USMLE Step 1 exam misconceptions

Hello everyone. The following is a detailed piece regarding preparation for the United States Medical Licensing Examination Step 1. I am a final year medical student and I completed my USMLE exam on June 10, 2012; I achieved scores of 99/266.

First I’d like to introduce and investigate some of the misconceptions and prejudices surrounding the USMLE Step 1 examination which seem to be especially prevalent within overseas students

Myth 1: You should only take the USMLE Step 1 exam after graduation.

Verdict: Baseless

the idea that one should wait until after graduation before taking USMLE Step 1 exam is patently false, based on a risk that is no less present when taking the exam after graduating. No matter your level of experience or amount of preparation, Step 1 represents a risk for anyone who undertakes it given the simple fact that it is an unpredictable exam.

The benefit of taking USMLE Step 1 before graduation is that you are still immersed in the detail of your medical education, typically resulting in a score that is substantially higher than when taken post-graduation. This gives you the benefit of relying on still-fresh study habits and medical information that remains fresh in your mind and helping you to find the right tempo to study and prepare, tasks that are often lost in the fray after you enter the medical profession.

Rather than wasting your time during your medical education, spend it reviewing USMLE recommended textbooks in order to prepare for Step 1! Keeping in mind that American students take Step 1 at the end of their second year and Step 2 at the end of their fourth year, waiting until after graduation to take Step 1 can only negatively affect any competitive edge you’ve gained.
Myth 2: You must memorize the Kaplan series and know it by heart.

Verdict: Incorrect and a potential time-waster.

actually what i know for sure is that American medical students are rarely intersted in studying Kaplan in thier USMLE step 1 preparations; the appropriate books on this section of the test are mentioned further on. While Kaplan is an excellent series, the idea that it is the ultimate base for the USMLE Step 1 exam is simply untrue; the Step 1 exam does not have a well-defined syllabus, forcing most students to turn to the syllabus released on usmle.org.

Instead of cramming all of the material into your memory, much of it not found on the exam, it is a good idea to focus on key areas. Replacing the Physiology book with BRS Physiology and replacing Pathology with Golijan (you’ll need to supplement biostatistics with high yield biostatistics) are key ways to replace Kaplan with less time-consuming and far better focused material.

Remember that much of the information contained in Kaplan is vague, especially the Genetics section of Biochemistry, and it is rarely included on the exam. On the other hand, some topics require more study material than is recommended including cancer chemotherapy and lysosomal storage diseases. When it comes to mastering Microbiology, the use of Levinson is crucial..

Myth 3: You need clinical experience to fully understand USMLE Step 1’s clinical vignettes.

Verdict: Not necessarily true.

As mentioned above, American students typically take the USMLE Step 1 exam prior to graduation; if clinical exposure isn’t necessary for students in the United States to be successful in their exams, it is not necessary for students in other countries, either.

While serving in a clinical setting in hospitals will certainly help you to better understand methodology and practices leading to diagnosis, management and treatments, it is definitely not imperative that you have clinical experience before taking the USMLE step 1 exam. Most of the cases the exam will present you with can be easily understood by simply applying the knowledge of basic medical sciences that you’ve acquired through your studies; in-depth topics, such as those of radiographs and gross specimens, can be practiced with resources available freely on the internet and via your university; even the sound of a heart sounds and murmurs can be easily studied with the help of Google!

With patient management scenarios only appearing very rarely in the Step 1 examination, a basic knowledge of medical science is all you need to prepare you; the Step 2 CK examination offers a more in-depth focus on patient management.

Myth Number 4: A good study indicator is “number of reads.”
Verdict: Not necessarily true.

If there is one certainty when it comes to studying it is that each and every person has a unique method that works best for them and this makes the idea that any one style should work for everyone baseless. While more than a single read of the material will certainly be necessary, a rigid sequential study method typically follows the Kaplan series and offers little significant benefit.

I’ve been asked repeatedly by my peers as to how many reads I’ve completed and my answer is always the same: the number of reads is not the best criterion to use when judging one’s preparation – that’s the purpose of the NBME sample assessment. The truth is that you shouldn’t let the idea of the importance of your number of reads dictate how you study; some people study quickly and spend minimal time on each topic, allowing them more time to revise, while others find that an opposite method works best for them.

The above being true, a person who has completed two reads could very well be as prepared as someone who has completed seven; it is also worth noting that some subjects require more reads than other – pharmacology, for example.

So what study method is the best? That’s entirely up to you. Instead of forcing yourself into a rigid “number of reads” dominated method, work within your own already well-developed study habits instead. Always remember: if you scored well on the NBME test then you’re doing well.

Myth 5: If you score below 95 on the USMLE Step Exam, you’re done.

Verdict: Absolutely untrue.

While Step 1 is very important, it is crucial to remember that it is not the only criterion considered when judging a candidate; a well-rounded candidate will be judged on all material, including the Step 2 CK and Step 2 CS exams, electives, research experience and more. Not everyone will score a 99 on the Step 1 exam and there is no need to lose confidence in your abilities if you don’t. Like any exam, Step 1 will present challenges and not every exam can be your best.

If you do face a disappointing score on the Step 1 exam than simply study hard and compensate with Step 2; losing hope will not get you anywhere.

Myth 6: Step 1 focuses only on broad concepts.

Verdict: False; study, and study hard.

Students preparing for the Step 1 exam often work under the idea that it will not require much knowledge of particulars, focusing instead on broader concepts and ideas in preparation for Step 2. This is patently false and all students must realize that there is far more to learn for this exam than was presented in college, all in additional to new concepts. The particulars of Microbiology, Immunology and Pathology alone will demand endless information with the exam disguising many knowledge-based questions with exercises in in multiple-process thinking.

Myth 7: Up to 80% of the Step 1 exam is based on Pathology.

Verdict: False.

While it is true that upwards of 95% of the exam will contain clinical vignettes that can be directly correlated to Pathology, the subject matter contained on the exam will vary from subject to subject. For example, you may be given a vignette on Ataxia-Telegiectasia while being tested on an immunological or molecular biology concept. With the recent change on the USMLE exam to include more clinical vignettes, the variety of knowledge required to do well on the exam is more prevalent than ever.

I would recommend dividing your attention equally among all subjects in order to give yourself a good framework from which to work. There is no rule about topic inclusion and the exam itself is constantly updated to reflect current medical standards, leaving you to decide which subjects are most worthy of your attention.

Myth 8: Delaying the exam will help to increase my score.

Verdict: Potentially false; even the opposite could prove to be true.

While delaying your taking of the exam in order to provide more time for study may seem like an attractive idea when you’re feeling rushed and short on time, it is worth keeping in mind that that month could just as easily lead to a loss of remembered information.

Momentum in serious study is important and momentum can only be maintained with sustained effort towards your exam preparations. Choose your exam date and stick with it, allowing your positive momentum to carry you directly into the exam room and removing all of the risks that come with breaking your academic rhythm.

Myth 9: I’ve heard that Virology is a main focus in Step 1 so I’m focusing my studies there.

Verdict: False; exams are not standardized.

The lack of uniformity in Step 1 exams means that you cannot trust what you’ve heard as it may or may not pertain to your particular exam. Exams vary in content and even scoring method, leaving you in the dark when it comes to guessing about content.

Instead of worrying at the last minute about cramming one particular topic or another, work to split your study time evenly between all major subjects, spending extra time on topics within Pharmacology and Microbiology not because they are likely to appear more often on the exam but because they are more complicated areas of study. This will ensure that you have a firm grasp of each subject and will allow you to avoid the trouble you’ll face when your exam is full of Biochemistry and you’ve spent the past week cramming Virology.

see also

How to study for usmle step 1 exam

7 reasons make you fail in usmle step 1