Think Twice Reflections on Medical Education


Planning is Everything: How to Approach a New Med School Course

"Plans are nothing, but planning is everything."  -General Dwight D. Eisenhower

One of the unifying features of students who are struggling in medical school is that they did not approach their courses with a deliberate plan. In general, I've found that it's rare for even well-performing students to plan their approach to their studies. Nevertheless, I think that almost anyone could do better in med school if they take some time to think about how they want to organize their efforts.

Planning your approach to a medical school course should involve, at least, the following steps:

1. Read the syllabus

2. Talk to your friends

3. Decide what you will do

4. Make a schedule

5. Revise the schedule as needed


Read the Syllabus

I'm actually shocked by how few people do this. It may be written by your seemingly crotchety old professor but the syllabus is still often the single best source on how best to prepare for your course. It will usually contain a list of competencies (the usefulness of this varies), course expectations, assignments and due dates, and often a list of reading materials that other students have found helpful. Jot down the assignments, due dates, and reading materials--you'll use them later in this process.

Talk to Your Friends

No doubt you have friends in the med school classes ahead of you (if you don't, make some!). Before you start a new course, you should talk to them about what study materials they used. What books did they read? Were the lecture notes good study material for the test? Did they use practice tests? Did they think the practice tests helped? Did they purchase any commercial test question books (e.g., Board Review Series, PreTest)?

Make sure you ask them how they did in the course. If they didn't do well, or as well as they'd hoped, ask them if they know people who did better and what they did differently.

Jot down everything you found out from this step.

Decide What You Will Do

This is the part where you determine all the steps you're going to take to succeed in your medical school course. You will need to determine:

  • will you attend lectures or watch recorded lectures (if recorded lectures, what will your schedule be)?
  • are you going to print the lecture notes or read them on a screen?
  • are you going to take notes in a traditional notebook, directly onto printed lecture slides, or type them into your computer?
  • what are you going to read? pick 1-2 of the textbooks/review books you jotted down in from the syllabus and your discussion with your friends
  • what will you use for practice materials? practice tests from your professor or commercial question books
  • what time of day and for how long will you read and study
  • when during the week will you build review of past material into your schedule (Sunday night's are often good for this)
  • will you study alone or will you study with a group sometimes
  • where will you study (home, library, coffee shop, etc.)
  • how will you review the material in the days leading up to the exams

Make a Schedule

I always liked to do this in Microsoft Excel but you can free-hand it as well. On the left hand side of a piece of paper (or on a printed calendar), list the dates that your course will span. If you have a traditional semester-based course system, this will span quite a number of days. If, like Temple University, you're in a block-based course system, you'll have a more manageable number of dates. Next, decide how many review days you want to have at the end of the course. Let's say you want 2 days of just pure review before the final exam. Next, mark any days you know you will not be studying (e.g., rest days, events you will need to attend, etc.).

Add up the total number of days in the course and subtract exam days, your review days, and non-study days. This will give you the total number of days that you will actually spend reading and studying for the course.

Your next step will be to divide your reading materials and question books by the number of study days you've calculated. This will give you the bare minimum number of pages/questions you will need to study per day in order to keep abreast of the material.

For example, at Temple University (at least when I was an MS2) Microbiology and Infectious Diseases was taught as a seven-week dedicated block course with a mid-term exam and a final exam. The first mid-term as at the end of the fourth week. The first four weeks covered bacteria, fungi, clinical infections from bacteria and fungi, antibiotics, anti-fungals. This covers pages 1-219 in Clinical Microbiology Made Ridiculously Simple, a popular review book on this topic. With four weeks of studying, minus weekends and 2 study days before the mid-term, you have 18 days to study this book. That means you will need to read 12.1 pages per day of study--round up to 13 and you'll finish a little bit earlier. If you have another study book in mind, perhaps the microbiology chapter in First Aid for USMLE Step 1, repeat the process to figure out how many pages per day you should read from this book to finish on time. Next, figure out how many questions per day you will need to from your question sources (e.g., if you have 180 questions total, you should do 1o practice questions per day). To see what the final result might look like, download this excel file of a Sample Schedule for 4-week Period. You'll see each date listed on the left and, glancing across the row you'll see how much of each source you need to finish per day of study.

You don't need to do an even amount of reading on each day--if you want Monday-Wednesday to be your reading days, then you'll have to divide your total number of pages by a smaller number of reading days and read more on each of those days. Design your schedule to your own needs.

Plans Are Nothing: Revise Your Schedule As Needed

The schedule you have created and the general plans you have made will give you an approach to organize your work for your course. It is not, however, written in stone. If you find that you have a good reason to not follow the plan--then alter the plan. You may, for example, realize that you are reading too much on week days and you'd like to do some of your reading on Saturday mornings. Alter the plan accordingly. You may find that you chose too many reading sources and you need to delete an entire column from your schedule. If that's really the best choice for you, then go ahead.

In short, the plan is a tool to help you manage your work. It is not a task manager forcing things to do things its way.


The Importance of Doing “Nothing”

by: Ross



Photo Credit: Smallbones, Wikimedia Commons

I think many medical students make the mistake of spending too much of their studying time on reading and not enough of their studying time doing "nothing." As the quote marks indicate, by "nothing" I don't mean literally nothing. I mean thinking without engaging with an actual source of material. In a way, what I'm suggesting is that medical students should deliberately devote some time to studying from their own mental contents.

The amount of material to be studied in medical school is enormous. It's easy to get overwhelmed and feel that you have to keep reading in order to get through all the material. But by spending too much time on just reading, too many students give short shrift to time that could be profitably spent thinking. There's a reason that many of us come up with our best ideas while in the shower, sitting on the toilet, or while laying in bed before falling asleep. These aren't magical places--they just happen to be places where you spend time without engaging with someone else's written work. For many of us, these may be the only places where we are alone with our own thoughts.

The important upside of this activity is forming new connections between your concepts. The idea is that a new fact learned by itself is a new fact you have--congratulations. But that fact by itself is both difficult to apply to diverse situations and also hard to remember unless you form connections with other things you know. Your reading material or lecturers may direct you at some of the relevant connections that you should form, but they're never going to be able to point out all of them due to space and time constraints. If you're going to learn well, you need to do your own thinking.

As an example, you might take a break from studying microbiology to ponder the material you've just read. Let's say you were must reading about selective culture media. MacConkey's Agar, you've read, is a selective medium for growth of lactose-fermenting organisms. You then say to yourself--what are the lactose-fermenting organisms? If you don't remember, make a mental (or physical) note to yourself to look it up when you return to your work. Moving on, you think about lactose--reminding yourself from your biochemistry lessons that lactose is a disaccharide composed of two monosaccharides--galactose and glucose. Breaking down lactose requires special enzymes. Bacteria that produce those enzymes, such as through the lac operon of E. coli, are able to ferment lactose. . . . which means E. coli must be a lactose fermenter and grows on MacConkey's Agar.

I'm rambling here from my own memory . . . which is exactly what you should do when you're thinking. You don't have to think it onto a blog post, but the fact remains that one of the best ways to form connections between your mental contents is to simply sit or walk and reflect on those mental contents.



Memorizing vs. Understanding in Medical School

by: Ross

Perhaps the most tired refrain when it comes to medical school advice is that students should study not by memorizing content but by thoroughly understanding the concepts being taught. It seems to me that everyone that says this to students thinks that he's the first person to ever think of it. In fact, most of us have been hearing this exact same advice since high school of earlier. I'm a little jaded on this piece of advise, at least as its usually given, because I think it lacks truly helpful meaning for the rigor of studies involved in medical school and, if taken the wrong way, can seriously trip some students up.

In principle, the "don't memorize--understand" prescription is basically true--you cannot possibly turn all of the material you will cover in medical school into lasting and useable knowledge by only memorizing. There should be an emphasis on really engaging with the material, making connections in your knowledge, understanding the relationships between concepts, and realizing when some particular fact being studied is really just an instance of a more general phenomenon.

Nevertheless, I have problems with the general advice of "don't memorize--understand." I think it needs to be questioned in at least two ways.

1. It's just not always true. 

Medical students absolutely must memorize some things. It's just a plain fact that some--even most--of the things we are tested on and which we apply in the clinic are not amenable to some higher understanding that enables them to be more easily committed to memory. For example, the side effects of a particular drug to not necessarily follow from a deeper understanding of how the drug works--often, pharmacologists don't even fully understand why drugs have particular side effects (or there is controversy on that point). Nevertheless, the physician needs to know the side effects of the drugs he commonly prescribes. How is he to accomplish this end? By memorizing them!

Moreover, medical school involves learning an entire language that is used to communicate with other healthcare professionals. We don't say "sweaty." We say "diaphoretic." We don't say "winded." We say "dyspneic." Often, our clinical mentors want us to not only know the medical term for things but also the eponym--the names of the people who discovered it (e.g., "adrenal failure secondary to meningococcemia" should also be remembered as "Waterhouse-Friedrichson Syndrome").

The fact is that much of medical school curriculum needs to be memorized, and some part of that requires additional consideration for higher understanding. The exhortation "don't memorize, understand" fails to acknowledge this and defaults on the much more difficult goal of actually helping students figure out what needs to be understood and what needs to be memorized.

2. Understanding is hard to do.

It's easy enough to tell people to study to understand rather than memorize, but in actual practice this is really difficult. How to best study to achieve understanding is a huge, complex topic in pedagogy--it's often really hard to figure out. Accordingly, most of the students I've encountered who were over-memorizing did not actually set out with the goal of memorizing everything--they actually thought they were studying to understand the material and just ended up only having a shallow understanding of the material because their methodology was, unbeknownst to them, not ideal for their stated goal. In order for the advice of "don't memorize--understand" to carry any usefulness, it would need to be accompanied by real principles of how to study in order to reliably achieve a strong conceptual understanding of the material. These principles are usually conspicuously absent.

What's actually needed:

Undoubtedly, the people who are telling students "don't memorize--understand" are really trying to help. Unfortunately, for the reasons I've elucidated, I think it's really not very helpful at all (and can often be perceived as patronizing by students seeking advanced degrees). What we really need instead is a method that students can use to reliably separate the material that needs to be memorized from the material that needs to be more deeply understood and a method that they can apply to achieve consistent understanding of the latter type of material. I have a few ideas on this, but that's the subject for future posts.




USMLE Study Tool: The Memorization Sheet

By: Joe

Memorization Sheet Word Document

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.


 Memorization Sheet

Bactericidal antibiotics

Bacteriostatic antibiotics

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

Manic Episode

Suicide risk factors

Panic Disorder

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


The Think Twice Strategy Guide for USMLE Step 1

The Think Twice Strategy Guide for the USMLE Step 1 (a .pdf download of this post)

Memorization sheet

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.

Recommended Materials

Robbins and Cotran Pathologic Basis of Disease

Rapid Review Pathology

Lippincott’s Pharmacology

Clinical Microbiology Made Ridiculously Simple

BRS Physiology

Lippincott’s Biochemistry (or) Rapid Review Biochemistry

High Yield Neuroanatomy

How the Immune System Works

Doctor’s In Training (DIT) review course

USMLE World Qbank




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.


186-210 210-225 225-240 260-280
Rapid Review Pathology*





BRS Physiology





Lippincott's Pharmacology**





Clinical Micro Made Ridiculously Simple


Rapid Review Biochemistry***


Lippincott's 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]

Score Prediction

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:

  1. 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?)
  2. 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).
  3. 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.

Legal Information/Copyright

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 (  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.