The Step 1 Survival Guide STEP 1 FACTS: • • • • • • • • • •
322 Questions. 7 one-hour blocks, each with 46 questions. Average 78 seconds per question. If you click through the tutorial, you add 15 minutes to your 45-minute break time. You can take the optional break time at any time between blocks. Finishing a block early does not add time to subsequent blocks – it does add to break time. Passing score = 188 (the 2-digit score is no longer reported). 60%-70% correct = pass. MD programs: 2009 passing rate = 94% | 2010 passing rate = 92%. DO programs: 2009 passing rate = 81% | 2010 passing rate = 82%. Average scores (US seniors): matched = 225 | unmatched = 216. Once you pass, you cannot retake the exam to improve your score. Step 1 is very challenging. Despite the hype, very few US medical students find the test easier than expected. Harder than I expected Easier than I expected About the same as I expected
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A track record of success on standardized tests (e.g. in MCAT) does not guarantee a high score. Hard work and solid planning will maximize your potential. All questions are single best answer. You’ll have to exclude apparently good options. Mostly clinical vignettes, some research scenarios – reasoning and pattern recognition rather than straight recall. On average students report… o 5-10 multimedia questions on the test. o 5-10 sequential questions (2 questions asked of a single vignette) on the test. o 17% of questions include significantly more than 5 answer options. o 18% of questions require interpretation of images. o 16% of questions test information students perceived as obscure.
RESIDENCY FACTS: • • •
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The average program receives 716 applications. Residency programs rely on Step 1 scores to screen out applications. Percentage of residency directors citing factors when considering a candidate: o 73% cite Step 1/Level 1 scores. o 71% cite letters of recommendation in the desired specialty. o 68% cite personal statement. o 62% cite grades in clerkships. o 61% cite Step 2/Level 2 scores. o 59% cite class ranking/quartile. Many students don’t discover their real passion until they are in clerkships – after taking Step 1.
PREPARATION PRINCIPLES • • •
Study regularly for short periods over the long term. The amount of information you retain will plateau if you try to study intensively over a short period. Put a big picture framework in place early on by making a first pass through the material. This allows you to associate new material to existing material and retain more. Build spaced repetition of resources into your plan. This is key to improving retention.
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Repeat weak areas more often but make sure you repeat all areas. Otherwise, you may turn strengths into weaknesses. US medical students we surveyed rated Behavioral Medicine as the fourth hardest discipline on test day – harder than pathology. Doing well in Medical School is a great foundation for Step 1 and important to Residency Directors. Study Step 1 material that aligns with your medical school curriculum and you’ll do well in both. Make sure you have everything you plan to master organized in one place before you start studying intensively. Familiarize yourself with any resources that you plan to use well before you plan to use them. Don’t wait until the last moment to find out that something doesn’t work for you. Proper planning minimizes stress and maximizes scores. Put a plan in place that you are comfortable with before you start studying intensively. Ask an upper-classman you trust to review your plan. Be cautious of anyone who says the test is easy with the benefit of hindsight. You can also email
[email protected] for advice. Create a daily schedule for each phase of study. Try the schedule out before you enter each phase to check that it works for you. At a minimum include 3 quick, healthy meals, a 30 minute walk, 2 hours of non-study, and 8 hours of sleep. Take one day off studying each week. In an emergency, these can act as catch up days – however, relaxation time is key to making it through your Step 1 preparation time. Once you have a plan that works – stick to it. Make sure you understand the material during your first pass putting it into your own words if necessary so you are not trying to figure out what it means for the first time during your final review. Understanding the logic behind material will mean less rote memorization – it will also help you reason through novel scenarios to the best answer on test day. Study with purpose. Actively aim to retain material at each pass rather than passively viewing or reading. For instance, cover your book and immediately try to retrieve material. Seeing information in multiple ways aids retention. Make sure your studies are multimodal: o Use exam-like questions – limit use of recall questions. Testing on information just studied helps you to retain it. Because answering questions is active it helps you maintain attention. Exam-like questions help you understand the way you will apply knowledge. Exam-like question demand integrated knowledge which helps you integrate. Immediate testing of material helps you retain it. Spaced retrieval makes knowledge easier to retrieve later (The Testing Effect). Choose a plan that gets you through two Qbanks. When we survey US medical students there was a clear relationship between number of Qbanks completed and scoring higher:
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Read material. Reading is a faster way of covering all testing points than questions. You should make reading active by taking notes and immediately testing yourself in Qbank. Engage in a dialogue with text – “What does this mean?” What else do I know about this condition? What process is this like? High-Yield Lectures. Lecturers can explain how they mastered material more vividly than in text. Lecturers can integrate more elegantly than cross references in review books. Lectures provide forward momentum when your energy is low – for instance when you are still directing your energy to your medical school curriculum. Lectures provide push to help you cover topics you dislike. Illustrations and animations help you visualize concepts.
HIGH-YIELD STUDY PLAN: • •
Each High-Yield Lecture ends with ~5 USMLE-style questions, so you actively apply knowledge. 1 High-Yield Session = Four 30-minute lectures + 20 USMLE-style questions = 3 hours of study.
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1 Qbank block = 46 USMLE-style questions = 2.5 hours of study.
•PRE-PREPARATION | > 6 months to go •High Yield: Occasional Lectures | Qbank: 15 Qs/week| Prep time: negligible •CHECK UP 1 | 6 months to go •NBME Form 11
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•IN-CURRICULUM PREPARATION | 6-26 weeks to go •High Yield: 1 Session/week| Qbank: 15 Qs/day| Prep time: ~1 hours/day •CHECK UP 2 | 6 weeks to go •NBME Form 11
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•REMEDIATION | 4-6 weeks to go •High Yield: Repeat weak Sessions | Qbank: Incorrect/MyQuestions | Prep time: variable •CHECK UP 3 | 4 weeks to go •Kaplan Sim 1
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•FINAL MONTH | 1-4 weeks to go •High Yield: 1 Session/day | Qbank: 2 blocks/day| Prep time: 8-10 hours/day •CHECK UP 4 | 4 weeks to go •Kaplan Sim 2
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•FINAL WEEK | 2-7 days to go •High-Yield: Review High-Yield folder| Qbank: 2 blocks/day| Prep time: 8-10 hours/day
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•FINAL DAY •Review sheet| Relax
Accelerated plans. We recommend using this plan in full. If you do need a faster plan, here are some recommendations. 14 weeks Shorten Phase 2 to 10 weeks by studying ~2 hours a day. Cut out Phase 3. 6 weeks Start with Phase 4. After 3 weeks, repeat topics in which you are weak. Move on with Phase 5.
CHECK-UPs: • •
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Take a test before studying in earnest. Expect to do badly. Seeing that you need to raise your score lends urgency to your study. Seeing progress from a baseline keeps you motivated. On balance, most students find the NBME self assessment forms (CBSSA) to be fairly reflective of the test and a reasonable predictor of performance. However, use all score estimates to reduce stress and not as a reason to stop studying. We don’t recommend focussing on NBME forms as the test approaches. They don’t include explanations and are not an efficient learning tool. You should complete at least one full length simulated exam prior to the test. You cannot expect to have the stamina for an 8-hour test unless you do full length simulations. On test day, students sitting other, shorter tests come and go throughout the day. Consider taking your practice tests in a library environment so you can practice shutting out distractions. We don’t recommend taking a simulated exam less than 2 weeks from test day. A poor performance could unsettle you and damage your performance.
PHASE 1: PRE-PREPARATION General • If your medical school curriculum isn’t already in a calendar application work as a class to add it. Include all tests, breaks, and your school’s Step 1 “must test” date. Add your study plan to that calender based on the recommendations provided here and what works for you. • If your goal is a great score, you need to study more than just the highest yield material. Create a High-Yield Folder and condense material from other resources into it. o Purchase First Aid, take it to a print shop and have the binding removed so it can be added to your High-Yield Folder. Use First Aid to keep material you add organized. o In March, add the Step 1 High Yield course pack to the folder (First Aid Page refs included). o Watch out for high yield, helpful handouts from class and add. o Use single topic review books during your curriculum, extracting key information to add to your folder. If you do not have access to Kaplan lecture notes, we recommend… Pathology – Goljan Rapid Review Biochem – Goljan Rapid Review Micro – Micro Made Ridiculously Simple Gross Anatomy – BRS Anatomy Behavioral Medicine – BRS Behavioral Neuroanatomy - High Yield Neuroanatomy Pharmacology – BRS Pharmacology Physiology – BRS Physiology
Step 1 High Yield • View lectures that align with your medical school curriculum. As well as helping with your coursework, this will ensure that you are comfortable with the course. Qbank • Start doing ~15 USMLE questions per week that align with your coursework. Understanding the way the USMLE tests material will help you identify the test-relevant material that you should be adding to your High-Yield Folder during your curriculum. Add key information from Qbank to your High-Yield Folder.
PHASE 2: IN-CURRICULUM PREPARATION. General • Continue migrating information to your High-Yield Folder. By the end of Phase 2, you have a single folder containing all the material you plan to master for Step 1. Other review books may now be used for reference only. • If you plan to create flashcard for Pharm and Micro, create them before you are in a period of intense study. • At the end of each week, set aside time to quickly review your notes from the previous week. Step 1 High Yield • Cover one High-Yield Session per week (~3 hours). Follow the order recommended in the syllabus, unless you have a medical school test, in which case you should plan to cover the relevant High-Yield Session that week. • Follow along in your High-Yield Folder taking notes – put a check mark next to each First Aid heading you review and understand. Place an X next to any heading you find challenging. • Immediately apply your knowledge using the interactive USMLE-style questions at the end of each High-Yield Session. Qbank • Do 15 Qbank questions per day covering material studied the previous week (spaced retrieval). By the end of phase 2, you will have completed a first pass of Qbank. Continue to add key information from Qbank to your High-Yield Folder. • Each week, do one block that mixes all topics studied to date.
PHASE 3: REMEDIATION General • The hours you study per day will vary depending on whether you are still in class. • If you recover your weak topics early, start phase 4 and do more questions per day. • Schedule an activity you enjoy immediately after the test to reward your hard work.
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Check the USMLE website for late-breaking announcements.
High Yield • Repeat High-Yield Sessions focused on the weaknesses identified in the Check Up, reviewing the relevant sections of your High-Yield Folder. • Review all First Aid headings that you marked with an X during Phase 2. Seek help with anything you still find challenging and add an explanation in your own words in First Aid. Your goal in this phase is to be able to put a check mark next to every heading. Qbank • Create mixed topic tests out of incorrect questions and questions from your Qbank MyQuestions pool. • If you have time, repeat questions you answered correctly in areas where you are weak.
PHASE 4: FINAL MONTH General • Consider scheduling a practice test at the Prometric center. Using the exam software in exam conditions will remove uncertainty on test day. • As mentioned above, if you decide not to schedule a practice test, know your route to the testing center. Download the NBME test software, work through some questions and take the tutorial. This will give you the confidence to click through the tutorial on test day and add that time to your break. The only part of the tutorial you must complete on test day is testing your headphones. • If you change your test date within 30 days of the test you incur a fee. We strongly recommend that you avoid changing your test – if you have follow a plan like this one you will be great shape and delaying will be counter-productive. • At the end of each week, set aside time to review your notes from the previous week. High Yield • Complete one High-Yield Session per day following along in your High-Yield Folder. Regularly pause the video to read all notes that relate to the lecture. • Use x1.5 speed to compress your review time – but be honest with yourself. If you are not absorbing information at the faster speed use regular x1 speed. • Answering the questions at the end of each section a second time is helpful but optional. Qbank • At this point, consider purchasing an additional, 1-month Qbank. Doing two blocks a day will help you complete it.
PHASE 5: FINAL WEEK • •
Don’t study any new material in the last week. Go over your High-Yield Folder covering even portions each day.
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Create a separate cheat sheet by writing out anything you haven’t mastered. Study immunology, microbiology, and pharmacology last, as they are the hardest to retain. Continue doing two 46 question mixed topic blocks. Plan out how you want to distribute you break time on test day.
PHASE 6: FINAL DAY • •
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Your goal today is to ensure that you are well rested and relaxed on test day. Some students take the day off. Some students find a day off more stressful than studying. Limit yourself to 5 hours and focus on reviewing your cheat sheet. Absolutely no study of new material. Keep the same sleep schedule/meal schedule you have been using up until this point. Avoid talking to others who have taken the exam about the test. It will just stress you out. Make preparations for test day. Buy snacks, drinks, and make yourself lunch.
TEST DAY: • • • • •
We don’t recommend you do any review on the morning of the test. Bring snacks, water, and simple lunch. Wear layers so you can adjust for temperature. You can’t bring anything into the exam room except your ID. No watches or hats. Many students report seeing strings of related questions - don’t be distracted by perceived patterns or over-sampling.
QUESTION PRACTICE: • • • • • • •
You are not going to know every question on test day. Practice picking the most plausible choice, marking the question, and returning if time allows. Questions that you perceive as unfair/obscure can throw your performance on subsequent questions. Practice calmly moving on. The test includes a few experimental questions that do not count towards your score, however assume that even the most bizarre question counts. Don’t expect any test-wise clues on the test (i.e. correct answers more precisely defined than distracters). Buzzwords still appear occasionally but don’t count on them. You have 78 seconds per question. You should start using the timed-tutor mode as early as a possible. Use the Test mode in the final few weeks. Most students take more care and go slower in the actual test. Aim to finish practice blocks with at least 2-3 minutes to spare in order to compensate for this. Bear in mind that you will answer re-used questions more quickly and score higher in them.
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Treat any correct answer that you weren’t certain of as incorrect and add it to your MyQuestions pool so you can repeat it. For incorrect items, review full explanations and then reKaps. For correct items it is better to read explanations but you may find that the reKaps are enough. If you recognize a wider weakness on your first pass, view the high-yield overview tables from medEssentials. Do not waste time checking the timer. Check your timer at the half way point and then with 10 questions to go to ensure you have a chance to answer all questions. You will be provided with a white board for note-taking – keep scrap paper handy when using Qbank to determine how you will want to use this resource on test day. Qbank and the test software both provide access to lab values. Many questions include panels of lab values. Being able to quickly recognize abnormal values will save you time. The lab values in the test will not be grey – learning to recognize key values will save you time. Qbank provides information on whether changing your answer choice positively or negatively impacts your score. Use this information to decide whether to have the courage of your conviction or second guess yourself. Experiment to see whether reading the answer choices first when you hit a long vignette allows you answer more quickly. A good Qbank should be examlike: o No straight recall questions o o o o o o o
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Realistic clinical vignettes NBME phrasing No “picky” questions No “tricky” questions No negatively worded questions No buzzwords or clues for the test-wise Sufficient but not overwhelming evidence All distractors plausible
o A good Qbank should also focus on: o o o o o o o o
Multiple vignettes on important diseases Oversampling of the high yield concepts No questions on untested topics Oversampling of hard questions No questions easier than the test Oversampling of multistep questions Oversampling of integrated questions Oversampling of unfamiliar question types
