The following is a write-up posted by "Golf med student" over at SDN
First of all I want to say that my
initial goal was 240. It seemed like the magical number that would at
least get you in the door at most specialties. The point I want to
make is this, get a score in mind that you want to achieve and work
towards it. You need goals in order to push you further. If you
surpass your goals in your studies then continue to increase your
goal so that you can achieve the highest score you possibly can. Even
though 240 was my goal internally and a score that I would be happy
with, I was really pushing for 250. When it comes to standardized
exams I have learned in my experience that I fail in achieving my
goals more often than not. Maybe that is just because I set too high
of goals for myself to begin with but that’s another story. The
idea here is that shoot for the moon because if you fail at least
you’ll fall among the stars. But when I started getting 250s on my
practice exams I tried to push for a 260. Don’t sell yourself
short! Believe in yourself!
My study prep really was based on a few
guiding principles that I used. I also experimented a bit with
different methods but I will give below the schedule that I would
follow knowing what I know now starting in the fall. This method is
really just my own but I think it gives you the best chance to get
the highest score you possibly can.
The first principle I based my schedule
on was the idea that we can only remember about 75% of what we
see/read. Since we are not in clinic yet (US medical students) it can
be hard to remember everything without actually having experienced
it. This concept led me to use multiple resources that used different
types of learning modalities. The idea is that you read something,
listen or watch something, and then also answer questions on the
topic.
The next principle kind of ties into
the last one in a sense because I knew I would forget things, I
decided that I was also in need of spaced repetition. I did this by
narrowing down resources as the year went along. I’ll explain this
a bit later but all I really did was start with subject books focused
on anatomy, biochemistry, etc. before starting a comprehensive review
source like First Aid. It made knowing the information in first aid
seem like it wasn’t too much and just the bare essentials. I added
in firecracker also here but I used it in a way that I don’t think
many have tried. I’ll detail it out more below.
The last and probably most important
principle I used was that it takes 10,000 of something to become
proficient. In this case it is 10,000 questions. They don’t
necessarily all have to be unique but you want to try to go through
the thinking process of eliminating all the answers for a certain
reason. For instance maybe the first time I see a question I only
know what the correct answer is but all the other choices don’t
make sense. The second time I see the question I want to try to
eliminate all the others based on the information in the stem in
order to lead me to the correct answer choice. This makes the
question just as valuable the second time around.
Now on to the schedule!
If I were to do it again I would
personally start my STEP prep in August. I would spend the fall
getting a broad understanding of all the topics I covered in first
year and then onto in second year including the things we are going
to cover in the upcoming spring semester. By reading all of these
books you may not remember everything in the book but you become
familiar with the book to the point that you can use it for quick
reference during dedicated studying. Then if you have to reread up on
lets say the difference between conus medullaris and cauda equina
syndrome you have a general sense of where it is in the book and it
only takes a few moments to jog your memory rather than having to
learn it for the first time. At my medical school the topics we were
on a block schedule so during first year we covered anatomy,
biochemistry and cell biology, physiology, microbiology and
immunology. In the fall of second year we covered neuroanatomy and
pathology principles including hematology/oncology pathology and
musculoskeletal pathology. During the spring we covered behavioral
science, cardiology pathology, pulmonary pathology, renal pathology,
gastrointestinal pathology, endocrine pathology, reproductive
pathology, and skin pathology.
Anatomy – HY Anatomy – I read this
book during the fall semester, I don’t necessarily feel that it
aided me in any questions but it was a good review of anatomy from
the previous year and I think helps in creating a solid foundation to
build on that you need in this area. As many have said before they
have many radiographic images that are helpful. I hardly ever missed
any anatomy questions when I finally got to qbanks so maybe it could
be attributed to this book or just learning it really well during the
block.
Embryology – HY Embryology – This
is really a great book! I didn’t feel like I really learned my
embryology well during our anatomy block but after reading this book
I felt much more comfortable answering the questions that would come
up. I think if you feel weak in this area, I would definitely pick
this up because it’s a quick read and prepares you well to answer
questions on the topic.
Biochemistry – Lippincott
Biochemistry – I also read this book during the fall semester. It
was extremely useful! I know that many say it is too long and is not
worth it. I graduated with my undergraduate degree in biochemistry
and I felt this was so much better organized than RR Biochemistry.
The images and diagrams were easy to navigate and I referred to it
many times during my dedicated step study
Cell Biology – HY Cell and Molecular
Biology – I was also a cell and molecular biology minor so this
book was something I was really familiar with. It was a good
refresher and a quick read so not too much of a commitment.
Genetics – HY Genetics – This was
also a very quick read and had good coverage of the topics that were
covered in questions. Not a big commitment in terms of reading but I
felt worth the little amount of effort.
Physiology – BRS physiology – The
gold standard when it comes to physiology. You can’t really go
wrong with this book. I re-read it but felt it was lacking in some
areas specifically cardiac physiology and respiratory physiology.
Maybe that’s just because I used big Costanza and West respiratory
physiology. I went back and added in some info that I felt was
important to the book but they ended up not being very important in
the end. Just stick to this book for physiology and you’ll be good
to go as far as the basics.
Microbiology and Immunology – Review
of Medical Microbiology and Immunology (Levinson) – I actually read
Medical Microbiology Made Ridiculously Simple (MMRS) but I felt this
book was much better and didn’t have all the fluff that was in
MMRS. Maybe I didn’t get a lot out of MMRS because I also used
picmonic (I’ll talk about picmonic soon!), which has a similar kind
of learning style but much better organized. The parasite review was
just so much better in Levinson and that was a weakness I felt that I
had so that could be it as well. The immunology section was also
short and to the point. I have a pretty strong background in
immunology so maybe it wouldn’t be ideal for those that feel a
weakness.
Neuroanatomy – HY Neuroanatomy –
This is another book that is great! Has everything in it that you
need to know for STEP and more. I would highly recommend it! Plus it
is short and does not take long to read.
Behavioral Science – BRS Behavioral
Science – I know that the last edition of First Aid recommended HY
Behavioral Science but it is just not enough. I read the HY and
constantly had to go back and read the BRS. I wish I would have just
sucked it up and read the BRS to begin with like I planned. My lowest
test subject on my actual exam ended up being this so I ended up
paying for not reading this book. In addition to reading this book I
would also recommend watching the Kaplan videos on Behavioral
Science. The guy that does them is absolutely amazing and simplifies
the subject enough to help answer a lot of questions.
Pharmacology – Katzung & Trevor’s
Pharmacology Board Review and Examination – There are two of these
books that seem similar online but one is the entire text and the
other is a review. Pick the review book! It was short and had basic
information that allowed me to create a framework for each of the
actual drugs. Questions at the end of each chapter were nice as well
to make sure you picked out important information. I also watched the
Kaplan videos for this topic because Raymond is amazing and helps a
lot with understanding the pharmacology.
Pathology – Pathoma/RR Pathology –
Your test no matter what subject it is heavy in or balanced will be
mainly pathology. It makes sense then to read a couple of books on
the topic. I started with Pathoma and watched all the videos while
reading the text. I then read RR. I did not listen to the audio and
I’ll tell you why. Those tapes are now almost 15 years old!
Information has changed and he has everything that he talks about in
the book. Read the book and you’ll be better prepared. It brings
everything together at the end because he integrates the physiology
and biochemistry with the pathology.
So those are the books I would read
during the fall to prepare you for a spring full of questions and
First Aid. The reason for reading is mainly a leveling process. Each
school is slightly different in the curriculum they stress so all of
our education is slightly different. I feel these books are basic
enough where it is material that everyone should have at least heard
of after the first two years of medical school. I added in videos to
the topics of behavioral science, pharmacology, and pathology because
I think they are the most tested. I know microbiology is also heavily
tested but it is just memorization in the end and we also had very
good lectures in the subject at my school. I also think here is a
good time to talk about picmonic. If you haven’t heard of it check
it out. It is definitely not for everyone but it helped me immensely
to have a starting point for memorizing the topics they covered. I
think that for me personally it worked best for biochemistry and
microbiology but that was most likely due to the fact that it hasn’t
been around very long and those were really the only cards I got to
see a lot. I would focus on doing whatever cards you are currently
learning in class. If you are in microbiology learning about
gram-positive bacteria do those cards. Listen to the audio for each
card once at the very beginning of the week or two weeks you are
studying that topic and then during the week look at them right
before you go to sleep. You’ll have some crazy dreams but it makes
them stick in your mind when you are under pressure. They have added
many more cards now and I tried to use them but I had already
memorized the topic before seeing them so they weren’t as helpful.
They correlate directly with what is in First Aid so you know it is
essential information that will show up on the exam. The amount of
questions I got right in biochemistry and microbiology were mainly
due to this resource so I would highly recommend it.
The springtime is for learning how to
answer questions and getting First Aid filled out to use as the
ultimate resource in your final study period. After all this reading
you might think that you would be well prepared to answer questions
but it really doesn’t happen that way. It takes time to understand
how concepts are going to be asked and what the important information
is. Don’t worry! I had the same experience and it is just a process
of playing the game.
First qbank – USMLE Rx – Start with
this qbank! There are a little over 2700 questions so try to have it
done by the end of February. The questions all have links to the page
where it is in First Aid. This helps you get acquainted with FA and
where everything is. I cannot tell you even after doing this how many
times I would write something somewhere and then find it printed
somewhere else. Learn where things are in FA and you’ll save
yourself time from writing down redundant information. Go through the
qbank by the way it is divided in First Aid. For instance I started
with Behavioral Science. I first read the section in FA and then
would answer the questions associated with that topic. This will be
your first read through FA and will also aid in knowing where
everything is. For pharmacology and pathology, I answered the
questions by organ system instead. Reading FA and then answering
questions over the topic helps to cement the information in your
mind. When putting information from the question into FA I only wrote
down the core objective at the end of each question. I did the
questions in tutor mode because immediate feedback is so important. I
only used timed mode when I was in my final prep period. I will
explain this in more detail later though.
Second qbank – Uworld – The reason
for doing this second is that you can reset this bank and you want to
do this twice because it really is the best prep for the detail on
the exam. This will be your first pass through the bank. It is harder
than Rx so don’t worry if you see your scores drop. (Also unlike Rx
when you click on an answer it doesn’t let you change it and shows
you the explanation.) Do it on tutor mode and write in all the
educational objectives at the end of the explanations into your First
Aid. Don’t do this by specific topic like you did with the previous
one. Select all subjects and organ systems so you start to get a feel
for what it’s like to have mixed exams. You’ll want to try to
complete this by the end of March.
Third qbank – Kaplan – This qbank
tests a lot of minutiae but I got several questions on my exam
correct because of the questions I saw here. This was also my only
place to see menkes disease (it is definitely in FA in the biochem
section) so you know it has been on the real thing before. The bank
also does a good job of giving you plenty of practice with the arrow
questions for physiology. For example the patient comes in with this
disease, happens to x, y, z. It is also the best for behavioral
science and laboratory medicine. First do the diagnostic exam to see
where you are after two qbanks. Do it in tutor mode with all subjects
and organ systems selected. Write down the key concept at the end of
the explanation in your First Aid. You’ll want to try to complete
this by the end of April
During uworld and Kaplan banks read
First Aid for a second time. Take the time to find information that
you missed in your first pass! You’ll start to be surprised by how
much you missed and how much information is actually in First Aid.
Dedicated STEP study time:
So for this it really is up to the
individual but this is how I did it and I don’t think many other
people did it this way. I scheduled 5 weeks of dedicated study time.
It was a little more than the month that I thought I would need but
it gave me the ability to take one day off a week and also celebrate
my MBA graduation and my fiancée’s birthday. During the time I
thought that it was too much but now that I have my score back I am
happy with my decision on taking 5 weeks. So here is what I would
recommend based on that 5 week schedule. If you choose to do
something other than this it is fine, by this time you kind of know
where you are and where you want to go. I don’t think any of the
DIT or Falcon review courses are worth it at this point either if you
have followed this schedule from August. Those are designed to help
people pass STEP who haven’t been studying very hard during second
year.
Uworld – Second pass. This time you
want to set it up for timed and select all subjects and organ
systems. Review the entire test after you complete it. This helps get
you prepared for the real thing by getting your timing down and
working on your thinking process. You stop worrying about whether or
not you got a question right and just learn to try your best and move
on. You know all of the answers to this qbank so any question you
miss means there is a fault in the process you are using to answer
the question. Find it and work on it. Sometimes it is that you are
thinking too much and other times its because you aren’t paying
attention. Find the right balance that allows you to function at your
optimum level. Try once again to finish this qbank in 4 weeks. It
should be easier this time since you aren’t writing everything
down. Don’t worry if you aren’t getting every question right! I
know of people who had a second pass percentage rate around the 80%
mark and still did well. The key is to figure out why you missed
those questions the second time around! I did my questions every
morning.
Firecracker – This is what I did in
the afternoons. I know this is not how most people use this program
but based on my experience with it during first year this is what I
did because I knew it would work for me. I completely reset my
account so that I did not have any topics flagged. Prior to this I
may have flagged about 40% of the topics with none from the organ
systems section. I then did approximately 50 topics a day so that I
could finish flag everything within four weeks. It is definitely a
lot towards the end but this was my way of reviewing as much as I
could with spaced repetition so I wouldn’t forget what I learned in
the first week by the time I took the exam at the end of the fifth
week. I knew after the Kaplan diagnostic exam where my weaknesses
were so I did those sections first to give myself the opportunity to
see those cards the most. This may not be for everyone but it
definitely helped me with my microbiology, dermatology, reproductive,
and renal questions that were a relative weakness going in to
dedicated study time.
CBSSAs- DO THEM ALL! All of the ones
online are around $50 and there are 6 so it is an investment but I
saw several questions and pictures from these on my actual exam. In
my mind that in itself makes it worth it. Try to do one once a week
starting with the first week so you can have them done before your
exam. Don’t stress too much about the scores you get. Most people I
have talked to tend to get a score a few points above their highest
CBSSA. Also this is a great chance to meet with a study group.
Throughout my second year, I met with a group of like-minded students
that were dedicated to STEP studying at an early date. We would meet
once a week and answer 10-15 questions over an hour from a question
book and just discusses how we each arrived at the answer. We
continued this process by meeting up on Sundays to discuss the
questions we missed on the CBSSA. You don’t get the correct answer
for the questions you missed if you choose extended feedback (you
should choose this option, its $10 more but you only take STEP 1 once
so its worth it!). You just get the question and detailed statistics
on the different subjects and organ systems. You can use this to
tailor your studying for the next week if you aren’t doing the
Firecracker method.
Last week before the exam: Do the two
practice exams on Uworld, they are pretty good but tend to
overestimate your actual score. Try to focus once again on limiting
the number of mistakes you make in your thinking process. At this
point you know or have seen it all and it is just about minimizing
stupid mistakes. By that I mean mixing up biostatistics formulas or
other simple questions that are supposed to be the easy ones. You
can’t get the highest score you’re capable of without learning to
do this. For example, on one of these practice exams was a classic
“EXCEPT” question. STEP isn’t allowed to ask these questions
anymore but they have technical way of doing it. They give you a
vignette and you have no clue what it is. You look at the answer
choices and see that you know four of them but the other one is a
mystery and you’ve never heard of it. The point of the question is
to know those more common four and exclude them based on the
information in the vignette so you can choose that one you’ve never
heard of before. If you are able to do that with good reasons for
excluding each wrong answer choice you are able to think like the
question writers and that is the name of the game! The other thing to
do during this week is read through First Aid for the last time. You
have put a bunch of notes in there from all of the questions you’ve
answered. Use a fine tooth comb and find all the little details that
you don’t remember. Don’t worry if you are finding there is too
much to First Aid and you can’t possibly know everything in there.
Just by doing this you’ll get several questions correct that you
wouldn’t have on your exam. I know because that’s what happened
for me (do you remember what the dihydrorhodamine test is used to
diagnose? Chronic Granulomatous Disease and it is in First Aid!) A
few days before your exam do the free 138 questions given by the
NBME. They are good questions and a couple showed up on my exam.
Take the day off before your exam! You
need to be in top shape for tomorrow and not tired. Watch a movie,
eat well, and get some good rest! Do whatever you have to do to
relax.
Wake up early on the exam day and get
to your testing center early (like 30 minutes early). You don’t
want to add stress to the actual day. I ate some protein (eggs and
bacon) for breakfast. All I am saying is to eat something that will
last and keep your energy up for the exam. I also did 10 random
questions and read the rapid review section at the end of First Aid
before I left. This helped me to get in the question-answering mood
and was a good overall review of commonly tested items. Take plenty
of food and drinks. Try to mix it up so you can eat whatever you want
(I took some sandwiches, crackers, and candy bars… filling, salty,
sweet). I also took some 5 hour energy shots with me. I drank one
before I went in and then another in the afternoon. I know I’m
blatantly copying their ad but I don’t feel the crash with it as I
do with coffee or cokes so that is why I choose it over them. It kept
my energy up and felt great the whole day. Try to stay calm, cool,
and collected. Don’t over think and try to minimize your mistakes.
Manage your break time. They give you about 45 minutes of break time
plus whatever time from skipping through the tutorial. I did a little
of the tutorial because the auscultation on the exam allows you to
move the stethoscope around and change from diaphragm to bell unlike
any of the other testing services. I would get done answering all the
questions around 20-15 minutes left in the block mark and then review
all of my answers for another 10 minutes so I would have about 5-10
minutes after every block. I took a thirty-minute break for lunch
after the fourth block. I took slightly longer breaks in the
afternoon because I knew that I would be tired from answering all
those questions earlier in the day. I ended up using almost all of my
time.
Congratulations! You’ve just
completed taking one of the most stressful exams of your life! Go
enjoy life and catch up with all those friends you’ve ignored for
the past month while you’ve been studying! It usually takes about 3
weeks to get your results which will be posted to the same website
where you registered for STEP 1. They only release scores on
Wednesday and will send an email saying your scores will be uploaded
later that day. If you take your exam during May/June they may have a
single date for everyone for a certain heavy testing period. For
example, when I took the exam all the scores from May through June
19th were uploaded on July 9th. They usually
post this information to their website if they are going to do
something similar during the time you take it.
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