Essential Resources for the USMLE Step 1

The goal of this column is to provide you with the resources you need to excel in medical school. For more clinical resources, visit Emily Cooper’s blog, Med-Source, which she maintains as a “one-stop guide” for med students.

I was planning to expound upon pathology this month, but having just completed Step 1 of the boards (formally known as the US Medical Licensing Exam or USMLE), it seemed appropriate that I share the pearls that I gleaned while the material was still somewhat fresh in my mind. I studied for just over 5 weeks, which felt like just the right amount of time. Any shorter and I would not have been fully prepared, any longer and I would have started to forget what I learned at the beginning.

From the outset, I would highly recommend creating a study schedule in which you cover all of the material in First Aid during the first 3 1/2 to 4 weeks, doing at least 50 questions each night and then only reviewing questions during the last week.

The highest-yield online sites for the Boards are the question banks. Although pricey, the questions provide the best way to assess your progress and, next to First Aid, were my most valuable study resource.

  1.  Kaplan Qbank still serves as the industry standard. Your subscription provides access to more than 2000 questions that can be sorted by both discipline and organ system. A 1-month subscription costs $199, a 3-month subscription costs $279, and a 6-month subscription costs $499 (discounts may be available through your medical school). This program allows you to customize tests with your unused and/or incorrect questions, so that you can focus on your weaker areas. Although the interface is not identical to the real exam, it is close enough that the real exam will not feel foreign. Kaplan’s other strong points are their explanations for the answers. After completing a test, make sure to read the full answers, as a lot of information is packed into explaining why certain choices are incorrect.


  2.  USMLE World is the steadily growing upstart rival to Kaplan. They have now amassed more than 2000 questions as well, making this q-bank capable of standing on its own as a review source. The format is identical to the FRED format that you will see on the real thing. As with Kaplan, you can track your performance. I found the questions to be slightly more representative of the real exam than the Kaplan questions, but the explanations were not as thorough.


  3.  Practice exams provided by the National Board of Medical Examiners also come highly recommended and are available for $45 each. Other students who have used these exams say that they are the most representative of the real exam, with form 1 being the easiest and form 3 the most difficult.


  4.  When you register for Step 1, you get access to practice content. The 3 blocks of content are easier than the real exam, but they are a good confidence booster and are worth running through if only to know that you have covered the “official” material. The Kaplan Qbank subscription also comes with a .pdf file of explanations (an answer key without explanations comes with the content).


  5.  Also, be sure to check out resources offered by your school. At the University of Pennsylvania, we have access to USMLEasy, which provides online question banks for all of the step exams. If you don’t have free access, you can check out sample quizzes on Medscape and learn more about the Step 1 q-bank.


The volume of print material available to prep for the boards is virtually limitless. Fortunately, First Aid — along with upperclassmen — should help you wade through and select the most valuable choices. Below, I listed the top 1 or 2 choices that my colleagues and I chose for each subject. It may be useful to go to your medical bookstore and look through the major series (High Yield, BRS, and Rapid Review) to decide which style works best for you. Also, First Aid has extensive reviews of the subject-based review books in the last section.

  1.  First Aid for the USMLE Step 1 2008 (Le T, Bhushan V, Rao DA): Treat this book as your Boards bible. Learn it, love it, know it. Take all of your notes in this book so that when you review at the end, you only have to go back to 1 book.


  2.  Biochemistry: Focus on the key enzymes and clinical consequences. Any one of the following will suffice:
    •  Lippincott’s Illustrated Reviews: Biochemistry (Champe PC, Harvey RA, Ferrier DR);


    •  BRS Biochemistry and Molecular Biology (Swanson TA, Kim SI, Glucksman MJ);


    •  High-Yield Biochemistry (Wilcox B).




  3.  Pharmacology: Focus only on those drugs mentioned in First Aid and master the general pharmacology chapter. I used only the flashcards and felt that they were more than adequate.
    •  Pharmacology Flashcards (Barron) — One side has a clinical vignette and the other has all the key information on the drug;


    •  Lippincott’s Illustrated Reviews: Pharmacology (Howland RD, Mycek MJ, Harvey RA, et al);


    •  Appleton & Lange Review of Pharmacology (Krzanowski JJ).




  4.  Microbiology: Clinical Microbiology Made Ridiculously Simple (Gladwin M, Trattler B)


  5.  Immunology: High-Yield Immunology (Johnson AG) or Medical Microbiology and Immunology (Immunology section only) (Levinson WE)


  6.  Pathology: BRS Pathology (Schneider AS, Szanto PA, Kim SI, et al)


  7.  Physiology: BRS Physiology (Costanzo LS)


  8.  Anatomy: High-Yield Gross Anatomy (Dudek RW, Louis TM)


  9.  Embryology: High-Yield Embryology (Dudek RW) or BRS Embryology (Dudek RW)


  10.  Neuroanatomy: High-Yield Neuroanatomy (Fix JD) or Clinical Neuroanatomy Made Ridiculously Simple (Goldberg S)


  11.  Behavioral Science: High-Yield Behavioral Science (Fadem B)


  12.  Histology: High-Yield Histology (Dudek RW)


As indicated above, First Aid is the quintessential source for Boards review. Take all of your notes in this book, writing in it as you go over your q-bank answers.

  1.  During your review days at the end, go back and reread your annotated copy.


  2.  Do questions! Each night after studying, answer at least 50 questions on what you studied that day. Towards the end of your studying, complete blocks of 50 random questions to better simulate the real exam.


  3.  Know the basic pharmacology chapter. The concept of epinephrine reversal will be on your Boards.


  4.  Study with a friend. You may or may not want to actually study out loud, but at the very least you should have someone you meet everyday and sit with to help get you through. Five weeks is a long time to sit in a room by yourself.


  5.  Sleep, eat, exercise, go out. Your life doesn’t need to stop because you are studying. If you get going before 10 am, you should be done by 8 pm with time to chill out.


 One last thought: you will be fine. If you feel overwhelmed, channel that energy into doing an extra block of questions rather than freaking out about the exam. Everyone panics a little at some point, but panicking is not productive. Doing questions is. Good luck!

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