USMLE Step 1 Study Guide (by a hairy Neanderthal)

I have been reluctant to write a post about the USMLE Step 1 because I believe there is a lot of advice out there already. I also believe that when the time comes to take the Step 1, you already will have been in medical school for a while and have a sense for how you study as well as a serious collection of books (most of which you bought and never read). 

At this stage in your higher education, you are probably reluctant to take exam related advice from your colleagues as well.

The reason for this exam related mistrust most likely has its roots in the speculation and scuttlebutt that revolves around your medical school's exams. Really, consider how many times have you heard statements like, "I heard the professor say that (insert random topic) is DEFINITELY going to be on the test," or, my personal favorite, "Oh dude, I barely studied."  All of these "tips" probably ended up as pure unadulterated B.S.  So, you don't trust your medical school pals.  I don't blame you. Liberal Arts students are a lot more fun. Go get some new friends.

Since I went to medical school like you, I don't expect you to trust me either. So, to gain your trust, I will hang my head in shame and admit that I did not get a 99 on my USMLE Step 1 Exam.

Dang! 

Trust me now?

I believe it's a simple fact that by the law of averages, you probably won't get a 99 on Step 1 either. The addendum to the previous statement is that you should still work very hard and do your best (that's what your mom would want and who can disagree with your mom).

When I was looking for advice on message boards online, I found that most of the advice was coming from people who claimed to have done really really REALLY well on the USMLE. Still don't trust me? Check out the student doctor network forums and have a blast. It takes about three minutes to realize that most people are living in a world of rumors where he said she said talk reigns supreme. This is usually coupled with the uncanny knack for bloviation (I spot it very easily since I consider myself the master).

You know who these people are on the message boards. They sit amongst you in class. They are a different breed of person. They like to upload pie charts of their practice tests, study guides, pictures of themselves studying and time tables that include a regimen for a 36-hour workday. They document there preparation with meticulous detail including tips on how to avoid your girlfriend, when the optimal time to go to the bathroom is and diet advice that will make your Gastroenterologist envy your perfect pooh.

After you read the crap that's posted about the USMLE, your brain will probably (if it didn't, I'll spot you this one) jump to the logical conclusion that more people seem to get 99s than actually take the stupid exam.  Or at least it certainly feels that way.   I believe that the majority of people who write about their Step 1 experience do no reflect the silent majority of people who fit into the rest of the bell curve that must exist.  It's simple; not everyone can get a 99, but the people who write about their Step 1 experience sure do! So...

If you are looking for advice from a "man" who has a distended cranium, slumped forward shoulders, ridiculous kyphosis, with hands that hang past his knees, you my friend are in the right place!  If you are the medical student who has no grasp of the wheel and have no clue how to start a fire, you may join the club of intellectual knuckle dragger's like me! Read on my Neanderthal brothers and sisters!

The list below is the materials I used and recommend.

 

THE LIST

(It's Kaplan heavy, so watch out)

 

Study like you are taking the test - The day you take your exam is really long. I quote Wikipedia,

"The exam was an eight-hour single-day computer-based test composed of seven 50-question sets (350 multiple-choice questions in total). However, as of May 9, 2008 the number of questions has been reduced to 48 questions per set with a total of 336 questions for the day. The time provided for each section has not changed. Each section is one hour long, allotting a minute and fifteen seconds for each question. ^[1] The test taker is permitted 45 minutes in total for the whole day for the purpose of breaks that can only be taken between sections. There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the allotted 1 hour time limit, the remainder of the time is added to break time. ^[2] The test is administered atPrometric testing sites around the world.

Study the same way. I assume your getting my drift.

Kaplan Videos - These are great when accompanied the Kaplan lecture notes. The videos are lectures of professors teaching with power point. What I like is the fact that word for word is taken from the lectures and put directly into the Kaplan lecture notes. I am not sure if it is illegal to bootleg copies of the books or videos, so I don't sell them. I will just tell you how to get them! There are a lot of videos--about 24 hours of lecture per subject. At six hours per day, you can get through them in about a month or a month and a half. I purchased the videos is from the site UsmleStep.com. There is also a host of other study materials for Step 2, etc. if you are interested. http://www.usmlestep.com/2005-kaplan-step-1-dvds-lectures.htmKaplan 

Kaplan lecture notes (the holy blue books) - The Kaplan lecture notes can be found on ebay and are a stack of blue books. The prices range from 250-350 dollars plus or minus shipping. If you click this link, you should see the search "USMLE Step 1 Kaplan." I like the idea of these books because it's what the fine people at Kaplan recommend. You really don't have to use any other books except maybe First Aid (which is not the only book you need contrary to popular belief).

You really don't need any other books. I am serious about this. Don't bother with your other books except for reference. All the Kaplan people do all day is study what comes up on the USMLE. That's it; KAPLAN people have no lives. Trust them. They are serious. I have never seen anyone from Kaplan Smile. Serious.

First Aid - I am not a huge fan of this book. It's for the memorizers amongst us. If you can read lists with no context and interpret graphs with no explanation this is the book for you (why are you reading my blog if you are?). I heard a lot of talk about First Aid before I took my exam. "It's the bible without Jesus." "It's all you need." "Dude, best book ever! You're reading something else?" Bollox. If someone says any of these statements in your presence please take the following advice:

Walk towards this soothsayer slowly. Make sure your arms are akimbo for effect. Smile, deep down you are a nice person. Now that you are in position take a slow deep breath and proceed to kick this person in the kneecap. You have just met a person who is in medical school who "barely studies!" You're a hero! Now go call the on call Orthopedic Surgeon because you're a nice guy and went to medical school in the first place to help people.  Now help that jackass. 

I do believe you should look at the First Aid book. I do believe it helps for memorization. I do not believe it should be used as your primary text! If you are planning to stare at this book for two months and do well on the exam, think again.

Pass Videos - There are three DVD's that come with this set. The teacher is a very large dude who teaches good USMLE concepts in an entertaining way. Plus he loves a kid in the back who makes connections to other topics. "Jesus (that's the kid's name)! My man! Making connections!" Entertaining, hilarious, slow at times, but well worth watching.

Goljan Pathology Mp3's - You must know who Goljan is already. Goljan's pathology mp3 lecture course with notes can be found online. Since I took my exam, I don't think I could listen to him ever again. He teaches very well, and I think he is very smart but his voice just got grating after a while. Use it until you hate it. By then, I am sure you will know your stuff so well that pathology will be a breeze.

Question Banks - Do as many questions as you can.  Your life's ups and downs should revolve around questions. Girlfriend broke up with you?  Do some questions.  Wondering what you should do right before you are about to get a new haircut to replace your mullet? Do some questions.  You turned 32 and have a quarter million in debt because you went to an out of state medical school?  STFU and do some questions. 

I think question banks are great. It's no secret that the more questions you do, the better off you will be. As for the rumors regarding the Q-banks, word on the street is that Kaplan is the best to use. USMLE World is harder, but still very good as well as being the cheapest.  I liked the fact that USMLE world also uses diagrams to explain some of their answers. I recommend doing all of them (I still did not get a 99, but my mom is proud).

USMLERx - Made by the people that make the first aid book. If I were to choose between the First Aid book and the USMLERx question Bank, I would take the question bank, because you get asked on the whole drop knowledge questions you either know or you don't. It is a question bank of essential, must-know facts. The answers for the questions are actually pages copied directly from First Aid book.  It's like studying from the First Aid book with a clinical vignette that the first aid book left out. 

Step 1 Score Estimator - When your doing q-banks, if you go to medschoolforums.com or click this link,http://www​.medfriend​s.org/step​1_estimato​r/ You can estimate your two and three digit score using Kaplan's Q-bank. It's really helpful and frighteningly accurate.

NBME exam - A lot of people take stock in the NBME practice exams. They can be found at www.usmle.org The advice is take the first exam when you begin to study just to get a feel for your weak areas (don't freak out if your score sucks). The rumor is that NBME exam 2 is the most accurate predictor. I took it a week before I tested, and it was within a few points of my real score. I have heard this same type of talk from a number of students and colleagues.

That's it. I hope it helps. It's only the essentials. If you think there is stuff I should add delete, etc., leave a comment or shoot me an email.

Trust me now?