发信人: ericusa (eric), 信区: MedicalCareer
标 题: Step 1 Survived
发信站: BBS 未名空间站 (Sun Jun 29 08:43:26 2008)
I took the USMLE step 1 exam yesterday. Thanks for everyone's encouragement,
and I learned a great deal from the experiences presented in this forum. I
’m very grateful to my parents as they gave me whole-hearted support and
provided me extremely valuable advice throughout my Step 1 preparation. This
is a brief description about what I did under a tight time constraint.
Many people believe that US medical students should be well prepared for the
Step 1 exam because of their two-year diehard pre-clinical course work. The
truth is that while the majority of AMGs are able to pass the exam with
certain review efforts, an intensive preparation is definitely necessary for
achieving a high score. Our pre-clinical courses cover a broad basic
medical science knowledge base, but the courses on their most part are not
specifically designed for the Step 1 exam, especially since it doesn't offer
enough clinical correlations. The University of Southern California medical
school, for example, improved their Step 1 median score from around 210 to
230 after they implemented an integrated curriculum. Unfortunately many
medical schools haven't follow suit. Another issue is how much time is
available for the preparation. From January to middle May this year, all of
my classmates haven't had time to focus on Step 1 because of heavy course
work load, volunteer work and other activities. Our final exams ended on May
16, and everyone was required to take the Step 1 exam before July 1 - that'
s a 6-week time window. In recent years, the mean Step 1 score for AMGs have
been around 217 so a very high score is not a norm for AMGs.
Information Retention Strategies
Many supposed “high yield” review books are designed for Step 1
preparation under a tight time constraint. In general, the best strategy is
to focus on a few resources and get to know them very well. I treated this
as a good opportunity to consolidate what I have learned in the past two
years at school, and catch any stuff that had not been taught in our courses.
The real challenge was to retain a large amount of information within a
short time period. Similar to other people’s experiences, I found the
following are helpful:
1) Try to understand the mechanisms and ask a lot of “why”. The more
thinking the more to remember.
2) Use Kaplan lecture videos with Kaplan lecture notes. The visual images of
the lectures and teacher's voices attracted my attention.
3) Do as many practice questions as possible. This has several benefits: as
a learning tool I learned some materials not covered in other review books;
tested my knowledge and spotted weakness, forced me to think and make
choices thus create a deeper memory; developed “pattern recognition” and
“educated guessing” abilities; familiarized myself with the testing
interface and questioning style; and practiced time management.
4) Use First Aid as the guide, make notes when reviewing questions and other
books, and annotate all information into FA. At the final week, all review
materials were in one place.
5) Use Goljan's Rapid Review Pathology (2nd edition) and his audio lectures
as the basis for “integration”. If one has difficulty in understanding his
audio, the unofficial “transcript” can be helpful.
6) Repetition is the key. Unless you have a photographic memory, read FA,
Goljan RRP, and listen Goljan's lecture audio multiple times.
Warm up (about 2 weeks)
From January to April
- I talked to some senior students and learned people's experiences,
including posts from this forum;
- Collected best study materials I can find, I bought most of the popular
Step 1 review books;
- Tried a small amount of questions from qbanks, just to get a sense of what
the exam questions could be like.
Roughly I spent about two weeks for the Step 1 during this time. After our
final exams, I spent another 6 weeks for preparation. Total preparation time
was about 8 weeks.
First run (about 4 weeks):
- Watched Kaplan lecture videos one subject at a time;
- Read through corresponding Kaplan lecture notes;
- Read the FA section for the subject, referenced Kaplan lecture notes and
other review books for details if necessary;
- Did online UW questions for the subject (100% completed);
- Made notes on the materials not coved by FA;
- Listened Goljan 5-day lecture audio and reviewed his RR Pathology book.
This is a 4-week hard-core study and emphasized conceptual understanding.
The Kaplan lecture videos guided me to go though all Kaplan lecture notes.
Reading FA before Kaplan could be too dry. Tried to understand what was
listed in FA, and applied the knowledge to answer UW questions. Made notes
to any new materials found in the questions, Kaplan notes and other review
books, and consolidated them with FA.
Second run (about 2 weeks):
After going through all subjects in the first run, I read many posts about
recent Step 1 experiences to learn what I needed to work more. The NBME
forms also helped me to diagnosis my weakness. In the second run,
- Practiced NBME forms 1-6;
- Practiced UW self-assessment exam;
- Did some Kaplan qbook questions;
- Did some USMLERx questions;
- Practiced Kaplan qbank (about 50% completed);
- Participated in the tutorial at the Prometric center ($42) to get familiar
with the environment and practiced the NBME sample 150 questions;
- Reviewed FA and my own notes, tried to remember as many details as I can.
These two weeks were mainly for practice and memorization. Mixed subjects
and using timed mode to simulate the real exam, and paid more attention to
those fact-based questions. The brutal force memorization in the last five
days before the exam was really helpful.
The Actual Exam
It's better than expected because I prepared for the worst. The set of
questions I got is not that bad and definitely doable.
The user interface:
It's the same as UW qbank so everything felt like home.
This was not a problem for me. Many questions have a stem length similar to
or longer than UW but I was able to complete each block within 50 minutes. I
took block 1 and 2 before a five minutes break. After block 3 and 4 I had a
half hour lunch break, then another five minutes break after block 5 and 6.
Question style and difficulty level:
One student's description is pretty accurate:
Step 1 = (Typical UW block + longer question stems) – (obscure triple jump
logic mandated by many UW questions) + (fair number of classical ‘easy’
questions) + (occasional crazy off the wall stuff you heard in some random
lecture during 1st year and hopefully retained)
The overall difficulty level is somewhere between NBME questions and UW.
About 60-70% of the questions I can immediately pick up an answer, and for
the rest I need some thinking or reasoning. Among the seven blocks, five are
not too bad and two of the blocks are more difficult. I think those two
blocks contained more “experimental” questions. One question stated “Here
is the diagram” but it was nowhere to be found – clearly an incomplete
For some of the questions, there were no direct answers from FA, UW, Kaplan,
and Goljan. UW and Goljan taught us the reasoning method and we need to
figure out the answers. (Some people complain these kind of questions come
My test was heavy on pathophysiology (about 50-60%). Pharmacology and
microbiology were well represented. Other subjects were more evenly
distributed, for example, about two anatomy, four neuroanatomy, four
behavioral science, and maybe three biochemistry questions per block. I got
two clinic embryology questions total.
Only one question involving a heart sound. Moving the mouse over the body
image helped locate the source, but was not necessary to picking an answer.
Personal Opinion on Review Materials
Everyone chooses the review materials based on their own background,
schedule, study habit, and personal taste. I bought the latest editions and
hoped they contain updated information and corrected errors from previous
editions. I also like paperbacks since it's otherwise impossible to read
through that many books in a few weeks. Here are my main study materials:
- FA (First Aid 2008): the bible for Step 1. It outlines the high yield
facts that cover a large portion of the actual exam. Its content represents
the absolute must know/understand, but packing a whole ton of random facts
into the human head just doesn't work well for many people. The general
consensus is that in FA cell biology is nonexistent, neuroanatomy and
immunology are weak, microbiology and some portions of pathology are not
great. To fill in the knowledge base gaps and ease the learning curve, other
review materials such as Kaplan lectures/notes, UW qbank, and review books
can be used. One needs to read or reference FA multiple times to memorize
- UW (USMLE World on-line qbank): it really gets you to think like Step 1
wants you to think. It's designed to target those high range difficulty
questions in the actual exam with second-order reasoning style. Don't be
discouraged if you feel UW questions are hard (for some questions, less than
20% of the people got it right. Many biochemistry and pharmacology
questions are harder than the real thing. I started with 55-60% correct,
toward to 70-80%, cumulative 73%). UW's explanations are excellent which
encompass multiple areas, and really integrate the knowledge. Thus UW can
also be used as a learning tool. You won't be surprised if similar questions
show up in the real exam. When I started UW I had some sense for most of
the questions but I can only narrow down to two choices for some of them.
After carefully reviewing Kaplan, FA and other books, it helped me to answer
many of the questions. In UW, pathology and pharmacology take a big chunk,
while cell biology and neuroanatomy are underrepresented. UW alone is not
enough, as it only covers a portion of knowledge in FA. If time permits, it'
s worth to go though all of the explanations UW provides.
- RRP (Goljan Rapid Review Pathology 2nd edition) and his 5-day audio
lectures: the meat and potatoes of pathology/pathophysiology if you can
digest them. RRP is much more than “pathology”; it integrates multiple
areas and fills in many holes in the knowledge base. Be aware that for the
most part RRP has an “outline” style similar to FA, so it's not an easy
read with more than 600 pages. If you already have solid fundamentals, this
book is fantastic; if anything is not clear, you may refer to the
corresponding section in Robbin's. The images in RRP are excellent. Goljan's
audio lecture covered much high yield stuff. Listen to him multiple times.
- NBME self-assessment tests (Forms 1-6, $45 each online): the stuff from
the authorities. These are closer to the easier/middle range difficulty
questions in the actual exam, and NBME won't release the answers for a good
reason. It's also a fair predictor for the actual score, and can be used to
diagnose one’s knowledge base weakness. UW self-assessment test ($25 for
the test, $20 if bundle with UW subscription) is worth doing too, what’s
more, you'll get the answers/explanations and up to two weeks for review.
- Kaplan lecture videos (2007) combined with the lecture notes (I used the
2008 edition but the 2006/2007 edition could be fine too): a perfect
marriage. The lecture videos are well presented with a lot of high yield
information. Some Kaplan lectures are even better than what we had in school
. Except some slow talks in physiology, overall I'd like to rank the lecture
videos very highly. The lecture notes are also well-organized with clear
explanations, and work very well with the videos. Some people only use the
notes and that could work just fine. However Kaplan designed the lecture
notes, videos and qbook as a complete learning system so it's best to
utilize the system's full potential. The qbook covers some materials not in
the notes. Kaplan stated that the notes are meant to be supplemented by
lectures. If time is tight, at least listen to the Kaplan Webprep audio
series. The videos helped me retain information, and it's also very good for
IMGs to learn how to pronounce many medical terms.
- Kaplan qbank: used to be the dominate player in town. Most are first-order
questions, and some of them may ask too much about details (for example,
some microbiology questions could with “low yield” details so don't waste
too much time on those). For most questions, either I knew the answer right
away, or I don't remember the details to answer them. The real exam also
contains some first-order questions so don't give up on this one. In recent
upgrades Kaplan tried to add some more difficult, second-order questions.
- USMLERx qbank: the neglected child. Yes most of its questions are
straight forward, yes it doesn't offer much more than FA. But it does a good
job as it supposes to do: helping people retain the information from FA.
When I was not sure about memorizing some sections of FA, I used USMLERx to
check it out.
Are those “enough” for the Step 1? This is a tough question. Everyone has
a different background and goal. Each person will also get a different set
of questions for the exam. Keep in mind that no matter how many books you
have read, there could be some questions in the exam you have no clue. Some
other popular review materials to consider if time permits (based on my
quick skimming through of those books):
- Anatomy: usually a low yield subject but some people got quite a few
anatomy questions. Kaplan and UW are good; FA + Kaplan + UW should be
adequate. Chung's BRS Anatomy (6th edition) is pretty detailed. I only read
a portion of the BRS book, and it’s a good source if you're weak on anatomy.
- Neuroanatomy: Kaplan neuroanatomy lecture is fine. Fix's HY Neuroanatomy
（3rd edition） is pretty dense with many great MRIs. White's USMLE Roadmap
Neuroscience is an easy read (White is also one of the authors for Kaplan
- Cell and Molecular Biology: Kaplan's chapter is very good. Dudek's HY Cell
and Molecular Biology (1999 edition) is “short and sweet”. People usually
choose the latest editions for review books except this one. Newer editions
contain too much information.
- Embryology: It's a low yield subject and FA + Kaplan + UW usually should
be adequate. HY Embryology (2nd edition) is a short easy read, with the same
author as for HY Cell and Molecular Biology.
- Behavioral: Kaplan is quite extensive. Kaplan qbook and qbank have some
good behavioral questions. If you still need more, either BRS Behavioral
Science or the shorter HY book should be fine.
- Biochemistry: Kaplan Biochemistry book (it also contains the genetics
portion) rocks, Hansen really knows his stuff. Rapid Review Biochemistry is
also a popular choice (Goljan is one of the authors).
- Biostatistics: Kaplan or HY Biostatistics (2nd edition).
- Histology: a low yield subject. HY Histology (2nd edition) has some
excellent pictures. Again Dudek is the author.
- Immunology: Kaplan is awesome. Levinson's Medical Microbiology and
Immunology (Lange) is also good. HY Immunology (2nd edition) is an easy read.
- Microbiology: Kaplan is in a table format for the most part, and it
already contains extensive information for the board. Clinical Microbiology
Made Ridiculously Simple (4th edition) is very extensive too; it uses a
plain simple language and “entertainment” style that could help
memorization to some extent. If weak on micro go with CMMRS, otherwise
Kaplan + FA should be adequate.
- Pharmacology: FA + Kaplan + UW are OK; USMLE Roadmap Pharmacology (2nd
edition) is a good addition. The two authors, Katzung and Trevor also wrote
several popular pharmacology books. Case Files Pharmacology presents 52 real
-life clinical cases.
- Pathology: Kaplan Pathology video is good but the notes are only so-so. If
you are finding Goljian RRP overwhelming, you might try BRS Pathology (3rd
edition) before RRP. BRS is easier to learn but basically there isn't much
integration and no good images so other sources like Webpath can be used. I
prefer Goljan's RRP though, because it incorporates a lot of pathophysiology
which is really the bulk of the path & physiology content on step 1.Listen
to Goljan's audio lecture multiple times too. Goljan is an excellent teacher
and explains concepts well, and the high yield stuff he emphasized really
shows up in the exam.
- Physiology: Kaplan lecture video and notes are extensive. BRS Physiology
(4th edition) is another popular choice. Costanzo is the authority on board
physiology, and her BRS book becomes a classic.
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