Received my score recently – 259/99. Was very pleased and surprised by this – to be honest I was aiming for a 240+ and after taking the exam Id considered being happy with a 230ish – my report was quite unexpected. I have a feeling that the step makes you underestimate your performance and your abilities so don’t be discouraged by how daunting it seems right now – the mountain of material WILL get covered and it will all start to make sense. Ill try to keep this as simple as possible, which shouldn’t be too hard considering my study strategy wasn’t all that convoluted to begin with. -­‐
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I didn’t follow any complicated time lines
I didn’t have a set date to Kinish particular sections by.
Didn’t do Kaplan or Falcon but signed up for DIT (doctorsintraining online course) to make sure I wasn’t missing out on anything big. Studied on my own at home – 8/9 hours on a good day. Took few weekends off. Till term 5, I was a poster child for using the school notes to study for classes. I never really opened any external study sources or veered too far away from what was required knowledge to do well in the exams. I did well in classes, and on taking the step I feel there is some correlation there for sure. Starting Term 5 I decided to start focusing on this impending behemoth mostly as everyone in my term had started to freak out about it. Things I did that I feel helped me out:
Strategy for getting through TERM 5:
PATHOPHYS:
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Never opened a page of the pathophys notes (term 5’ers as you start going thru the course you’ll start to realize why I call this a good decision) Instead I opted to study each system by myself using these resources that I trusted
o BRS Physio (I actually never used this book in term 2 – “read above about poster child for notes” but Klipped through a few pages in term 5 and I was sold)
o Goljan Pathology -­‐ aka rapid review (I had completely covered this book in term 4 along with Robbins and had some annotations)
o FIRST AID 2010!! (Clearly the blueprint of most med students study strategy)
♣ I highly “highly” recommend you get your FA copy bound into a Kile folder – I got mine done at Staples but you can do it yourself if you are already on the island. This makes it so easy to add notes/diagrams and annotation becomes a breeze. o USMLERx Q Bank (choice explained below)
o High Yield Neuroanatomy (1x)
o BRS Behavioral (1x)
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Reason I give for not using the Class notes: While I hear some sections are good and teach interesting info, the step will never deal with the minutiae they stress. And while its nice to think that those details are important, its sad to say at this point in our lives – getting a good step score is the most valuable thing us med students can do. Bear in mind -­‐ your sgu exam performance might suffer a bit, as did mine for ignoring the class notes but I had already decided to accept that. PHARM:
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Dr. D does an amazing job running this department and preparing the notes and exams. To do well in this class you need to know the major points in the notes and his exams become very simple. For the step, honestly knowing the Pharm in FA and maybe a few annotations from UWorld is more than enough. I felt Pharm was one of the most straightforward sections on the step, a fact echoed by UWorld questions. Ok, lets get to the meat of the matter = STEP 1 preparation. I’ve divided this into 2 sections – prep during Term 5 and prep once I got back home and had about 7 weeks entirely dedicated to studying. Term 5:
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I honestly did not stress too much about timelines during term 5. I decided I would rather learn everything well instead of worrying about keeping up with the school schedule. My plan if you can call it that at this juncture (it resembled more of an amorphous semisolid blob of an idea) was to become familiar with the material I was going to use for the board prep. I didn’t want to use any resources during those 7 weeks that I hadn’t already committed time too. Familiar = good! For every system in pathophys – I did the following
For eg. Cardiology
o Read through the Cardiac Phsyio chapter in BRS and made sure I understood the major concepts. Do some of the questions on the back o
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to make sure. Read through Cardiac pathology on Goljan Rapid review – note this only works well if you have a decent path base. If not you might have to refer to Robbins or other external sources to make sense of his highly condensed bullet points. Read through that system in FA start to Kinish – annotate additional information that should be fresh in your mind from your read thru of BRS and Goljan – Klip back and forth as necessary.
Do the cardiology questions on USMLERx!
♣ Now I know most people swear by UWorld questions – but I wanted to save UWorld for the 7 week prep and not waste the good questions on my half ass knowledge base.
♣ USMLERx questions are a bit easier so they work well as a Kirst Qbank, but better yet – each Question explanation has the scanned First Aid page (w/ page #) included so it makes it super easy to annotate.
♣ I wish I could say I did this for every system – I started midway through and found it very useful – studying gets boring after a while and doing questions is a nice break (har har).
That’s it! – Try to get through those 3 books once and Id say you are off to a great start for board prep. I personally didn’t Kinish FA completely – maybe 2/3rds of the way but got through BRS and Goljan. Enjoy the rest of your short time left on the island and the company of your classmates and friends – trust me, you will sorely miss it during your upcoming 2 months of forced isolation. Post 5th term:
Ok, you’ve had your farewell with your friends – the grand Kinale at bananas was all that you dreamt it would be. Several hours/days later you’ve hopefully reached somewhere you intended to be with or without your worldly possessions (expletive LIAT)
Now what?
First things Kirst – are you in a surrounding where you can devote a decent amount of quality study time without being interrupted or bothered? A place where you wont be constantly distracted by better alternatives to sitting by yourself alone in a room with your favorite medical books? Oh wait that’s everywhere.. Point being choose a place where you are comfortable staying for 2 months with minimum amount of stress. It doesn’t take much to unhinge the best of us during this period!
Alright – these were the resources I used
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(as before) BRS Physio, Goljan rapid review & FA 2010
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USMLE World Q Bank
Did 1 to 2 blocks a day (46 Q/block) on timed mode, and then reviewed and annotated my FA reading their explanations
Takes a good amount of time to review blocks when you Kirst begin, but that speeds up considerably by the time you get about half way through UWorld. Do take your time to fully understand the explanations – I did a considerable amount of learning from these blocks. I did about 1.5x World. Did a full run through once and then did the 450 or so questions I had Klagged for review. If I had to do it over again I think I would keep it the same, I got done with UWorld about 10 days before my test date and I didn’t feel comfortable starting a new Qbank (Kaplan) so I repeated questions. In terms of similarity to the step – UWorld is exactly the same format and very closely emulates the actual testing software (Fred 2.0)
However the questions themselves are more challenging than the majority of those tested in the USMLE. USMLE World Self Assessment
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Did UWorld self assessment form 1 about halfway through my prep (month before test date)
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Was an accurate representation of my eventual score (254 if I recall correctly)
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Goljan Audio lectures!
Explained further down, but I considered these a valuable resource!
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Doctors In Training Online Course (more on this later) Schedule -­‐ day to day
Find a schedule that works for you – it should suit your personal study style and at the same time not drive you insane. I had 7 weeks, some of you will have more (3 months or so) – I always felt that to do well its important to not get burnt out, difKicult when every single day is a procession of the same (Get up, study, sleep) This is what I did, it may mean nothing to you but Ill include it for completeness sake. -­‐
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Wake up 8-­‐9am every day, shower + breakfast – be cracking open the books by 10am ish
Get 3 hours of studying in Get some lunch (hour break) I usually tackled something lightweight directly post lunch, as I always felt groggy. Another 3-­‐4 hours of studying By the evening I would start feeling the exhaustion of staring at a computer screen or FA all day, so I took up going for a run or biking while listening to Goljan Audio. It was a refreshing change of pace and he does a marvelous job of getting across the big picture on all relevant pathology and reinforcing some overlooked details. Even more so, Prof Goljan is hilarious and I always found it hard to not crack a smile at some of his sayings, “ Crescent rolls might taste good, but if you got them in your kidney, you’re going to die!” He even nails in some microbio and biochem while he’s at it. All in all I highly recommend listening to his audio lectures. I got through most of them during my two months.
Get back home I’d get another hour or so of solid studying in and happily call it a day. Take the rest of the night off to relax, do something mindless (watch TV etc.)
Go to bed by midnight -­‐1am, Rinse and repeat!
That was my daily schedule – now for some actual content:
Order of Subjects:
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My original plan was to tackle my weakest subjects Kirst and take as much time as I needed with them before moving on. SGU administers the BSCE II and a practice NBME to sorta help you Kigure out which subjects those might be. However I didn’t get my NBME breakdown a week or so into my studying and I disagreed with its assessment so.. take those with a grain of salt.
1) Biochem
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I started with biochem as not only had it been over a year since tackling it in term 1, it is a massive massive topic and very high yield.
I know several reference books are recommended for biochem (lippincotts etc.) I personally stuck to First Aid.
However saying that, the biochem section is probably -­‐
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the most heavily annotated segments in my FA. I drew out most major pathways – marked associations with systemic path wherever I found them.
Wrote down associations with Pharm whenever they came up. Pharm and Biochem are very complementary – drugs work on pathways!
Having these associations annotated helped cement them well in my head as I read over FA over and over again. In general looked up info online If I felt FA was lacking in explanation/detail
Added many details from UWorld explanations
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What my STEP tested on
Many straight forward 1st/2nd order questions
Some answer options used alternate names for enzymes (eg. Methionine synthase = Homocysteine methyltransferase), so be aware of that
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Nutrition was highly tested on my exam
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Know which enzymes are located in which compartments of the cell
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Amino acid derivatives!
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Genetic disorders – know the mode of inheritance each follow!
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Understand the Lac Operon well (not explained in FA!)
Overall Biochem was highly tested but mostly straightforward. I recommend keeping this one for early in your prep to gain a proper understanding and then redo at the very end along with Micro to rote memorize the important details. There were a few molecular questions that I had never heard off and had no idea about, so in the heat of the moment I chalked them up to being experimental =)
2) MICROBIO
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Micro, oh Micro, what don’t I have to say about you.. Micro had been the bane of my existence since I Kirst took it in term 4. If you are like me and hate memorizing you will probably agree.
However micro is a HUGE (cant stress this enough) portion of not only the step, but eventually our day to day clinical practice (infections and the drugs used to treat them)
Like Biochem I used FA as my primary source to study micro, UWorld however has a hefty chunk of questions on micro that test for many details not included in FA. Lots of annotation to do here folks!
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What my STEP tested on
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some stains
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virulence factors (IMP! E.g. How a strain of E.coli that cause meningitis in a newborn could spread = K-­‐1 antigen)
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those silly FA mnemonics like OVRPS, B-­‐BRAS and NO StRES were useful
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start associating D.O.C for treating microorganisms early on, as its easy to get confused while trying to cram them. o
Fungi had a decent amount of questions – typical presentation and locations were provided
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Viral and bacterial genetics
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Vaccines
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Hepatitis serologic markers
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ToRCHes and congenital infections!
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D.O.C for infections. I had anticipated them asking questions about which drugs to use in case of allergies or pregnancy but personally didn’t have any.
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Side effects of antimicrobials
Overall most questions were straightforward (seems like this a common trend for the step isn’t it? Told you guys not to worry!) Again, always a few that seem right out of left Kield but not much you can do about those. Behavioral + Psych
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I know you’re getting tired of hearing me say this – but Behavioral is huge for the step and only getting bigger!
I had about 25-­‐30 questions related to behavioral/
Psych which amounts to nearly 10% of the exam, so I am clearly not trying to exaggerate its importance
Know your Epi and Biostats cold. This is one of the few topics the USMLE takes allowance in twisting the presentation of the question and can make a simple question feel unsolvable. Highly recommend using the BRS Behavioral – very quick read and will make the FA bullet points more understandable. Final count of resources used:
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from DIT)
First Aid = cover to cover read thru – 3x (includes 1x Goljan Rapid Pathology -­ cover to cover – 3x
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Goljan audio lectures – 1.5x
BRS Physiology – 2x
USMLERx – 0.5x
HY Neuroanatomy – 1x
BRS Behavioral – 1x
USMLE World – 1.5x
DIT – 1x DIT
I know some people swear by DIT and I don’t blame them. Personally I used the DIT lectures mainly as an alternative to reading thru all of FA once again on my own (so boored..). However his constant use of active learning i.e. making you pause the video after covering a topic to answer basic questions ensures that you pay attention and don’t gloss over the basic details. This constant regurg can only help. He mentions some interesting details that seemed more clinically relevant than step 1 oriented – however they helped me cement some details that are still stuck in my head. Personally I would recommend if you plan on joining DIT to do it as early as you can (start of term 5). They email out 15 short 1st order questions per week which if you utilize them force you to do a bit of FA every week – when everything else is waning, forced motivation can be a good thing. Also they include the relevant FA page # so looking them up is a breeze. I wish I had used this myself, but I only heard about and joined DIT at the very end of the term. I started the DIT videos after my Kirst complete read through of FA. DIT covered my 2nd read through and during the day in between the videos I would cover the corresponding sections using BRS Physio and Goljan Rapid review getting me a 2nd and 3rd read through of those books respectively. -­‐-­‐
At this point I ran out of time and steam – the below sections remain incomplete. Systems
Neurology
Heart
Miscellaneous
Last week
I recommend doing a quick Kinal review of FA and any points that jump out as unfamiliar – jot them down on a separate notebook. This is useful for the last day of prep – all I did the day before my step was go through this notebook and do the high yield and rapid review pages of FA (the end of the book) and looked through the images. TEST day
Conclusion