USMLE-Step-1-Guide-7-31-2012

A Resource for USMLE Step 1 Preparation Compiled by the Office of Medical Education Tulane University School of Medicine 1430 Tulane Avenue, SL-6 New Orleans, LA 70112 Phone: 504-988-6600 Email: [email protected]

USMLE - What's it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams that must be passed in order to become eligible for medical licensure: • • • •

Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), usually taken during the fourth year; Step 2 Clinical Skills (CS), usually taken during the fourth year; and Step 3, typically taken during the first year of post graduate training.

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 2 Clinical Knowledge (CK) assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine. This is the computer-based, multiple-choice portion of Step 2. Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of the USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations measure skill sets different from those measured by traditional multiple choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public. Implementation of the clinical skills examination began in June 2004. The clinical skills examination is a separately administered component of Step 2 and is referred to as Step 2 Clinical Skills, or Step 2 CS. USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States. Step 3 assesses whether you can apply medical knowledge and understand biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. Requirements for licensure in each state are set by the state's medical licensing boards, but there is a nationwide sixattempt limit for each component of the exam. Each state board may determine the maximum number of times that a person may take each Step exam and still remain eligible for licensure. In Louisiana, applicants have six attempts to pass USMLE Step 1, four attempts to pass USMLE Step 2 and four attempts to pass USMLE Step 3. All sections of the exam must be taken within a 10-year span. But what we're really here for is to talk about preparing for Step 1. Step 1 is your first BIG hurdle. And make no mistake about it, this is a VERY important test. An excellent performance on Step 1 can definitely help you when it comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options. A failure on Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue.

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Step I: Basic Information How is Step 1 scored? When you take Step 1, the computer records your responses. After your test ends, your responses are transmitted to the NBME for scoring. The number of test items you answer correctly is converted to two equivalent scores, one on a three-digit score scale and one on a two-digit score scale.. On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 210 to 230, and the standard deviation is approximately 20. Your score report will include the mean and standard deviation for recent administrations of the examination. All score users are urged to rely on the three-digit score since its equivalence is maintained over time through statistical procedures. The two-digit score is derived from the three-digit score. It is used in score reporting because some medical licensing authorities have requirements that include language describing a "passing score of 75." The two-digit score is derived in such a way that a score of 75 always corresponds to the minimum passing score. Only you and the state medical boards will see the two-digit score; it is no longer being reported through ERAS. Multiple-choice items are provided in blocks of approximately 45 to 60 minutes. Blocks of items are constructed to meet specific content specifications. As a result, the combination of blocks of items creates a form of the examination that is comparable in content to all other forms. The percentage of correctly answered items required to pass varies from form to form. However, examinees typically must answer 60 to 70 percent of items correctly to achieve a passing score.

What is the minimum passing score? The USMLE program provides a recommended pass or fail outcome for all Step examinations. Recommended performance standards for the USMLE are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments will be posted at the USMLE website. The 2012 minimum passing score for Step 1 was 188.

What is Tulane School of Medicine policy on USMLE exams? Step 1 Exam 

For classes graduating in 2012 and beyond, USMLE Step 1 must be passed by September 1st of the third year. Students not passing Step 1 are required to take a leave of absence until a passing score on Step 1 is achieved.



The Committee on Academic Performance and the Senior Associate Dean for Student Affairs may recommend a delay in a student sitting for Step 1 until a study program is satisfactorily completed.

Step 2 Exam 

All students are required to pass USMLE Step 2 CK and Step 2 CS prior to graduating medical school. Students not passing both Step 2 CK and CS by April of their fourth year of medical school will be required to take a leave of absence until passing scores on both Step 2 CK and CS are achieved.



All senior students must sit for USMLE Step 2 CS and Step 2 CK before December 31st of their senior year in order to be allowed to participate in the Match. This motion was passed in order to assure that every Tulane senior participating in the Match will be allowed to graduate and begin residencies on time. You will still be required to have passing scores on both parts of Step 2 in order to graduate, but will have until June to do so. This will allow for retakes if necessary.



A student may accumulate a maximum of 24 months of leave for the purpose of meeting the USMLE requirement.

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Failure to pass USMLE Step 1, Step 2 CK and Step 2 CS will result in a student being withdrawn from the academic rolls as a medical student. How do I apply for Step 1? The initial application for Step 1 is done on the Internet. Go to http://www.nbme.org/students/licensing.html. Click on the link that says “NBME Licensing Examination Services Website”. In the yellow LOG IN box, please note you do not have a USMLE ID number yet. Instead, click on "First-time user" and follow the instructions. As part of the application, you will indicate a 90-day eligibility period during which you plan to take the exam. Payment is also required at this time (the 2013 fee is $560). 2013 Application materials will be available in the second half of September 2012. • Print out the application form, which will require your signature and a picture. Bring the form to the Student Affairs Office to request an authorized signature. • Then take the form to the Registrar's Office (131 S. Robertson St, 15 th floor) and have the school seal put on it. • After that, you're ready to mail it in.

Where do I take the test? Thomson Prometric, a part of The Thomson Corporation, provides scheduling and test centers for the computerbased components of USMLE. Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs). Prometric test centers are located throughout the U.S. In Louisiana there are centers in: • Alexandria • Baton Rouge • Bossier City • Metairie

How do I schedule my test? Once your application has been processed, you will receive an email from NBME notifying you that your application is complete. About a week later, you will receive a second email from them notifying you that your scheduling permit is available; this message will include instructions for accessing the electronic scheduling permit using the registration entity's interactive website. PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. You MUST bring it with you to the test center on the day of your test. You will not be allowed to take the exam without your scheduling permit. Once you've gotten your permit, you may schedule your test online at www.prometric.com for any available test date that is within your approved 90-day eligibility period. Not all Prometric centers are open on weekends, and USMLE exams are not necessarily offered every day the centers are open. Please note that May through July is one of the busiest periods for these testing centers because of the large USMLE demand during that time - PLAN AHEAD! No fee is charged for changing testing appointments 31 or more days prior to the first day of the scheduled test. If you must reschedule outside the approved eligibility period, you will need to reapply and pay an additional fee (see following page):

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Appointment Change Fees Table for Computer Based Examinations The date that you change your appointment

Prometric Testing Region

Step 1

Step 2 CK

Step 3*

31 or more days before (but not including) the first day of the scheduled test date

All testing regions

No Fee

No Fee

No Fee

Fewer than 31 days and more than 5 days before (but not including) the first day of the scheduled test date

All testing regions

$50

$50

$50

US and Canada

$104

$117

$207

Africa, Asia (including Hong Kong and Pakistan), Australia, China, India, Indonesia, Latin America, Middle East (including Egypt), Thailand

$252

$283

N/A

Europe (including Israel), Korea, Taiwan

$286

$321

N/A

Japan

$461

$519

N/A

5 or fewer days before (but not including) the first day of the scheduled test date

Please note that these fees are subject to change at any time—always check http://www.usmle.org for current information.

What is the format of the test? The Step 1 test day lasts 8 hours. The 8 hours includes the test itself as well as break time. The exam consists of approximately 322 multiple choice questions arranged in seven blocks of 46 questions each, which means you will have about 1.25 minutes per question. During each block you can answer questions in any order, go back and review questions in the block, and change answers. Once you have exited a block or the time for that block has expired, you will no longer be able to review questions or change answers in that block.    

Some blocks are harder than others. Don't panic if your first block happens to be a more difficult one. The questions are random, so don't expect a block of pathology questions, a group of pharmacology questions, etc. Some questions will include pictures - histology, gross pathology, CT images, etc. Step 1 includes only SINGLE BEST ANSWER questions. This is the traditional, most frequently used multiple-choice format. These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.

Most score reporting of Step 1 results occurs within four weeks of testing.

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Can I practice taking the test? You should acquaint yourself with the test software well before your test date(s). Practice time is not available on test day, and test center staff is not authorized to provide instruction on use of the software. A brief tutorial on the test day provides a review of the test software, including navigation tools and examination format, prior to beginning the test. It does not provide an opportunity to practice. 1.

You can practice by downloading materials from the USMLE website (http://www.usmle.org/practice-materials/index.html). The NBME software has over 100 practice test items and a software tutorial. Some practice items may include multimedia files, such as video or audio clips.

2.

You can schedule a practice test at a Prometric Test Center. Once your Step 1 application has been processed and you have received your Scheduling Permit, you are eligible to register for a Practice Session for that examination. Practice Sessions are available at Thomson Prometric, a part of The Thomson Corporation, test centers. The Practice Sessions use the same sample test materials that are available on the USMLE website; however, they do not include any multimedia items. NO NEW SAMPLE TEST MATERIALS ARE PRESENTED AT PRACTICE SESSIONS. Those who are eligible to register for a Practice Session may take only one session per exam registration. Please note that Practice Sessions are not available on major local holidays or during the first two weeks of January. The Practice Session is a maximum of 3.5 hours and is divided into three 1-hour blocks of 46-50 multiple choice test items each. When you complete the session, you will receive a printed percent correct score.

If you register for a practice session, a YELLOW Scheduling Permit will be mailed to you within two weeks which will allow you to schedule the Practice Session. Do not schedule a Practice Session using your permit for the actual Step examination. The $52 fee for the Practice session must be paid directly to Prometric by credit card at the time you schedule your appointment.

What's on the test? The NBME's Comprehensive Basic Sciences Exam is the closest thing to the real thing that they will let anyone see. In fact, since ALL of the items written by NBME are copyrighted, you should be a little leery of anyone other than NBME who claims to have "actual USMLE questions". The NBME offers a breakdown of the content areas on the test: SYSTEM**  

25%-35% General principles 65%-75% Individual organ systems

PROCESS*    

20%-30% Normal structure and function 40%-50% Abnormal processes 15%-25% Principles of therapeutics 10%-20% Psychosocial, cultural, occupational, and environmental considerations

* Percentages are subject to change at any time. See the USMLE website for the most up-to date information. ** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system specific. NBME also publishes a more detailed outline of the topics covered on the Step 1 exam. Use this as an outline to make sure you are covering all of these topics in your study plan. You'll find the complete outline of what's on the Step 1 exam at the end of this book in Appendix A.

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Step 1: Preparation Several things have been proven to help students prepare to do their best of Step 1. 1. LEARN the material you are currently studying in your classes. Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. It is the purpose of the testing agency to see how adept you are at taking partial information and, based on that, figuring out an answer you consider to be a high probability response. You can't do that with MEMORIZED material, but you can do it using material that you have LEARNED. 2. KNOW how to approach multiple choice questions and PRACTICE. Some people seem to instinctively know how to answer multiple choice questions correctly, others of us not so much. There are skills that you can learn to help you answer these kinds of test questions. Here's how Kaplan recommends approaching vignette styled multiple choice questions: 1. Assemble key clues into a mental "snapshot" of the patient 2. Understand precisely what is being asked 3. Allow a few moments to think, recall, and to anticipate possible answers 4. Compare the given choices to your anticipated answer 5. Mark choices that match best 6. Rule out choices that don't account for all findings 7. Mark the best answer Kaplan's experts say that people who are bad at multiple choice questions focus on the choices rather than the stems of the questions. This is a very inefficient approach and one that tends to result in more mistakes. Those who are good at multiple choice questions focus on the stems, not the choices. If you always feel that your performance on multiple choice tests doesn't equate with your mastery of the material, you might think about having your test-taking skills analyzed. 3. ALLOW enough time to prepare, but not too much. Although you will have approximately 10 weeks from the time school ends to the deadline for taking Step 1 (September 1), four to six weeks should be plenty of time to prepare for Step 1. Many students in the past who have taken longer than 6 weeks to prepare later said they felt they took too much time and actually lost ground with their studying. Analysis of our own students over the years shows that you get the most "bang for your buck" by studying for 6 to 9 hours per day for 4 to 6 weeks. 4. MAKE a study schedule and stick to it. This is a critical step in successful Step 1 preparation. More detailed information about study schedules can be found in the following section. 5. STUDY smart. Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study. Explain concepts out loud to a study partner, practice answering questions by explaining why the right answers are right and the wrong answers are wrong. If concept mapping works for you, do it. If there are other methods that work for you, use them.

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OTHER STEP 1 ADVICE The ways in which USMLE exams are similar to medical practice: 1. you must find key information 2. the information you need may be buried 3. there are distractions 4. there is time pressure 5. you must use probabilities to make decisions 6. you’ll never know it all 7. situations won’t exactly fit what you’ve learned Mistakes most commonly made when preparing for Step 1: 1. passive studying 2. insufficient practice with questions 3. memorizing, not understanding the material 4. inappropriate test day strategies 5. misreading or misinterpreting questions

So, where do I start? 1.

Self-assessment. The first thing you need to do is take some sort of diagnostic test to see where your areas of strength and weakness are. Diagnostic tests are available from Kaplan, NBME, and a variety of other online sources that are listed later in this guide.

2.

Make a study schedule. Lots of sample schedules are out there and two are included later in this guide. BUT - please remember that these schedules were made by individual students and the schedules reflect those students' individual circumstances. When you prepare your own study schedule, you must first look at your own diagnostic test results and prepare your schedule with more time allotted to weaker subjects, and less time to stronger subjects. Individual study pace also needs to be factored in, as some accomplish more per study day than others.

Here’s some advice from Kaplan’s Judy Schwenker: 1.

Take a comprehensive test to begin as a measure of where your recall is right now. Use the Kaplan diagnostic test if you have taken it.

2.

Once you know your percent correct score for each subject, use the information to decide the relative amount of review time to put into each area. For example, if Physiology is 20% lower than Microbiology, you should be spending at least 20% MORE time reviewing Physiology than you put into Micro.

3.

As you begin to review a subject, look over some questions on the material before you start review. This will help keep you focused on what is important to know and show you how you will need to use the information on the test.

4.

As you move through the material, create your own condensed summaries of the key material so you can review this right before test day. 20-30 pages per subject are a decent size to shoot for, because otherwise you will end up taking overly detailed notes and they won’t help at the end.

5.

As you finish a subject, use the QBank to create and take a test with maybe 50 items from each subject that you have completed up to that point. So if you have finished Anatomy and Physiology, you would do a 100item test under timed, test mode assessing those 2 areas. By the end, you will be taking long practice tests under test conditions that cover all the completed subject areas. This helps keep the earlier material in memory, and gives you a more accurate picture of your preparedness. It also gives you good practice for

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the mental stamina and pacing needed on test day. 6.

Plan time during the final 2-3 weeks to do nothing but review your own summaries and take increasing numbers of simulated test modules of 50 items each under timed conditions (one hour per module). This is the final “get it all fresh in mind, build mental stamina, and intensive test practice” phase, which should lead right up to 2 days before your actual test date. Our experience has shown that students who are doing 70% or better on our full length simulated exams (or comparable practice tests created with Qbank or IV Qbank) by their test dates DO PASS, so this is a good level to aim for. You may also choose to take one of the NBME tests to get a predicted USMLE score. If you do decide to do this be advised that based on feedback from message boards, Form 1 seems to be the most reliable.

Additional Advice from Kaplan Tips for the Week Before During the last few days before the exam you should be tapering off your studying, and getting into mental and physical shape. 1.

This is not the time for cramming in new material…but time to organize and integrate what you already know. Work on making what you know more accessible.

2.

Review keywords, phrases and concepts. Look over your summary notes one more time. This is the time to drill yourself on essential information. The key is to practice recall, not simply read over the material again. What you need to know is probably already in your head. Your task now is to train yourself to access it when you need it. Doing practice questions is a good way to reinforce your recall skills. Use them to clarify your understanding.

3.

No one can know everything that is asked on this exam. Be honest with yourself about what you do and do not know. Knowing that you do not know something gives you more sense of control on the exam and makes you less likely to panic when you encounter the material and/or waste time on questions you are not likely to get correct.

4.

Get yourself onto the right time schedule. Wake up every day at the same time you will need to on the day of the exam. This will get your circadian rhythms coordinated with the exam schedule. Do not nap between 8:00am and 5:00 pm; otherwise, you will be accustomed your body to shutting down during the critical exam hours. If you get up at the same time each day, you will find it easier to fall asleep at night. By getting into a proper sleep-wake cycle, you will find it easier to get sleep the night of the exam as well.

5.

You should be getting a sufficient amount of sleep. For most people that means at least 6 to 7 hours a night. Sleep is an essential time for your brain to consolidate what you have learned. You need sleep; it makes you a more efficient learner when you are awake.

6. Take some time each day to relax. Have a good meal. Take a walk in the fresh air. Find time for exercise. The change of pace will refresh you and the physical activity will help you relax and sleep at night. 7. If you haven’t done so already, visit the Prometric Test Center where you will be taking the exam. It will be indicated on your exam entry ticket. This will ensure you know how to get there and how much time you should allow for the commute. You can see where you should park, and see what the computer set-up is like. 8. Review the tutorial at http://www.usmle.org/practice-materials/index.html. Become familiar with the interface, the location of key information on the screen and how to navigate between screens. If you walk into the exam familiar with the exam, you will not have to use any of your valuable break time to do this on the test day.

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Tips For The Day Before The Exam 1. Take the day off from studying. This is your day to relax and gather your strength before the main event. Get out of bed at the same time you will have to get up the next day. If you feel you must study, limit yourself to reviewing your own notes and flashcards. 2. Have some fun. Go for a walk. Listen to your favorite music. Go see a good comedy or an action movie that will allow cathartic release. Go shopping. Spend time with a significant other. Do whatever you like. You have worked hard and deserve it. 3. Make sure that you have checked out the basics for the exam: • Have you worked through the USMLE tutorial? •

Do you know where the Prometric center is, and how to get there?

•

Do you have alternative transportation if, for example, your car does not start?

• Do you trust your alarm clock to wake you up in time? If not, make arrangements with friends as back up. You want to be sure to wake up rested, refreshed, and on time. • Layout what you'll need for the exam before you go to sleep. This includes photo identification, scheduling permit and confirmation number, as well as any personal items like eyeglasses. While you're at it, don't forget to pack a lunch! 4. Call your friends and classmates and make some plans to celebrate. You'll need to blow off some steam anyhow, and talking with colleagues will remind you that you are not in this by yourself. 5. Be sure to do some physical activity. Just taking a walk for an hour will help relax you. 6. Get a good night's sleep. To help you sleep, consider a hot bath or warm milk. Avoid taking sleeping medication as it may leave you groggy in the morning.

Kaplan’s Tips for Test Day… 1. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized. You will be given a locker to store your personal items and then assigned a computer station. Remember that you have a total of seven hours to complete 322 questions, and a total of one hour to be used throughout the day for breaks and lunch. 2. To cope with fatigue, you will need to schedule breaks. Our recommended schedule for the exam is: Question Block

Break time at end of Block

Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7

No break 5 minute break 5 minute break 30 minute break No break 10 minute break Done!

This allows you 10 minutes extra to use as needed. Remember that you will need to sign in and out when you take breaks. You should also be aware that if you leave the exam room during a block, it will be marked as an irregularity in your testing session. Therefore, you need to consider after each block if you want to take a bathroom break.

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3. Start with the beginning of the question block and work your way to the end. The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. The flow experience is a state of optimal concentration and maximal performance. 4. Do not skip any questions. If you don't know it when you come to it, you are not likely to know it later. Skipping around wastes time and can end up confusing you. Deal with each question as you come to it, answer it as best you can, and move on to the next question. 5. Limit your use of the marking feature to no more than two or three questions per block. Of course you should answer each question as you come to it, but you may want to double-check yourself on a few questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used correctly, marking will help you revisit questions where you have a high probability of getting the answer correct. Misused, marking causes you to not give a question your full attention the first time around. You simply may not have time to go back and look at questions you have marked, especially if you mark a lot of them. 6. Be cautious about changing answers. In general, your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. If you change an answer, you are most likely making it wrong! Your first impulse is usually the correct one. Stay with it unless some clear insight occurs to you. 7. If you finish a question block with time left over, go back and "check" only those answers that you have previously marked. Checking almost always leads to changing and tends to reduce your score. If you have a spare moment, make sure that you have entered an answer for every question in the block and then, relax. Sit, take a break, and mentally prepare yourself for the next block of questions. Focus on the questions to come, not the ones that have passed. 8. Monitor your time. Know how much you have left, so you do not find yourself rushed at the end. Work on your pacing from the beginning of the question block. Check your watch every 10 questions to make sure you are on the correct pace to finish. If you pace yourself throughout the block, you should not be squeezed for time at the end. 9. Relax. During the breaks between question blocks, try to relax and not think back over the exam. The desire to recall questions is strong, but not helpful. Those questions are in the past; you will never see them again. Focus on relaxing and making the most of your break. Remember, you will always tend to remember those questions you get wrong. Another piece of important advice: BRING FOOD TO THE TEST. If you are used to having caffeine, bring coffee too.

AND HERE’S SOME PREP ADVICE FROM SOME OF OUR STUDENTS….

"I'd recommend studying no more than about 5 weeks. Any more and you will start forgetting things you learned earlier. I caution you to take what your classmates say about their exam with a grain of salt, because every exam is different. Also, ‘buzzwords’ are not typically used on Step 1. Rather than use the words ‘smudge cells’, for example, they’ll probably just show you a blood smear." “Have a planned study schedule that you stick to. If you fall behind, you’ll have a hard time getting through everything and still being able to review material.” “Get one good review book and one good question bank and really learn them. Don't try to use too many sources.” 12

“Start early, stick to a schedule, try not to become overwhelmed with all available resources. Pick a couple for each subject because in my experience you cannot absorb it all. Use First Aid as a scaffold – it really is helpful for recall association.” “The last week/few days before Step are very distracting – don’t give yourself too much time to study, 4-6 weeks worked for me. Be prepared mentally for the anxiety the week before the test – focus on easier subjects to review.” “Do as many questions as possible, from as many resources as possible. You can remember more than 3 weeks of information. During my actual exam, I recalled information from first year lectures.” “The best advice I got was to take every course seriously; I focused on my med school courses and did very little specific boards study other than the question bank. I wish I had started to use ‘First Aid’ the first semester of first year; I also wish I had started the question bank first year and that I would have used it during the first and second year courses.” “Confidence in your own knowledge is very important going into the exam. You know what they are trying to ask you, the problem is that questions are worded in such a way that it is often difficult to know exactly what the question is asking. Whatever you can do (practice tests etc.) to improve your confidence will allow you to avoid second-guessing yourself or over stressing during the actual exam so that you can figure out exactly what the question is trying to ask.”

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Resources Review Courses Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. Unfortunately some programs schedule their courses at times of the year that don’t coincide with most first-time test takers’ preparation efforts. Nevertheless, here is the information on some review courses that are available. Costs and dates are always subject to change; check the company websites for the most up-to-date information.

DOCTORS IN TRAINING http://www.doctorsintraining.com Part 1: January – May A series of 34 emails is sent to you every Monday and Thursday containing 15 questions (510 total high-yield questions) with specific page references to First Aid for the USMLE Step 1. Short answer videos are provided. Part 2: Variable start date after March 80 hours of high-yield, physician-taught lectures divided over 15 days. First Aid is the reference source for these sessions. Cost: $795 (plus tax and shipping) Program does not include access to any question bank resources. *This program is fairly popular with Tulane medical students; 12/13 Class of 2012 students who utilized it recommended it, but several note that it requires a great deal of study time (feels “drawn out”) and is best used as a review of First Aid. A three-week live course in Galveston, TX is also available some years, but it takes place during May.

KAPLAN

http://www.kaptest.com/Medical-Licensing/ LivePrep: Structured, live lecture-style preparation. 7 week course: $3,399 14 week course: $5,499 CenterPrep: Review video lectures at your own pace at a Kaplan center. 3 month access: $3,399 6 month access: $5,499 9 month access: $6,999 Classroom Anywhere: Over 240 hours (14 weeks) of live online lectures. Recent class: June 18 – September 23, 2012 (6:00-9:00 PM EST) - $3,999 LivePrep Retreat: 6-week live lecture retreat in a hotel setting. Previous retreats have taken place in Atlanta and Chicago. *Must call Kaplan for current pricing and more information. Live Question-Based Review: 12 hours of guided USMLE question-based review. Pathology (2 sessions) Pharmacology (2 sessions) Biochemistry (1 session) 2012 sessions: June 4 – June 8, 2012 (7:00 PM – 9:30 PM EST) - $299 OnlinePrep: Web-based course with access to approximately 200 hours of online video. 3 month access: $2,399 6 month access: $3,899 9 month access: $4,999 *Most programs also include access to assessment tests and simulated exams. Bundle packages (including access to Kaplan’s QBank) are available. Free Live Online seminars and practice exams are also offered by Kaplan; check their website for current details.

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FALCON PHYSICIAN REVIEWS http://www.falconreviews.com Live: 7-week intensive review in Dallas, TX. Complete package includes books, lodging, daily breakfast and lunch, high-speed internet service, daily clinical vignettes, daily tutoring, diagnostic exam, and 3- or 6-month question bank subscription. July 15 – August 30, 2013; more dates available Double occupancy - $4,999; single occupancy - $6,499. Online Video Review: 325 hours of in-course instruction (140 hours of streaming video lectures); includes a full set of Falcon textbooks and QBank access to either USMLE World or USMLE Consult. “Until your exam” access: $1,599 2-Go: Instruction and streaming video materials for iPhone (~250 hours). Comes with a full set of Falcon textbooks and 3 months of QBank access. 1 month access: $1,299 2 month access: $1,699 3 month access: $2,099 12 month access: $3,499 *Options can be bundled. Watch out for viewing limits on learning modules.

NORTHWESTERN MEDICAL REVIEW http://www.northwesternmedicalreview.com Options include short-term live lecture review courses (3-15 days), private tutoring, question bank access, video library access, hard copy study materials and books. Live review courses last between 3 and 15 days and typically take place in East Lansing, MI or Chicago, IL. Prices range from $450 - $1,500. Visit their website for more information.

For Students with Documented Learning Disabilities or ADHD: Marshall University Medical H.E.L.P Program http://www.marshall.edu/medicalhelp (from the website) The Marshall University Medical H.E.L.P. Program began in 1986 with a vision of helping medical students and physicians with learning disabilities and/or ADHD succeed academically. Since that time, Marshall Medical H.E.L.P. has worked with approximately 600 students from across the United States and several foreign countries. A five week intensive course is held four times each year in January, March, June, and September, with individual one-on-one sessions available the rest of the year. Throughout the intensive program topics such as reading and comprehension, reading rate, learning strategies, memorization techniques, test-taking skills, error analysis, and self-esteem are targeted for improvement. Contact Ryan Orwig, HELP Coordinator, at 304-696-6315 for more information. A non-refundable deposit of $500 is required. It will be deducted from the total amount due, at a later date. The tuition for a spot in the program costs $4500. Students are responsible for room and board and all living and transportation costs. This 5-week course is held four times a year: January 23—February 24, 2012 March 26—April 27, 2012 June 25—July 27, 2012 September 17—October 19, 2012

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Question Banks Practice questions are a key component of USMLE Step 1 preparation. Many students suggest obtaining access to one question bank (Kaplan or USMLEWorld are the most popular choices) and using it concurrently with course studying for the year before Step 1, then buying another to use for intensive preparation before the test (USMLEWorld is more difficult and perhaps better suited for this use). If you have any other suggestions for efficient ways to use question banks, please e-mail your tips to [email protected]. QUESTION BANK Kaplan Medical (QBank) http://www.kaplanmedical.com

USMLE World http://usmleworld.com/

USMLE Consult http://www.usmleconsult.com

DETAILS Internet-based question bank providing tailored CBT-format exams (over 2,000 questions). Test content and performance feedback are provided by organ system and discipline. Questions are representative in style and at times content to those on the actual exam. Reading the often detailed explanations is time well spent. There is a free online demonstration. Requires time commitment. iPhone and Android accessibility. Offers useful “timed tutor” mode. An excellent bank of well-constructed questions that closely mirror those found on Step 1. Questions demand multistep reasoning and are often more difficult than those on the actual exam. Offers excellent, detailed explanations with figures and tables. Features a number of test customization and analysis options. Unfortunately, the program does not allow other application windows to be open for reference. Users can see cumulative results both over time and compared to other test takers. *Very popular among Tulane students (182/208 students used it, according to the most recent OWL Club survey). A solid question bank that can be divided according to discipline and subject area. Questions are more straightforward than those on actual exam. Offers concise explanations with links to Student Consult and First Consult content. Users can see cumulative results both over time and compared to other test takers. Student Consult also offers a Robbins Pathology test bank ($35 for 1 month, $49 for 3 months) featuring 500 USMLEstyle questions as well as the Scorrelator ($35), a 3-hour, 150-question mock exam that predicts your USMLE Step 1 score.

COST 1 month: $99 12 months: $249

1 month: $99 2 months: $145 3 months: $185 6 months: $299 12 months: $399

1 month: $75 2 months: $115 3 months: $135

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USMLE Rx http://www.usmlerx.com

USMLE Easy http://www.usmle-easy.com

A well-priced question bank that offers Step 1-style questions accompanied by thorough explanations. Some obscure material is omitted, making it more straightforward than other question banks. Each explanation includes highyield facts and references from First Aid. However, the proportion of questions covering a given subject area does not always reflect the actual exam’s relative emphasis. Question stems occasionally rely on “buzzwords”. Most useful to help memorize First Aid facts. Provides detailed performance analyses. A question bank based on the PreTest series. Many questions are shorter and more obscure than those on the actual Step 1 exam. Users can track questions completed as well as customize tests. Useful as a supplemental review after other resources have been exhausted. *USMLEasy Lite (25% of questions) is available for free through AccessMedicine (see Online Resources).

1 month: $89 3 months: $149 Till You Pass*: $199

1 week: $39 1 month: $79 3 month: $169

Other Study Resources There are many more websites and books available than those that are listed here. If you find a book or website that you find helpful, please send it to [email protected] so that it can be included in our list of resources. Remember that you can easily get overwhelmed by using too many resources as you study, so pick out the few that seem to work best with your style of studying and learning and go with them. What works for one person may not work for another, so be careful about using a book just because someone else said it worked for them. Try it for yourself - if it doesn't fit you, move on to something that does. A number of books are available for check-out in the Office of Medical Education library. Online Resources

ONLINE RESOURCE AccessMedicine http://www.accessmedicine.com

Lippincott’s 350-Question Practice Test for USMLE Step 1 www.lww.com/medstudent/usmle

DETAILS Innovative online resource that provides students, residents, clinicians, researchers, and all health professionals with access to more than 60 medical titles from the best minds in medicine, updated content, thousands of images and illustrations, interactive self-assessment, case files, diagnostic tools, a comprehensive search platform, and the ability to view from and download content to a mobile device. 350-question comprehensive USMLE practice test. Review mode and test mode available. These questions have been written and reviewed to provide excellent diagnostic practice.

COST Free for Tulane students through Matas Library subscription (can be accessed from the library website through the “databases” link). Free; must be registered for an account at lww.com.

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Database of Medical Mnemonics http://www.medicalmnemonics.co m NBME Self-Assessment Services https://nsas.nbme.org/nsasweb/ser vlet/mesa_main

WebPath: The Internet Pathology Laboratory www.library.med.utah.edu/WebP ath/webpath.html

A free, non-profit, online searchable database of medical mnemonics to help remember the important details. PDA version available. The material presented in these self-assessments is provided by the NBME for educational purposes only. Medical students and graduates may find them to be useful tools as they prepare for USMLE Step1, Step 2 CK, and Step 3. Participants will receive a performance profile and a score interpretation guide immediately after completing a self-assessment.

Free.

Contains over 2700 images with text that illustrate gross and microscopic pathologic findings along with radiologic imaging associated with human disease conditions. For selfassessment and study there are over 1300 examination items. There are more than 20 tutorials in specific subject areas.

Free.

Basic exam: $50 Expanded feedback version: $60

Library Resource ExamMaster: free for Tulane students. Register at http://www.exammaster2.com/wdsentry/tulane.htm. Books  First Aid for the USMLE Step 1 (McGrawHill Medical)  Appleton & Lange Review for the USMLE Step 1 (McGraw-Hill/Appleton & Lange)  Blueprints Step 1 Q&A (Lippincott Williams & Wilkins)  Board Review Series (Lippincott Williams & Wilkins)  High-Yield Comprehensive USMLE Step 1 Review (Lippincott Williams & Wilkins)  High-Yield Pathology (Lippincott Williams & Wilkins)  Kaplan QBook  NMS Review for Step 1 (Lippincott Williams & Wilkins)  Platinum Vignettes (Elsevier)

  

    

Rapid Review Series -USMLE Step 1 (Mosby) aka Goljan’s Robbins Review of Pathology (Saunders) Step Up: A High-Yield, Systems-Based Review for USMLE Step 1 (Lippincott Williams & Wilkins) Underground Clinical Vignettes (Lippincott Williams & Wilkins) USMLE Road Map Series (McGraw-Hill Medical) USMLE Step 1 Made Ridiculously Simple (MedMaster Inc.) USMLE Step 1 Recall: Buzzwords for the Boards (Lippincott Williams & Wilkins) USMLE Step 1 Secrets (Mosby)

Mobile Applications  Cram Fighter (iPhone)  Kaplan Mobile QBank (iPhone)  Skyscape USMLE Step 1 Recall (Several)

Study Schedule One of the biggest pieces of advice that students and experts alike give surrounds the idea of developing and sticking to a study schedule. Again, everybody has their own idea of what works for them and what doesn't, or what topics need to be studied more, but you also need to have a starting point. Remember you must create your own study schedule based on YOUR individual needs. You’ll find a sample 28-day study schedule at the back of this book in Appendix B.

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APPENDIX A: NBME OFFICIAL LIST OF STEP 1 TOPICS

Biochemistry and molecular biology

Biology of cells

GENERAL PRINCIPLES  gene expression: DNA structure, replication, exchange, and epigenetics  gene expression: transcription  gene expression: translation, post-translational processing, modifications, and disposition of proteins(degradation),including protein/glycoprotein synthesis, intra/extracellular sorting, and processes/functions related to Golgi complex and rough endoplasmic reticulum  structure and function of proteins and enzymes  energy metabolism     



Human development and genetics



    Biology of tissue response to disease



adaptive cell responses and cellular homeostasis intracellular accumulations mechanisms of injury and necrosis apoptosis mechanisms of dysregulation o cell biology of cancer, including genetics of cancer o general principles of invasion and metastasis, including cancer staging cell/tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors principles of pedigree analysis o inheritance patterns o occurrence and recurrence risk determination population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium principles of gene therapy genetic testing and counseling genetic mechanisms acute inflammatory responses (patterns of response) o acute inflammation and mediator systems o vascular response to injury, including mediators o principles of cell adherence and

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migration microbicidal mechanisms and tissue injury o clinical manifestations chronic inflammatory responses reparative processes o wound healing, hemostasis, and repair; thrombosis, granulation tissue, angiogenesis, fibrosis, scar/keloid formation o regenerative processes o

 

GENDER, ETHNIC, AND BEHAVIORAL CONSIDERATIONS AFFECTING DISEASE TREATMENT AND PREVENTION, INCLUDING PSYCHOSOCIAL, CULTURAL, OCCUPATIONAL, AND ENVIRONMENTAL Progression through the life cycle, including birth  cognitive, language, motor skills, and social and through senescence interpersonal development  sexual development  influence of developmental stage on physicianpatient interview Psychological and social factors influencing patient behavior





personality traits or coping style, including coping mechanisms psychodynamic and behavioral factors, related past experience family and cultural factors, including socioeconomic status, ethnicity, and gender adaptive behavioral responses to stress and illness maladaptive behavioral responses to stress and illness interactions between the patient and the physician or the health care system patient adherence (general and adolescent)



establishing and maintaining rapport



data gathering



approaches to patient education



enticing patients to make lifestyle changes



communicating bad news



“difficult” interviews



multicultural ethnic characteristics

    

Patient interviewing, consultation, and interactions with the family

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Medical ethics, jurisprudence, and professional behavior

        

Nutrition

consent and informed consent to treatment physician-patient relationships death and dying birth-related issues issues related to patient participation in research interactions with other health professionals, including impaired physician and patient safety sexuality and the profession; other “boundary” issues ethics of managed care organization and cost of health care delivery

MULTISYSTEM PROCESSES  generation, expenditure, and storage of energy at the whole-body level  assessment of nutritional status across the life span, including calories, protein, essential nutrients, hypoalimentation 

functions of nutrients



protein-calorie malnutrition



vitamin deficiencies and/or toxicities (including megaloblastic anemia with other findings) mineral deficiencies and toxicities

 Temperature regulation Adaptation to environmental extremes, including occupational exposures





physical and associated disorders (including temperature, radiation, burns, decreased atmospheric pressure, high-altitude sickness, increased water pressure) chemical (including gases, vapors, smoke inhalation, agricultural hazards, organic solvents, heavy metals, principles of poisoning and therapy)

Fluid, electrolyte, and acid-base balance disorders Inherited metabolic disorders, including disorders related to amino acids, purines, porphyrins, carnitine, fatty acids, and carbohydrates

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PHARMACODYNAMIC AND PHARMACOKINETIC PROCESSES  pharmacokinetics: absorption, distribution, General principles metabolism, excretion, dosage intervals  mechanisms of drug action, structure-activity relationships (including anticancer drugs)  concentration- and dose-effect relationships, types of agonists and antagonists and their actions  individual factors altering pharmacokinetics and pharmacodynamics  mechanisms of drug adverse effects, overdosage, toxicology  mechanisms of drug interactions  regulatory issues  signal transduction, including structure/function of all components of signal transduction pathway such as receptors, ligands  cell cycle/cell cycle regulation

MICROBIAL BIOLOGY AND INFECTION Microbial identification and classification, including principles, microorganism identification, and nonimmunologic lab diagnosis Bacteria

Viruses

Fungi

Parasites

   

structure processes, replication, and genetics oncogenesis antibacterial agents

   

structure processes, replication, and genetics oncogenesis antiviral agents

  

structure processes, replication, and genetics antifungal agents

  

structure processes, replication, and genetics antiparasitic agents

Prions Epidemiology, outbreaks, and infection control

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QUANTITATIVE METHODS  scales of measurement Fundamental concepts of measurement  distribution, central tendency, variability, probability  disease prevalence and incidence  disease outcomes  associations  health impact  sensitivity, specificity, predictive values Fundamental concepts of study design  types of experimental studies

Fundamental concepts of hypothesis testing and statistical interference

    

types of observational studies sampling and sample size subject selection and exposure allocation outcome assessment internal and external validity

  

confidence intervals statistical significance and Type I error statistical power and Type II error

For all systems: Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental  emotional and behavioral factors  influence on person, family, and society  occupational and other environmental risk factors  gender and ethnic factors

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HEMATOPOIETIC AND LYMPHORETICULAR SYSTEMS Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function  cell/tissue structure and function o production and function of erythrocytes, hemoglobin, O2 and CO2 transport, transport proteins o production and function of platelets o production and function of coagulation and fibrinolytic factors  repair, regeneration, and changes associated with stage of life Abnormal processes  infectious, inflammatory, and immunologic disorders o infections of the blood, reticuloendothelial system, and endothelial cells o autoimmunity and autoimmune diseases o anemia of chronic disease o non-immunologically mediated transfusion complications, transplant rejection  traumatic and mechanical injury  neoplastic disorders (including lymphoma, leukemia, multiple myeloma, dysproteinemias, amyloidosis)  metabolic and regulatory disorders, including acquired o nutritional anemias o cythemia o hemorrhagic and hemostatic disorders o bleeding secondary to platelet disorders and disorders of primary hemostasis  vascular and endothelial disorders  systemic disorders affecting the hematopoietic and lymphoreticular system  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the hematopoietic and lymphoreticular systems  congenital and genetic disorders affecting the hematopoietic and lymphoreticular systems Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the hematopoietic system o blood and blood products o treatment of anemia, drugs stimulating erythrocyte production o drugs stimulating leukocyte production o anticoagulants, thrombolytic drugs o antiplatelet drugs o antimicrobials and antiparasitics o antineoplastic and immunosuppressive drugs in the clinical context of disease  other therapeutic modalities

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CENTRAL AND PERIPHERAL NERVOUS SYSTEMS Normal processes  embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, neural crest derivatives  organ structure and function o spinal cord, including gross anatomy, blood supply, and spinal reflexes o brain stem o brain, including gross anatomy and blood supply; cognition, language, memory; hypothalamic function; limbic system and emotional behavior; circadian rhythms and sleep; control of eye movement o sensory systems, including proprioception, pain, vision, hearing, balance, taste, and olfaction o motor systems, including brain and spinal cord, basal ganglia, and cerebellum o autonomic nervous system o peripheral nerve  cell/tissue structure and function o axonal transport o excitable properties of neurons, axons and dendrites, including channels o synthesis, storage, release, reuptake, and degradation of neurotransmitters and neuromodulators o pre- and postsynaptic receptor interactions, trophic and growth factors o brain metabolism o glia, myelin o brain homeostasis: blood-brain barrier; cerebrospinal fluid formation and flow; choroid plexus  repair, regeneration, and changes associated with stage of life, including definition of brain death Abnormal processes  infectious, inflammatory, and immunologic disorders (including demyelinating disorders, myasthenia gravis and muscle channelopathies, and disorders of the eye and ear)  traumatic and mechanical disorders  neoplastic disorders, including primary and metastatic  metabolic and regulatory disorders  vascular disorders  systemic disorders affecting the nervous system  idiopathic disorders affecting the nervous system  congenital and genetic disorders, including metabolic  degenerative disorders  paroxysmal disorders  disorders of special senses  psychopathologic disorders, processes, and their evaluation o early-onset disorders o disorders related to substance use o schizophrenia and other psychotic disorders o mood disorders o anxiety disorders

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o somatoform disorders o personality disorders o physical and sexual abuse of children, adults, and elders o other disorders  drug-induced adverse effects on the central and peripheral nervous system  neurologic pain syndromes Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the nervous system o anesthetics o hypnotic sedatives o psychopharmacologic agents o anticonvulsants o analgesics o stimulants, amphetamines o antiparkinsonian drugs and drugs for dementia, Alzheimer type; multiple sclerosis; and restless legs syndrome o skeletal muscle relaxants, botulinum toxin o neuromuscular junction agonists and antagonists o antiglaucoma drugs o drugs used to decrease intracranial pressure o antimigraine agents o drugs affecting the autonomic nervous system, including all general autonomic pharmacology o antimicrobials, antineoplastic drugs, and antiparasitics o drugs used to treat cerebrovascular disorders o treatment for substance abuse disorders  other therapeutic modalities

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SKIN AND RELATED CONNECTIVE TISSUE Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function  cell/tissue structure and function, including barrier functions, thermal regulation, eccrine function  repair, regeneration, and changes associated with stage of life or ethnicity  skin defense mechanisms and normal flora Abnormal processes  infectious, inflammatory, and immunologic disorders o bacterial infections o viral infections o fungal infections, including mycoses, dermatophytosis o parasitic infections, ectoparasitic infestations, and mycobacterial infections o immune and autoimmune disorders  traumatic and mechanical disorders (including thermal injury, decubitus ulcers, effects of ultraviolet light and radiation)  neoplastic disorders o keratinocytes o melanocytes o vascular neoplasms o other  metabolic, regulatory, and structural disorders  vascular disorders  systemic disorders affecting the skin  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the skin and related connective tissue  congenital and genetic disorders affecting the skin and related connective tissue Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the skin and connective tissue o anti-inflammatory agents o emollients o sunscreen o retinoids o antimicrobial and antiparasitic agents o cytotoxic and immunologic therapy and antineoplastic drugs  other therapeutic modalities

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MUSCULOSKELETAL SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function  cell/tissue structure and function o biology of bones, joints, tendons, skeletal muscle o exercise and physical conditioning  repair, regeneration, and changes associated with stage of life Abnormal processes  infectious, inflammatory, and immunologic disorders  traumatic and mechanical disorders (including fractures, sprains, strains, dislocations, joint injuries, repetitive motion injuries, and impingement syndrome)  neoplastic disorders  metabolic, regulatory, and structural disorders (including osteomalacia, osteoporosis, osteodystrophy, gout, and pseudogout)  vascular disorders  systemic disorders affecting the musculoskeletal system  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the musculoskeletal system  congenital and genetic disorders affecting the musculoskeletal system Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the musculoskeletal system o nonsteroidal anti-inflammatory drugs and analgesics o muscle relaxants o antigout therapy o immunosuppressive and antineoplastic drugs o drugs affecting bone mineralization o antimicrobial and antiparasitic agents  other therapeutic modalities

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RESPIRATORY SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function o airways, including mechanics and regulation of breathing o lung parenchyma, including ventilation, perfusion, gas exchange o pleura o nasopharyx and sinuses  cell/tissue structure and function, including surfactant formation, alveolar structure  repair, regeneration, and changes associated with stage of life  pulmonary defense mechanisms and normal flora Abnormal processes  infectious, inflammatory, and immunologic disorders o infectious diseases  infectious diseases of the upper respiratory tract  pyogenic infectious diseases of the lower respiratory tract and pleura, viral infections, and associated complications  other infectious diseases of the lower respiratory tract o immunologic disorders  allergic and hypersensitivity disorders  autoimmune disorders o inflammatory disorders  pneumoconioses  acute and chronic alveolar injury  chronic obstructive pulmonary disease  restrictive pulmonary disease  traumatic and mechanical disorders  neoplastic disorders (including upper airway, lower airway and lung parenchyma, pleura, and metastatic tumors)  metabolic, regulatory, and structural disorders  vascular and circulatory disorders (including thromboembolic disease, pulmonary hypertension, pulmonary edema, and pleural effusion)  systemic disorders affecting the respiratory system  idiopathic and degenerative disorders  drug-induced adverse effects on the respiratory system  congenital and genetic disorders affecting the respiratory system Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the respiratory system o decongestants, cough suppressants, expectorants, mucolytics o bronchodilator drugs

o anti-inflammatory and cytotoxic drugs o antimicrobial agents and antiparasitic agents o antineoplastic agents o pulmonary vasodilators  other therapeutic modalities

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CARDIOVASCULAR SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function o chambers, valves o cardiac cycle, mechanics, heart sounds, cardiac conduction o hemodynamics, including systemic, pulmonary, coronary, and blood volume o circulation in specific vascular beds  cell/tissue structure and function o heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function o endothelium and secretory function, vascular smooth muscle, microcirculation, and lymph flow (including mechanisms of atherosclerosis) o neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism  repair, regeneration, and changes associated with stage of life Abnormal processes  infectious, inflammatory, and immunologic disorders  traumatic and mechanical disorders  neoplastic disorders  metabolic and regulatory disorders (including dysrhythmias, systolic and diastolic dysfunction, low- and highoutput heart failure, cor pulmonale, systemic hypertension, ischemic heart disease, myocardial infarction, systemic hypotension and shock, and dyslipidemias)  vascular disorders  systemic diseases affecting the cardiovascular system  congenital and genetic disorders of the heart and central vessels  idiopathic disorders  drug-induced adverse effects on the cardiovascular system  degenerative disorders Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the cardiovascular system o coronary and peripheral vasodilators o antiarrhythmic drugs o antihypertensive drugs o measures used to combat hypotension and shock o drugs affecting cholesterol and lipid metabolism o drugs affecting blood coagulation, thrombolytic agents, and antiplatelet agents o inotropic agents and treatment of heart failure o immunosuppressive, antimicrobial, antineoplastic, and antiparasitic drugs o drugs to treat peripheral arterial disease

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GASTROINTESTINAL SYSTEM

Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function, including alimentary canal, liver and biliary system, salivary glands and exocrine pancreas, motility, and digestion and absorption  cell/tissue structure and function o endocrine and neural regulatory functions, including GI hormones o salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins, bile salts, and processes o synthetic and metabolic functions of hepatocytes  repair, regeneration, and changes associated with stage of life  gastrointestinal defense mechanisms and normal flora Abnormal processes  infectious, inflammatory, and immunologic disorders  traumatic and mechanical disorders o malocclusion o hiatal hernia o obstruction o perforation of hollow viscus and blunt trauma o inguinal, femoral, and abdominal wall hernias o esophageal, intestinal, and colonic diverticula  neoplastic disorders, including benign and malignant  metabolic and regulatory disorders (including motility disorders, malabsorption, hepatic failure, cholelithiasis, nutritional disorders)  vascular disorders (including portal hypertension, esophageal varices, hemorrhoids, anal fissure, ischemia, angiodysplasia, thromboses, vasculitis)  systemic disorders affecting the gastrointestinal system  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the gastrointestinal system  congenital and genetic disorders affecting the gastrointestinal system Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the gastrointestinal system o treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux o drugs to alter gastrointestinal motility o fluid replacement o pancreatic replacement therapy and treatment of pancreatitis o drugs for treatment of hepatic failure and biliary disease o anti-inflammatory, immunosuppressive, antineoplastic, antimicrobial, and antiparasitic drugs  other therapeutic modalities

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RENAL/URINARY SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function o kidneys, ureters, bladder, urethra o glomerular filtration and hemodynamics o tubular reabsorption and secretion, including transport processes and proteins o urinary concentration and dilution o renal mechanisms in acid-base balance o renal mechanisms in body fluid homeostasis o micturition  cell/tissue structure and function, including renal metabolism and oxygen consumption, hormones produced by or acting on the kidney  repair, regeneration, and changes associated with stage of life Abnormal processes  infectious, inflammatory, and immunologic disorders o infectious disorders  upper urinary tract  lower urinary tract o inflammatory and immunologic disorders  glomerular disorders  tubular interstitial disease  traumatic and mechanical disorders  neoplastic disorders, including primary and metastases  metabolic and regulatory disorders o renal failure, acute and chronic o tubular and collecting duct disorders o renal calculi  vascular disorders  systemic diseases affecting the renal system  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the renal/urinary system  congenital and genetic disorders affecting the renal/urinary system Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the renal and urinary system o diuretics, antidiuretic drugs o drugs and fluids used to treat volume, electrolyte, and acid-base disorders o drugs used to enhance renal perfusion o anti-inflammatory, antimicrobial, immunosuppressive, antineoplastic, and antiparasitic drugs o drugs used to treat lower urinary tract system  other therapeutic modalities

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REPRODUCTIVE SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes, including gametogenesis  organ structure and function o female structure (including breast) and function o male structure and function o intercourse, orgasm o pregnancy, including ovulation, fertilization, implantation, labor and delivery, the puerperium, lactation, gestational uterus, placenta  cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones  reproductive system defense mechanisms and normal flora Abnormal processes  infectious, inflammatory, and immunologic disorders (female and male)  traumatic and mechanical disorders (female and male)  neoplastic disorders (including female reproductive, male reproductive, breast [including fibrocystic changes], trophoblastic disease)  metabolic and regulatory processes (female and male)  prenatal and perinatal counseling and screening  systemic disorders affecting reproductive function  disorders relating to pregnancy, the puerperium, and the postpartum period Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the reproductive system and management of normal reproductive function o female reproductive tract  fertility drugs  oral contraception, other methods of contraception  estrogen, progesterone replacement, treatment of menopause  stimulants and inhibitors of labor  estrogen and progesterone antagonists  stimulators and inhibitors of lactation

obstetric problems complications affecting other organ systems disorders associated with the puerperium antepartum, intrapartum, postpartum disorders of the fetus idiopathic disorders drug-induced adverse effects on the reproductive system degenerative disorders congenital and genetic disorders affecting the reproductive system

o o o o    

male reproductive tract  fertility drugs  androgen replacement and antagonists o gonadotropin-releasing hormone and gonadotropin replacement, including all gonadotropin-releasing hormone antagonists o abortifacients o antimicrobial and antiparasitic agents o antineoplastics o restoration of potency  other therapeutic modalities affecting the reproductive system o

33

ENDOCRINE SYSTEM Normal processes  embryonic development, fetal maturation, and perinatal changes  organ structure and function o hypothalamus, posterior and anterior pituitary gland o thyroid gland o parathyroid glands o adrenal cortex, adrenal medulla o pancreatic islets o ovary and testis o adipose tissue  cell/tissue structure and function, including hormone synthesis, secretion, action, and metabolism o peptide hormones o steroid hormones, including vitamin D o thyroid hormones o catecholamine hormones o renin-angiotensin system  repair, regeneration, and changes associated with stage of life Abnormal processes  infectious, inflammatory, and immunologic disorders  traumatic and mechanical disorders  neoplastic disorders (including pituitary, thyroid, parathyroid, adrenal cortex, pancreatic islets, neural crest, pheochromocytoma)  metabolic and regulatory processes (including diabetes mellitus, pituitary, hypothalamus, thyroid, parathyroid, pancreatic islet disorders, adrenal disorders)  vascular disorders  systemic disorders affecting the endocrine system  idiopathic disorders  degenerative disorders  drug-induced adverse effects on the endocrine system  congenital and genetic disorders affecting the endocrine system Principles of therapeutics  mechanisms of action and use of drugs for treatment of disorders of the endocrine system o hormones and hormone analogs o stimulators of hormone production o inhibitors of hormone production o hormone antagonists o potentiators of hormone action o antiobesity agents o nonhormonal therapy for endocrine disorders

34

IMMUNE SYSTEM Normal processes  development of cells of the adaptive immune response, including positive and negative selection during immune development  structure, production, and function o granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors o T lymphocytes, including T-lymphocyte receptors, accessory molecules, cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes o B lymphocytes and plasma cells, including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes o structure and function of lymph nodes, host defense mechanisms, host barriers to infection, mucosal immunity o immunogenetics o Rh and ABO antigens, including genetics  cellular basis of the immune response and immunologic mediators o antigen processing and presentation in the context of MHC I and MHC II molecules, including distribution of MHC I and MHC II on different cells, mechanism of MHC I and MHC II deficiencies, and the genetics of MHC o regulation of the adaptive immune response o activation, function, and molecular biology of complement o function and molecular biology of cytokines  basis of immunologic diagnosis Abnormal processes  disorders with alterations in immunologic function o abnormalities in adaptive immune responses o deficiencies of phagocytic cells and natural killer cells o complement deficiency o HIV infection/AIDS o Non-HIV infections of lymphocytes o systemic diseases of immunologic function o systemic disorders affecting the immune system and the effect of age on the function of components of the immune system  immunologically mediated disorders o type I, type II, type III hypersensitivity o type IV hypersensitivity o transplantation risks and rejection, including transfusion reactions o isoimmunization, hemolytic disease of the newborn  drug-induced adverse effects on the immune system, including Jarisch-Herxheimer Principles of therapeutics  mechanisms of action and use of drugs that specifically affect immune function o vaccines (active and passive) o antiretrovirals

immunomodulating and antineoplastic drugs biologics, including monoclonal and polyclonal antibodies other therapeutic modalities

o o 

35

APPENDIX B: 28-DAY SAMPLE STUDY SCHEDULE FROM TULANE SCHOOL OF MEDICINE

Day 1

General Overview & Begin Biochemistry

Objective

Assignments

Source

Self Assessment

Complete sample test materials NBME CD-ROM for NBME or download from www.nbme.org General overview of Read Through Section First Aid material to be covered Introductory Material from First Aid, and Skim Section II Basic Metabolism Chapters 5 & 6, and sample Lippincott’s questions at end of each Biochemistry chapter. Bookmark figure 6.2 and refer to it before studying each biochemical pathway.

Day 2

Continue Biochemistry

Objective Structure & Metabolism of Carbohydrates

Assignments Chapters 11, 12, 13 & questions

Source Lippincott’s Biochemistry

Glycolysis

Chapter 7 & questions

Lippincott’s Biochemistry

Gluconeogenesis

Chapter 8 & questions, Review Lippincott’s Figure 6.2 again! Biochemistry

Citric Acid Cycle

Chapter 9 & questions

Hexose Monophosphate

Chapter 10 & questions

Day 3

Continue Biochemistry

Objective Lipid Metabolism

Assignments Chapter 17 & questions

Source Lippincott’s Biochemistry

Phospholipids &Glycolipids

Skim Chapters 18, 19

Lippincott’s Biochemistry

Lippincott’s Biochemistry Lippincott’s Biochemistry

Cholesterol & Steroid Chapter 20, Sect. I –VII Metabolism

Lippincott’s Biochemistry

Steroid Hormones

Lippincott’s Biochemistry

Chapter 20, Sect. VII

Details

Est. Time

Complete 150 sample questions, and note trouble areas to focus on.

3 hrs

Learn about the test, and how to best use First Aid as a resource.

4 hrs

Understand the role of ATP. Know where the electron transport chain and oxidative phosphorylation occur and how they fit into the overall metabolic scheme. Review the main classes of cell receptors and signaling mechanisms.

2.5 hrs

Details Est. Time Review the digestion of sugars and disorders 3 hrs of fructose, galactose, and lactose metabolism. Spend more time on glycogen metabolism, its regulation, and related disorders. Use Figure 13.7 to memorize the glycogen storage disease Know the start and end points, hormonal 1.5 hrs regulation. Energy yield and various fates of pryruvate. Study it by comparison to glycolysis. Know 1 hr the reactions & regulation unique to gluconeogenesis. Focus on start and end points, place in overall 1 hr metabolism, and regulation. Shim reactions an focus on G6PD deficiency 1 hr

Details Est. Time Focus on roles of pancreatic lipase and bile 3 hrs salts. Fatty acid metabolism: know where synthesis occurs, relationship to glucose metabolism, and role of triacylglycerols for storage of fatty acids. Review mobilization of and oxidation of fatty acids. Finally, carefully review eicosnoids, focusing on figure 17.20 Gain senses of what these are, but do not 1 HR memorize structure of pathways. Focus on related disorders instead, using figures 18.10, 19.4 Review Cholesterol synthesis (esp. the role of 2 hrs HMG CoA reductase) and its regulation. Understand synthesis and role of bile salts. Review biology of lipoproteins and their role in atherogenesis. Key figure are 20.12, 20.14, 20.16 Know the major enzymes deficiencies in 1 hr 36 steroid synthesis and know where steroid receptors act in the cell. Study figures 20.19,

20.20

Day 4

Continue Biochemistry

Objective Protein & Enzymes

Assignments Chapter 1-4 & questions

Digestion of Dietary Chapter 21 Proteins and Nitrogen

Lippincott’s Biochemistry

Metabolism of Amino Chapter 22 Acid Carbon Skeletons

Lippincott’s Biochemistry

Details Est. Time Become familiar with basic properties of 4 hrs amino acids, levels of protein structure, hemoglobin, and collagen. For enzymes, focus on appreciating (not memorizing) the Michaelis-Menten equation, types of enzyme in clinical diagnosis. Learn the various pancreatic proteases and 2 hrs how they are regulated. Understand transamination and oxidative deamination, but don’t memorize Pathways. Spend more time on urea cycle and ammonia metabolism focus on figures 21.4, 21.11, 21.17 Emphasize relevant disorders. Focus on 1 hr figures 22.2, 22.16

Objective Assignments Heme, Porphyrins, Chapter 23 Serotonin, Histamine and Catholamines Gylcosaminglycans and Skim Chapter 14, 15 Glycoproteins

Source Lippincott’s Biochemistry

Details Est. Time Focus on the porphyrias and bilirubin 1 hr metabolism. Focus on figures 23.5 and 23.7

Lippincott’s Biochemistry

Nutrition and Vitamins Chapter 27, 28

Lippincott’s Biochemistry

Nucleotide Metabolism

Chapter 29

Lippincott’s Biochemistry

Know what they are and know the related 1 hr disorders. Don’t get too bogged down in details – just study figures 14.12 and 15.14, then move on. Know the daily energy requirements and 3 hrs vitamin deficiencies. Focus on absorption of vitamin B12 and pernicious anemia, as well as vitamin D. Focus on figures 28.12, and 28.18 Understand differences between de novo and 2 hrs salvage purine synthesis. Study purine degradation and the Pathophysiology of gout and ADA deficiency. Study figures 29.7, 29.9,29.10

Day 6

Finish Biochemistry

Day 5

Source Lippincott’s Biochemistry

Continue Biochemistry

Objective Assignments Ingrative Metabolism Chapters 24, 25, & 26

Source Lippincott’s Biochemistry

Details Est. Time Synthesize the information you’ve reviewed 5 hrs this week by studying insulin, glucagon, the fed/starved states, and the metabolic aspects of diabetes mellitus. Time spent on these topics will be VERY WORTHWHILE Details Est. Time Study general principles of pharmacology. 2 hrs Specific agents will be covered with relevant organ systems. Know different types of adrenergic and 5 hrs cholinergic receptors cold. Study figures 3.3, 3.6, 4.2, 5.2, 6.15, and 7.10.

Day 7

General Pharmacology

Objective Pharmacokinetics & Pharmacodynamics

Assignments Chapter 1, 2

Source Lippincott’s Biochemistry

Autonomic Drugs

Chapters 3 – 7

Lippincott’s Biochemistry

Day 8

Begin Microbiology

Objective Bacteria

Assignments Chapter 1 – 15

Day 9

Continue Microbiology

Source Clinical Microbiology made Ridiculously Simple

Details Est. Time Rely heavily on charts. Start building buzzword 10 hrs associations with characteristics of each organism and how is identified (with a special stain, culture medium, etc.) Also, time spent with Qbank questions here will be golden

37

Objective Antibiotics

Assignments Chapter 28 – 33

Fungi

Chapter 20

Antifungal

Chapter 34

Day 10

Finish Microbiology

Objective Viruses

Assignments Chapter 22-29

Antiviral

Chapter 37

Parasites

Chapter 30, 31

Antiparasites

Chapter 35, 36

Clinical Vignettes

Source Lippincott’s Pharmacology

Details This is high yield material, read, review and continue to do Qbank questions to keep building buzzword associations. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations. Lippincott’s This is high yield material, read, review and Pharmacology continue to do Qbank questions to keep building buzzword associations.

Est. Time 6 hrs

Source Details Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiviral agents, particularly Pharmacology mechanisms of action. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiprotozal and antihelminthic agent, Pharmacology particularly multi-drug regimens Underground Good for group study and another way to Clinical Vignettes – keep sharpening buzzword recall. Microbiology

Est. Time 6 hrs

Est. Time 4 hrs

Day 11

Immunology & General Pathology

Objective Review Immunology

Assignments Part VII

Cellular injury

Chapter 1

Source Medical Microbiology & Immunology: Examination and Board Review BRS Pathology

Inflammation

Chapter 2

BRS Pathology

Hemostasis

Chapter 3

BRS Pathology

Genetic Disorders Chapter 4 Immune Dysfunction Chapter 5

BRS Pathology BRS Pathology

Neoplasia

Chapter 6

BRS Pathology

Environmental Chapter 7 Pathology Nutritional Disorders Chapter 8

BRS Pathology

Day 12

BRS Pathology

Details Excellent, concise summary of immunology

1.5hr

1 hr

1 hr 2 hrs

1 hr 3 hrs

Focus on mechanisms of cellular injury and 0.5 hr differences between necrosis & apoptosis Distinguish mechanisms and histological 1 hr characteristics of acute vs. chronic inflammation Know coagulation cascade, types of embolism, 1 hr and types of shock. 0.5 hr Focus on immune deficiency disorders, 0.5 hr autoimmunity, and collagen vascular disease Distinguish between tumor suppressor genes 1 hr & oncogences, know mechanisms of carcinogenesis, and the properties of malignant cells. Quickly review 0.5 hr Review vitamin deficiencies to refresh biochem memory

0.5 hr

Cellular Biology

38

Objective Assignments DNA, RNA, Proteins Chapter 30 – 33

Source Lippincott’s Biochemistry

Details Est. Time Know mechanisms of DNA repair, different 3.5 hrs types/roles of RNA, mechanism of translation, and molecular biology techniques. Focus on figure 30.2, 30.16, 30.19, 30.22,31.11, 32.9 BRS Cell Biology & Know properties of membranes and 1 hr Histology membrane proteins

Cell Membranes

Chapter 1

Nucleus

Chapter 2

BRS Cell Biology & Know contents of nuclei, and RNA Histology import/export mechanisms.

0.5 hr

Cytoplasm

Chapter 3

BRS Cell Biology & Review organelles and function Histology

0.5 hr

Extracellular Matrix

Chapter 4

BRS Cell Biology & Know different types of collagen, basement Histology membrane composition, and other ECM components. BRS Cell Biology & Review types of epithelia and locations of Histology each. Review connective tissue focusing on bone histology

1 hr

Epithelia & Connective Chapter 5,6 Tissue Day 13

1.5 hrs

Objective Cell Physiology

Cellular Physiology & General Embryology Assignments Chapter 1

Source BRS Physiology

Embryology

Chapter 1-4

BRS Embryology

Birth Defects

Chapter 17, 18

BRS Embryology

Exam

Diagnostic Test

Board Simulator Series Body Systems Review

Good opportunity to identify weakness in organ system areas.

2 hrs

Day 14

Thorax

Objective Assignments Embryology of thorax Chapter 5, 11

Source BRS Embryology

Details Know the congenital cardiac abnormalities, and fetal circulation. Also understand the stages of fetal lung maturation.

Est. Time 3.5 hrs

Thoracic Anatomy

High Yield Gross 3 hrs Anatomy BRS Cell Biology & Be able to distinguish arteries and veins in 1 hr Histology cross section. Understand architecture of the gas diffusion barrier in the lungs.

Chapter 12 (Also use Netter’s Atlas for reference ) Histology of thoracic Chapters 11, 15 viscera

Day 15

Cardiovascular System

Objective Cardiovascular Physiology

Assignments Chapter 3

Source BRS Physiology

Cardiac Pathology

Chapter 10

BRS Pathology

Details Est. Time Know mechanisms of ion transport, action 1 hr potentials. Know stages from zygote through embryo. 3 hrs Review 3 Germ cell layers and their derivative tissues. 1.5 hrs

Details Est. Time Review hemodynamic, electrophysiology, 1.5 hrs cardiac cycle, blood pressure regulation, response to exercise, volume loss, altitude. Understand pre-load, after-load, Frank-Starling curve and condition. Study this chapter thoroughly 1.5 hrs

39

Vascular Pathology Cardiovascular Pharmacology

Chapter 9 Chapter 16–19 , 21

BRS Pathology Lippincott’s Pharmacology

Study this chapter thoroughly Know drugs used to treat CH, HTN, arrhythmias, angina, and hyperlipidemia

Day 16

Respiratory System & Begin Hematology

Objective Assignments Respiratory Physiology Chapter 4

Source BRS Physiology

Respiratory Pathology Chapter 14

BRS Pathology

Details Est. Time Know varies lung volume measurements, and 1.5 hrs understand acid – base disorders. Study this chapter thoroughly 1.5 hrs

Respiratory Pharmacology Clinical Vignettes

Chapter 22

Histology of Bone Marrow, Spleen, & Lymph Nodes

Lippincott’s Pharmacology Volume 1: Cases 1-19, Volume Underground 2: Cases 52-66 Clinical Vignettes – Patho-physiology Chapters 10, 12 (and a BRS Cell Biology & histological atlas for further Histology review

Day 17

Finish Hematology

Objective Anemia

Assignments Chapter 11

Source BRS Pathology

Hematopoietic & Lymph reticular Neoplasia Hemorrhagic Disorders Drugs affecting coagulation Anticancer Drugs

Chapter 12

BRS Pathology

Chapter 13

BRS Pathology

Chapter 20

Clinical Vignettes

Volume 1: Cases 74-102

Lippincott’s Pharmacology Lippincott’s Pharmacology Underground Clinical Vignettes – Patho-physiology

Day 18

Gastrointestinal System

Objective Embryology of Gut and Body Cavities

Assignments Chapters 10, 16

Chapter 38

Abdominal Anatomy

Chapter 3 (Also refer to Netter’s atlas) Histology of GI Tract Chapter 6

Source BRS Embryology

1 hr 5 hrs

0.5 hr Good opportunity for group review

2 hrs

Familiarize yourself with lymph nodes architecture and understand the spleen. Understand RBC, WBC, platelet

3 hrs

Details Est. Time Know Patho physiology and lab differentiation 2 hrs of various etiologies of anemia Distinguish between leukemia & lymphoma. 2 hrs Understand different types of each. Know how to diagnose and correct each disorder.

1 hr 1.5 hrs 1.5 hrs 2 hrs

Details Est. Time Understand rotation of gut and related 1.5 hrs malformations. Know which structures are derived of foregut, midgut, hindgut, in addition to vascular supplies. 2 hrs

High Yield Gross Anatomy BRS Cell Biology & Know layers of gut wall. Understand liver Histology structure, portal blood flow, and bile flow BRS Physiology Understand innervations of gut and gut hormones

1.5 hrs

GI Physiology

Chapter 6

1 hr

Day 19

Gastrointestinal System

Objective Gastrointestinal Pathology Hepatobiliary and Exocrine Pancreatic

Assignments Chapter 15

Source BRS Pathology

Details Study this chapter thoroughly

Est. Time 2 hrs

Chapter 16

BRS Pathology

Study this chapter thoroughly

2 hrs

40

GI Pharmacology

Chapter 24

Clinical Vignettes

Volume 1: Cases 40-73

Day 20

Genitourinary System

Objective Embryology of GU

Assignments Chapter 6, 13, 14

Anatomy of Pelvis and Chapters 4, 5 Perineum

Lippincott’s Know GI drugs as well as antiemetic Pharmacology Underground Good opportunity for group review Clinical Vignettes – Patho-physiology

2 hrs

Source BRS Embryology

Est. Time 3 hrs

Details

2 hrs

High Yield Gross Anatomy

Know the maturation sequence of 3 hrs spermatocytes and ovarian follicles. Know the anatomy of the nephron. BRS Cell Biology & Know the maturation sequence of 3 hrs Histology spermatocytes and ovarian follicles. Know the anatomy of the nephron.

Histology of GU Organs

Chapter 18, 19, 20

Day 21

Endocrine System

Objective Renal Physiology

Assignments Chapter 5

Source BRS Physiology

Diuretics

Chapter 23

Renal & Urinary Tract Pathology Male Reproductive Pathology Female Reproductive Pathology Clinical Vignettes

Chapter 17

Lippincott’s Pharmacology BRS Pathology

Chapter 18

BRS Pathology

Chapter 19

BRS Pathology

Volume 2: Cases 30-51, and 83-103

Underground Good opportunity for group review Clinical Vignettes – Patho-physiology

Day 22

Endocrine System

Objective Histology of Endocrine System Physiology

Assignments Chapter 13

Source BRS Embryology

Chapter 7

BRS Physiology

Insulin and oral hypoglycemic

Chapter 26

Lippincott’s Pharmacology

Steroid Hormones

Chapter 27

Clinical Vignettes

Volume 1: Cases 25-38

EXAM

Body System III – Test 1

Lippincott’s Pharmacology Underground Clinical VignettesPatho-physiology Board Simulator Series-Body Systems Review

Day 23

Nervous System

Objective Embryology of Head Neck, & Nervous System

Assignments Chapter 7, 8, 9, 10

Source BRS Embryology

Details

Est. Time 1.5 hrs 1.5 hrs

Study this chapter thoroughly

1.5 hrs

Know the different types of testicular cancer, 1 hr and the biology of BPH and prostate cancer Understand cervical, uterine cancer 1.5 hrs 2 hrs

Details Est. Time Review structure of endocrine organ, and use 1 hr an atlas for additional pictures. Know hormonal axes 2.5 hrs Know different types of insulin and their half 1.5 hrs lives. Know classes of oral hypoglycemic and side effects. 1 hr Good opportunity of group review

2 hrs

Tough questions, but great explanations. Well 1.5 hrs worth the time to push yourself a bit and solidify the material you’ve learned. Details Know bronchial arches/clefts and their derivatives. Understand the transition from neural plate to mature CNS. Know fate of

Est. Time 3 hrs.

41

neural crest cells. Head & Neck Anatomy Neuroanatomy

Chapter 8 (also refer to Netter) Chapter 1-23

Day 24

Nervous System

Objective Neurophysiology

Assignments Chapter 2

Source BRS Physiology

Neuropathology

Chapter 23

BRS Pathology

Clinical Vignettes

Volume 2: Cases 45-61, Anatomy Cases 40-56.

2 hrs

Neuropharmacology

Chapters 8,10, 11, 14, 15

Underground Clinical VignettesPatho-physiology Lippincott’s Review drugs used to treat epilepsy, Pharmacology Parkinson’s. Also review anesthetics and analgesics.

Day 25

Musculoskeletal System

Objective Embryology

Assignments Chapter 15

Source BRS Embryology

Est. Time 1 hr

Anatomy of Limbs and Chapters 1, 6, 7 (also use Back Netter) Histology Chapter 7, 8, 10 Anti-inflammatory Chapters 39, 40 Agents and Autacoids

High Yield Gross Anatomy High Yield Neuroanatomy

2 hrs 6 hrs

Details Understand Synaptic transmission and axonal conduction Know types of CNS infection, tumors, and vascular disorders. Good opportunity of group review.

Details

High Yield Anatomy

Est. Time 2 hrs 2 hrs

3.5 hrs

3.5 hrs 2 hrs 2 hrs

Lippincott’s Pharmacology

Day 26

Musculoskeletal System

Objective Dermatologic Pathology

Assignments Chapter 21

Source BRS Pathology

Musculoskeletal Pathology Clinical Vignettes

Chapter 22

BRS Pathology

Volume 3: Cases 9-18, and 96- Underground Good opportunity of group review. 104. Also Anatomy: Cases 62- Clinical Vignettes84 Patho-physiology

2.5 hrs

Exam

Body Systems II – Test I

2 hrs

Day 27

Behavioral Science & Biostatistics

Objective Clinical Vignettes

Assignments All cases

Source Details Underground Clinical VignettesBehavioral Science

Est. Time 3 hrs

Psychotropic Drugs

Chapter 9-12, 13

3 hrs

Biostatistics

Read entire book

Lippincott’s Pharmacology High Yield

Board Simulator Series-Body Systems Review

Details Est. Time Focus on malignancies (melanoma, SCC, BCC) 1.5 hrs and refer to a dermatology atlas so that you can differentiate between them. 1.5 hrs

Touch questions, but great explanations. Well worth the time to push yourself a bit and solidify the material you’ve learned.

Understand sensitivity, specificity, PPV, NPV. 4 hrs

42

Biostatics

Day 28 Final Review Exam Logistics

Be prepared to calculate risk, odds ratio, etc.

Final Review & Exam Logistics Review Any Remaining Topics and finish practice questions Prepare exam bag-with ID, ticket, directions to center, lunch.

4 hrs

Rest & Relax

43

APPENDIX C: 5-MONTH SAMPLE STUDY SCHEDULE (LATE APRIL TEST DATE)

Time Frame

Content Topic to Review

Pages in First Aid

November (begin studying during Thanksgiving break) Week 5

Heme/Onc & Pulmonary

46 pages

Week 1

Heme/Onc & Pulmonary

46 pages

Week 2

Cardio & Immunology

52 pages

Week 3

Renal

30 pages

Week 4

Biochemistry

52 pages

Week 5

Microbiology

60 pages

Week 1

Microbiology

60 pages

Week 2

GI & Embryology

54 pages

Week 3

Path, Pharm, & Musculoskeletal

60 pages

Week 4

Neuro

44 pages

Week 5

Endo & Repoductive

42 pages

December

January

February – Human Behavior course in progress March Week 1

Behavior & Psych

Week 2

Practice questions

Week 3

Practice questions

Week 4

CBCE Exam

Week 5

Shelf Exams

34 pages

This sample schedule is meant to be used as a framework for you to build your own individualized study plan; in addition to First Aid readings, challenge yourself to complete a set number of question bank items per week (or even per day as you get closer to the exam). Many thanks to Taimur Khan and Ryan Roach for their assistance in creating this sample schedule.

44

APPENDIX D: TULANE STUDENT USMLE STEP 1 OWL CLUB SURVEY RESULTS

Score

Questions Completed Vs. Score

270 260 250 240 230 220 210 200 190 180 170

y = 0.0053x + 213.71 R² = 0.1256

0

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 Number of Questions Completed

% of time studying Qs vs. score

Series1 Linear (Series1)

270

Score

250 230 210 190 170

y = -0.0069x + 226.63 R² = 4E-05

150 0

20

40

60

80

100

% of studying doing questions

45

2 3

0 2 1 1

Pulmonary

14 Renal

Infectious…

1

Genetics

Microbiology

4

Neurology

Cardiology

7

Pharmacolo…

Physiology

4

Pharmacolo…

1

Biostatistics

9

Ethics

12 1

Biochemistry

6

Neurology

3

Inflammation

5

Biochemistry

5

Heme/Onc

15

Pathology

10

Anatomy

Pathology

Number of Respondents 70 60 50 40 30 20 10 0

Endocrine

Number of Respondents

Studying which subject was most beneficial (i.e. most represented on the test)?

59

1

Which subject do you wish you spent more time on?

14

10

46

Score Distribution

270 250 230 Score

210 190 170 150 130 110 C/O 2010

C/O 2011

C/O 2012

Class

Class

C/O 2010

C/O 2011

C/O 2012

Median

224

232.5

225

Min

148

173

142

Max

265

264

263

47