time doing NBMEs, which were so very similar to the actual test (I even got the same

question).

3. Find a study buddy. I started studying with Joe in December, so we were able to see that we worked well together. We ended up creating a strict daily schedule and held each other accountable.  I also didn't feel lonely and knew that I had someone to talk to who knew exactly

how I felt.

* * * * * * * * * * *

Would spend the morning and early afternoon doing things I enjoyed, specifically being outside, reading non-scientific books, etc, while maybe skimming notes over breakfast. Made sure to exercise and meditate each day. In the afternoon, would go to school or a library for 8-10h and spend time outlining First Aid but most importantly answering Qbank questions and going through the answers, writing down the concepts I was unsure of. Best advice I received was to keep the studying patterns that worked for you so far in the pre-clinical years. Enjoyed studying around but not with others to stay disciplined but not distracted. Listened to Goljan in the car at times and found this helpful in spite of his personality.

Think the schedule was important, putting weakest (neuro) and broadest (micro-ID) areas first. Included several flex days for more time on a subject or a half-day off. 6 weeks was plenty of time-- more time would've been detrimental, because would've lacked motivation early on. Bought extra books (BRS neuroanatomy, micro made simple) but wish I hadn't, Qbank and First Aid were plenty. The 2 practice tests from Qbank very accurately predicted my score (taken within 10d of the actual exam).

* * * * * * * * * * *

1. Stick to your schedule no matter what. If you can get a little ahead do it.

2. Do the big topics first: Bio, Neuro, Micro, Drugs. Doing it early helps you save some time and energy for when you burn out at the end. I would also try to do subjects you feel weaker on in the beginning to allow time to boost your score in those areas. 

3. Do questions every day! Some people try to get through all of UWorld. I didn't but getting through at least 60% is probably a good goal. I also would aim for average or better than average on each test.

4. Keep reviewing drugs and micro every day. These were topics that repeatedly came up in all subjects so it's best to just keep reviewing and not wait until the end. They all sound the same and you'll just get them confused if you wait too late. 

5. I made sure to exercise 3-4 times a week just to have some time to myself. It was a great stress relief and a nice break. Within the last 2 weeks I wasn't able to exercise as much, but at that point it was crunch time. I also tried to take Sundays off to do life things: shop, cook, laundry, etc.

6. Don't wait until the last week to do practice tests because it will freak you out. I wanted to wait until I got through most if not all the material before taking full practice tests, but I wanted to leave enough time to adjust. 

7. NBME undershot my score by a lot. World Bank Assessment was the closest predictor of my score but was still under.

8. I thought I could have used 7-8 weeks in total to prep for the test, but mentally 6 was my limit. I was so burnt out and stressed by the end that I just wanted to take it and get it over with. There is no need to prep any further because it'll just tire you out. If anything, getting a head start on drugs and/or micro may be useful.

* * * * * * * * * * *

Practice exams (NBME) predicted my score really well, within 1 to 3 points. The UWorld assessments were within 10 points.

I only took 4.5 weeks, and it was plenty.

UWorld, First Aid, Goljan path and lectures, were the key things. As for anatomy, it was helpful to go over some key CT scans / X rays, but anatomy ends up being kind of low yield.

* * * * * * * * * * *

In full disclosure, I did within a standard deviation below the mean. This is pretty consistent with my preclinical exam performance. 

What worked was making a schedule, which I'd never done before but helped remind me I was making progress. I didn't leave space for time off, but took time when needed and had left some days at the end for questions only as was advised, so I ended up covering everything. I also treated it like a job as advised, used the study rooms in the new building which worked out great except for the first year exam week. I would have liked more time with just doing qbank questions, re-reviewing my wrong answers, etc. I probably had 20% left. I loved the progress bars by subject, even though it was dismal at first. For numbers orientation (for those who find that helpful), I was hitting in the 30s when I started reviewing, by the end I was averaging 70s. 

What didn't work was all those extra textbooks. There just wasn't time to use those before the study period, nor even during. Mine were free from a friend, but I would otherwise have spent hundreds better spent on another month with the Qbank. I was never one for textbooks. Don't change horses mid-stream was good advice. 

My CBSSA score was pretty close to my final. I took it 3 days before the exam. I would probably have done that earlier in retrospect, but all of that costs money. For that amount, you'd get more value from the qbank because it tutors you, while the practice exam just slaps you in the face for $50 and 4 hours of your time. It's also emotionally costly, and though I was usually not one to sweat exams, your self-confidence is not something you want to mess around with close to the date by taking and re-taking practice exams. 

In retrospect I could have benefitted from more prep time, which was also in line with my preclinical routine. 5 weeks would have been enough were it not for some unforeseen family drama, so it ended up being more like 4 weeks. Still, I'm glad I didn't keep pushing it off. I needed that time afterward to see my family and re-group before third year. 

I bare bonesed it: First Aid, Lange pharm cards (should have just started reviewing these bedside before sleeping in January), and the UWorld Qbank. I would not have had time to review another resource in the 6 weeks, so no regrets there. I may have benefitted from buying UWorld sooner, but every additional resource comes at a price. 

* * * * * * * * * * *

What worked?  Looking at sample study plans, reviewing plans with admin & older students. Having a set study plan.   

How did you maintain sanity/balance?! Took Daily Breaks for lunch, dinner and to work out. Also took 1 half day or full day off to hang out with friends or family. 

What would you do differently knowing what you know now? I would have started mixed Q banks earlier than the 6 week study period 

How closely did your practice exam (CBSSA or Q-Bank) predict your actual score? My actual score was ten points higher than the CBSSA and around the same as the USMLE WORLD QBANK. 

What resources were most helpful? First Aid, BRS Physiology, Goljan Pathology. USMLE World Q Bank. pharm flashcards  Least helpful? Having more than 3 books is unhelpful. 

What advice that you received was most/least helpful? 1) Questions Question Questions. 2)having Day off Days 3) Knowing yourself and your study habits so you can create a realistic and feasible study plan

How long was your prep period and was it long enough? 6 weeks - the length was perfect. 

* * * * * * * * * * *

What worked?  What didn't?

I found that the strategy of simplifying my sources of information worked well. I only used First Aid and USMLE world Q bank. Reading through First Aid a week before the test helped consolidate alot information that I hadn’t quite understood fully. Definitely try to go through world more than once (I got through it about 1.5 times).

How did you maintain sanity/balance?!

I tried to do something fun at the same time every day. For me developing a fixed routine was key and I’d go to the gym or play soccer before dinner every day.  I also treated myself to good food the whole time, which didn’t do my sanity any harm!

What would you do differently knowing what you know now?

6 weeks is a tad too long. I would have taken the exam halfway through the fifth week. Before you hit the 6 week study period, it’s hard to believe that anything other than the maximum amount of studying time is ideal, but given the sheer volume of information you want to take the exam when you feel like you know the most (you can’t know it all) and I found 5 and half weeks was my peak.

How closely did your practice exam (CBSSA or Q-Bank) estimate your actual score?

I took both Q bank practice test and two NBME exams. The first Q bank test was 3 weeks into studying and it was 10 points less than my other scores. I got the same score on the other Q bank practice test, the two NBME tests, and my actual exam – yes, the SAME score 4 times in a row!

* * * * * * * * * * *  

I studied for 5.5 weeks and would have been happy with 4.  My NBME double average was 3 points shy of my actual score, with a spread between the two NBME tests of about 25 points, which seemed like a lot.

The best advice I received was to focus only on First Aid and World Q bank; the worst was that the highest score you could make only using those was in the 220's.  You can probably get in the 270's with those resources alone.  They are more than enough, and keeping your resources thin allows for a second pass.

I liked to keep track of things in first aid that I thought I wasn't going to be able to remember: each day I would write a list of questions down on a piece of paper and scribble out answers.  I'd go back through that list the next morning.  Sometimes a detail would make it in on the list three days in a row, but in that way it allowed me to remember the more tedious facts.  Taking real structured notes, however, is just too time consuming for such a short period of time.

* * * * * * * * * * *

What worked?  What didn't?

What worked: reading the sections of first aid for the subjects that I was weaker in, or found intimidating - ie. Neuro and Micro. It’s not a matter of covering ALL of it, but rather some of those pages in good detail.

What didn’t work - trying to study 12 hours a day. I studied 8 hrs a day in the beginning, and closer to ten at the end. Always say to yourself, "it is better to spend 6 good hours than 12 unproductive hours on google/fb/email".

How did you maintain sanity/balance?!

I took one day off a week. period. this turned into a half-day off 2 weeks prior to the exam.

I also went to the gym. Between leaving, running, showering, and getting back to the med school, this took about 2.5 hours. I did it 5 days a week. I STRONGLY recommend this tactic as it did wonders on alleviating my stress level.

I also took 20-30min naps, whenever I was tired. This may sound counter-intuitive, but it came under the category of making my study-time of the 'highest quality' possible.

What would you do differently knowing what you know now?

Honestly? Nothing! I got engaged, I spent 1 day a week with my fiancée, and I stayed physically fit and slept 8 hrs a night. I was within 4 points of my goal Step1 score.

How closely did your practice exam (CBSSA or Q-Bank) predict your actual score?

I took CBSSA Forms 11 and 12 ten or eleven days before the exam and it was 16 points LOWER than my actual score. I heard that the WORLD forms were labor intensive and more stressful.

What resources were most helpful?  Least helpful?

I used FirstAid, Goljan Pathology, WORLD, and online pharmcards. I found that I barely had enough time to review Goljan - I ended up reviewing chunks of it as needed, more like a reference – never mind any other materials.

What advice that you received was most/least helpful?

most helpful - DO NOT get caught up in your numbers. You can generally track how you are doing on WORLD, but remember that some people take WORLD Q bank as a review after studying all the material, while others use it as a learning tool. I highly recommend that students use WORLD as a learning tool, not a confidence booster/shaker. You can trend your own numbers to see generally how you are doing, but don’t get stressed about being at/above/below the average for your Qbanks.

least helpful - that you should be studying 12 hrs a day, and take 1/2 day off every 2 weeks. That would have seriously burned me out.

How long was your prep period and was it long enough?  Too long?

I would have liked 3-4 more days - who wouldn’t?! - but in retrospect I think it was enough time. Perhaps an extra week would do more to decompress the situation and allow for the 1 day/week off while still having 2+ days for each major subject.

Friends of mine who intensely studied and then, last minute, decided to take more time, did not seem to be better off for it. Instead, they just seemed unnecessarily stressed for a longer period.

* * * * * * * * * * *

1. My Biggest Mistake: Spending too much time reading ALL of the UWorld Explanations. People told me to do this, and I did. But the explanations are dense and you don't retain a lot of it. Better approach - try to take away one key high yield fact from each question. Otherwise, you will spend too much time with this and not using your other resources (this is why I had to take more time than the allotted study period). Key to this period is efficiency. Be efficient.

2. Timing on the Real Exam - The trend on the USMLE is for longer, more complicated clinical vignettes. Longer than World Blocks. I was finishing with 15-20 minutes left on world blocks, but was down to the wire on the actual test. Just more to read. Be prepared for that.

3. NBME's 11, 12, and 13 are more challenging. These were released in the last two years and are more reflective of the changing nature of the test. Buy the "Expanded Feedback" option ($10 extra dollars) so you can review what you got wrong. If you need the answers (they don't give them to you), google it. Some group of med students on some forum is talking about it and through crowd sourcing you can figure it out. The answer choice structure at least were identical to some on my actual test.

4. Don't isolate yourself. If you study better alone, check in with a fellow test taker every week for one hour. It makes you feel less alone.

5. Devote some time to subjects Brown doesn't cover that much on, like Ortho. Know everything about the Rotator cuff.

6. I liked the Goljan Path book because it explains more "why" which is what the boards are about instead of just FA where it is facts. But at the same time you can't ignore FA because it is more comprehensive of other subjects.

* * * * * * * * * * *

What worked?

Surprisingly (or maybe not so much), staying off Facebook was crucial. I chose not to deactivate my account just as a test of my resolve; instead, I deleted the app from my phone, turned off email notifications, and literally changed my password to “DONEWITHSTEP1” so I would think twice before typing it in prematurely. I saved so much time by not logging onto Facebook – and I stayed much saner by remaining in my state of studying bliss instead of finding pictures of all my undergrad friends going on spring break to exotic places.

And, of course, focusing on questions was the most valuable thing I did. I went through the entirety of USMLEWorld’s question bank once and subsequently went through all of my incorrect answers once. I then used the software to find the categories where I had done poorly and redid question blocks from those categories repeatedly. Doing so helped me master those categories and also helped me psychologically – there’s nothing like running up your score to make you feel like you’re going to ace Step 1!

What didn’t work?

The study schedule that I had created earlier that year. I’m still glad that I created one (it helped me plan out what areas I needed to review and how many days I could take off), but I ended up completely changing my order around in several places. Don’t get stressed if this happens to you! I ended up spending a few minutes every weekend re-calibrating my study schedule based on what I had done the previous week and what I wanted to get accomplished in the coming week.

How did you maintain sanity?

Having a daily routine was very helpful for me. I went to the gym every afternoon, even the afternoon before my exam – doing so helped me feel like I was in control. I tried to get up at the same time each morning and I tried to go to bed at the same time each evening. That way, even though my study schedule (the schedule that I had planned months before and then unceremoniously abandoned) was changing constantly, I still felt like I was in charge.

The day before the exam was definitely the most nerve-wracking for me. To keep my sanity that day, I only looked at pictures from Goljan Rapid Review / First Aid / online that entire afternoon/evening instead of trying to cram in more details. I definitely would recommend this to all of you – cramming the day before Step 1 isn’t worth it!

And of course, Alex and Emily have no reason to lie – if you push your exam back instead of taking a week afterwards to celebrate, you’ll just feel miserable. I was part of a 13-person delegation to Cancun in the week after we took Step 1, and I’ll be honest that it was the most relaxing and enjoyable week of my life!

What would you do differently knowing what you know now?

I wouldn’t have bought so many prep books! First Aid, Goljan Rapid Review, med school notes, and USMLEWorld were more than sufficient for me.

What resources were most helpful? Least helpful?

USMLEWorld was by far the most useful resource, followed closely by First Aid and Goljan Rapid Review Pathology. I ended up buying a few other test prep books but barely looked at them because First Aid and Goljan provided me with more than enough material.

How long was your prep period and was it long enough? Too long?

I actually think I was the first person to take Step 1 in my class, and I would argue that our prep period was adequately sized. More important than the number of days you take is the study style you use – are you being an active studier (taking notes, highlighting, etc.) instead of just reading? Are you being a productive studier instead of trying to study with Facebook/CNN open? Are you transitioning to a purely practice-question state of mind in the week before the exam? And most importantly, do you have a vacation or something epic to look forward to after the exam? And in case you don’t think you have anything to look forward to afterward, I’ll tell you now – Step 1 studying is awful, but you’ll love your clerkships and you’ll love being a real “student doctor” instead of just a “medical student.” Good times are ahead, promise!

From MD13

• “My one major piece of advice would be to emphasize the U World questions over attempting to memorize First Aid. Going through the World questions slowly and reading the explanations completely is something I wish I'd done more of. Now that I'm thinking about it, one other thing would be to take more time off. Going into the test with a clear head is much more valuable than a couple of extra study days would be. … our coursework in the first two years is really the best preparation. I wouldn't advise anyone to do too much preparation before the actual study period, unless it's to get comfortable with some of the resources like First Aid that will eventually be used during the study period as you study for each block.”

• “One immediate thing comes to mind:  On test day, bring your NSAID (anti-headache) of choice for just-in-case.”

• “Do at least one 8-block practice test: The real test is only 7 blocks and feels more manageable, stamina-wise.”

• “Buying lots of books did not help. Microcards were decent.”

• “I personally thought the hype or stress associated with it far outweighed the material and exam itself. Studying for it was actually pretty enjoyable.”

• “My advice for people is not to try to change their learning behaviors for boards... even if their learning mechanism is a bit inefficient. I wish I had started pharm much earlier. I was quite weak on pharm and still feel weak on pharm even now. There weren't THAT many questions, and practically all of them are on mechanism, but I do think it's worth knowing.  Lastly, this year I started using first aid during each block we studied as an exam-prep tool.  I also wrote in lots of info into the margins of first aid.  This was CRITICAL. I wish I had done this last year as well.  I think that from day 1 students should have a copy and use it often.” 

• “QUESTIONS QUESTIONS - if I took it again, I would focus more on the

questions. Maybe read First Aid once in 1-2 weeks, finish Kaplan Q

bank, read First Aid again, and do USMLE World TWICE.”

• “Schedule the exam so that you have time for AT LEAST a week off afterwards, preferably two (I had three). Don't feel bad watching a bit of TV at night, going to the gym during the day, and taking other short breaks - they are important. And take a day off if you need it, they help you stay focused.”

• “Most importantly, I think it's best to try to learn everything really well the first time around as you go through classes.  I was continually shocked at how much I remembered from class and felt that I had a really solid foundation to work with in boards studying.  I would recommend trying to use books that you think you may use for boards throughout 2nd year to get used to them.  I used BRS phys and Goljan's path books for each block and for boards.  I also think Goljan's audio lectures are really helpful.

Don't get caught up in the rest of the class' obsession with boards.  I felt like going to lecture and studying for classes throughout the first two years prepared me very well for Boards.  I didn't do boards prep over the summer between years 1 and 2 and I didn't do anything over our breaks.  The dedicated study time is more than long enough to solidly prep for the test.

Definitely try to have some time each day for exercise, friends, family, food, and just in general taking care of yourself.  Don't shut people out of your life for 6 weeks just to study.

I studied at my apt all the time.  For me, it was better since I tend to operate on a different schedule than most.  It would have stressed me out to see classmates at the library all the time.  Again, throughout the first two years I think you get a sense of where you study well.  I had always studied at home, on my couch so I didn't want to change that for boards.”

• “Relax the day before the test.  Make sure to have other things to occupy your thoughts and your time.  Get plenty of sleep, eat well, etc etc.

Test day: get there early, I was able to start early and was done super early.  Bring lots of food and drinks.  I didn't bother looking at anything during the breaks, there is too much info and there's almost no way to choose what to review during those short times between blocks.  I took short breaks pretty frequently, just to get up and stretch.  A little longer break to eat lunch.  But honestly I just wanted to finish and be done so I tried to minimize break time.  The day sucks, you will walk out feeling like you failed.  But it will all be fine in the end!  It is a frustrating experience since you spend so much time studying and so little of what you study actually shows up on the test.  Finishing the test is one of the most anticlimactic experiences since you feel like you failed and then have to wait weeks to know your score.”

• “Minimize your resources. It will help you feel like you have a manageable amount of material. I used First Aid, Costanzo BRS Physio, Goljan Rapid Review Path, Microcards, and Brenner's Pharm flash cards, and that's it. I made notes in First Aid of anything that came up in those other sources that wasn't included in First Aid, and used post-it note tabs to mark the most essential pages. I also listened to the Goljan lectures, which definitely got me ~5 points on the exam. I did pharm cards every night before bed for ~30 minutes, and I think that helped.

QBank: I used World, which I think pretty much everyone does, and would highly recommend it, worth every penny. I also bought two assessment exams with my Qbank, which I also recommend. Get through the whole question bank if you can, ideally with enough time to review your wrong answers.  

General strategy: know yourself, and don't protect your ego by not testing your knowledge along the way. Do the assessment exam at the beginning, even if you don't want to. Knowing where you're starting, and what your actual strengths and weaknesses are, will be very helpful going forward. Do blocks of random questions all throughout your studying, don't just focus on the topics you covered that day. You might not get quite as many correct, but you'll be keeping more information fresh in your mind.

Also, you will probably feel like you got run over by a truck when you finish the exam, and that's ok. Hardly anyone feels good about it when they leave, and that's normal, it doesn't mean you failed.” 

 

• “Overall Advice: Your best preparation is putting the time into learning the material (especially physiology and general pathology) really well during your pre-clinical years. Going into boards study period, you will feel like you have forgotten everything you learned over the last two years, but you have not. You will 're-learn' it much faster the second time around.

 

Test Day: The actual test will feel harder than you anticipated based on the 150 "free" questions from USMLE and the NBME form exams. As you are taking the exam, do not be discouraged by the feeling that you are performing poorly and that there are extremely weird questions. It is normal to feel that way.

Question Banks:  I think that doing 'mixed question sets' from your question bank early on in your study period is an ineffective way to study. It is fine to do mixed sets to get used to the testing experience, but you will have such a random sampling of subject material that it is not easy to assimilate. I think I wasted a lot of time when I tried to understand the answers.

Instead, I recommend doing subject-specific question banks during your first run-through of the material: For example, if you study renal on Monday and pulm on Tuesday, on Tuesday do a full 46-Q set on renal and pulm only. And you can progress by adding on subjects as you go. That way you build on a strong base, and are able to actually learn the sometimes bizarre questions that USMLEWorld throws at you in a time-efficient manner.

But having said that, make sure you are doing questions throughout. Do not be tempted to "save" them. The 2000 questions on a given bank will keep you very busy. And if you run out, you can always try the many you got wrong a second time.

Do not feel badly if you cannot finish the entire bank -- I got 1300 done out of my 2000. Other people may tell you they did the whole thing plus parts of other question banks, but it is quality, not sheerly quantity that matters. (Anyone can blow through thousands of questions, but make sure you are putting the time into understanding why you were right or wrong on a given question.)

Schedule: I recommend trying to make your schedule such that you push through your first pass of all the subjects with 7-10 days left before the exam. You will feel like you need way more time to do that first pass-through, but you simply need to move on and let go! The last week - 10 days you can do mixed question banks and actually memorize the higher-yield material that you reviewed over the last few weeks.

Work Environment: Surround yourself with people that do not stress you out. Do something special everyday with people you care about. Eat well and exercise. Enjoy being control of your own schedule.

Pharm!!! Do not put off doing Pharm. Everyone feels overwhelmed and discouraged by this seemingly impossible list of meds (and, yes, it is impossible to know them all. Just do your best). Do bite size bits according to subject area -- e.g., during the cardio day tackle all of the cardio drugs. Force yourself -- you will be grateful that you put the time in once the last week rolls around.”

• “Work with the big picture and then add details to the scaffolding you create. Draw pictures, flow charts, tables and diagrams to actively process the information. Use these and your marked up First Aid book to study instead of using the texts, since it will be more efficient.”

• “Devote more time to weaker areas, yet try to cover all relevant material at least once.”

• “Link organ system material to first‐semester basic sciences.”

• “An effective daily plan is essential. Stay rested. It is difficult to store and recall information if you are exhausted, or unfocused, or experiencing personal distractions.”

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