From the Desk of Dr. Tao Le: Time to revise First Aid for the USMLE Step 1!

By Dr. Tao Le

It’s that time of the year!

I’m heading to New Haven this weekend to begin working with the Yale author team to revise First Aid for the USMLE Step 1 for 2013. The 2012 edition was a big step forward in terms of an all new page design and color throughout the book. We also added many new high-yield facts and purged the book of some outdated, low-yield stuff.

We also had some challenges as the new design forced the publisher to re-typeset the entire book and this introduced many inadvertent errors that were frustrating to both you, the students, and those of us here at First Aid/USMLE-Rx. We obviously plan to directly address this in the upcoming edition.

We also plan to refine the design of the 2013 edition and improve the quality of the existing images in addition to the usual high-yield fact updates. We appreciate the hundreds of suggestions that we received over the past several months and plan to review each one.

We want to hear from you!  Please post a comment below, and let us know what we can do with the upcoming edition to make it better, smarter, and the most valuable USMLE Step 1 study resource possible.


30 thoughts on “From the Desk of Dr. Tao Le: Time to revise First Aid for the USMLE Step 1!”

  1. This is great news! My question and really my hope is that the 2013 edition would be fully edited and all the errata in the 2012 edition would be corrected. I really do not see the point of continuing errata from year-to-year and publishing a PDF file 6 months after the book is released.
    I think the First Aid book is so well established that almost everybody taking Step 1 would buy it, so your company should not lose money if they spend time and money to correct the book.

  2. While I respect that First Aid is quite amenable to feedback and change, I find it very disconcerting that the foremost text resource for the USMLE Step 1 is so consistently littered with errors. I would much rather pay an extra $10 for a properly edited text than spend several hours revising it myself with a published errata list.

  3. I think it’s time FA needs a good competitor. The fact that there is no other books out there that challenges FA for market share ia hindering the quality improvement FA can use. Throughing the same old error leiden book at students every year is totally unacceptable. But FA is able to get by since there are nobody out there challenging them. Using FA for my step 1 was so frustrating that I have promised myself never to use anything FA/USMLERx publishes.

  4. While I am a big fan of your book, I must agree with the previous posts. It is disappointing to know that year after year, the first aid continued to be filled with many crucial careless errors (increase vs decrease, O2 vs CO2, and many others). I took me hours to correct the mistakes only to learn that more are already awaiting. First Aid and team, please work harder to avoid these mistakes as many of us are starting to question First Aid’s content credibility. Thank you!

  5. Here is how first aid can improve:
    1. GET RID OF ERRORS. I have missed too many questions because of these errors.
    2. You publisher better love you, this book is purchased by everyone i know.
    3. Keep the facts updated based on current treatment guidelines (unless of course its something like a “classic” drug that we must understand)
    4. MAKE A SEARCHABLE INDEX! In fact, if you really want to make some money, make an app that searches through the entire book and make us pay an extra dollar for it. Use your business brain!

  6. It is always room for improvement. The FA for Step 1 is so popular and useful in many ways that can not afford to have so many mistakes that need hours for correction . The Step 1 2012 edition was a great achievement however there are many things that can be improved like adding links to crucial concepts and references to webs. Also the USMLE Rx needs to be revised through the same concepts in order to be an integrative material manageable in a short period of time .
    Good Luck Dr Le . You have all our support !

  7. Hey everyone. It is very frustrating that even after erreta there are some mistakes. For example in endocrine section under glucagon it says “inhibition of insulin and further glucagon release” 2012 firsthaid. Now in erreta it says ” In the last phrase, glucagon stimulates (not inhibits) insulin release. Thus replace the last sentence with this: 3. Increases insulin release.” As far as i remember glucagon inhibits insulin release. Can someone out there help me out on this. Thanks

  8. Is there anything that either you or the publisher are going to do different to ensure the 2013 edition does not end up with 15 pages of errata like the 2012 edition? One bad year may be forgiven, but two consecutive years of large errata lists will make people consider other options. Personally, I will not be purchasing the 2013 edition until I know how bad it is or that I know that there is a new mechanism in place to ensure accuracy of the information.

  9. Hi all, thanks for all the comments and input! I shared some them with the team. The team is being reorganized to reduce the possibility of adding errors in the updates/new FA facts. We are speaking with the publisher’s typesetter in an attempt to reduce errors. We also asked the indexer to redo the index to make it more usable. We are also working on e-stuff – stay tuned. TL

  10. Along with a purchase of FA provide access to an online version of the book, similar to what is available through StudentConsult or Lippincotts. This would add value in being searchable and providing users with access when they were not able to carry a hard copy. Allow users to link their FA Qbank (USMLE Rx right?) account to their purchase of FA, and include direct links in answer explanations to the content in FA. Generate flashcards from tabulated data (eg: drugs) and other high yield facts that require rote memory association to include with each chapter of content on the online copy.

  11. LOL! Yale authors! The Ivy League is going down the drain considering the multitude of errors in the current and previous editions. My local community college freshmen could do a better job of editing. You ought to be ashamed of yourself repackaging half ***’ed work year after year and pawning it off as some sort elite material. I only hope that a competitor is soon found. Btw, where do you go to get the “Ivy League” editors? Starbucks?

  12. Here’s an idea. Instead of this blatant pandering, why don’t u give those who purchase FA2012 a refund or a free updated edition? Btw, you’ve been doing this with your Ivy League authors for how long and you can’t manage to get together a book without errors? Every year it is basically the same thing…with errors and all.

  13. TO FAR (nr 7): You are thinking in correct terms that glucagon and insulin are opposite hormones with counteractive effects. However you also have to reason your way to that glucagon will stimulate glucose release from the glycogen stores in the liver out into the blood, thus raising blood glucose. Whenever blood glucose increases you need an insulin response in order to facilitate the shift of glucose from the blood to the cells. Thus , glucagon may not directly stimulate insulin release but rather it will stimulate increase blood glucose which in turn will lead to an increase in insulin release.

  14. This has nothing to do with the type-setters or publishers. This is purely an editing disaster.

    Quit being greedy and offer a discount to all those who bought FA 2012.

    The amount of errors is flat out pathetic for any publisher/author let alone a medical review book .

    All you’re doing is copying information directly from larger textbooks which are in properly edited. How do you mess that up so badly?

  15. I am an IMG currently studying for the USMLE step 1 First of all, let me commend you on doing such a great job with FA. It is regarded as a must have in my country and is actually a very rich resource. I own the 2008 version of FA but I decided to get a more current one even though the reviews on Amazon weren’t great. Mr. Tao Lee I must say I am extremely disappointed and appalled by the sheer volume of errors in this book. A lot of them are very misleading and could actually cost one some questions on the exam. This is unacceptable to say the least and you MUST correct this in the next edition. Hopefully I won’t need to purchase that one as I would have passed the exam!

  16. I bought two FA for step1 (2006 and 2008) already, but my study is on and off. I plan to buy a new edition (which will be 2013) and really wish this will be the last one. I wonder if you will publish a pdf version as you did for 2012 edition.

  17. Please add more images including labels, especially:
    Neuro- (brainstem) xray, ct, mri ect…I had one question given elder’s psych problem, but asked to id which structure on infant’s brain would be involved if this pt was an infant. No idea
    Anatomy- most qs were only asking to id upper ext nerves (brachial plexus) after fracture and/ or dislocated. Some on ankles and calf.
    Gi- lots of pictures on gi, asking for disorders
    Embryo-showing newborn and/or stillbirth asking for disorders. Baby w/ big belly
    Micro- showing lots of microscopic images and ask for disorders ect…
    Genetics-pls add more pedigrees for modes of inheritance
    Molecular Biochem- pls add more types of mutations in DNA
    Biostate- qs had many bar graphs and line graphs asking for calculations and/or types of studies regarding such.

    *some strange qs* not sure whicn subject belong to: given types of machine in lab, asked on how to use on pts in term of different power( which power, in number, should be used) no ideas.

    *Pls update fa not just errors, but correlate it more to current qs. Refer to usmleword if you could.
    Thanks million

  18. Also, my friend also showed me another list of 2012 fa errors mentioned by conrad fisher on kaplan videos. I’m using my cel right now…unable to post it here.

    Pls post it here if anyone of you have it.

  19. First Aid 2012 Edition: ERRORS by Conrad Fischer

    Ritodrine is OFF THE MARKET! dangerous beta two agonist.

    Metaproterenol is NOT USED in asthma any more Isoproterenol is DANGEROUS in heartDZ

    Pregnant hypertension is FiRST with LABETOLOL . Labetolol. Labetolol. Not 1st alphamethyldopa.

    p175.Cryptosporidium Rx with Nitazoxanide

    p176 Malaria treatment is WRONG. NOT chloroquine. use mefloquine or atovoquone/proguanil.

    p186, Herpes best test is VIRAL CULTURE for HSV, NOT Tzanck prep

    p170 mycoplasma treat with DOxy, Macrolide or quinolone, NOT TETRA

    p 173. Candida albicans best treated with FLUCONAZOLE or CASPOFUNGIN, not ampho, NOT AMPHOTERICIN!

    p 168 Weil -Felix reaction is NOT USED! stop teaching it or putting in book! neither sensitive nor specific. use PCR for Rickettsia

    p176 Babesia is treated with Azithromycin and atovoquone. NOT Quinine/clinda. Quinine causes DEAFNESS with NO Better efficacy

    p176 BABESIA diagnosed by PCR!!! use Azithromycin and atovoquone.

    Number ONE beta blocker in ALL things cardiac is METOPROLOL

    p162 Legionella : ANY macrolide treats, Azitho and clarithro MUCH easier to take. ALso, Doxy or ANY quinolone. Erythro not the ONLY drug

    p194 MAI has NOT major features in common with TB. MAI is NOT in lung in HIV.

    p205 SHOULDN’T put “Methicillin” on top.missing OXACILLIN

    p206 . Penicillin-Cephalosporin cross reaction nowhere NEAR 5-10%! really !! only LESS than 1%. TOTALLY safe to use cephs if there is a rash to penicillin

    p207 Under “Carbapenems” forgot to put in Ertapenem and Doripenem. In general forget DAPTOMYCIN the MRSA drug that is oral too.

    p207 Under MRSA forgot: CefTAROLINE the only cephalosporine to cover MRSA forgot TIGECYCLINE the glycylcycline

    p209 Demeclocycline should NEVER be put under antibiotics. Demeclocycline is 100% for SIADH

    p 209 Under Macrolide PLEASE put erythromycin LAST.

    p213-214 forgot to put in MICAFUNGIN or Anidulafungin under echinocandins

    p214 ANidulafungin=EXCELLENT echinocandin. Put in POSAconazole, Vori, Caspo to oral cover Aspergillus. NO ampho for aspergillus any more.

    p216 AMANTADINE and RIMANTADINE are 100% OUT!!! as influenza treatment! gone! Finito!
    Kaput! No more! AMANTa/RIMANTa for flu Chronic hepatitis C gets THREE drugs! add EITHER BOCEPREVIR or Telaprevir to the usual interferon/ribavirin to get SURE up to 80% for Hep C

    p 219 !!! Metronidazole is SAFE in pregnancy. since 2006. Metronidazole SAFE in pregnancy INCLUDING 1st trimester MMWR Recomm Rep. 2006; 55(RR-11):1. CDC supported Metronidazole in pregnancy since 2006

    p265 year 2012 “First Aid: Step 1”. Echothiophate has NOT BEEN MANUFACTURED since 2003. Take your time! It is only a NINE YEAR DIFFERENCE!

    p265 Echothiophate is NOT manufactured since 2003. USMLE does NOT test obsolete, eradicated, DEAD drugs

    p266 MISSING “Tiotropium” the MOST useful antimuscarinic for COPD. put next to Ipratropium.

    p266 Under NO circumstance is methoscopolamine, pirenzepine or propantheline EVER used for ulcers EVER

    p266, Isoproterenol is NOT used any more! Ischemia is most common cause of AV block, Isoproterenol will KILL YOU if you have ischemia

    p267 REmove Metaproterenol. Historical use albuterol

    p268 Add Tamsulosin to alpha1 drugs. it is the MOST used & one missing! No orthostasis

    p269 SVT Delete propranolol. the answer has been metoprolol or atenolol since 1990.

    p281 put ACE inhibitors with Vasodilators. ARBSs are number two choice. First Aid lists the 3rd line drug, hydralazine, first

    p298 AST has NO PLACE in cardiac evaluation. Put MYOGLOBIN to rise in first 4 hours.

    p300 Typo!! it should say “angiotensin receptor ANtagonists” NOT “agonists” we use ARBs!!! in CHF

    p306 Diazoxide is ABSOLUTELY WRONG for hypertensive crisis. NOT USED since 1970’s.
    HOWEVER!! Labetolol (main drug) is left out

    p328. add “High Urine Sodium” for SIADH. add “ADH antagonists” conivaptan, tolvaptan for SIADH

    p333 Put METFORMIN on TOP ist Rx! Add the FORGOTTEN CLASS!!! Sitagliptin (januvia), saxagliptin, linagliptin. Use with metformin and sulfonylurea orally. “Gliptins’ are a Top ten drug in USA for >10 years.
    p351. Candida is NUMBER ONE infectious cause of esophagitis

    p359 say Colonoscopy OR occult blood. Colonoscopy is FIRST and BEST.

    p368 Ulcers. PPI is first, not sure why it is UNDER H2.

    p395 Add Dabigatran and rivaroxaban. these are 10a drugs. AKA “Pradaxa” Great for Afib. Not sure why forgotten.

    p397. Cilostazol for peripheral artery disease. NEVER coronary. dipyridamole rx for stroke only. Not Coronary. missing PRASUGREL TICAGRELOR PRASUGREL TICAGRELOR are alternatives to clopidogrel for combo with aspirin in CAD. Prasugrel MORE efficacy more bleeding. add eptifibitide and tirofiban to abciximab

    p401 PLEASE put “Tamoxifen PREVENTS 50% of BREAST cancer in those with 2 relatives with breast cancer” Please get this info out!

    p 418. Add Anti-TNF drugs (Etanercept, adalimumab) to Rheumatoid treatment. COX 2 NOT better! sulfasalazine in pREGNANT

    p419 BIG!!! do NOT answer Colchicine for acute gout! you will screw up test! use STEROIDS if NSAIDS do not work. Add Pegloticase to treat

    p420 TB is NOT a common cause of infectious arthritis. sorry, TB at LOWEST reported incidence in history of world

    p431 take OUT colchicine for acute gout. it was changed. . Probenecid DE-emphasized too

    p514 Paraldehyde is SOOO current! invented in 1829!!! Just one problem. it is not sold in USA. USMLE does NOT test drugs NOT made

    p514. Phenformin was REMOVED FROM THE MARKET IN 1970s there is NO PHENFORMIN MADE IN 40 years!

    p514. Paraldehyde has NO utility and is NOT MANUFACTURED in US. Phenformin was REMOVED in 1970s

  20. Lastly, number of qs per block is no longer 44. Its from 20 something to 40 something qs per blck. Each blck could have different # of qs but it seems like the last blck always has the least. Also, the relationship btwn 3 and 2 digits-scores is different now.

  21. I must say that one cannot rely on First Aid. The book has a poor quality with numerous errors, horrible index (most of the diseases are not even mentioned in the index), nightmare abbreviation. The quality of High Yield does not really reflect High Yield material, as First Aid is claiming. Most of the so called “First Aid High Yield” is just a few lines with errors that does not reflect the current Step-1 exam. There are lots of outdated drugs, lab techniques and recommendations that are not really high yield. It is really frustrating to waste so much time to look for errors/index. I would NOT recommend this book to students that really want to nail down Step-1 exam. DO NOT waste your money or take a chance to fail the exam and loose valuable time over First Aid, It is just another way of Monopoly (just like McDonald or others) and do minor things: change the cover of the book from light red and yellow to a darker red and yellow, or add more errors to the book. If First Aid is not just a money making Monopoly, lets see how is the 2013 version (another colorful book with tons of errors), or really addressing the poor quality of the book and fixing the numerous errors as mentioned by so many students over and over and over. I find it even more disturbing when First Aid’s Ivy league editors ask students to find/correct the errors and then one get a $10 gift card. It is not the job of the students to correct the book’s errors, it is the editor’s responsibility. I am Not going to buy the 2013, but I will read the posts from frustrated students. Hopefully, other competitors could listen to the students cry for quality and produce a higher quality Step-1 book and not just a colorful book with tons of errors, outdated drugs and low yield materials.

  22. page 288 for insulin in the 2013 the GLUT transport receptor is labeled as GLUT-1 when it should be GLUT-2.

  23. Hello just wanted to give you a quick heads up. The words in your post seem to be running off the screen in Chrome. I’m not sure if this is a formatting issue or something to do with internet browser compatibility but I figured I’d post to let you know. The style and design look great though! Hope you get the issue fixed soon. Kudos

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