Step 1 Reference Guide
Case Western Reserve University School of Medicine
January 2018
Created by Molly Kelly, Erika Lampert, Allie Reid, and Sarah Slaven, in
collaboration with the Student Affairs Office
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A collection of ~13,000 flashcards created and continuously edited by medical students. Each card is tagged so cards can be sorted by category/organ system.
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Step 1 Reference Guide
Case Western Reserve University School of Medicine January 2018 Created by Molly Kelly, Erika Lampert, Allie Reid, and Sarah Slaven, in collaboration with the Student Affairs Office
Table of Contents Content Page
- About the Resource Guide ………………………………………………………... 3
- Step 1: The Basics …………………………………………………………………. 4
- Studying: When, Where, and How a. Did students study before their dedicated study periods? ………………... 5 b. For how many weeks did students study? …………………………………. 6 c. Where did students study? …………………………………………………… 7 d. How, generally speaking, did students organize each day? ……………... 7 e. When did students take practice exams? ………………………………... 7- 8
- Studying: What a. Which resources were most commonly used? …………………………….. 9 b. Resource-by-resource advice ……………………………………………. 9 - 19
- Wellness ………………………………………………………………….……. 20- 21
- Final Advice: “What would you have done differently?” ……………………… 22
Step 1: The Basics How do I sign up? Before you can choose a test date and location for step 1, you must submit an application for a USMLE scheduling permit. When you submit this application, you will also be required to choose a three-month window during which you want to schedule your exam. The permit will allow you to pick an exam ONLY during this three-month window (if you wish to change the window at a later date, there are fees). The 2017 fee for the USMLE scheduling permit was $605. Apply here: https://apps.nbme.org/nlesweb/#/authenticate After filling out the application, you will receive a Certificate of Identification and Authorization Form that is pre-populated with your information. This form needs to be signed by the school registrar and then sent to the NBME. Please note that this form also requires a 2” x 2” passport-style photo, which you affix to the form. The registrar will mail this form for you; once the NBME receives it, you will get an email containing your Step 1 permit. Once you have this permit, you may register for your exam. What is the test like? Step 1 is a one-day exam administered on a computer. It consists of seven 60- minute sections, and each section has 40 questions. Occasionally, you may have a section with a few fewer than 40 questions, too. You are given 45 minutes of break time that you may use in-between sections however you would like. The testing software looks quite similar to that of U-world, so it navigating between questions on test day should not be difficult. Prior to beginning the exam, there is a 15-minute tutorial. If you skip the tutorial, these 15 minutes will be added to your total break time, giving you one hour instead of 45 minutes. You can view the tutorial ahead of time by accessing the following link: orientation.nbme.org/Launch/USMLE/STPF In the exam room, you are given:
- Double-sided dry erase sheet + dry-erase marker
- Noise cancelling headphones (which you can use only if you wish to do so)
- Audio headphones (parts of the exam do have audio) You are not allowed to bring food/drink into the exam room with you, but you may keep it in a locker outside the exam room. During breaks, you are allowed to access anything in your locker, including your cell phone, any study materials you wish to review, food, drink, etc.
Studying: When, Where, and How Should I start reviewing before my dedicated study time? Each student is inevitably going to have a different opinion on this. Of note, the overwhelming majority of Case students noted that looking back, if they had studied anything beforehand, it would have been pharmacology only.
Studying: When, Where, and How, cont. Where should I study? Case and Lerner students answered this question pretty similarly: about 2/3 of students stayed in Cleveland to prepare, while about 1/3 went home. A couple of students also split time between home and Cleveland. How should I organize my day? Excluding half- or full days off, most students reported 10-12 hours spent studying each day. Students tended to spend a half to two thirds of the day on question sets – that is, answering questions, reviewing the explanations, and annotating relevant material into First Aid. Most students reported ~2- 3 sets per day; many added in an additional set as they became more efficient. Per student report, the other one third to one half of the day was spent on micro, pharm, or other content review, most commonly with First Aid or Pathoma. When should I take practice exams? Students reported different approaches to timing of practice exams. A general approach endorsed by many was one exam at the start of study period, one exam after first pass of material, and several additional exams during repeated passes of material, as the exam date drew closer. For more information about when students timed their practice tests, check out the graphs on the following page. What should I use to study? See the Resources section for more information about which resources were most commonly used and tips about how to use resources effectively.
Studying: When, Where, and How, cont.
Studying: What, cont. ANKI BROSENCEPHALON CARDS A collection of ~13,000 flashcards created and continuously edited by medical students. Each card is tagged so cards can be sorted by category/organ system. Cost: free Download here: https://www.brosencephalon.com/flashcards/ “Brosencephalon was king if you start early in M2 or M1; it is not so good for classes, but dedicating a bit of time each day to memorizing cards from the relevant block proved to be nice when dedicated came around months later. I only did the sections I felt weak in.” BOARDS AND BEYOND Collection of >300 review videos organized by topic/organ system, with USMLE- style quiz questions at end of each video. Cost: varies depending on length of subscription Download here: https://www.boardsbeyond.com/signup Try sample videos before purchasing: https://www.boardsbeyond.com/samples “Really well made videos explaining everything. Used for areas of weakness.” “I wish I found this earlier in my studying. Awesome resource for teaching relevant anatomy. The neuro and cardio chapters are gold.” DOCTORS IN TRAINING Review course with videos and written workbook designed as a comprehensive review of step 1 content. Cost: $ Download here: https://www.doctorsintraining.com/shop/usmle-step-1/ “Did one video and quit. I don't think it's a high quality resource, but if you lack the organizational skills to coordinate your own study program this might be a good option for you.” “Helpful, but too many videos and took too much time. Was helpful in topics that I felt I needed more attention (e.g. ophtho stuff, interpreting EKG).” “I preferred this style of learning. More engaging and structured. Would recommend annotating First Aid with materials from the DIT videos.” “Watched a few of their vids when I was struggling w/ cards pharm.”
Studying: What, cont. FIRECRACKER Flashcard-based program that reviews material covered in First Aid and Pathoma; can organize cards based on topic or complete them randomly. Also offers practice exams. Cost: varies depending on length of subscription Download here: http://www.firecracker.me/pricing Can do seven-day free trial before purchasing “Used it very peripherally, before the exam period, did not like since it had so many questions that I felt were too specific and would never be asked.” “I used Firecracker during blocks 3 and 4. I am not someone who remembers details without the larger context so I did not find this mode of studying useful.” “Used it very peripherally, before the exam period, did not like since it had so many questions that I felt were too specific and would never be asked.” FIRST AID Most students use this as their central reference and annotate information gathered from other resources and Q-banks into First Aid. This provides a solid framework for studying, especially during first pass, and then can be used as reference during later passes. First Aid includes all of the testable information and topics but does not contain any in-depth explanations; thus, it is best used for review and memorization, not for primary learning. Most students made it through First Aid 2-2.5 times, and some made it through 3 times. Those that only made it through once commented that they wished they had done it a second time. Some students read through FA prior to the dedicated study period but many did not. While the dominant strategy was to annotate all of the other resources into FA, some students did not like having to read and memorize from a book and instead made flashcards of the information found in FA. Cost: ~$50 on Amazon “For the first half of my study period, I annotated everything that I reviewed into First Aid. After taking my first practice NBME, I realized I had not nailed down a lot of small details that are in First Aid. I spent the second half of my study time really reading over First Aid (I got through it three times over the 8 weeks) and capturing those details, and it made a huge difference in my score on practice tests. Getting my first aid spiral bound was also helpful (Staples can do this for ~$5-$10).”
Studying: What, cont. “I used these to help with Pharm. I liked that they were presented with vignettes that had all of the drug class information on the back. Pharm was the most difficult subject for me to get down for Step 1 because I didn't get a grip on how I was studying for it until late in my study period. I thought these were helpful overall.” “Sort of helpful. I worked through the flashcards for an hour prior to starting each day during dedicated study time. They helped me keep track of all the drugs and sort them into groups, but they were also much too detailed.” “Ran through these an hour a day, nothing special to them, they work. Case doesn't do a good job covering medications so pharm will be a subject most people need to devote time to.” “I attempted using these flashcards, but I found them difficult to learn from--the information didn't stick well for me. I felt there was too much information/detail on each card. I ended up using them more as quick reference and supplemented them with U-World and First Aid.” NBME PRACTICE TESTS Four-section tests written by the NBME that mimic step 1; exam is called the Comprehensive Basic Science Self-Assessment (CBSSA). Can be taken with or without timer mode. Forms with smaller numbers (13, 15) are older practice tests and forms with higher numbers (18, 19) are newer. Some claim that certain forms are more predictive than others of actual step 1 scores, but based on student responses there was little consensus about this. Toward the end of study period, many students took a full NBME exam and half of a U-world exam in one sitting to improve stamina before test day. Cost: $60 per test Download here: https://nsas.nbme.org/home “I’d recommend taking as many of these as you can. U-World questions were enormously helpful for reviewing material, but I quickly realized after taking practice NBMEs that the NBME questions test the material somewhat differently. This affected how I studied and what I focused on for the rest of my study period.” “Useful to gauge how you are doing.” “Helpful for building up stamina.”
Studying: What, cont. PATHOMA Pathology review that is organized into videos, with corresponding workbook. Does not review pharm, micro, physio, etc. Many students used this to learn material during the first two years and annotated into First Aid beforehand. The majority of students listened/watched 2-3x total. Cost: depends on length of subscription Download here: http://www.pathoma.com/ “One of the best resources out there, went through it multiple times. Chapters 1- 3 are the highest yield sections and I had many questions verbatim from there.” “Pathoma was a great high-yield resource. I would recommend going through the videos in order if possible, because there are recurring themes that appear throughout the videos. I annotated First Aid as I watched the videos the first time through. That way, during my second pass through Pathoma, I could watch the videos at a faster speed.” “I thought Pathoma was helpful for giving me a framework with which to think about topics. For example, it clearly spelled out all of the different renal pathologies I needed to know, and it highlighted important differences between them. However, I found that some important details were not captured in Pathoma. I therefore watched it through (and annotated as I went) once and then I continued to review the diseases Dr. Sattar mentioned with other resources (U- world, First Aid) to learn the missing details.” “Very good for developing the "why" of things before hardcore memorizing.” “Helpful in getting more details about disease processes/pathophys. He does a lot of the high yield stuff you'll see on Step 1 but probably won't have some of the obscure stuff.” “Did not rely on heavily. Watched everything once and selected topics (ovarian/testicular tumors, jaundice ddx) again later in study pd. Watched the first 3 chapters on general stuff twice.” PICMONIC
1,300 audiovisual mnemonics of 1-2 minutes each (similar to Sketchy). Has optional quiz mode as well. Cost: varies Download here : https://www.picmonic.com/pricing/medicine
Studying: What, cont. doing 2 separate question banks and increasing the N of questions encountered.” “I started U-world on day one and I completed one pass of the questions. I took my time with the questions: reading each answer choice, and really carefully annotating. I did not do a second pass because 1) it took me so long to get through it once and 2) I initially started the second pass, but I found that I was just getting questions right because I remembered the question, not the content. I think U-world is the most helpful resource but be sure to also review First Aid. I was missing a lot of small details and did quite poorly on my first practice test (by which point I had focused on U-world rather than reading First Aid). When I started supplementing U-world annotation with just reading First Aid with a close eye, my practice scores drastically improved.” Q-BANKS: KAPLAN Collection of questions with detailed explanations for each question and answer choice. Can organize question sets by topic or create randomized sets. Also offers practice exams. Each question has First Aid citation. Cost: depends on length of subscription Download here: https://www.kaptest.com/medical-prep/usmle/usmle-prep- course/step- 1 - qbank “It was ok at best but I felt that more questions couldn't hurt. There were lots of low yield facts that I never used. Finished about 10%.” “Barely used. Wish I didn't spend $$$ on it.” “Some of the questions were very detailed. The practice test for Kaplan was AWFUL. DO NOT DO IT; IT IS A WASTE OF TIME.” “I used this once I had finished U-World. I found it was more helpful to do new questions rather than go through U-World again because I found I had memorized many of the U-World answers. The Kaplan questions tended to be a little more detail-oriented and maybe weren't super representative of the actual exam but it was still good practice and I learned a lot from the questions I got wrong.” “I did a few hundred questions from the Kaplan Q bank after completing the U- world Q bank. I stopped because 1) the answer explanations were sometimes confusing 2) I felt there was unnecessary detail. I also just felt that I was spreading myself thin by using 2 different q banks; I thought it would be more helpful for me to solidify what I had already learned rather than try to keep learning new bits of content.”
Studying: What, cont. Q-BANKS: USMLE Rx
2,300 questions reviewing step 1 content. Each question has relevant First Aid citation. Can also subscribe to short videos that review high-yield content. Cost: depends on length of subscription Download here: https://www2.usmle-rx.com/content/step- 1 - qmax “Did not use. But I did use the USMLE RX VIDEOS which were AMAZING!!! They are essentially the pathoma video equivalent for first aid.” “I started using this Q bank during block 6. I finished almost all of this Q bank in addition to U-world. For me this was the best combination. The questions in this Q bank are excellent and it's a great teaching and learning tool. They include the sections of First Aid that correlate with each question. I finished this Q bank before I started on the U-world bank. Plus you can actually copy and paste stuff from this bank unlike U-World.” “Used this for micro during block 5 and neuro and psych during block 6 - good way to review first aid but not worth your time during dedicated. (unless you absolutely want max # of questions)” “Moderately helpful. It is helpful to do before step studying, but maybe not during step studying.” SKETCHY MICRO Cartoons explained in short videos (usually 5-10 minutes long) to help remember different microbes and important details. Found by most students to be a very helpful resource. A useful strategy was to print out the pictures corresponding to the videos and get them spiral bound or paste them into a notebook. Students then annotated the pictures with commentary from the videos, FA, etc. Another strategy was to create flashcards from the videos. Many students started watching the videos prior to the dedicated study time, i.e., during block 5, and then re-watched each video multiple times during the dedicated study time. On average, students spent 45 minutes to 1 hour on videos each day and felt that it was a nice break from Q-banks and First Aid. Cost: depends on length of subscription Download here: https://www.sketchymedical.com/#!/home Can try free trial before purchasing
Studying: What, cont. significantly more dense than those of Sketchy Micro, with many drugs being lumped into a single video. However, many students did still continue to use it and found it to be helpful for memorizing drugs and side effects, especially if they preferred visual memory cues over flashcards or brute force memorization. *Certain sections that students names as being the most helpful include: sympathomimetics, cholinergics, antibiotics, neuro-psych and anesthesia Cost: depends on length of subscription Download here: https://www.sketchymedical.com/#!/home “Also helpful though not quite as helpful as Sketchy Micro. The videos are longer and thus harder to pay attention to without zoning out. I found the sympathomimetics, cholinergics and antibiotics videos to be most helpful. I would watch 1-2 videos a day.” “YES. All I needed to do well on pharm on Step 1 and it's still helping me to this day on the wards. I tried to intersperse the sketchy pharm topics with their respective sections in First Aid and Pathoma but I didn't plan well enough and couldn't adhere to that schedule. Ended up just dedicating 1-2 weeks and did one chapter a day of Sketchy Pharm. Reviewed the pictures for second pass to make sure I remembered the images and knew what the symbols stood for. Would recommend over flashcards.” “Some of the sketchy pharm chapters are gold (neuro-psych and anesthesia come to mind). Some were too convoluted. Find out which work for you. I found it an easy way to learn pharm.” “This is the one resource I wish I had started sooner. It definitely takes a lot of time up front to put in to watching the videos because they are longer, but if pharm is one of your weaker points, it is so worth it. Specifically autonomic, anti- arrhythmics, barbituates/benzos/sleep drugs, and anti-epileptics are done very very well!” “Videos are longer than sketchy micro and not as good but I still found this to be very useful. Choose one pharm reference at the beginning and stick to it. For example, if you're using sketchy, don't mess around with the Lange flashcards.”
Wellness A common theme that presented itself amongst surveyed students is best summarized by the following response: “Before step 1 studying, older students tell you how horrible the work hours are and that you are 'stressed.' I think we would all do better to more realistically prepare younger students for things like the (sometimes overwhelming) anxiety and stress, self-doubt, and inherent loneliness that are part of this process. It is not just mentally grueling, but emotionally grueling as well.” How did students manage their stress? “Having a schedule in which you have flexibility in terms of time, but set tasks that you need to complete in the day helped me. Also, being able to make all of your decisions ahead of time so you don't need to decide what you are going to do next is massively helpful. The more brain space you can save for studying, the better you feel.” “Have a friend that you feel comfortable talking to when you feel down/have a breakdown. Help each other norm and don’t worry about what other people are doing if you are happy with your progress/plan.” How did students take breaks?