When studying for a test like the USMLE Step 1 (the first of three standardized exams required for medical licensure in the United States) it is important to find a method to separate high yield facts that must be memorized from conceptual ideas that must be studied and thought about. The following document is one I made during my Step 1 studying to do just that. It can be used with a study plan of your choice or with my complete study plan.
Knowing this material alone could probably get you 15-20% of the answers. I recommend printing two of these (attached above as a Microsoft Word Document) and, as you go through First Aid and other review sources, fill in answers on one of the two copies. This will be your answer sheet to reference throughout your board studying period (I wish I could just publish my answer sheet, but that material is the intellectual property of First Aid and other review sources).
Every other day you should go through the blank "Memorization sheet" and write your answers on another blank sheet of paper. Afterwards, check these answers with your answer sheet and re-emphasize the facts you got wrong. Alternatively, you could do half of the sheet every day.
This takes about 30 minutes, but it is incredibly valuable.
Drugs that induce P450
Drugs that inhibit P450
Drugs that cause Lupus
Disulfiram rxn drugs
X linked diseases
Hormones that signal via cAMP
Hormones that signal via IP3
Causes of Acute Pancreatitis
Causes of DIC
Features of SLE
Criteria for Schizophrenia
Suicide risk factors
Causes of Anion Gap Metabolic Acidosis
Regulation of Enzymes
Lysosomal Storage Diseases (FA full page - write page number in answer sheet)
Electrolyte Abnormalities (FA full page - write page number in answer sheet)
Draw: Virus Classification, Brachial Plexus, Basal Ganglia, Lung Volumes Chart, Embryonic Heart
By: Ross and Joe England
This method was originally developed by Ross England, a Temple University student in the class of 2012, to maximize his performance on the USMLE Step 1. With this method he achieved a 3-digit score of 262. An outline of his method was distributed to the class of 2013 and received a lot of positive feedback. Being his twin, I opted to use the same study strategy, with minor changes, and achieved an even higher score of 271. It is our belief that anyone who commits to this study schedule early in their 2nd year of medical school will improve their potential Step 1 score considerably.
The schedule for our approach to the boards can be divided into 5 stages: before winter break, after winter break, Doctors in Training/review book reading, First Aid repetition, and a pre-test taper.
A detailed description of each stage follows below. Additionally, there are notes on whether or not to purchase a Doctors in Training review course and on how to make the best use of the USMLE World Q Bank.
Stage 1: Before Winter Break
Before winter break it is important to study hard for your classes while familiarizing yourself with the board review material that you will be using in the future. [Strategic Point – You don’t want to be reading anything new during your 6 week board review period. If you follow the advice below, you will have broad exposure to every review source necessary to completely crush Step 1.] The schedule is modeled after the Temple University School of Medicine core block schedule, but can be easily adapted to any other medical school schedule.
[Strategic Point – It’s a good idea to add up the number of pages of textbooks and review books that you will need to complete before each exam and then divide this number of pages by the number of days you have until the exam. This will tell you how many pages you need to read each night]
Block 6: Introduction to Pathology, Pharmacology, and Immunology
-read all class notes/power points 2-3 times
-read the first 7 chapters of Robbins and Cotran Pathologic Basis of Disease (if you are pressed for time and want to exclude some of this reading, read at least chapters 1, 2, 6, and 7 )
-read the relevant chapters of First Aid on basic pathology, pharmacology, and immunology
-read chapters 1, 2, 3, 5, 6, 7, and 8 of Rapid Review Pathology (1, 2, and 8 are most important)
Block 7: Microbiology
-read the sections of Clinical Microbiology Made Ridiculously Simple (CMMRS) relevant to Bacteria, Fungi, and antibiotics during summer break
-read ALL of CMMRS again, preferably reading relevant chapters before the lecture on that topic
-pay close attention during lectures and add any obscure material that you think the professor might put on a test that is not already in CMMRS into the tables at the end of each chapter
-study these self-edited tables (mentioned above) 2-3 times before each exam
-read the Microbiology chapter of First Aid at least once
-(Optional) Buy Microcards and add all info you want to remember about each organism that isn’t already on the cards
-(Optional) For a stellar score on the NBME shelf exam at the end of the block, read How the Immune System Works chapters 1-8 (this is a very light read that will bring your intuitive understanding of the immune system to a new level)
Block 8: Cardiovascular and Respiratory Disease
-read all class notes/power points 2-3 times
-read chapters 11, 12, and 13 of Pathologic Basis of Disease
-read chapters 9, 10, and 16 of Rapid Review Pathology
-read the relevant chapters of First Aid
-read the relevant chapters of Lippincott’s Pharmacology
Block 9: Endocrine, Renal/Urinary Tract, and Reproductive Disease
-read all class notes/power points 2-3 times
-read chapters 19-24 of Pathologic Basis of Disease (I’ll admit, this is a ton of reading. Neither Ross nor I was able to finish all of this, and if you want to cut corners too, focus on Chapter 20 only)
-read chapters 19-22 of Rapid Review Pathology (don’t cut any corners here)
-read the Endocrine, Renal, and Reproductive chapters of First Aid
-don’t worry about extra pharmacology reading for this block, the endocrine drugs/renal drugs are covered well in First Aid
***Take it easy over winter break. I mean it. Don’t study anything. Because you are in for a crazy 4 months when it is over***
Stage 2: After Winter Break
This is the time where you need to begin preparation for Step 1 in addition to your class studying. The whole goal of this stage is anxiety management. We all had a block or two in the 1.5 years of medical school that gave us trouble. Use this time to brush up on those subjects. For Ross, it was the first 7 chapters of Robbins and Cotran that he never got around to during Block 6. For me, it was High Yield Neuroanatomy and about 1/3 of Lippincott’s Biochemistry (plus the relevant First Aid chapters on those subjects). I also subscribed to Kaplan Qbank for a month before the 6 week prep period began just to boost my confidence in my question taking ability and to do class specific questions (more on this later). [Strategic Point – Use this time to brush up on a weak point or two ONLY! This will allow you the most time to prepare for class and will lower your anxiety for what you will need to accomplish during the 6 week prep period. Trying to study for the entire Step 1 on top of classes is a recipe for unbearable stress. ]
Block 10: Psychiatry, Neurological Disease, Musculoskeletal Disease, and Autoimmune Disease
-read class notes/powerpoints 2-3 times each
-read the psychiatry, neurology, and musculoskeletal chapters of First Aid
-read chapters 3, 23, 24, and 25 of Rapid Review Pathology
-read relevant sections of Lippincott’s Pharmacology (especially psychiatry drugs)
Block 11: Gastrointestinal and Hematological/Oncologic Disease
-read class notes/power points 2-3 times each
-read the GI and Heme/Onc chapters of First Aid
-read chapters 11-15, 17, and 18 of Rapid Review Pathology
-read chapters 13 and 14 of Pathologic Basis of Disease
[Strategy Point – Between the beginning of Stage 3 and the end of Stage 4 you should complete the entire USMLE World Q Bank and go through all of the questions you got wrong again. You will need to average 50-100 questions a day to achieve this goal. See the section “How to Best Use the Q Bank” below for specific advice on how to maximize the time you spend doing questions.]
Stage 3: Doctors In Training (DIT)/Slow First Aid Review/Review Book Reading
DIT runs for 15 days. Ross and I both recommend that you do either DIT or spend an equivalent 15 days carefully going through First Aid and looking up everything you don’t understand. We also recommend that, if you do DIT, you do all 15 days in a row and start the day your prep period begins. This will ensure that you have all the high yield info in your First Aid before you start studying it in earnest. In the evening after each DIT lesson or First Aid session, aim to read 80-100 pages of board review books.
[Strategic Point – spending the first 12-15 days methodically reviewing First Aid, either on your own or with the coaching of DIT staff, is invaluable]
Deciding on which board review books and how much of each will be highly personalized. In the table below, Ross and I offer what little guidance we can. Using a variety of factors including your medical school grades, how much you had to struggle to achieve those grades, your history with standardized tests, your grades on the NBME shelf exams, etc. you can come up with a realistic goal score for yourself. Table 1 shows a recommended amount of reading to complete during the first 15 days of the study period (give or take 3 days, Ross and I both took 3 additional days to just finish reading) for four different goal score categories.
Another thing to consider in choosing your amount of outside reading (by outside, I mean in addition to First Aid) is your personal processing speed for reading. For example, even if you are capable, by all other predictive measures listed above, of a score in the 225-240 range, but you know you are a slow reader, you might want to do the recommended reading for the 210-225 range and spend the extra time really focusing on First Aid.
|Rapid Review Pathology*||
|Clinical Micro Made Ridiculously Simple||
|Rapid Review Biochemistry***||
|High Yield Neuroanatomy||
|How the Immune System Works (Ch. 1-7)||
Table 1. Recommended Supplemental Reading for Different Goal Scores.(*For Rapid Review Pathology, take all blue margin notes that are not already in First Aid and add them in. ** For Lippincott’s Pharmacology – focus on neurologic drugs (psychiatric medications, seizure drugs, anesthetics), diabetes medications, and anti-arrhythmics. ***For biochemistry, focus on metabolic pathways and experimental methods.)
[Strategic Point – You can reduce the amount of reading you need to accomplish during Stage 3 by using these resources to bulk up on your weaknesses in Stage 2. For example, I read all of High Yield Neuroanatomy and much of Lippincott’s Biochemistry before the 6 week prep period began]
Stage 4: First Aid Repetition
During this stage you will read between 80 and 120 pages of First Aid every day. When you come upon a detail you did not know, write it down on a lined sheet of paper. Review the papers at the end of the day, highlight things you STILL did not know, and then go over the highlighted items once more. Ross and I both went through First Aid three times in addition to the first 15 day run-through. During each round of First Aid you should see your “Did Not Know” (DNK) sheets decrease in number.
[Strategic Point: Each round of First Aid reading in Stage 4 should take between 3 and 6 days depending on your reading speed and information processing ability. On days where you find the material easier, try to get more pages done, thus leaving extra time to manage your trouble areas]
In addition to this, every other morning you should devote 30-60 minutes to going through the high yield, hard-to-remember stuff. We recommend making a “Drawing List” of everything you want to memorize (ex. glycogen storage diseases, seizure drugs, gram negative bacteria classification etc.). On our website you will find some valuable resources for this purpose. One, in particular, is a list of every set of hard to remember facts that comes with good mnemonic strategy in First Aid, for example SIG E CAPS for the symptoms of depression. I recommend printing it, laminating it, and using dry erase markers to practice. I can’t make you an answer sheet because the mnemonics are copyrighted by First Aid, but you can go through and easily find the answers yourself to make your own answer sheet.
[Strategic Point: Print the memorization sheet attached to this blog post (above) and fill it out during your reading of First Aid and other sources]
[Strategic Point: These mnemonics are pre-prepared and they should be reflexive by test day. Don’t let studying difficult and obscure facts distract you from the completely easy, high yield concepts]
Stage 5: Taper
Like preparing for any big athletic event, the taper is vital. Ross and I both took it easy the last 3 days before the boards, doing maybe 75% intensity at 3 days out, 50% intensity at 2 days out, and 25% 1 day out. The day before, we recommend you just quickly breeze through your “Drawing Sheets” and most recent “Did Not Know” sheets, then just relax.
DIT: To Spend the Money or Not?
Many people ask if DIT is really necessary or not. It’s a toss-up, but Ross and I both err on the side of it not being necessary. Going through First Aid on your own with a fine-toothed comb and looking up everything you don’t understand in reputable references should be just fine. That being said, there are some advantages to doing DIT. (1) It is low energy, allowing you to think more about the material at hand without burning out. (2) It is active learning, with plenty of quizzes and educational study breaks in the middle of the lessons. (3) It is an opportunity to be somewhat social – many people in your class will be doing DIT, and participating in the camaraderie and inside jokes is not a bad reason to sign up (the cabin fever of those last 4 weeks of the study block are bad enough without making it 6 weeks completely cut off from social interaction).(4) They have an awesome slogan.
How to Best Use the Q Bank
Some people buy the USMLE World Q Bank much earlier than the beginning of the study period and use it to practice during Blocks 10 and 11 (or even earlier). This is not necessarily a bad idea, but it leads to a common temptation: doing block specific questions from the QBank to prepare for your class exams. Ross and I both think this is a waste of the best use of your QBank. Here’s why:
USMLE World is, hands down, the best of the question banks (I tried a few of them). It is not just a learning tool--it is a predictive tool that allows you to track your progress during your study period.
So let’s say you’re studying for your Heme/Onc exam and you succumb to the temptation to do all the Heme/Onc questions in UWorld. What’s the big deal? The big deal is two-sided. First, you will likely get high scores on those practice tests because Heme/Onc is all you’ve been studying for the last few weeks. Second, you won’t have any Heme/Onc questions left during your study period and will therefore be inadvertently avoiding Heme/Onc questions for your entire board prep period.
All in all, you will have managed to inflate your percentage score on your UWorld account (leading you to believe you are more prepared than you really are) while also cultivating a weakness (making you less prepared than you otherwise would have been).
My solution is to use another question bank (I used Kaplan) during Stage 2 to practice subject specific questions and to build confidence in your ability to answer Step 1 style questions correctly. Then purchase UWorld at the beginning of Stage 3.
[Strategic Point – always use random, timed mode including all subject areas in your practice tests during Stages 3 and 4. This increases the predictive value of your scores.]
[Strategic Point – Make a journal and jot down little facts you did not know from UWorld questions – especially the ones you don’t think are in First Aid]
[Strategic Point - Do not be discouraged if your UWorld scores start to drop off slightly near the very end. Once you have exhausted all of the easy questions, like biostatistics and ethics, the tests become a little harder than they were in the earlier portion of your study period]
Some websites have score predictors based on UWorld performance and other factors. Ross and I both found that these predictions were not very accurate. In both of our cases, the self-assessment exams produced by UWorld gave the most accurate prediction of our scores. There are two of them, and they can be purchased separately or with a Q Bank subscription. All four exams (two for me and two for Ross) predicted our respective scores within 6 points or better. It is probably best to do these assessments 1-2 weeks before your exam date, to get maximum predictive value for your score while still giving you a good idea of which topics still need work.
A Word on Maintaining Your Sanity
Ross and I have been told that this study schedule is “intense,” but neither of us thought it was all that bad. A few tips on what might make these 12-15 hour days more bearable:
- Exercise: If you aren’t already on an exercise program, you should consider starting one a few weeks before your study period at the very latest. Do whatever kind of exercise you want, but Ross and I think that the short duration, high intensity variety is optimal for board studying. Do a set of sprints instead of a half hour jog. Lift heavy and fast instead of high repetitions. Save yourself a trip to the gym by doing body weight exercises at home such as push ups, pull ups, squats, etc. Better yet, mix all this together into 5-10 minute circuits that leave you on the ground gasping for breath. Then immediately go do some studying (some scientific studies have demonstrated an increase in information retention after intense exercise…anything helps right?)
- Nutrition: Get your nutrition in order at least several months before the boards. I know you didn’t read this guide for nutrition advice, but doing some research on the benefits of carbohydrate restriction might be a good starting point. We don’t buy into too many health supplements, but there seems to be a strong body of evidence in support of fish oil and vitamin D3 (stock up…because sunlight will likely be in short supply for at least 6 weeks).
- Sex: Have it as much as possible with a willing partner. If you don’t have a willing partner, I imagine some self love could go a long way towards stress relief. That’s all I’m going to say on that topic.
On Getting Honors at Temple
Doing everything I mentioned above will not only assist you in reaching your maximum Step 1 potential, it will also help you on your medical school exams. One last tip towards this end: For blocks 8-11, always, always, always do the relevant questions from Robbins and Cotran Review of Pathology. Many of the professors take their questions directly from this book. It is low hanging fruit.
Why We Think It Works
What we have created here is a rational method for rapidly learning an enormous amount of medical information. Ross invented the method intuitively on this basis. However, our respective successes on the USMLE Step 1 Exam are indicative of the efficacy of the method. We are also convinced that we improved the method on the second iteration (Joe’s study period), as we are both extremely comparable students (we’ve always scored almost identically on everything in the past) and his score was improved relative to Ross’s.
We do not guarantee any particular score on the exam for people using our method. We just think it’s a good method. Leave it at that.
We (Ross England, Joseph England) own the copyright to the contents of this document (2011), the original publication of which can be found on Think Twice (blog.think2x.com). We hereby grant permission for the distribution of unaltered copies of this document to anyone provided they are given freely for the purpose of medical studies. We do not grant permission for sale of the contents of this document. We do not grant permission for the distribution of altered versions of this document.