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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).

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