Making Your Step 1 Review Effective
January 14th, 2015
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
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
Program Decision Making
Specialty
Family Medicine
Psychiatry
ObGyn
Pediatrics
Emergency Medicine
Anesthesiology
General Surgery
Neurology
Internal Medicine
Pathology
Transitional Year
Orthopedics
Diagnostic Radiology
Neurosurgery
Otolaryngology
Dermatology
Plastic Surgery
Mean US Med scores
2011 (2009)
Years of
Matched
residency
213 (214)
3
214 (216)
4
220 (219)
4
221 (219)
3
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)
3
4
5
4
3
3
1
5
4
6
4
5
Mean hrs/
week
52.5
48
61
54
46
61
60
55
57
45
58
58
53.5
45
-
Schedule type
Uncontrollable
Controllable
Uncontrollable
Uncontrollable
Salary range
$175k-$220k
$173k-$248k
$251k-$326k
$160k- $228k
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
Program Decision Making
Specialty
Family Medicine
Psychiatry
ObGyn
Pediatrics
Emergency Medicine
Anesthesiology
General Surgery
Neurology
Internal Medicine
Pathology
Transitional Year
Orthopedics
Diagnostic Radiology
Neurosurgery
Otolaryngology
Dermatology
Plastic Surgery
Mean US Med scores
2011 (2009)
Years of
Matched
residency
213 (214)
3
214 (216)
4
220 (219)
4
221 (219)
3
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)
3
4
5
4
3
3
1
5
4
6
4
5
Mean hrs/
week
52.5
48
61
54
46
61
60
55
57
45
58
58
53.5
45
-
Schedule type
Uncontrollable
Controllable
Uncontrollable
Uncontrollable
Salary range
$175k-$220k
$173k-$248k
$251k-$326k
$160k- $228k
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
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
First Step:
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
A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble
likely affected in this patient?
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 likely affected in this patient?
○
○
○
○
○
○
A
B
C
D
E
F
○
○
○
○
○
○
A
B
C
D
E
F
Effective Prep
Establish a S.M.A.R.T plan
Spaced Repetition
Active Learning
Question Practice
Using my Kaplan Step 1 Qbank and other
programs EFFECTIVELY!!
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
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
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Getting Started…
or Planning Ahead…
Speak the Language: Build your test
question vocabulary
Glossary of Terms Frequently Used in Test Questions
Term
Abolish
Absolute value
Abundant
Account for
Acquire
Acrid
Adjacent
Aggravate
Alter
Amenable
Amplify
Apparent
Arrest
Attenuate
Attributable to
Bear
Causative agent
Cessation
Cloying
Coalesce
Comprise
Concomitant
Concurrent
Confer
Definition
To do away with, to eliminate
The distance from zero, disregarding + or - sign
Plentiful, numerous
Explain, justify
Get, obtain, gain
A sharp taste or smell
Near or next to
Irritate, make worse
Change, modify
Changeable, yielding, pliant
Enlarge, make bigger
Visible, evident
To stop, check or hold
To weaken or reduce in force or amount
Result from, be caused by
To support, hold up, endure, show or exhibit some feature
Cause
Discontinue, end
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
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
5 + 1 common EARLY preparation
mistakes
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
6. INSUFFICIENT exam-like question practice
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
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
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
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
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
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!!
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
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 2nd Step 1 Qbank (min. 1 month)
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Create an Effective Study Plan
• Get organized TODAY!!!
 Note important spring 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!! DO IT – NOW!!
• 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
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
Using Extra / Vacation Time
• Link review of 1st year content to topics of current course
lectures, such as systemic Pathology
• Use extra / vacation time to review 1st year content that
doesn’t easily link to current classes WHAT?!?!
• Begin using USMLE-style questions at exam pace ASAP
• Note problem topics revealed by testing for extra
attention once 2nd year classes end
• Where will you go for fresh questions for use in final prep
period -> Kaplan Sim exams!!
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Organize Yourself After 2nd 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!
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
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)
Study Sequence
Assessment Scores
# FINAL Study Days
Anatomy
70%
7
2
Physiology
45%
1
5
Biochemistry
60%
6
3
Behavioral Science
75%
8
2
Pathology
50%
3
5
Microbiology
60%
5
3
Immunology
45%
2
3
Pharmacology
55%
4
5
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Plan Your CURRENT & LAST Month
Carefully
Questions* should drive you BACK to study SPECIFICS!
Content
Questions
Total
Study Time
Topical
Question Review
*Questions do not TEACH…they “TEST!” Always remember that!...
Test Simulation
EXAM
DAY
Questions* should drive you
BACK to study MORE!
*Questions do not
TEACH…they
“TEST!” Always
remember that!...
“Whether you believe
you can, or you can’t,
you're right.”
Henry Ford
“We estimate that we will see domestic
production of medical school graduates
functionally surpass our current number of
GME postgraduate year one pipeline
positions by 2015 or sooner.”
41 52.5
78
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)
NRMP Program Director Survey Results
(2014)
Percentage of Programs Citing Each Factor in Selecting Applicants
to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3
http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf
Thank you for your attention today!
What are your questions?
Scott Robertson
scott.robertson@kaplan.com
Regional Medical Programs Manager