Tips for USMLE Step 1Presentation by: Joe WalshFor educational purposes only

Test Format350 questions7 sections of 50 questions at 1hr each (one section does NOT count).8hrs total time. 45min of break to distribute.Add 15min to break if you skip tutorial (recommended).Finishing a section early adds remaining time to break.Register by Dec & ideally schedule for mid-June.Need 3-4mos of hardcore study time.Register online at www.nbme.org - schedule 3 mos elgibilityEligibility period with NBME, Scheduling Permit with prometric.

Types of Questions

Example Question 1 What are the calcium-dependent proteins responsible for cell-to-cell junctional adhesion?A. CadherinsB. CollagensC. IntegrinsD. ConnexinsE. OccludinsFactual Questions

Example Question 1 What are the calcium-dependent proteins responsible for cell-to-cell junctional adhesion?A. CadherinsB. CollagensC. IntegrinsD. ConnexinsE. OccludinsFactual Questions

Example Question 2 A 34-year-old Brazilian housewife from Rio de Janeiro complained of a cutaneous ulcer on the left forearm and palpable subcutaneous nodules. Her illness had begun as a small pimple about 2 months prior to presentation. On physical exam she presented with a 10 mm ulcer on her left forearm and subcutaneous nodules ascending linearly towards the axilla. Mycological cultures yield Sporothrix schenkii. What do you prescribe as treatment?A. MebendazoleB. ActinomycinC. TeraconazoleD. ItraconazoleE. NystatinFactual Qs with a Trick

Example Question 2 A 34-year-old Brazilian housewife from Rio de Janeiro complained of a cutaneous ulcer on the left forearm and palpable subcutaneous nodules. Her illness had begun as a small pimple about 2 months prior to presentation. On physical exam she presented with a 10 mm ulcer on her left forearm and subcutaneous nodules ascending linearly towards the axilla. Mycological cultures yield Sporothrix schenkii. What do you prescribe as treatment?A. MebendazoleB. ActinomycinC. TeraconazoleD. Itraconazole (Potassium Iodide)E. NystatinFactual Qs with a Trick

Example Question 3 A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?A. Acute blood lossB. Chronic lymphocytic leukemiaC. Erythrocyte enzyme deficiencyD. Erythropoietin deficiencyE. ImmunohemolysisF. Microangiopathic hemolysisG. Polycythemia veraH. Sickle cell diseaseI. Sideroblastic anemiaJ. b-Thalassemia trait Reasoning Questions

Example Question 3 A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?A. Acute blood lossB. Chronic lymphocytic leukemiaC. Erythrocyte enzyme deficiencyD. Erythropoietin deficiencyE. ImmunohemolysisF. Microangiopathic hemolysisG. Polycythemia veraH. Sickle cell diseaseI. Sideroblastic anemiaJ. b-Thalassemia trait Reasoning Questions

Example Question 4 A 68-year-old male with a history of type 2 diabetes and peripheral vascular disease develops abdominal pain from bowel ischemia. Exploratory laparotomy revealed a 4-cm region of necrotic colon, which was subsequently resected. Where was this ischemic region most likely located?A. Ascending colonB. Hepatic flexureC. Splenic flexureD. Descending colonE. Sigmoid colonReasoning Questions

Example Question 4 A 68-year-old male with a history of type 2 diabetes and peripheral vascular disease develops abdominal pain from bowel ischemia. Exploratory laparotomy revealed a 4-cm region of necrotic colon, which was subsequently resected. Where was this ischemic region most likely located?A. Ascending colonB. Hepatic flexureC. Splenic flexureD. Descending colonE. Sigmoid colonReasoning Questions

Example Question 5 A 46-year-old male presents to the emergency room with tearing pain in his chest radiating towards his back and blood pressure 84/40. He is pale and diaphoretic but remains conscious. He tells you that he is a Jehovahs witness and refuses to receive any blood products before or during surgery. What do you tell the patient?A. Your request is against my ethics, and I feel that I must find another doctor for you who is willing to comply with your request.B. I insist that you receive a blood transfusion because otherwise you will probably die.C. We will only use blood products as absolutely necessary to save your life.D. We will comply with your request because your condition does not appear life-threatening.Ethics Questions

Example Question 5 A 46-year-old male presents to the emergency room with tearing pain in his chest radiating towards his back and blood pressure 84/40. He is pale and diaphoretic but remains conscious. He tells you that he is a Jehovahs witness and refuses to receive any blood products before or during surgery. What do you tell the patient?A. Your request is against my ethics, and I feel that I must find another doctor for you who is willing to comply with your request.B. I insist that you receive a blood transfusion because otherwise you will probably die.C. We will only use blood products as absolutely necessary to save your life.D. We will comply with your request because your condition does not appear life-threatening.Ethics Questions

-Do NOT use common sense for these.-Learn medicolegal rules (Hi-Yield or BRS Behavioral Science).-Dont take into account sounding mean.Ethics Questions

Meaning of ScoresPassing score was raised from 174 to 182 in May 2003.Average is usually ~215 and each standard deviation is ~20 points (theoretical max 300 but curve exists).Mean & SD for your specific test will be given with your score.If normal distribution, 68% of values are within 1SD and 95% are within 2SD.Two digit score (1-99) does NOT equal percentile.

Meaninglessness of ScoresBe careful judging advice based on scores (target, styles).Set a realistic goal for your needs and abilities (stepping stone).Competitive residences include Ophthalmology, Orthopaedics, Neurosurgery, Emergency Medicine, Radiology, etc.Also competitive to go to top 10 programs or desirable geographic locations in ANY field.Usually breaking 1SD is sufficient.

Creating a GoalDifferent studying strategies based on goals:Passing the test (master core high-yield info)Breaking 1SD (high-yield plus know some low-yield)Breaking 2SD (high-yield plus lots of low-yield info)

Risky if you create an unrealistic goal.

Creating a GoalHow do you know what goal you can achieve?Honoring classes is sometimes unrelated.People who did well in classes may do poorly on Step 1 and vice versa.Luck component (many different test versions; different score distributions & curves)

Diagnostic ExamsFree Kaplan diagnostic test (% correct x3) = Starting pointCan realistically increase score by 10% raw score max (or 30 points max) each month.NBME diagnostic test 1-2mos before test (evaluate progress & effectiveness of study plan).Adjust studying in final month based on diagnostic.Only use First Aid or other general source in final week.Check-out testing site (can walk around inside).COMMON SENSE: Sleeping & Eating (physical = mental)

Kaplan or NOT?Boxers or Briefs?

DEPENDS!!

KAPLAN or notPros:Keeps you on trackExtrinsic motivationProven recordSkilled teachersGeared towards achieving a good score

Cons:ExpensiveNot unique or individual preparationGeared towards passing or 1SDStifling towards additional independent study

General Study StrategyContentQuestions

General Study StrategyChoose books for content reviewFormat your comfortable with/used in M2 classesHigh yield without extraneous infoClass notes NOT BEST SOURCEDont spend too much time on anatomy, Biochem, Behav. Sc.Emphasize ACTIVE reading - Ask questions to reinforce what youve learnedGradually work questions into study planStart w/ 1 block of 50 q and inc q weekRead explanations carefully - write down wrong answers Constantly reassess strengths and weaknesses

GENERAL SOURCES-Dont write in First Aid until last 2-3mos.-Read multiple times -Use as starting point for content review

Content ReviewConsensus must read booksMicro Ridiculously SimpleConstanzo BRS or Physio textBRS PathPathophysiology for Boards and WardsPharm Cards

Question ReviewKaplan Q-Bank2000+ questions: excellent stratification by subject, organ system, etc..NMS question bookBlackwells free test onlineNBME tests(2)Robbins question book

-Board Simulator Series (BSS): organized by Organ Systems.-5 books of questions & explanations, four-and-a-half tests per book.-Reading explanations is more painful than doing the questions.-90% of those who start BSS never finish (too painful).

Specific Books UsedANATOMY: Hi-Yield Gross AnatomyBEHAV SCI/PSYCHOPATH: Hi-Yield Behav Sci BIOCHEMISTRY: BRS Biochem(didnt like HY)EMBRYOLOGY: Hi-Yield HISTOLOGY: Hi-Yield (nothing is needed)IMMUNOLOGY: Hi-Yield (nothing is needed)NEUROANATOMY: Hi-Yield, Ridiculously Simple (BRS = too detailed)MICROBIOLOGY: Ridiculously Simple, Micro CardsPATHOLOGY: BRS, Pathophysiology for B & WPHARMACOLOGY: Lippincotts, Pharm CardsPHYSIOLOGY: Costanzo TextAUDIO SOURCES: Goljan, Gold Standard

WEEK/DAY OF TEST ADVICEWeek of:Get up early and be active during dayGo over first aid slowly one last timeReview pictures, notes, wrong answersDay of:Pack lunch, bring layers(cold test center)After:Run, dont walk, to pub

*Not advocating any one study strategy - just want to let you guys know whats out there and what myself and my peers have found most helpful in preparing ourselves for the test.*This will be on AOA website along with a wealth of other study resources so no need to take notes*One section is experimental - very vague - some students will assume/pray that these represented the most difficult questions on the test but no one can know for sure.*Highly recommend skipping tutorial - 15 min can make the difference if youre a slow test-taker*Cannot hurt to schedule as early as possible as long as you plan to take it within the 3 mos elgibilty period - a lot of students will want to push back test so if this is a possibility consider it in your scheduling - Helps if you know 3rd year schedule but not crucial - I took mine on June 13 and had 2 weeks to veg out before I started my first clerkship*People speculate that approx. 60% = passing score and that % x 3 = total score1 SD approx 240 put you in the ball park for most competitive programs2 SD approx 260No sure fire way to achieve score you want but setting a goal gives you an idea how much work you have to put inQ-bank is also a good idea to gage where youre goingDecide whether you want to use mult books for each subject or read one book mult times