Month: May 2018

I recently came across a well-done episode of the excellent Surviving Medicine podcast entitled “USMLE Step 1 Advice – How I got a 260.” Frank Cusimano, the medical student and PhD candidate who hosts the show, deviates from his usual interview format to read a letter from a colleague who scored a 260. The letter, though quite dense, brings up a number of good points that are worth reiterating. Here’s a summary of some of the take-home messages (with my own advice sprinkled in, marked with MSB>), though I highly recommend checking out the podcast via the above link (or via iTunes/Google Play/other Android apps).

• Other people may have come up with study plans that worked for them, but you need to tailor one that will work for you.
• There is no substitute for quality time spent studying.
• There is no substitute for learning the material correctly the first time! A recipe for failing Step 1 is trying to make up for not learning the material in the first place. Step 1 study resources are review resources. If you don’t learn the material properly during your MS1 and MS2 years, there’s nothing to review.
• The difference between a 220 and a 260 is random facts from your courses that are not in First Aid. That’s why it’s important to learn the material in-depth the first time (see last point). Further, that’s why it’s important to relegate First Aid to its proper place. You may wind up with four detailed questions on urinary incontinence (as the letter-writer on the show did), MSB> or four on chronic granulomatous disease (as I did).
• That said, First Aid is an essential reference, and it’s important that you know about every topic listed in it.
• During MS2, familiarize yourself with your Step 1 resources during the courses. Get a feel for what material is important for the boards. Also, by learning your way around the books you’ll be using to review for Step 1, you’ll be able to hit the ground running. Don’t go overboard though. Relegate First Aid to a quick 30-minute perusal during each course. Pathoma can be used much more thoroughly during the organ block courses; MSB> I recommend at least going through all the videos. If you have extra time to listen to podcasts (after listening to your medical school coursework and then to Goljan), you can listen to Pathoma‘s audio files as well.
• What you shouldn’t worry about:
  • How you score on UWorld questions (it doesn’t matter until ~7 days out).
  • Finishing UWorld. Quality use of UWorld (post forthcoming) is more important than sacrificing depth so you can finish all of the questions.
  • MSB> What your classmates are doing.
• Apparently you must get ≥6 months of UWorld in order to have the option to reset the Q-bank (question bank). MSB> I personally never reset my Q-bank though.
• UWorld is the most useful Q-bank, and I didn’t like Kaplan. MSB> Don’t buy any other Q-banks. You won’t have time to use them if you’re going through UWorld carefully and using a variety of books that most of your classmates will have overlooked to review (as I recommend). I also tried Kaplan and didn’t like it. None of the other Q-banks write questions anything like the test, nor are their figures and explanations as good as UWorld. They are not worth your time.
• The NBME practice exams (with the score reports) are the most useful predictors of your score and provide crucial practice for test day. They don’t let you review all the questions though, MSB> but there’s a good method I used to help get around this (post forthcoming). Also, to predict your score, you can combine NBME tests with your UWorld data
• Don’t take a practice test within the last 5 days.
• Do lots of UWorld questions with mixed material the week of to keep yourself fresh and prime your brain to answer USMLE-style questions quickly.
• Plan some half days and some full days off of studying to do something you enjoy (MSB> preferably something that won’t cause a massive hangover).

The USMLE Step 1 is no joke, so you’ll want to go in having studied from the best resources. No one resource contains everything you need to know (yes, this includes First Aid); consequently, I recommend having a wealth of resources and drawing from the best of them for each subject you need to review for the boards.

1. Crush Step 1: This one’s the grandaddy. The top drawer. The Rolls-Royce. I relied on this book more than any other resource (save for UWorld). Although the chapters vary in quality, most of them give great, concise explanations of what you need to know for each topic. The only chapters to skip are biochem. The general pharm chapter is top-notch (I wish I had it when I took the course). Use it towards the beginning/middle of each organ block.
   
   

   

   

   
2. Clinical Microbiology Made Ridiculously Simple: I covered this book in “How to Crush Microbiology.” It’s worth another mention, however. I read through the whole thing around the middle of my micro review for step 1 and found it a worthwhile way to review this high-yield topic. The silly, visual mnemonics (or should I say “mnemococci”) came in handy and earned me a few points on the exam. They complemented Sketchy Micro quite nicely as well. This book was a good way to get another “pass” through the material.
3. USMLE Behavioral Science Made Ridiculously Simple: You can read this (while taking notes and highlighting) in 2 or 3 hours and it will fill in all of the “extra” concepts you need and can’t find elsewhere. It also will help you review a lot of high-yield facts for psychiatry. This was a pretty interesting “tasty treat” to read as far as Step 1 prep books are concerned.
4. Clinical Neuroanatomy Made Ridiculously Simple: Starting to notice a theme here? A lot of the MRS series books are quite good. That said, they all have different authors and vary greatly in quality, with Clinical Microbiology MRS leading the pack. Clinical Neuroanatomy MRS, however, takes a different tack. Unlike Clinical Micro MRS, Clinical Neuroanatomy is tiny (barely over 50 pages, and small enough to fit in your white coat). It’s an excellent review book. Most notably, it contains one page with five key sections through the brainstem. Each section is drawn as a cutesy mnemonic (e.g., a gingerbread man) that lets you pin the key features down. Your struggles memorizing cranial nerve nuclei have come to an end. I found the beginning of the book much higher-yield than the end, which gets a bit off-the-rails describing each pathway. Read through it and copy down the key diagrams towards the beginning of your neuro review.
5. Clinical Pathophysiology Made Ridiculously Simple: This is the second-best book in the MRS series. It’s relatively short (187 pages), and it contains short chapters on each organ block that will get you oriented as you begin reviewing each one. It does a great job of walking the fine line between oversimplifying the material and dragging on too long. It was—along with Pathoma, Crush Step 1 and First Aid—one of the few books I had spiral-bound to make it easier to read and to write in it.
   
6. Clot or Bleed: A Painless Guide for People Who Hate Coag: This is a short eBook by pathologist and master educator Kristine Krafts, MD. It only takes a few hours to read, and it breaks down coagulation into a simple, memorable framework that will help you speed through boards questions. It’s worth every penny. Her other resources (e.g., the free Path Bites email list) are worth checking out as well, but I particularly liked Clot or Bleed.
   
7. First Aid Cases for the USMLE Step 1: Obviously everyone gets First Aid. Surprisingly few of my classmates, however, realized that there’s more to the series than First Aid alone. Though I didn’t find First Aid for the Basic Sciences: General Principles or [same]: Organ Systems to be that helpful, Cases is a real gem. It’s short, and features dozens of one-page cases in Q&A format that go through the common presentations you need to know, sorted into chapters by organ block. The interactive, case-based format is more engaging than reading, and I found doing cases in it to be a good way to “take a break” from hardcore studying while still learning. It’s best used towards the end of reviewing each organ block so you will get the most out of each case (and have a reasonable success rate in answering the questions).

These seven books may raise a few eyebrows since they’re not as well-known. I found them extremely helpful, however, and I trust you will too. I’m surprised that the word about them hasn’t gotten around yet. Fortunately, you’re in a select crowd that knows what’s up.