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Step 1 Advice

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Introduction

The Step 1 exam is probably the toughest, and focuses largely on the more 'undergraduate' topics of the basic clinical sciences. Most US students take this after completing their 2nd/3rd year. For non-US graduates, this exam is also best approached at a similar time in your course. For those that decide to take the USMLE later in their career (especially those that take it post-graduation), it is important to bear in mind that this exam will contain the most 'non-clinical' material, much of which will be from topics that you probably were glad to leave behind at medical school.

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Exam format & syllabus

Question format:

The Step 1 features single-best-answer multiple choice questions (MCQs). It's a staggering 8 hours long - there are 7 hour-long blocks of 50 questions each, with the final hour being break-time. You can't really take breaks in the middle of a block (these count as 'irregularities'), but are allowed to in-between the blocks. It's upto you to allocate your break time effectively between the blocks, and you can use this time to do anything you like, including look at your notes. But you can't unfortunately go back to already answered blocks of questions to change your answers!

Subjects tested in the exam:

General Principles, Hematopoietic and Lymphoreticular Systems, Central and Peripheral Nervous Systems, Skin and Related Connective Tissue, Musculoskeletal System, Respiratory System, Cardiovascular System, Gastrointestinal System, Renal/Urinary System, Reproductive System and Endocrine System.

From the USMLE website:

The test is designed to measure basic science knowledge. Some questions test the examinee's fund of information per se, but the majority of questions require the examinee to interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through application of basic science principles. Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.

Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees.

There is a syllabus, but it's only worth looking at when you're feeling a little too demotivated to work. If looking at this doesn't scare you into working harder than you ever have done before, then nothing will. In USMLE's own words, it's not really a curriculum. In other words, learn everything. Then learn some more. If you're interested, you can take a look at the syllabus here:

>The USMLE Step1 website

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Recommended books

With such a vast syllabus, choice of texbooks is largely down to personal preferrence. You do not need to read a book for every topic - a combination of First Aid, plenty of practice questions and the use of lots of useful notes available on the internet (some of which we'll try and put up on this site), it is possible to keep your use of textbooks for individual subjects down to a bare minimum. Go with what you find hardest - if you struggle with Biochemistry (most people do!) then use an extra textbook for that. Other topics, such as Pathology, are relatively more 'clinically orientated', so post-graduate exam takers in particular will tend to find these easier, hence not requiring much more than the essential materials to cover these areas.

Here are a few of the highly recommended texbooks:

General: First Aid for thr USMLE Step 1

A MUST HAVE! The gold standard of USMLE revision books. Buy it, read it, then read it again. Many, especially post-graduate students, have used this as the basis of their revision, using more detailed 'specific' books to supplement their reading. It is not really enough to just use this, but whatever you do, make sure you do not take the exam without reading this book.

General: Kaplan Step 1 Qbook

A MUST HAVE! 850 questions with answers and explanations. A good way to get a feel of the style of questions asked in the exam. Useful to use before using Qbank (see below) or as an adjunct for use on the train so that you don't waste those valuable revision minutes when you are without internet access...

General: Step-Up: A high-yield systems based review

Lots of charts and diagrams. This books is ordered in an 'organ-based' (rather than systems-based) scheme, and is therefore considered a refreshing change by users.

Anatomy: High-yield Gross Anatomy

There are pleny of anatomy textbooks out there, but those that are targetted towards the Step 1 are probably of more use - it's one thing knowing the anatomy, but as with all exams, it's the 'learning for the exam' rather than just 'learning the topic' that ensures success. There is also a 'High-yield Embryology' by the same publisher.

Anatomy: High-yield Neuroanatomy

By the same publishers as the other anatomy high-yield textbooks, this one is written in a clear and straightforward style.

Behavioural Science/Statistics: High-yield Behavioural Science

Short and to the point. Personally, we feel that a combination of our medical school teaching, First Aid and common sense is enough for the Step 1, but other test-takers do recommend this book. In fairness, there are questions that appear in the Kaplan practice bank that do go beyond the contents of First Aid, so it does seem that First Aid is missing a few topics. With the inclusion of a basics statistics chapter, use this book to fill in those blanks.

Biochemistry: Lippincott's Illustrated Reviews: Biochemistry

We hate Biochemistry. Because it's hard. Dehydrogense this, carboxylate that...just makes you want to go and phosphorylate yourself. This book takes a while to get through, but has some excellent diagrams and explanations of the key topics. Use it, and fear Biochemistry no more. OK...fear a it a bit less.

Biochemistry: Rapid Review: Biochemistry

Another option for the Biochemically challenged. Comes with lots of useful tables and charts and diagrams - and even a couple of question CD-ROMs too.

Microbiology & Immunology: Clinical Microbiology Made Ridiculously Simple

If you like your textbooks to be suitable for children (ages 3+ only) then you'll like this one. It's chart based and features lots of images and other memory aids such as mnemonics. It is also useful for learning about antibiotics too. If time is running out, this is a great read.

Microbiology & Immunology: Rapid Review: Microbiology & Immunology

More grown-up than the 'ridiculously simple' series. Some say this is one of the best from the 'rapid review' series. The accompanying CD-ROM questions are good but are said to be poorly formatted.

Pathology: BRS Pathology

Although it forms a large part of the exam, as discussed above, Path is often considered by post-grads to be one of the the easier topics due to the increasingly clinical slant of the questions. Undergraduates may, however, find the sheer volume of this topic a little overwhelming, and so a good 'high yield' revision aid is a must. With that in mind, BRS Path is one of the most highly recommended by Step 1 takers.

Pharmacology: Pharmacology for the Boards and Wards

As you would expect, there are hundreds of pharmacology texbooks out there. It is therefore best to stick to one designed for the USMLE. Whilst it can be a little wordy at times, this book is a good review of the material required for the Step 1. Lots of good tables.

Physiology: BRS Physiology

Physiology is probably the second biggest topic to feature in the Step 1 exam. Big topic means big syllabus, so yet again, we recommend a good summary books to begin with, rather than going straight for the detailed texts. This is exactly such a great review book for the Step 1. Very easy to read, and also features practice questions.

Physiology: Physiology

If you have the time and motivation, this is a much more detailed and thorough journey through the world of Physiology. Probably best to use the BRS book as your main text, with this one to clarify any concepts that you're finding difficult. It's actually written by the same author as the BRS one too. One reviewer of this book described her as the 'Goddess of simplifying Physiology'. Revise4finals figure that God must know what's in the exam. So if buy her books, you must pass?

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Online revision

If you're wallet is feeling a little too light after contributing several hundred dollars towards the privelege of taking the Step 1 exam, then you probably won't want to read this section, as the only real way to do this is by spending yet more money. The key to passing Step 1 - as with most exams - is getting in lots of practice questions. For the Step 1, this is where Kaplan excells. Several products are on offer:

Qbook

A textbook containing 850 questions with detailed answers and explanations. A good start to the world of USMLE-style questioning.

Qbank

An online question bank containing over 2000 questions. Goes HIGHLY recommended by many, many students. Most US students certainly seem to use this, and after using it myself, I can see why. The questions are probably the closest to those encountered in the real exam, and the explanations are generally very good. At $199 (for 1 month's unlimited access) it is by no means cheap, but after investing so much money and time in working for the Step 1, doing badly is not really an option. With this in mind, it does make sense to get as much useful preparation in as possible, something that this site definitely offers. You can also subscribe for 3 months if you wish to spread out your learning experience.

Qreview

Similar to the above, but this instead features vignettes (scenarios) rather than 'short' multiple choice questions. Users of this have found it useful. If you have the time and money then there's no harm in getting more questions under your belt, but if you are short of funds and time and can only really afford to use one of these online question sites, then go for the QBank.

Home study programmes

If you're feeling particularly keen, then Kaplan have a variety of lecture-based home study programmes on offer. These include various combinations of audio, video and paper-based lectures and revision notes. Be warned though...these are expensive. If that isn't an issue, however, and you want a thorough review of all of the topics that will appear on the exam, then these programmes are considered very good, with all material contributed by experienced tutors. Of particular note, are the lectures given by the rather 'legendary' Dr Goljan. His 35+ lectures are simply excellent, and are superb examples of entertaining medical teaching. He does indeed 'make learning fun'. Which is particularly impressive given that he teaches pathology. Although we cannot condone reckless (and of course, illegal) breaches of copyright, rumour has it that these lectures are now widely available for download on the internet. For free. Now you didn't hear that from us...

How do I sign up?

Simple. Click on the link below, then click on the word 'join', and then go and learn something:

Kaplan Test Prep and Admissions (Kaptest.com)


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