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 Studying for the USMLE Sample Schedules Study Resource Information Class of 2009 Board Survey Results Class of 2010 Board Preparation Calendar Frequently Asked Questions 4 5 12 16 18 27 28

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".

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 QBank 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. Youll be grateful you did next year. Use practice exams!

! ! ! ! ! ! !

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 peoples 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 lets 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

! ! ! ! ! ! ! !

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% 30%-50% 15%-25% 10%-20% Normal structure and function Abnormal processes Principles of therapeutics Psychosocial, cultural, occupational and environmental considerations

Step 1 has approximately 350 multiple-choice test items, divided into seven 60minute 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. Kaplans 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, youll 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 Kaplans Q-Bank, although Q-Bank has a longer history with the USMLE Step 1.

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,

! ! ! !

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 JanuaryFebruary-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.

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
Behavioral Science

Estimated Comment Time

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. 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. High yield. Perhaps the most important subject. Again, review early and late. Know Costanzo, shockingly effective. 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 Don't neglect it, but don't blow it out of proportion. First Aid stuff high-yield. 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, cardiotoxicity. 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. Fairly good yield. Glance over immuno- deficiencies-in First Aid the day before the exam. Principles more than details. 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.

Biochemistry

3-4 days

Physiology Anatomy/Histology

4 days 1-1.5 days

Embryology Pharmacology

0.5 days 3-4 days

Microbiology

2-3 days

Immunology Pathology

1-2 days 4-5 days

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Sample Schedule #2 (Lippincott Williams & Wilkins) Assumption: 28 total available days, including the day before the exam. General apportioning of days: Wrap-up: 2-3 days before your exam Days off: schedule as rewards for keeping to your schedule; 1-2 days Full study days: 24 Days by subject: Pathology: 4 days Physiology: 4 days (might be fewer if you are strong in physiology) Pharm: 4 days Micro/Immuno: 4 days Biochem: 3 days Behavioral Sci: 1.5 days Gross/Embryo/Cell/Histo: 1.5 days Neuroanat: 2 days Systems Schedule: Nervous: 3.5 days Cardiovascular: 3 days Respiratory: 2.5 days GI: 2 days Renal: 2.5 days Reproductive: 2 days Musculoskeletal: 2 days Heme/Lymph: 2 days Basic Concepts/General: 2 days Note: a day means an 8-hour day. An hour means a full hour with 5-minute breaks as needed. In addition, you will do 2 hours of questions daily.

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Sample Schedule #3 Total Study Time: 32 days # Wrap up days= 4 days # days off= 2 days (take as half days) Total Study Days= 26 (minus wrap up days +days off) Days Per Subject Path =4.5 (consider BRS) Pharm = 4.5 (consider Lippincotts and First Aid) Physio = 3.5 (Consider BRS) Micro/Immun = 4.5 (Consider Micro Made Ridiculously Simple and Lange-immuno) Biochem and Molecular Bio = 3 (consider BRS and High Yield) Behavioral Science = 2 (Consider High Yield) Neuroanatomy = 2 (Consider High Yield Neuro) Gross Anatomy and Embryo = 2 (Consider First Aid and High Yield) Typical Study Day 8-12 Study 12-1 Lunch 1-5 Study 5-8 Dinner, Exercise, Family Time 8-11 Questions 11:30 BED!!!

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Sample Schedule #4 (40 Days of Navy Seal Training) Topics: 1. General Principles/Biochem 2. Behavioral Science 3. Hematopoeitic/Lymphoimmune System 4. Nervous System 5. Dermatology/Connective Tissues Disease 6. Musculoskeletal System/Anatomy 7. Respiratory System 8. Cardiovascular System 9. Gastrointestional System 10. Renal System 11. Reproductive System 12. Endocrine System Daily Grind: Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day 1: Biochem 2: Biochem/Genetics 3: General Principles 4: Behavioral Science 5: Heme and Lymph 6: Heme and Lymph 7: Catch-up 8: Nervous System 9: Nervous System 10: Skin and CT Disease 11: Musculoskeletal and Anatomy 12: Musculoskeletal and Anatomy 13: Anatomy/Microbiology 14: Catch-up/Microbiology 15: Respiratory 16: Respiratory System 17: Cardiovascular System 18: Cardiovascular System 19: Cardiovascular System 20: Gastrointestional System Day 21: Catch-up Day 22: Renal System Day 23: Renal System Day 24: Reproductive System Day 25: Reproductive System Day 26: Endocrine System Day 27: Endocrine System Day 28: Catch-up/Full 8 hour practice test Day 29: Review: Skin/CT/Musculoskeletal Day 30: Review: Cardiovascular and Neuro Day 31: Review: Endo/Repro/and GI Day 32: Review: Respiratory/Renal System/Microbiology Day 33: Review: GenPrin/Micro/Drugs Day 34: Review: Biochem/Anatomy Day 35: Full 8 hour practice test Day 36: Review Day 37: Review Day 38: Review Day 39: Do nothing related to USMLE Day 40: USMLE

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The Right Resources As you embark on your studies for the USMLE Step 1, choosing the appropriate study materials is crucial to your success. There are tons of review books and sample test question books available for your preparation but money and time are two factors you must consider. Many of these review books cost over $25 and take a significant amount of time to go through. So, here are some recommendations for books that may maximize your study success. General ! First Aid for the USMLE 1 by Bhushan. Le, and Arnin Sample Questions ! Kaplan Services (Q-Bank, full length practice tests) ! Retired NBME Basic Medical Sciences Test Items by NBME ! USMLERx Step 1 Qmax Test Bank ! USMLE Steps 123 Step 1 Question Bank (Be sure to make time for sample questions!!!) Anatomy/Embryology/Histology/Neuroanatomy ! Anatomy: Review for the New National Boards by Johnson ! High-Yield Anatomy by Dudek ! High Yield Embryology by Dudek ! High-Yield Neuroanatomy by Fix Behavioral Science ! First Aid know the First Aid chapter ! High-Yield Behavioral Science by Fadem ! BRS Behavioral Science by Fadem (Be sure to have a decent understanding of the main topics in biostats.) Biochemistry ! BRS Biochemistry, Marks ! Lippincott 's Illustrated Reviews: Biochemistry by Champe Physiology/Neurophysiology ! Physiology by BRS, Costanzo Microbiology/Immunology ! Medical Microbiology & Immunology: Examination and Board Review by Levinson ! Clinical Microbiology Made Ridiculously Simple by Gladwin ! High-Yield Immunology by Johnson Pharmacology ! Lippincott's Illustrated Reviews Pharmacology by Harvey ! Pharm Cards: A Review for Medical Students by Johannsen ! Pharmacology: Examination and Board Review by Katzung

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! !

Pharm Companion First Aid know the section in First Aid!

Pathology ! BRS Pathology, Schneider ! First Aid ! Goljian audio recordings

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Class of 2009 Board Survey Results A survey conducted by a panel of students, the Office of Student Affairs, and the Department of Educational Development and Research was designed to assess the following with respect to USMLE Step 1 preparation: ! ! ! ! Time spent studying Perceived usefulness of the curriculum Perceived usefulness of study resources General wellness

This survey was administered in the spring of 2007 following the exam season for the Class of 2009. Overall, these data should guide your USMLE Step 1 preparation. Keep in mind that the MCAT Physical Sciences and performance on the practice USMLE Step 1 administered 4-5 months before the exam were found to be good indicators of actual USMLE Step 1 performance.

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Zoomerang | Board Study Survey: Results Overview

Board Study Survey

Results Overview
Date: 9/27/2007 5:35 PM PST Responses: Completes Filter: No filter applied

2. Please indicate when you first began to seriously study for Step1?
Summer after first year Fall Semester Second year Early Spring Semester (JanuaryFebruary) Late Spring Semester (February March) After classes finished March 9, 20007 Other, please specify Total 7 3 8% 4%

27

32%

13

15%

35 0 85

41% 0% 100%

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3. Please rate the intensity of your studying during each of the periods below
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option. Not at all Low Medium High

Summer 2006 August - October 2006 NovemberDecember 2006 JanuaryFebruary 2007 March 9 -March 6, 2007

58 69% 46 55% 27 32% 8 10% 2 2%

22 26% 32 38% 42 49% 38 45% 0 0%

3 4% 5 6% 13 15% 28 33% 5 6%

1 1% 1 1% 3 4% 10 12% 78 92%

4. How many hours per week did you exclusively devote to studying for the exam?
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option.

<5

5-10

11-20

21-30

>30

Summer 2006 Fall Semester 2006 Christmas Break 2007 January early March 2007

59 70% 39 46% 26 31% 7 8%

18 21% 33 39% 24 29% 31 37%

5 6% 12 14% 17 20% 19 23%

2 2% 0 0% 12 14% 11 13%

0 0% 0 0% 1 1% 8 10%

0 0% 0 0% 4 5% 7 8%

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6. period?
0 <5 6-10 >10

On average how many hours per day did you study during this designated study 0 2 39 43 84 0% 2% 46% 51% 100%

Total

7. How well do you feel that the first year curriculum prepared you for this examination?
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option. Not at all helpful Somewhat helpful Moderately Helpful Excellent preparation

Human Body Molecules to Medicine Blood and Lymph P&D CVPR

5 6% 34 41% 4 5% 8 9% 2 2%

30 35% 36 43% 29 34% 44 52% 6 7%

37 44% 12 14% 37 44% 29 34% 42 49%

13 15% 1 1% 15 18% 4 5% 35 41%

8. examination?
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option.

How well do you feel that the second year curriculum prepared you for this

Not at all

Somewhat helpful

Moderately helpful

Excellent preparation

Nervous Systen DEMS ID

2 2% 2 2% 4 5%

14 16% 11 13% 9 11%

33 39% 39 46% 35 41%

36 42% 32 38% 37 44%

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Life Cycle

3 4%

22 26%

35 41%

25 29%

9. How often did you attend class during first year when it was NOT required?
Rarely attended About half of the time Most of the time All of the time Total 1 5 24 55 85 1% 6% 28% 65% 100%

10. How often did you attend class during second year when it was NOT required?
Rarely About half of the time Most of the time All of the time Total 7 19 29 30 85 8% 22% 34% 35% 100%

15. Did your sleep habits change during the 4 week study time?
Slept More No Change Slept less Total 23 41 21 85 27% 48% 25% 100%

16. How much protected study time do you believe is adequate for good preparation?
Less than 4 weeks 4 weeks is about right 5 weeks Greater than 5 weeks Total 8 28 35 14 85 9% 33% 41% 16% 100%

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17. Did you reschedule your examination date?

Yes No Total 22 63 85 26% 74% 100%

18. If you rescheduled your examination date was this due to

Anxiety about being ready Personal, health or family problems Prometrics (Testing Center) problems Other USMLE problems Total 19 3 86% 14%

0 0 22

0% 0% 100%

19. How did you spend the majority of your study time?
Studying Alone Studying with Others Balance between alone and with others Total 76 4 5 85 89% 5% 6% 100%

20. meetings, email, etc)

Yes No

Did you interact with other medical students during the study period? (eg in person 65 18 83 78% 22% 100%

Total

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21. If you interacted with other medical students, was this

Helpful Anxiety producing Other, please specify Total 29 21 19 69 42% 30% 28% 100%

22. Please tell us how helpful the following study guides were in your studying
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option. Did not use Not at all helpful Moderately helpful Very helpful

First Aid Step Up Goljan Path Goljan Notes Pharm Cards Langmans Embryology Wheaters Functional Histology BRS series High Yield series Rapid Review series Ridiculously Simple series Microbiology Made Ridiculously Simple

0 0% 44 52% 35 41% 58 69% 25 29% 62 74% 65 77% 11 13% 61 73% 73 87% 64 77% 42 49%

2 2% 6 7% 1 1% 2 2% 9 11% 12 14% 8 10% 4 5% 7 8% 1 1% 6 7% 3 4%

19 22% 17 20% 14 16% 16 19% 28 33% 9 11% 11 13% 28 33% 11 13% 5 6% 10 12% 22 26%

64 75% 17 20% 35 41% 8 10% 23 27% 1 1% 0 0% 42 49% 4 5% 5 6% 3 4% 18 21%

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Micro Cards Kaplan Review Books

54 64% 67 80%

4 5% 5 6%

14 17% 11 13%

12 14% 1 1%

23. studying.

Please tell us how helpful the following commercial resources were in your

Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option.

Did not use

Not at all helpful

Moderately helpful

Very helpful

Qbank USMLErx First Aid Qbook Kaplan Books

9 11% 72 87% 76 92% 69 83%

1 1% 1 1% 3 4% 6 7%

30 36% 3 4% 2 2% 6 7%

44 52% 7 8% 2 2% 2 2%

24. Please tell us how helpful the following review sessions were in your preparation.
Top number is the count of respondents selecting the option. Bottom % is percent of the total respondents selecting the option. Did not use Not at all helpful Moderately helpful Very helpful

Pathology with Dr. Shikes Pharmacology with Dr. French Embryology and Biochem with Dr. Besessen Immunology with Dr. Cohen Reviews provided by 4th years

20 24% 38 45% 49 58% 41 49% 60 71%

7 8% 14 16% 5 6% 10 12% 5 6%

44 52% 22 26% 15 18% 21 25% 12 14%

13 15% 11 13% 16 19% 12 14% 7 8%

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Study Skill Review with Dr. Doyle

59 70%

13 15%

11 13%

1 1%

26. How much of your study time did you devote to USMLE, Kaplan or other questions?
Less than 10% About 25% 25-50% Greater than 50% Total 14 27 34 10 85 16% 32% 40% 12% 100%

27. How much of your study time did you devote to content review?
Less than 10% About 25% 25-50% Greater than 50% Total 0 1 26 58 85 0% 1% 31% 68% 100%

28. What was your state of mind as you entered your clinical training?
Poor Fine Good Excellent Total 12 25 26 20 83 14% 30% 31% 24% 100%

Thank you for taking the time to fill this out. We hope that the results will help your class for Step 2 and other classes that follow you. You will be entered into a drawing for Gift cards.

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Class of 2010 Board Preparation Calendar October 2007: ! Class of 2009 board preparation survey and Class of 2010 strategy and outline for the 2007-2008 year ! MSIII and MSIV panel for questions about the boards November 2007: ! How to tackle questions from on the boards: overall test taking strategy ! Setting up a study schedule ! Ongoing fall and spring: USMLE Step 1 trivial pursuit o Barbara Wilson has been turning First Aid into flash cards and will be developing game-based group learning sessions as a fundraiser for the class (e.g., $5 per person to play with perhaps 5 games going on game night) December 2007: ! 1st option for mandatory basic science shelf exam o Results to test takers will be available over break ! Possible session on wellness/relaxation/stress relief January 2008: ! 2nd option for mandatory basic science shelf exam o Results will be available to students around the end of January ! Content sessions each approximately 3 hours, probably Fridays from 1-4 o 2 physiology high yield o 1 pathology high yield ! Ongoing wellness session February 2008: ! Content sessions o 1 pathology o 2 pharmacology ! Ongoing wellness sessions and individual fitness activities (group rides/hikes/etc) March 2008: ! Final exams for Infectious Disease and Life cycle ! Begin the 5 week break for the boards/vacation/relaxation ! Ongoing wellness sessions and individual fitness activities (group rides/hikes/etc)

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Frequently Asked Questions (answers from student affairs and current 3rd years) How important is the score anyway? For better or for worse, residency programs do look at your USMLE scores as part of their evaluation of resident candidates. It is however just one aspect of your application, which will also include your clinical evaluations, letters of recommendation, basic science grades, and Dean's Letter. The more competitive the specialty (i.e., Neurosurgery, ENT, and Dermatology), the more likely the scores will be used as part of the initial screen students for interviews. If you are leaning towards a particular field(s), ask residents or attendings about the relative importance of Step 1 and check the available data posted on Blackboard Charting Outcomes in the Match. Overall, just keep in mind that while your score does matter, it is only one of many criteria that will help determine your success in matching at the residency of your choice, so keep things in perspective. When should you start studying? The truth is that you already started studying for Step I the first day of medical school, since this exam is basically a cumulative exam of the first two years. In terms of focused studying for the boards, however, most students find that 3-4 weeks is sufficient. Is there enough time in the 2nd year to study for the boards? You should study for class as you have been and review when you have time. Christmas break is a good time to get in a little extra review. Dont sacrifice your coursework for the boards, that material is on there too, especially infectious disease that is placed conveniently right before boards. (- 3rd year med student) What is the best way to use the review books? One thing I wish I knew, and someone probably even mentioned at one time but I ignored it is that review books are for REVIEW! I spent much of my winter break trudging cluelessly through the ID section of First-AID before we had even had our ID course. I thought it would be good to put a decent dent in first-AID and that it would also help give me an edge in our upcoming ID class. However, I just numbed my mind trying to memorize list after list of bugs and drugs without any scaffolding to support this information. Needless to say, these short-term memories collapsed quickly, and I walked away from this time-wasting experience with only a fine dust coating of familiarity with some of the ID terms. (- 3rd year med student) What do you think about pushing back your test date? Don't push your step 1 date back; pick a time and stick to it. You will do nothing more than stress yourself out by prolonging the agony. If you don't trust yourself, then do what I did - book a flight to Las Vegas two hours after step 1 four months in advance. (- 3rd year med student) What worked best for you? Following what works for you and ignoring what everyone else says - it will only make you panic and waste time in the end. What are some things that kept you sane? Taking time for myself. Take a few hours every now and then to get out and get some fresh air.

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How did you make time for friends and family?

You have to eat sometime!

What are some tips for getting through the test day? It's not as bad as it sounds. Take good food with you, bring a little sugar, and some Gatorade. Take small breaks every hour if you need them. Don't stress over a bad section. And remember that everyone walks out thinking they failed. For other frequently asked questions, visit: http://www.usmle.org/FAQs/faqusmle.htm

-Good luck and happy studying!!!

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