Study time: 32 days
Study materials: First Aid Step 1, QBank, internet
Score: 249/99

“What’s the best way to study for Step 1?”

Go to medical school. The first two years of medical school are worth taking seriously. Sure, you might not see the relevance of studying the lysosomal storage diseases, or the different causes of nephritic syndrome, or the side effects of drugs you can’t even pronounce. But from a pragmatic standpoint, these topics are fair game for Step 1. Medical school as well as Step 1 isn’t something to cram for. So develop your own study method and stick with it. You are going to be learning for the rest of your life so get used to it. With that said, balance is key. Don’t party all the time but don’t study all the time either. Your life isn’t on hold just because of medical school. Don’t ever forget that.

Personally:Starting medical school, we are inducted into a life of spending money: tuition, housing, and tons of “required’ textbooks. Depending on your medical school these textbooks may or may not be needed to survive. Personally, I didn’t buy a single textbook until First Aid for the USMLE Step 1. That’s not to say I didn’t study. I’ll be the first to admit that I studied my fair share. My own approach to studying isn’t to memorize. As medical students, we can all cram. We’ve been doing it since high school. But my philosophy is that it is more important to be able to understand concepts.

“What’s the best way to prepare for Step 1?”

Step 1 Study Schedule: Personalize it. You’ll have different time constraints than others. You might have 4 weeks to study or 8 weeks. You might have a wedding to go to in the middle of your study period. You might have different study habits than your best friend. You may be the type to be able to sit down for 12 hours straight and read straight. Simply put, do whatever it takes to review the material. If you’ve taken the first 2 years of medical school seriously, then most of your study schedule isn’t a STUDY schedule but a review schedule. I hope that you aren’t trying to cram 2 years of medical school into 4 weeks. It can be done, but I’m sure it’s going to hurt. Also, my previous advice about not putting your life on hold for medical school doesn’t apply anymore. If you are preparing for Step 1, then sad to say your life is on hold. You know what? Too bad, it won’t hurt for long.

Personally: I used First Aid , a QBank, and the internet. First Aid is the foundation of most study schedules. Before crawling into a cave for a month to study for Step 1, I asked several friends if they would feel prepared for Step 1 if they knew First Aid from cover to cover. All of them said yes. Honestly, First Aid isn’t that thick. Sure, it’s jam-packed full of information, but it is safe to say that most of the material won’t be new to you. On top of First Aid, I used a QBank to “test” my knowledge. The key to using QBanks in my opinion is not to just use it to test your knowledge but also to learn. I read every explanation of every possible answer choice for every question whether I got the answer right or wrong. Always reference First Aid or the internet if you don’t understand something. You will slowly build your knowledge base with this method. In the end I could safely say that I knew First Aid quite well and I had gone over every question/explanation in an entire QBank. With that said, this approach worked for me but might not work for you.

Days before the test

In these days, panic will most likely start creeping up on you. Planning a couple of days without any scheduled material to study allows you to focus on your weak subjects and gives you the flexibility to freak out and take a half-day off to find your sanity, as I did. It is perfectly fine to take time off during your review schedule. Do whatever it takes to be productive when you are setting time aside to study. Don’t study just to say “I studied 18 hours a day for 2 months.” Time alone isn’t going to improve your score. Well-focused time is worth 100 times more than time staring blindly at a book. If you are sleepy, consider taking a nap. Stressed out? Consider going for a jog. If you feel focused, consider studying as long as you can.

You know more than you think you know

I know you won’t believe me. I didn’t believe it myself. But you really do. You’ve most likely prepared for the past 4+ weeks for exam day. In reality, you’ve studied the past 2 years for this day. By now you either know it or you won’t. One extra study day won’t make a difference. Thinking about postponing your exam for extra study time? Forget about it. Relax the day before your test but I won’t sugar coat it. You’ll end up flipping open First Aid a couple times during this day to review a high-yield topic. Fine. But sweating over the miniscule details that might or might not end up on a single question? It’s not worth sacrificing your energy and focus on such details. Get a good night’s sleep or at least try.

Test Day

You have done all you can. Now it’s time to prove it. Be well rested. Be well prepared. Know where you are going. Know how to get there. Know the exam format. Do the best you can! And a grueling 8 hours later, step out and bask in the feeling of completing the hardest test you’ll take, most likely ever.

This is part 4 of a 4 part series and are archived in the Testimonials Section.

There’s an adage that floats around my school every year about April: “two months, two weeks, two number two pencils.” It is often accompanied by, “and you’re only allowed to yell at two patients.” I refer, of course, to the United States Medical Licensing Exam, the bane of our existence, that which puts most of us on a PPI and a fair few on an SSRI. It is our CPA exam, our bar exam — except we do it over and over (Step 1, 2CS, 2CK, 3, Specialty, Recertification…….). The test is more like a marathon than anything else and preparing for it is almost completely unlike studying for a regular exam. So it’s my hope to reassure you that if you take the tests seriously and prepare as such, you’ll be fine. I’m not promising 250-level fine (who wants to be Derm anyway) but you, too, will graduate medical school.

Two #2 Pencils
I haven’t sat for Step 3 yet BUT I do have a good friend who has, and she reassures me that she also doesn’t memorize things very well. Her advice was to take it towards the end of intern year and prepare for 2-4 weeks in what little down time you have with a question bank. The content is the same material you’ve been practicing for the last 10 months and it is almost certainly beat inside your skull by then. She also pointed out that you could probably pass it as an M4 but you can’t register until you start residency (I checked).

This is part 2 of a 4 part series and are archived in the Testimonials Section.

There’s an adage that floats around my school every year about April: “two months, two weeks, two number two pencils.” It is often accompanied by, “and you’re only allowed to yell at two patients.” I refer, of course, to the United States Medical Licensing Exam, the bane of our existence, that which puts most of us on a PPI and a fair few on an SSRI. It is our CPA exam, our bar exam — except we do it over and over (Step 1, 2CS, 2CK, 3, Specialty, Recertification…….). The test is more like a marathon than anything else and preparing for it is almost completely unlike studying for a regular exam. So it’s my hope to reassure you that if you take the tests seriously and prepare as such, you’ll be fine. I’m not promising 250-level fine (who wants to be Derm anyway) but you, too, will graduate medical school.

Two Patients:
Full disclosure for Step 2 CS:
Total time studying: about 16 hours comprised of reading FA Step 2 CS and doing occasional short cases with friends.
Test Date: April 1, 2009 (most of the way through 3rd year).
Final Score: PASS.

Many American students assume that Step 2 CS is designed to weed out foreign grads and is easy for any native-English speaker to pass. They are only partly correct. Yes, a huge part of the test is intelligibility, but an equally huge part is attitude. You may not like paying a thousand dollars and flying halfway across the country, but you are not too good for this test. Walk in there thinking it’s a waste of your time and they will fail you, it happens every year.

That covers two of the tested sections, the third is knowledge; both medical knowledge and knowledge of how standardized patients work. I was lucky, my med school (Arkansas) has one of the best standardized student teaching clinics in the country and we work with SPs from the first week of M1 year. It’s how we learn to do H&Ps before entering the hospital and it’s a regular part of our tests. If you haven’t had much exposure to actor-patients, remember one thing: treat them as if they’re really sick. Show empathy. Act like the doctor you want to be.

I used FA Step 2 CS to study and it impressed upon me three important aspects of the test that differed from my previous exposure to standardized patient exams. Now, every patient encounter plays out roughly the same: history, physical, counseling, note, ddx, plan. What studying changed for me were the history, differential, and plan.

The History
The major change I made in my history taking for the exam was based on the realization that the test is not about getting to a diagnosis; it’s about filling in grader’s checkboxes. You’ll notice in First Aid every interview has 5-7 social history checkboxes that may have nothing to do with the primary complaint. Ask them anyway. Also, don’t forget to ask every patient about allergies and medications, it’s easy to forget in the heat of the moment and they will always be on the grading checklist.

The Differential
When I first started studying for this exam I had a hard time coming up with good differentials primarily because I would mentally hone in on one diagnosis and forget other possible ones after leaving the room. My solution was to write down what the patient could have any time he or she answered a question about symptoms. It’s not about the differential being “right,” it’s about being reasonable.

The Plan
Just like the differential, it can be hard to think of five reasonable things to do in the 2-3 minute window you have to write this part of the note. If your ddx is good, include tests to rule out other conditions. It’s also pretty easy to justify a CBC, BMP, and imaging on just about anybody. Don’t forget if you order imaging to include the region you want a picture of. And yes, it is perfectly okay to make fewer than 5 orders; I just wouldn’t do it for each encounter.

So I took Step I on June 15, 2009 and I must admit that it was a cute little quiz; hopefully Step II will be more of a challenge. LOL, it would be nice to talk like that, but in reality Step I was by far the “test of the year.” It certainly lived up to its reputation of being the hardest test that you will ever take in your medical training. I had heard of Step I’s reputation before I started my first year of medical school, so I knew that I needed to have a plan of attack before I started my second year of medical school. I started researching every aspect of what the test would be like by visiting popular sites like firstaidteam.com, Student Doctor Forums, etc. The most important thing I learned from my research was that I needed to formulate a plan that fit MY learning style. All because someone scored a 255 on Step 1 with their plan, it didn’t mean that their plan would even help me break a 185. So I read the study plans of other medical students and formulated my own plan.

My plan was to choose a couple of solid resources and know them cold; the resources I chose were a commercial question bank, First Aid, BRS Pathology, and Medical Microbiology Made Ridiculously Simple. I also learned from my research that nothing takes the place of learning the material well when you are actually in school, so I decided to utilize my core resources throughout the school year as I learned my school material. My school taught us everything through systems, so after we were completely done with the cardiovascular system, I would read through the cardiovascular section in First Aid. After I read through that First Aid section, then I created tests in qbank based on cardiovascular system only; I did these questions untimed and on tutor mode so that I could read the explanation for every question whether I got it right or wrong. If there was an explanation that I didn’t know or that was explained better in qbank then I typed it up in a Word document (having 2 monitors or running qbank inside VMWare Fusion on a Mac makes it easier to do this). Now of course it wouldn’t make much sense to type up facts that I didn’t know unless I planned to incorporate it into First Aid. So actually as soon as I bought my copy of First Aid I took it to Fedex Kinkos and got the book unbound and 3-hole punched for like $40 as you can see below:

This modification to my First Aid book allowed me to organize my typed qbank notes according to the corresponding First Aid section or add helpful pictures and diagrams that I found on the web. Like I said before, this may not work for everyone but it really worked for me and aided me in learning the info in First Aid.

So throughout the school year I had been reading the sections in First Aid and doing the qbank questions as the material was covered in class. My overall goal was to read First Aid at least three times before I took the beast; I reached my goal for all but five sections in First Aid. A lot of my classmates couldn’t believe that I wasn’t reading Rapid Review Pathology by Goljan, but the style of the book just didn’t work with my learning style; also I felt that by reading all the explanations in qbank that I would more than cover the pathology that I needed to know for the test in addition to what I was learning in BRS Pathology.

When the big test day came I actually was able to get a good night of rest, which I think is really important because all the practice tests you take from qbank or from NBME are 4 hours, which is hard enough, but the real 8-hour test can really test your endurance. I arrived at the Prometric center at about 7:30 a.m. and the directors there gave me my locker where I put all my belongings. I walked in to the computer room and started my test, wondering how well my studying prepared me for the real thing. While I was taking the test, all I could think was that this test had questions that were overall much harder than what I had seen in the 2,035 qbank questions. Of course there were really easy questions but most of them required me to really think through what was being presented and chose the correct answer out of the 2 choices that I always seemed to be left with after crossing out the other choices. At times I got flustered because I felt like I was doing horribly and at other times I smiled because I knew I nailed a string of questions. When I walked out of the test I honestly had no idea how I did. But thankfully, I received my scores and I did very very well!!! Honestly, First Aid is amazing!