HOW TO
SURVIVE
The USMLE Step 1
Image taken from: http://www.sonofthesouth.net/uncle-sam/images/uncle-sam-wants-you.jpg
ADVICE FROM SAMUEL ANADAN FOR THE USMLE
FALL
2008
Co-Founders of SD Survival Guides: Samuel Anandan (Class of 2008), Akeem Marsh (Class of 2007)
“How to Survive” Guide –The USMLE Step 1
1
TABLE OF CONTENTS
Congratulations on making it all the way to 5th Year!
So unlike the other survival guides, this is going to be more informal. This guide is meant to help
you prepare for the USMLE Step 1. However, more than anything you’ve done so far, this is an
individual journey. And it really is a long and hard one, like Luke’s quest to become a Jedi, or
Frodo’s quest to destroy the ring. Get the picture? And like any journey, you have to pack the right
things, get your plan straight from the start, and keep going forwards no matter what hardships and
hurdles may arise. This may very well be one of the most stressful times of your life, let alone in
Sophie. But with perseverance, dedication, and hard work, you can get through it.
Topic
Pages
Advice from Samuel Anandan on Passing The USMLE Step 1
2
Additional Advice from Upper Years
6
Tips for Dealing with Test Anxiety and Studying Long Hours
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How to Survive: The USMLE Step 1
Samuel Anandan (Class of 2008)
Barry Ladizinski (Class of 2007)
Akeem Marsh (Class of 2007)
Shayla Syed (Class of 2007)
“How to Survive” Guide –The USMLE Step 1
ADVICE FROM SAMUEL ANANDAN ON PASSING THE USMLE STEP 1
In this guide I’m mostly going to talk about what I did and what helped me. I advise that you read
this in its entirety, and take away from it whatever you see fit. Some things may work for you, some
won’t. Maybe none of it’ll be what you think is best. So it’s best that you get advice from multiple
people before you start studying. There are some key points throughout that everyone should pay
attention to, which I’ll list at the end. First, find what works for you. Maybe you’ll talk to the people
who got a 260, and ask them what they did, and they’ll say they did Kaplan Qbank or USMLE
World twice over, read every BRS book again, read all of first aid, and read all the Kaplan books. If
you do all this, I’m sure you’ll get a great score too, but not everyone’s capable of doing something
like that. So ask anyone and everyone what they did, filter out the best advice, and do your thing.
Now, let’s go over some USMLE basics. First, the format. The test consists of seven blocks, each
with 48 questions. You’ll have an hour per block. You have an allotted break time of I believe 45
minutes. The exam starts off with a tutorial, which takes around 15 minutes; if you know the format
of the computer program (called FRED) beforehand, you can skip it, and add 15 minutes to your
break for a grand total of an hour. Each block consists of questions from all disciplines, the vast
majority in case vignette format, and most with around 5 answer choices, although it varies. I had
one multimedia exam question, which asked me to listen to a heart sound to help diagnose a
condition (I guessed on it). Note that there are experimental questions scattered throughout the
exam which won’t count towards your grade; however, you won’t know what’s experimental and
what’s not, so you have to answer every question. It’s a long, grueling exam. The exam center
provides you with noise-cancelling headphones, but I believe you’re now allowed to bring soft foam
earplugs. And please do…. I had a guy coughing like a madman in my room for the first half of the
exam. You’re taking this exam with a bunch of people, but you have your own cubicle, complete
with a nice movable monitor, a super comfy chair, and a dry erase pad with markers and an eraser.
All your belongings have to be locked up in a locker outside the testing rooms.
Now, on to the more important part of preparing for the exam. When you start is up to you. If you
start too early, you may start forgetting stuff and keep having to go back to refresh, and you may
also burn out easier. If you start too late, then that’s just not smart, is it? My advice would be to
start in January. Your pathophysiology (aka Intro to Clinical Medicine) course covers topics by
system, providing you with an excellent framework to do systems-based USMLE studying. So
when pathophys does GI, you do GI anatomy, pharm, physio, and path. That’s what I basically did.
Some subjects, like microbiology, immunology, behavioral, biostat, and biochem won’t quite fit in
the systems-based plan, so you have to fit that in somewhere else.
Now what books should you use? Once again, depends on you. For each subject, I used the
following. This is just for your info, so you know how I personally prepared, but you need to choose
the books that work for YOU.
1.) Biochemistry: Lippincott’s biochem (which I only partially read), the Kaplan course, and
intense First Aid for the USMLE (hereafter abbreviated FAFTU).
2.) Anatomy: FAFTU only (very low yield on the USMLE)
3.) Histology: FAFTU only (even lower yield on the USMLE)
4.) Neuroscience: Road Map Neuro and FAFTU
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“How to Survive” Guide –The USMLE Step 1
5.) Physiology: BRS Physiology and FAFTU
6.) Behavioral Science: FAFTU only
7.) Biostat: FAFTU
8.) Pharmacology: Intense FAFTU and some Kaplan and some Lippincott’s
9.) Micro/Immuno: Micro Made Ridiculously Simple and FAFTU
10.)Pathology: Goljan audio lectures and Rapid Review Pathology, path cards, Kaplan, FAFTU
There’s some stuff on the exam that’s high yield, and some stuff that’s low. Pharm, path, physio,
and micro are your HIGHEST YIELD subjects, no question. Biochem is also relatively high yield.
Anatomy and histo are LOW YIELD. VERY LOW YIELD. If you have the time, and want to read
something like BRS Anatomy or Road Map Anatomy, that’s great. But if you don’t, realize that
you’ll only get maybe 5 questions on anatomy and histo.
For biochemistry, the Kaplan book is really good, as is Lippincott’s or BRS. FAFTU is a great
review, but don’t use if as your initial source, unless you somehow remember most of your
biochem. For neuro, I found Road Map to be a bit difficult to get through, only because I forgot a lot
of the pathways and stuff, but it’s still worth reading, because it has a plethora of clinical correlates.
For physio, BRS is great, but if you need more substance, go with Costanzo’s Physiology. There
are a fair amount of behavioral questions on the exam, although most are where you need to tell a
patient something, and they give you five choices. You know what I mean, like the patient comes
into the office wanting a mastectomy because of family history of breast cancer, and they ask you
how you’d respond. These are tricky, and I had like 3 of them in every block of my exam.
Another thing to note: there’s a good amount of biostat on the test! And you thought it disappeared
for good, huh? Most of what you need to know is in FAFTU, stuff like specificity, PPV, relative risk
reduction, and so forth. You’ll learn a lot of biostat from doing practice questions, so worry not.
Pharm is relatively straightforward. Know your mechanisms. Know your side effects. FAFTU gives
you both. If you know FAFTU cold, I think you’re set for the pharm part of the exam. For micro, a
read-through of Simple or Lange will be great, along with a thorough read of FAFTU. And then we
come to the biggest beast, pathology. The best source for this section without question is
Goljan. The Sophie Treasure Chest, on the SDSG computer, has Goljan’s audio lectures, which
are like gold. You’ll understand murmurs and anemias and everything else better after hearing his
lectures. But use it along with his book, Rapid Review Pathology, highlighting whatever he says
in the lectures, and adding whatever he didn’t. That’s what I did, and it’s truly invaluable. The
Kaplan book is also pretty good, as is BRS and path cards (I use the lippincott’s cards). DON’T
NEGLECT PATH!
Now, you can really see anything appear on the USMLE. I actually had a general chemistry
question! It was something about finding delta G, you know that Gibb’s free energy or some
nonsense. I had two equations, each with their own delta G, and I had to find the delta G for the
overall reaction. Now, don’t go and study gen chem, but just be prepared to see something out of
the blue like that.
I started in January, but it was really light studying until maybe March, when I started doing
questions. And speaking of questions, MAKE SURE YOU DO A LOT OF THEM. There are many
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“How to Survive” Guide –The USMLE Step 1
qbanks, but the two qbanks most people use are either Kaplan Qbank, or USMLE World. I had
Kaplan Qbank, but I heard USMLE World was better, so I used that in its entirety, and only did like
5% of Kaplan. The format of USMLE World is basically identical to the USMLE (except for the way
lab values are displayed). Both qbanks offer detailed explanations, summary facts for each
question, and the ability to tailor your test by either subjects or systems. I HIGHLY recommend
USMLE World, based not only on my experience, but those of others as well. It’s quite
representative of the USMLE, and cheaper than Kaplan. Do USMLE World, you won’t regret it.
As for the Kaplan course, it’s costly. $1200+ to be exact. Now, the material you learn there isn’t
revolutionary…. it's all in the books and courses you’ve taken. However, Kaplan gives you a set of
their lecture notes, some of which are quite good (especially pathology). You also get a bunch of
audio lectures and Qbank. I took the course, and I thought it was worth it for me, because it forced
me to go to lecture and sit there and study. It kept me on pace, made me study every subject on
time, and provided me with the framework I needed. If you can keep yourself on pace just fine, you
may not need the course. Also note that the course isn’t long. It’s about a month, and they cover
subjects really fast. Path was done in three days, and they only really covered general path,
although it was a great lecturer (Dr. Barone). Pharm was covered in two. Each day was 4.5 hours,
starting at 8am in the morning at Downstate. You have the entire afternoon to study. Taking the
course is tiring, because you need to get up so early, and then go home and still study. But if
money’s the issue, think about it this way. When you get your score back, will you look back and
regret not taking the course to potentially add a few points? If so, take the course, no regrets, no
looking back. If you’re fine studying on your own, that’s great too. As you can see, preparation for
this exam is all about you and what you find best.
The Kaplan course helped me. Reading the books I read helped me. Goljan really helped me. But
the BEST things to me were FAFTU and USMLE World. It’s a killer combination. Read FAFTU two
or three times through. Memorize as much as possible. Now people will tell you that to pass, you
need to know FAFTU cold. Don’t listen to those people. Yes, you do need to know FAFTU. But that
book has so much freaking info in there, I think it’s nearly impossible to memorize it word-for-word.
So know the most important things, but don’t listen to people who freak you out with nonsense.
Don’t rely solely on FAFTU, but use it in combination with everything else, and rely on it more and
more nearer to the exam. FAFTU is gold. USMLE World is gold. And Goljan is gold. I can’t
stress this enough.
Sam’s Rules for USMLE Studying
1.)
2.)
3.)
4.)
5.)
6.)
7.)
8.)
9.)
Find what works for you.
Start not too early, but not too late. The January before your exam is ideal.
Do questions!
You can be tested on anything…. even general chemistry. Don’t freak out.
Give enough time to high yield material (the 3 Ps and micro): path, pharm,
physio, micro.
Don’t neglect the 3 Bs: behavioral, biostat, and biochem
Don’t listen to people who freak you out.
USMLE Gold: Goljan, FAFTU, USMLE World.
You’ll pass. Loads of people did before you, loads will after you. And 95% pass
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The day before the exam, try to relax. FAFTU has a great super-duper-high-yield section at the
back, tables consisting of common findings and most common causes. Read that as a refresher,
get good sleep, eat a good dinner and a good breakfast, and go to your site on time. Have your
permit and ID ready. Go in there with confidence. Do whatever it takes to help you feel confident. I
listened to The Final Countdown by Europe (it’s one of the training montage songs from Rocky IV),
and that gave me the adrenaline rush to go in and stare this test in the face.
I know you’ll be stressed. I was really stressed during this time, and as some of you may
remember, I was also occupied with a bunch of other things, all of which were more fun than
USMLE studying. But know where your priorities are. It’ll be stressful, it’ll be bad, so expect that
going in. If I can get through it, I know you can too.
After the test, relax and relax, and when you’re done, relax some more. You’ve earned it. Waiting
for your score can be just as nerve-wracking as preparing for the test itself. The week before the
results came out, I was quite nervous. The NBME now reports scores online, so you’ll get an email
with a link to your score report. I was very satisfied with my score, especially since before the
results were out, I was thinking I did really badly. Which, by the way, is also a common feeling. So
if you walk out of the exam thinking you failed or did really badly, worry not. That’s a good sign,
because this is one heck of a hard test. If you walk out thinking you aced it, be a little scared….
seriously, no matter how much you know, I don’t think anyone should come out thinking they aced
the test.
Just remember, everything will be OK in the end. Study hard. I know you’ll succeed and become
great doctors. I’m proud to have known you all during my time in Sophie, and hopefully we’ll all
graduate and work together as colleagues in the future. Good luck, and for the last time (maybe),
may the force be with you!
Sincerely,
Samuel Anandan
StarWars2585@yahoo.com
AIM: DarthDooku2585
ADDITIONAL ADVICE FROM UPPER YEARS
Advice from Shahla Syed:
I have a lot more advice for Step 1 - don't overburden yourself with reading too many books,
because that will probably lower your score rather than raise it. Pick a select few and stick to
those. My recommendations are learn Micro, Immuno, Behavioral, and Pharm from First Aid.
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For anatomy, if you have BRS, go through the chapter summaries and clinical outlines at the end
of each chapter because First Aid isn't enough. For biochem, well I never understood biochem to
begin with, so pick any review book and learn it if you didn't already. First Aid is a good review
of biochem if you already know biochem, but you can't learn it from first aid.
Pathology - many people say use BRS, but I hear even better than that is Rapid Reivew written by
Goljan who is awesome. The book is lengthy, but incorporates a lot of the other topics into it, and I
think it also has questions which is nice. I haven't read it, but I believe it may also incorporate the
biochem you need to know, in which case you may not need a biochem review book. Also, Goljan
has a 100 page path outline which is excellent, and a shorter 36 page high yield packet if you don't
have time for the 100 page packet. I'd recommend using those. People also say use BRS or
Costanzo for learning physio - take your pick, I didn't read either of them so I wouldn't know. I also
would advise not using the Kaplan books because they actually miss a lot, and I didn't do QBank
either but I heard it is not very similar to the exam. I hear USMLE World is a lot cheaper and a lot
more effective at covering the concepts covered on the exam, so that is a better choice. It's also
more difficult that QBank but people say is more like the real exam.
So bottom line - First Aid, Anatomy BRS, Rapid Review for path, Physio review book, and Goljan
packets. That's all :)
I hope this helps, and I wish I had known these things before I started studying!!
Advice from Barry Ladizinski:
For step 1 the basics/general principles are really important... first aid is okay but just really try to
understand everything this last year ("WHY something happens, NOT WHAT") anyway hope this
helps you’re about to join the real world so really enjoy your last year as a professional student...
Advice from Akeem Marsh:
Feeling anxious, Getting nervous, freaking out? Well certainly don’t do any of those things.
Actually you can do a little of it . It is a big exam, and carries a lot of weight, plus it will be with
you for a while. Read through the beginning chapter in first aid for USMLE step 1. That
should clear up any qualms you have about the exam itself, such as how many questions, how is
the format, how is it graded… Once you have done that and have your understanding, it is time to
tackle studying. Now, with all the material you have learned thus far, it is very easy to become
completely overwhelmed in exactly what you NEED to know for the exam. The amount of material
that you have processed in the past few years is just mind-boggling, but let me tell you that you
know more than you think you know. Some people will swear up and down that they forgot
EVERYTHING or at least some things, but everyone remembers much more than they think that
they know. Also, we all have our strong subjects and our weak subjects. The weaker subjects you
should probably devote more time to.
I recommend that everyone begin studying months in advance, but not too early. I would say
about 2 or 3 months before the Step, because I believe this time period to be ideal. You will
become sick of studying after a time, so be forewarned. That is why I suggest not starting the
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study specifically for the step too far in advance, plus the courses that you take systems path and
pathophys are good prep 4 the board.
The most important subjects to study vary by board as self-reported from after the exam people
would say, that their exam emphasized certain topics. Each person said different topics. This
could be a big bias tho, because people tend to remember what they got wrong and in turn would
lead them to say that their weak subjects were emphasized when in fact there were relatively few
questions on it. I found the best way to describe it was like a really long miniboard, but the
questions were not long, they were like 2 or 3 lines but required much more thinking!
I would say, however you choose to study for the step, integrate it with first aid. Review the
relevant sections of first aid when you complete a subject, or system, and write stuff in when you
feel necessary (that is why they have those huge margins). At the end of your studies, you
should have read through first aid at least 2-3 times before taking the step, and you would
definitely get at least your passing score which is the most important thing (but probably a
lot better).
As for what specific books to use, I recommend that you use whatever books had worked for you in
the past when studying for miniboard exams. Actually, you can use more condensed versions of
them if possible. For instance, for physio, the Costanzo text is great, but if you don’t feel like
reading all of it then the BRS is more than sufficient. I would recommend at least reading a book
for physio (ie BRS), for path (ie BRS or Goljan Rapid Review), and for any other subject that you
are weak on! For all other items, first aid by itself, along with the question bank that you choose
certainly would be more than sufficient. As for what question bank to use, I would recommend
using USMLEWORLD or USMLE RX (preferably world). From personal testimony of those that
used it, it was most similar to the exam in terms of content and format. As for Kaplan Qbank, I
would say if you want to do that please don’t spend $$ on it, borrow someone else’s. I personally
felt that it was way over rated, because it was very nitpicky and basically just tested whether or not
you read the Kaplan review books.
DO LOTS OF QUESTIONS, AS I AM SURE THAT YOU ALREADY PLAN ON DOING!! DO
THEM VERY FREQUENTLY, AND I WOULD RECOMMEND THAT YOU USE THEM AS A TOOL
TO TEST YOURSELF. For instance, when you complete neurology, you should do a question set
in neuro. This information is explained in that first chapter of first aid, but I thought I’d reiterate it
here to bring the point home.
Another thing that you absolutely have to do is go over both the NBME form exams, and the
NBME released items. Those in fact are the most similar of anything to the USMLE. The only
problem is, there is only maybe 800-1000 or so questions amidst them, so you certainly will need a
qbank to test yourself. Check the student government computer, there is a huge compilation of
USMLE materials left behind, courtesy of yours truly. Overall, take heed to Shahla Syed’s advice
because I think that it is excellent, I am pretty much repeating/paraphrasing what she said, except
that the bolded items listed above are what I think to be important for you to do that she did not
mention.
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One the SDSG computer, there is a file called Imagebank, and I found that to be a very good
review for the boards, like a week before the exam especially for those of you who like me, did not
really look at any pictures while studying LOL.
One last item, I found Goljan (pathology) audio files to be excellent! Especially for those of you
that like to exercise and/or are commuters, you can just put on some Goljan audio and listen and
learn. His teaching style is amazing, the way he explains things and integrates items from other
subjects is right on point. Not everyone found his files to be that good, but I think that if you just
listen to them more than once (and the 2nd time around, speed up the audio) it would be good.
Especially for those particular systems that you are weak on, as I listened to those files several
times. [I even played it in my sleep to get subliminal messages lol, not sure if it worked but hey
can’t be a bad thing!]
I think that you guys having made it to the fifth year (yay) are well on pace to do well on this exam.
Just keep the faith in yourself, listen to the advice of the upperclassmen and study diligently as you
always do, and I believe that you all have the potential to set a record in sophie in terms of first
time pass rate. Let that be your guiding light, not just because you want to pass and move on to
the next level, but because you all want to and will become great doctors for your patients!!! That
is essentially who we are really working for in medical school. Hope that this advice has been
helpful and, feel free to contact me again about anything, same email or u can contact
akeem.marsh@downstate.edu my new email .
TIPS FOR DEALING WITH TEST ANXIETY AND STUDYING LONG HOURS
Here is some information that Akeem found on the Internet that you might find useful:
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Concentration/ Anxiety Tips
Your inability to focus is likely just due to anxiety. One simple method that seems to help others
minimize how often their mind wanders that you might want to try involves a simple tallying
procedure. Each time you notice that you aren't focusing on the task at hand, make a tally mark on
a separate sheet of paper. The mere act of having to tally the instances gradually reduces the
frequency, probably due to some subtle process of negative reinforcement. At any rate, it's worth a
try and actually has decreased the problem for many who have tried it. But don't expect this to be
an instant fix. You have to keep making yourself keep the tally for a number of days or even a few
weeks to begin to see the impact.
You may also need to vary your study mode more frequently, switching from just review reading to
trying some questions or to summarizing key aspects because each mode switch reawakens
attention. Others find that taking short breaks more frequently in a long study day helps them stay
focused.
Here are some tips on handling anxiety:
Tip 1: Some weeks or days prior to the exam, use an index card to list several of your greatest
personal strengths and attributes. Examples: I am an intelligent and caring person. I react well
under pressure. I am going to be a great (fill in career goal). Keep the card handy so that
whenever negative thoughts intrude while you are studying or practicing, you can pull the card out,
read each statement and reflect on your abilities. Luxuriate in the calm, positive feelings that are
associated with each of these true statements. Fairly soon, you won’t even need the card because
you will know the statements by heart and be able to mentally review them as an antidote to the
welling up of negative thoughts.
Tip 2: Keep a master tally sheet nearby each time you sit down to study. Make a tally or hash
mark each time you find yourself engaging in negative thinking, daydreaming or otherwise mentally
escaping from the study situation. For many students, the mere act of tallying reduces the
frequency of these behaviors and they find that their daily tally decreases over time. This is really
a mild form of behavior modification that you can apply to your own study behavior. Though
simple, it works well for many people.
Tip 3: Months (or at least a few weeks) prior to the exam, spend some quiet time thinking back in
your life to recall an event in which you were the hero of the situation. Perhaps you walked in on a
serious fight between two friends and were able to bring it to a peaceful resolution. Perhaps you
administered CPR successfully to someone or orchestrated a successful fundraising event for a
charitable cause during high school or college. Whatever life event you select, it must be a
situation in which your abilities and actions solved a problem or saved a bad situation. Now spend
at least 10 minutes each day in a quiet place reliving this event, trying to bring back the memory in
as much detail as possible. What time of year/day was it? What were you wearing? What was the
setting like? As you practice, it will take less and less time for you to get back the memory in
graphic detail. The purpose of this exercise is to allow you to mentally revisit the event quickly,
because stored with this event memory are all of the associated feelings of being in control, being
a successful problem solver, being confident, being a winner. When used as part of a time-out in
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an exam, these associated emotions then act to counteract the negative emotions associated with
the test-taking process.
Tip 4: During the actual test, have a thought-through pacing plan that you used in practice testing
in the final week or two. By knowing what time you have to complete each section of a test, you
can establish 1/4, 1/2 and 3/4 points before you even begin answering questions. Then, when you
reach a time marker item, check your time use. Worrying about running out of time contributes to
anxiety and often leads to time-wasting behaviors such as checking the clock every couple of
minutes--a nervous habit that actually increases the time it will take you to finish the booklet
because frequent glances at the clock continually interrupts your thought process and often results
in the need to re-read once you look back at the question.
If you do run short of time toward the end of a block, use question "triage." In other words, scan
the remaining items to find ones that are easier and mark these on your grid sheet first (taking
special care to find the right bubbles to mark). Then return to the remaining items and mark an
answer for all of them. Remember that no answer is an automatic error, so never leave items
blank. Pacing problems will be far less likely to occur if you work through lots of sample tests
during your preparation. With practice, you will sense the right pace and so be able to walk in on
test day confident that you can handle it because you have already done so in practice mode. If
you do this, the test setting will feel more familiar and less strange, and the more familiar it feels,
the less anxious you will be.
Tip 5: If you feel anxiety welling up during the exam that is interfering with your ability to
concentrate on the questions, shut your eyes, lean back, roll your neck and rotate your shoulder
muscles. Take several slow, cleansing deep breaths and exhale slowly. This "mental time out"
helps break the cycle of anxiety and will usually help you return to the task at hand with a greater
sense of calm and better concentration.
Note: If you experience significant anxiety symptoms such as muscle twitching, insomnia, nausea,
or chest tightness when you think about taking exam or during them, then these tips may not be
enough to help you overcome the problem. If this happens, seek professional help from either a
psychiatrist or a cognitive psychologist who is experienced in helping people overcome situational
anxiety. Therapies can include anti-anxiety medications, self-hypnosis instruction, etc. But don’t
delay because each of these treatments requires time to become effective. In seeking a
professional to help you, don’t see just anyone. The professional needs to have experience in
treating this type of problem, so not just any therapist will do.
How to Study Actively
One of the most common problems when people are studying for long periods of time is that they
fall into passive, almost mindless mental habits. Eyes dutifully move over the lines of print, but not
much goes into long term memory. Even worse, if the information is being reviewed, it already
looks familiar, so you can easily fool yourself into thinking 'Yes--I remember this--I know how this
works.' Unfortunately, following along when the information is all laid out on the page and being
able to call the relevant information from memory when you are dealing with a question on that
material later are not the same thing. Even when you know a lot, you may apply the wrong
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information to an item, or get confused about what applies from what you recall. Here are some
tactics that you can use to study more actively, which all require doing something with the
information, rather than simply reading through it with the intention to remember.
Look over some practice questions on a topic you are about to review first.
If it's been a while since you studied a topic, you may not actually be able to answer the items yet,
but just reading the question, to get a clear sense of what's being asked is your goal here. After
you finish looking at the items, traces of what was called for by the items will linger in your memory,
making the question-relevant information jump out once you begin reviewing this content.
Make key aspects and relationships stand out in your study notes.
Most people take notes when they review. But if you aren't careful, it's easy to just write down
without really thinking about the information. To make those study notes really work for you, take a
few minutes to look over the kind of material you are about to review. Is it describing several
disorders that present similarly? Are there key lab tests that tell you which disorder you are dealing
with? Do the disorders hit different groups of patients (the very young, post-menopausal women,
certain ethnic groups, for example)? Can you generate a way to compare and contrast the
varieties of disorders, showing how they are similar and different from each other? Once you have
a clearer sense of the kind of information you are dealing with, decide how to represent the key
aspects on paper in a way that highlights these aspects. Techniques for doing this can include:
1. Using boxes with arrows to show the ordered steps of a process or sequence of events.
2. Color highlighting your notes, e.g., pink for lab data information, blue for presenting symptoms,
yellow for incidence (who gets it), green for morphological changes, etc. Now when you look over
pages of notes, you can scan all the pink to see how the anemias differ in terms of their labs, for
example.
3. Use a tape recorder to make summary notes instead of paper. You can even ask yourself
questions, leaving a pause after for later listening and self-quizzing. By forcing yourself to
articulate what you want to remember in your own words, you are more likely to remember the key
points and you have a portable study aid to plug into later, in the car stereo while you are driving or
using a Walkman to listen to while you do chores or take a walk.
4. Make charts of related groups, such as the types of meningitis. Rows for each type, columns to
show the bug, presenting findings, typical lab results, prognosis, etc. Color code as necessary to
make exceptions and shared features and key aspects stand out.
Switch activities to stay mentally alert.
If you are sitting at your study table and find that you are just spinning your mental gears, stop what
you are doing and do something else. You might switch to a different kind of material as a break
(shift from internal medicine to psychiatry, or from Microbiology to Physiology, for example). Look
at a clinical website on the study topic for a change of pace. You can also try doing a few practice
items on the material, then look up the related material in your review source to understand the
correct and each incorrect answer. Now, what you read is relevant to an actual question and this
will help you take in the information because it is perceived as more meaningful than just reading
page after page in the book.
Find a study partner to do questions out loud.
If you are enrolled in a Kaplan Center, find someone who is willing to sit with you for an hour or two
several times a week. Agree in advance what topic you want to focus on, then take turns doing
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“How to Survive” Guide –The USMLE Step 1
items out loud, reading the stem out loud, stating what you think is being asked, and talking
through your reasoning as you evaluate all the possible answer choices. The other person should
listen for reading or reasoning mistakes and give feedback. Then switch roles and you give the
feedback. Don't get bogged down in fine details while dong this, however. The goal of the session
is to refine how you interpret and reason with what you already know, not to worry about checking
out every little detail. Use the question explanations when you get stuck because neither of you
recalls, or just skip that question and move on. This is an excellent way to practice applying what
you know and to improve your accuracy in understanding and reasoning through test questions.
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