Making Your Step 1 Review Effective
January 13 th , 2014
Scott Robertson
Regional Medical Programs Director scott.robertson@kaplan.com

“We estimate that we will see domestic production of medical school graduates functionally surpass our current number of 41 52.5
78 positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate
Medical education 225 765 2015 http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519
Source: New England Journal Of Medicine
(http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519)

Specialty
Family Medicine
Psychiatry
ObGyn
Pediatrics
Mean US Med scores
2011 (2009)
Matched
213 (214)
214 (216)
220 (219)
221 (219)
Years of residency
3
4
4
3
Mean hrs/ week
52.5
48
61
54
Schedule type
Uncontrollable
Controllable
Uncontrollable
Uncontrollable
Salary range
$175k-$220k
$173k-$248k
$251k-$326k
$160k- $228k
Emergency Medicine
Anesthesiology
General Surgery
Neurology
Internal Medicine
Pathology
Transitional Year
Orthopedics
Diagnostic Radiology
Neurosurgery
Otolaryngology
Dermatology
Plastic Surgery
223 (222)
226 (224 )
227 (224)
225 (225)
226 (225)
226 (227) n/a (236)
240 (238)
240 (238)
239 (239)
243 (240)
244 (242)
249 (245)
4
5
1
5
3
3
4
6
3
4
5
4
-
53.5
45
-
57
45
-
58
58
46
61
60
55
Controllable
Controllable
Uncontrollable
Controllable
Uncontrollable
Controllable
-
Uncontrollable
Controllable
-
Controllable
-
Controllable
$239k-$316k
$331k-$423k
$284k- $383k
$408k (median)
$184k- $231k
$239k- $331k
-
$397k-$600k
$377k-$478k
$287k- $637k
$245k (median)
$313k-$480k
$275k-$499k

Specialty
Family Medicine
Psychiatry
ObGyn
Pediatrics
Mean US Med scores
2011 (2009)
Matched
213 (214)
214 (216)
220 (219)
221 (219)
Years of residency
3
4
4
3
Mean hrs/ week
52.5
48
61
54
Schedule type
Uncontrollable
Controllable
Uncontrollable
Uncontrollable
Salary range
$175k-$220k
$173k-$248k
$251k-$326k
$160k- $228k
Emergency Medicine
Anesthesiology
General Surgery
Neurology
Internal Medicine
Pathology
Transitional Year
Orthopedics
Diagnostic Radiology
Neurosurgery
Otolaryngology
Dermatology
Plastic Surgery
223 (222)
226 (224 )
227 (224)
225 (225)
226 (225)
226 (227) n/a (236)
240 (238)
240 (238)
239 (239)
243 (240)
244 (242)
249 (245)
4
5
1
5
3
3
4
6
3
4
5
4
-
53.5
45
-
57
45
-
58
58
46
61
60
55
Controllable
Controllable
Uncontrollable
Controllable
Uncontrollable
Controllable
-
Uncontrollable
Controllable
-
Controllable
-
Controllable
$239k-$316k
$331k-$423k
$284k- $383k
$408k (median)
$184k- $231k
$239k- $331k
-
$397k-$600k
$377k-$478k
$287k- $637k
$245k (median)
$313k-$480k
$275k-$499k

Understand what you need to know and do in order to solve USMLE questions

Step 1 Evolution
Single Jump, 1980’s
Which of the following is the drug of choice for a patient diagnosed with oral thrush?
○ A. Amphotericin B
○ B. Fluconazole
○ C. Griseofulvin
○ D. Ketoconazole
○ E. Nystatin

Step 1 Evolution
Double Jump, 1990’s
A 28-year-old HIV-positive man complains to his physician of a recurrent whitish film that seems to grow on his tongue and oral mucosa. A germ tube test is positive. Which of the following is the drug of choice for this patient?
○ A. Amphotericin B
○ B. Fluconazole
○ C. Griseofulvin
○ D. Ketoconazole
○ E. Nystatin

Step 1 Evolution
(Triple Jump, today)
Answer = B

Step 1 Evolution
(Triple Jump, today)
A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities.
Furthermore, she is having a more difficult time recalling the names of common objects.
He states that he often finds her wandering around the house with an “absent” look on her face. Which of the following structures is most recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities. Furthermore, she is having a more difficult time recalling the names of common objects. of the following structures is most likely affected in this patient?
○ A
○ B
○
○
B
C
○ C
○ D
○ E
○ F
○
○
○
D
E
F

To excel on (not simply “pass”) your exam…
• Set up a strategic study plan and stick to it
• Anticipate that questions can present the basic clinical sciences in a different format than you are typically used to seeing
• Review the material in ways that mimic current question demands
• Study actively, not passively
• Build in tactics to minimize forgetting key information
• Focus on understanding, not just memorizing
• Know the USMLE testing software by appropriate use of Kaplan diagnostic , Qbank, and sim exams

Speak the Language: Build your test question vocabulary
Glossary of Terms Frequently Used in Test Questions
Term Definition
Abolish To do away with, to eliminate
Absolute value The distance from zero, disregarding + or - sign
Abundant Plentiful, numerous
Account for
Acquire
Acrid
Adjacent
Aggravate
Explain, justify
Get, obtain, gain
A sharp taste or smell
Near or next to
Irritate, make worse
Alter
Amenable
Amplify
Apparent
Arrest
Change, modify
Changeable, yielding, pliant
Enlarge, make bigger
Visible, evident
To stop, check or hold
Attenuate To weaken or reduce in force or amount
Attributable to Result from, be caused by
Bear To support, hold up, endure, show or exhibit some feature
Causative agent Cause
Cessation Discontinue, end
Cloying
Coalesce
Comprise
Concomitant
Concurrent
Confer
A too sweet smell or taste
To grow together, combine as one thing
To include or contain
To accompany or occur at the same time, along with
Same as concomitant, but associated with time
To give

1. PASSIVE studying – wholly focused on content review or video review or curriculum notes review…
2. Insufficient or INAPPROPRIATE practice with questions
3.
MEMORIZING content, but not understanding
4.
MISREADING, misinterpreting questions
5.
DEVELOPING inappropriate test day strategies

The ACTIVE study cycle for all subjects…
Self Test Analyze
Remediate

Review Actively…from the start!
• Make summary notes of key aspects
• Color code to cluster and highlight similarities/exceptions
• Use diagrams and charts to summarize key data
• Do questions before and after reviewing
• Know “most commons” and “hot topics”
• Change study modes frequently to refocus your attention
• Use Qbank properly
• Work with a question partner
• Consider other Kaplan online resources to offer a fresh view of Step 1 topics you find difficult

Use Your Qbank Properly
• Begin using timed mode as soon as possible
• Cover answer choices initially to focus on question stem information
• Look at why, not just what you missed when testing
• Look for patterns among your errors, then adjust study to minimize these errors
• View questions as a guide to what content to focus on and how to store the material in memory for easier application to questions
• Avoid thinking of practice test scores as a judgment on your intelligence
• Keep mixing in items on content reviewed previously to better retain and to adjust to random nature of real exam

Try Question Partnering
An activity that can help you identify habits that are costing you points on exams
A nice change of pace from solo reviewing
An opportunity to learn new approaches to solving questions
A chance to provide these same benefits to your partner
An ACTIVE learning technique!!

How many questions is “enough?”
• Too many too soon wastes questions and may reinforce incorrect beliefs about the depth / difficulty of the Step 1 subject material
• Too few too late will not adequately prepare you for test day – cramming suppresses learning!!
• Sources:
Kaplan Step 1 High Yield, Step 1 Qbank, Step
1 sims (2), a 2 nd Step 1 Qbank (1 month)

Create an Effective Study Plan
• Get organized TODAY !!!
 Note important school dates and deadlines
 Schedule review tasks around those dates
• Self-assess TODAY !!
• Hard to know where you need to go until you first know where you are starting from! Online Kaplan
Diagnostic is your answer!!
• Integrate use of study resources TODAY !!
• Print materials like the First Aid pages
• Online resources like Qbank, NBME assessments
• Interactive resources, e.g. classmates, med advisors

Using Extra / Vacation Time
• Link review of 1 st year content to topics of current course lectures, such as systemic Pathology
• Use extra or vacation time to review 1 st year content that doesn’t easily link to current classes WHAT?!?!
• Begin using USMLE-style questions at exam pace now
• Note problem topics revealed by testing for extra attention once 2 nd year classes end
• Reserve enough fresh questions for use in final prep period -> Kaplan Sim exams!!

Organize Yourself After 2 nd Year Classes End

First 2/3 of remaining time:
1. Take first overall assessment early (Kaplan sim #1), rank order subjects by test results!
2. Complete planned review of all Step 1 subjects!
3. Final subject content review occurs in weakest to strongest order!
Final 1/3 of remaining time:
1. Cycles of practice testing --- identify weak spots - review these again to refresh + clarify!
2. Refresh highest yield topics + rote during final 2 weeks!
3. Take final overall assessment (Kaplan sim #2); plan last week of review!
No study the final afternoon and evening before exam day!!!
Allow for final assimilation and accommodation processes!

Final Review - KEY POINTS
•
Self-assess comprehensively (sim #1) approximately 1 month to six weeks before exam date
• Allocate final # days to spend per topic based on sim #1 results, as shown below
• Take simulated exam #2 approximately 7 to 10 days before exam date; review completely for final most challenging study review
•
Optional: take NBME self-assessment ($50
– 4-hour exam)
Anatomy
Physiology
Assessment Scores
Biochemistry
70%
45%
60%
Behavioral Science
Pathology
Microbiology
Immunology
Pharmacology
75%
50%
60%
45%
55%
Study Sequence
5
2
8
3
4
7
1
6
# FINAL Study Days
3
3
2
5
5
2
5
3

Plan Your Last Month Carefully
Questions* should drive you BACK to study SPECIFICS!
Content
Questions
T o t a l S t u d y T i m e
Topical
Question Review
*Questions do not TEACH…they “TEST!” Always remember that!...
Test Simulation
EXAM
DAY

Questions* should drive you
BACK to study MORE!

Scott Robertson scott.robertson@kaplan.com
Regional Medical Programs Manager