Step 1 Study Guide

For the Class of 2010

University of Colorado at Denver Health Sciences Center

School of Medicine Office of Student Affairs “Examinations are formidable even to the best prepared, for the

greatest fool may ask more than the wisest man can answer” (Colton) .

A Special thanks goes to the following class of 2009 students for their work generating the survey data and their work in helping develop the study guide from

those results :2009 :

Liz Wilson Josh Sykes Nate Lane

This document was edited by Brian Harry, Barbara Wilson, and Shin Kamaya, class of 2010 .

The information contained in this handbook was gathered by the Office of Student Affairs as well as by current/former medical students at the University of Colorado School of Medicine and is meant to serve as a guide. Gracious permission has been given to use the information in the handbook by the following entities allowing our students to benefit from their work .Albany Medical College Baylor College of Medicine Boston University School of Medicine Boston University School of Medicine Brown Medical School Case Western Reserve University School of Medicine Creighton University School of Medicine

Dartmouth Medical School Educational Commission on Foreign Medical Graduates Emory University School of Medicine Jefferson Medical College Johns Hopkins University School of Medicine Keck School of Medicine of the University of Southern California University of California, Davis, School of Medicine University of California, Irvine, College of Medicine University of Iowa Carver School of Medicine Loyola University Chicago Stritch School of Medicine Mayo Medical School Mercer University School of Medicine Mount Sinai School of Medicine of New York University Rush Medical College of Rush University Medical Center Saint Louis University School of Medicine The Brody School of Medicine at East Carolina University Vanderbilt University School of Medicine Wayne State University School of Medicine Yale University School of Medicine www.usmle.org www.nbme.org www.prep4usmle.org www.studentdoc.com 2

Table of Contents :page Introduction to the USMLE Step 1 4 Studying for the USMLE 5 Sample Schedules 12 Study Resource Information 16 Class of 2009 Board Survey Results 18 Class of 2010 Board Preparation Calendar 27 Frequently Asked Questions 28 3

Introduction OK, so you're approaching the end of your second year. Having gone through about a thousand pages of Path, and countless lectures of Micro, you are so ready for a major break from the books, right? Well there's still one hurdle to cross before you reach the promised land of clinical medicine: Step I of the USMLE, or "the boards." Although this examination can seem pretty intimidating, a logical and well thought out approach to studying helps the great majority of students. So first and foremost, don't panic! Believe it or not, our students do very well on the Boards and if you have done well in the first two years, you should look at this as

nothing more than a review session .This guide is meant to provide a framework and some simple suggestions for studying for Step 1. Remember, these are just suggestions and no one approach to studying is right for everyone. The key to success is to think about the topics and issues that need to be covered, make a realistic study plan, and

then do your best .What is the USMLE Step 1

The three Steps of the USMLE assess a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Results of the USMLE are reported to medical licensing authorities in the United States for their use in granting the initial license to practice medicine. STEP 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. The USMLE Step 1 is split into a variety of sub disciplines, similar to the curriculum of most medical schools. Within each subtopic, an attempt is made to test knowledge on "Normal Processes", "Abnormal Processes", “Principles of Therapy" and "Psychosocial, cultural and environmental considerations." The basic disciplines include topics in biochemistry and molecular biology, cell biology, genetics and development, pathology, psychiatry, physiology, pharmacology, microbiology, immunology, and statistics. The NBME further specifies the topics to be tested within physiology, including systems biology

(neurobiology, immunology, general physiology, etc.) .USMLE Step 1 Question Format

There is only one question format for USMLE Step 1: "Single question best answer ."

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Studying for the USMLE Step 1 USMLE Step 1 is usually considered the hardest of the USMLE exams to do well in. As a result, this is the test that everyone studies the most for. The

basic techniques for studying for USMLE Step 1 are straight forward :1 .Sample questions. Sample questions. Sample questions .

2 .Focus on your weaknesses .

3 .Study for the USMLE as you study your medical school course .

Review Courses/Options Keep in mind that there are also many review courses that can help you organize your studying if you are willing to spend the time and money. If you feel you may benefit from a review course, the best thing to do is to ask someone who has taken these courses to see what they are really about. Kaplan offers a range of products that can help one prepare for the boards. These include Q-Bank ( 2000 test questions that simulate the boards format- a web based product), Intense Prep (live lecture review done in three weeks which also includes over 1000 exam like questions), MedPass (video set lecture series that also includes over 1000 board questions), and other web based products (WebPrep, Qreview). The strength of the Kaplan assets is the simulated tests, which have very similar questions to the boards and have a format that is similar to the boards. Many students find the Q-Bank questions to be particularly useful, as they provide the opportunity to simulate the setting that will be encountered on test day with a computer-based exam. Kaplan also offers a series of review books are part of the above packages. Ask other students who used them if they found them to be effective. The www.kaplan.com site offers more specific details about any of their

products .If you are looking to attend a live review course, our office has had success referring students to these (3) locations listed below. Our office is

not endorsing these programs over other programs .PASS Program, Champagne, IL, 217-378-8018, http://www.passprogram.net

Institute for Professional Preparation, University of Missouri Kansas City, www.umkc.edu/ipp Falcon Review, Dallas, TX www.FALCONREVIEWS.com

What are students telling us about their strategies for studying ?Most Effective Techniques

• “Attend class! This is where you learn about clinical medicine. You’ll be grateful you did next year ”.

• “Use practice exams ”!

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• “Doing tons of sample questions and understanding all the right and wrong answers; studying with one or two people; using only

one review book for each topic ”.• “Going through review books, taking notes on stuff to memorize

and doing questions ”.• “Concentrated studying in a group for allotted time ”.• “Stay away from stressed out classmates ”!• “Make a realistic schedule and stick to it ”.• “Do questions in bulk ”.• “Take a pretest to identify your areas of weakness. Then, create a

study guide/schedule based on your needs, not the needs of your study group ”.

Least Effective Techniques • “Not paying attention to the material in the course then trying to

learn it later on your own ”.• “Drinking too much coffee; going over all the notes from the first

two years ”.• “Listening to other people’s advice as to what was important to

study ”.• “Hysterically running around in despair ”.• “Trying to study from too many books. Stick to one major

resource supplemented with smaller specific subject books ”.• “Studying with too many people ”.

What topics are more/less emphasized on the boards ?While some of you have started studying already, some may not even be sure what is on the exam everyone is so nervous about, so let’s start at

the beginning. Step 1 covers material from the following categories • anatomy ,• behavioral sciences ,• biochemistry ,• microbiology ,• pathology ,• pharmacology ,• physiology ,• interdisciplinary topics, such as nutrition, genetics, and aging .

The above material is tested as basic science questions, or as questions referring to individual organ systems. The general breakdown is :

40%-50% General principles 50%-60% Individual organ systems

The individual organ systems are :• hematopoietic/lymphoreticular • nervous/special senses

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• skin/connective tissue • musculoskeletal • respiratory • cardiovascular • gastrointestinal • renal/urinary • reproductive • endocrine

The test can also be broken up into normal vs. abnormal processes :30%-50% Normal structure and function 30%-50% Abnormal processes 15%-25% Principles of therapeutics 10%-20% Psychosocial, cultural, occupational and environmental

considerations Step 1 has approximately 350 multiple-choice test items, divided into seven 60-minute blocks, administered in one eight-hour testing session. The current passing score is 185. This corresponds to answering 60-70%

of the questions correct for the exam .The most heavily emphasized subjects are Physiology, Pathology, Microbiology, and Pharmacology. Pathology is probably the most important single subject, since it ties in all of the other topics. By devoting the appropriate time and energy and utilizing the right resources, conquering all of these subjects will be well within your reach. Also, don't forget the basics of Biostatistics, as sensitivity and specificity and positive and negative predictive values are favorites for the USMLE. Just

knowing these will be worth several extra questions answered correctly .How important are sample questions and practice exams ?

Generally speaking, doing practice questions and exams is definitely helpful for many reasons: it directs your emphasis towards certain topics, identifies your strengths and weaknesses, and gets you in the right frame-of-mind for taking this exam. Many people have found it helpful to do 25-50 questions each night to review the subjects they studied earlier in the day. As the test day approaches, you should definitely take some longer

test blocks back to back to build up your mental stamina for test day .Kaplan’s Q-Bank has been a favorite of students here and all over the country. It is favored for providing a good simulation of a computer based test (CBT) and for having a comprehensive database of questions. With the proper preparation, you’ll find your Q-Bank scores and confidence peaking as you near test day. Two other question banks that are highly recommended in First Aid are USMLERx Step 1 Qmax Test Bank and USMLE Steps 123 Step 1 Question Bank. Both are less expensive than Kaplan’s Q-Bank, although Q-Bank has a longer history with the USMLE

Step 1 .7

Most of our students couple practice questions with First Aid for the USMLE Step 1. The Office of Student Affairs also has a plethora of other Step 1

study prep guides which you may check out .Regardless of how you approach it, practice questions of the proper caliber will be a big help in your review, especially in regard to timing and mental endurance. Also, if you count yourself among the computer/testing-phobic, it may be wise to get some other computer testing resources just to get used to reading off a screen rather than a

book .What is the testing day like ?

There is no denying the fact that the testing day is long. Just be sure to remind yourself that it used to be two days !!

There are seven one-hour blocks of 50 questions, and you are allotted eight hours to complete the test .

In addition to the exam blocks, your test experience begins with a 15 minute computer tutorial. However, this is identical to the one on the CD sent in your packet, so it is best to skip it on test day and take the 15 minutes as break time. If you do this, you begin with 1 hour of break time,

which you are able to take between sections at any point during the day .Some people complete a couple of sections at a time and then take a prolonged break, while others choose to take a 5 minute break at the end of each section. You can always access a screen on the computer which tells you your total time remaining both for your current section and for the test day as well as how many sections you have left, so time

management is not a major issue as long as you pay attention .Remember, for the exam, you are not allowed to have any of the following

with you during the exam :• mechanical or electronic devices, such as cellular telephones,

personal digital assistants (PDAs), calculators, watches of any type, electronic paging devices, recording or filming devices, radios ;

• outerwear, such as coats, jackets, head wear, gloves ;• book bags, backpacks, handbags, briefcases, wallets ;• books, notes, study materials, or scratch paper ;• food, candy, gum, or beverages .

You can have food and drinks outside of the exam room, or in your locker for breaks. Bring high energy food and drinks to the exam so you can have little snacks throughout the day to keep your energy up and avoid eating

big meals that will make you tired .When you come to the exam, you need to bring your scheduling permit

and a form of legal identification :• passport ,

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• driver's license with photograph ,• national identity card ,• other form of unexpired, government-issued identification ,• ECFMG-issued identification card .

Important Note: Your name as it appears on your Scheduling Permit must match the name on your form(s) of identification exactly. If the name listed on your Scheduling Permit is not correct, contact your registration

entity immediately .Applying to take and scheduling the USMLE Step 1

1 .Go to http://www.nbme.org/2 .Click on “ENTER NLES SITE ”

3 .Click new first time user and create a login name and password When applying for Step 1, you must select a three-month period, such as January-February-March or February-March-April, during which you prefer to take the examination. A Scheduling Permit with instructions for making an appointment at a Prometric Test Center will be issued to you after your registration entity processes your application and determines your eligibility. The Scheduling Permit specifies the three-month eligibility period during which you must complete the examination. During peak periods, allow up to approximately four weeks for processing of your application. On receipt of your Scheduling Permit, you are able to contact

Prometric immediately to schedule a test date .http://www.prometric.com/default.htm Remember :

• You must have your Scheduling Permit before you contact Prometric to schedule a testing appointment .

• Appointments are assigned on a "first-come, first-served" basis; therefore, you should contact Prometric to schedule your exam as

soon as possible after you receive your Scheduling Permit .• You may take the test on any day that it is offered during your

assigned eligibility period, provided that there is space at the Prometric Test Center you choose .

• Prometric Test Centers are closed on major local holidays .

This means sign up early because the process takes time – but remember – you can only sign up six months in advance !

Rescheduling People have different thoughts on whether this is wise to do or not, but regardless, if you are going to reschedule, be aware that you will have a rescheduling fee if you do it less than 5 business days in advance.

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Putting Together a Schedule Obviously, the more time you put into studying, the better the results you will most likely see. So if you are organized enough and willing, spend as much time as you feel necessary, and simply alter the schedule we are

suggesting based on your own desired preparation time .Keep in mind that this time of studying is really just a comprehensive review of material that you already know. You will not learn many things for the first time, though you will notice that as you synthesize information they may seem new since you finally make sense of them! At first it may seem as though you need to go through everything again and this may very well be true, especially for biochem, but the rate at which you relearn

things is quite rapid, so don't panic .As you plan your study time, it is important for you to establish your goals for the boards-to borrow terms from First Aid, do you want to just pass, to beat the mean, or to go for the gold. Your decision will be important in deciding how intensely you approach your studies. The following is a schedule for someone who wants to do well, but who wants to have a

reasonable study schedule for about 3 weeks .Before we begin, let's just lay out a couple of general principles :

• Make your schedule and stick to it. Many have benefited from approaching studying for the boards as a job. Punch the clock for a set number of hours per day and then, provided you actually worked in that time, let yourself leave it behind when the time is up.

• Include breaks in your schedule. Schedule an hour a day for exercise, time to hang with friends and family, or whatever else you want to do. Your motivation level and overall efficiency will be enhanced by

adequate rest periods .

• Get plenty of sleep and good nutrition .

• Remember that First Aid for the USMLE Step 1 is your gold standard! Before you study each subject, spend a brief time reading over the high yield facts in First Aid, and return to it again when you are finished to emphasize the important tidbits. KNOW

THIS BOOK INSIDE AND OUT !!!• If you used a review book during the class, use it now. There are so

many books from which to choose, so if you have one with which you are familiar, use that one .

• Be sure to hit the large, important subjects (path, pharm, micro, physio, and biochem) more than once during your preparations. Hit them hard in the beginning for two days or so, and then come back at some point in the last week for a 1 day speedy, thorough review. You will be amazed how much you pick up that second time

through .

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• As has already been said, use practice tests to your advantage. Schedule them into your evening time or use them whenever you get tired of studying during the day. As the test approaches, try to

do several back-to-back one hour blocks to ready you for the exam .• Don't completely blow off any subject. It is silly to miss some easy

points in something like Biostatistics when the information can be picked up in just a little bit of time. At the minimum, at least read

the high-yield facts in First Aid .• One last time for emphasis -- especially during those last couple

days, be sure to come back to First Aid .

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Sample Schedules The samples below may or may not be representative of what will work for you. Please use these as a way to think about creating your study

schedule .Sample Schedule #1

Day working: 19.5 days – 25.5 days (not counting days off and review) This schedule does not differentiate between basic science and system-

based studying Topic

Estimated Time Comment

Behavioral Science 1 to 1.5 days Actually tested and fairly easy questions you need to cash in on, but you have a book, Fadem (BRS), which is short and has

questions .Biochemistry 3-4 days Perhaps the most tedious of the

subjects review early (1-2 days) and late (1-2 days), saving the questions for the later time. Lippincott is a heroic effort, but an excellent resource, particularly if

you used it before .Physiology 4 days High yield. Perhaps the most

important subject. Again, review early and late. Know Costanzo,

shockingly effective .Anatomy/Histology 1-1.5 days Honestly low yield. The focus

should be on clinically useful stuff: which fractures relate to which nerves, winging of the scapula, etc. Radiographic images can be emphasized but generally stick to the basics; i.e. you see an x-ray with fracture at the midshaft of the humerus, what nerve is at risk? KNOW the basic X-rays in

High Yield Anatomy Embryology 0.5 days Don't neglect it, but don't blow it

out of proportion. First Aid stuff high-yield .

Pharmacology 3-4 days Enormous volumes of material. Remember to think categorically. You have to know your autonomics. Know major side affects if they are bad, i.e.

agranulocytosis, cardiotoxicityMicrobiology 2-3 days Sorry guys, it's in there, even the

worms, but not enough to justify slaving over them. Know the parasites in First Aid. Try to combine micro with your antibiotics review, they are related in real life and surprisingly on the

boards too .Immunology 1-2 days Fairly good yield. Glance over

immuno- deficiencies-in First Aid the day before the exam.

Principles more than details .Pathology 4-5 days One of the big-hitters on the exam,

should also be a big-hitter in your

prep. Another subject you want to hit both early and late. The BRS path book (Schneider) is a time-

tested favorite .