Study Tips

Surviving Step 1: Setting Goals for Step 1


By Walter Wiggins

In my post (“Preparing for the Boards”), we discussed several things you can and should be doing right now to get yourself ready for Step 1. Now that Step 1 is on your mind, you may have a number in mind for your ideal Step 1 score. Coming up with this number can be tough, as your Step 1 score is an important criterion by which you are evaluated by residency programs. More competitive residency programs will want to see higher Step 1 scores. Satisfaction with your performance requires planning, hard work, and knowing what your goals are before you’re too far along.


Illness Scripts and Semantic Qualifiers


By Mark Ard

“Illness scripts” and “semantic qualifiers” underlie many of the questions on USMLE tests because, according to a large body of academic work, this is how physicians think. In this post, I want to work backwards from a USMLE-style question and show you how you can take complicated question stems and reword them, using semantic qualifiers, and then fit them into your ever evolving arsenal of illness scripts. First, let’s get some definitions out of the way.

Illness Scripts

A generic framework for understanding disease including the enabling conditions (genetics, age, gender, etc) the pathophysiologic fault (ischemia, invasion by microorganism, etc), and the sequelae (complaints, signs, symptoms) (1).

Semantic Qualifiers

Paired opposing descriptors that can be used systematically to compare and contrast diagnostic considerations: sharp/dull, acute/chronic, tender/non-tender, productive/nonproductive, insidious/abrupt, proximal/distal (2). (more…)

Deliberate Practice: Optimizing Your Studying


By Mark Ard

Consider two students during their month of dedicated Step 1 study time.

Student A wakes up at 8 a.m. after two hours of snoozing (no one wakes up at six if they don’t have to). He eats, gets ready, and starts working at 8:30 a.m. He reclines on the couch and starts reading where he left off in First Aid, highlighting all the bold topics. When he doesn’t understand something, he checks Wikipedia. He isn’t really learning anything, so he stops at 9:30 a.m. (it’s been getting progressively sooner). He watches a show, checks Facebook, falls asleep. Ok it’s noon. “I’ve worked for four hours.” He eats. Opens a Q-bank in tutor mode. If he gets a question wrong, it’s a stupid question. If he gets it right, he pats himself on the back. Ouch, 40% block. “They’re just testing minutiae.” He then does another block while watching TV (30%, but it’s ok, he was distracted). Then reads First Aid while watching more TV. Goes to bed at 10 p.m., so he can wake up at 6 a.m.

Student B wakes up at 8 a.m.. She gets ready, eats, and starts working at 9 a.m.. She checks her calendar. Flash cards first, a fan of the Leitner system. At 9:30 a.m., she checks her reading plan. First Aid, with supplemental images/explanations from her course textbooks. She hates reading, so she only reads for 25 minutes, then goes outside for five minutes. A follower of the Pomodoro technique. She carries on this way until noon, eats, and starts a Qbank block at 1 p.m. It takes 2.5 hours to go through the block and review each answer, right or wrong. She annotates key points into First Aid. She makes flashcards for need-to-know facts she struggles with. She finishes at 6 p.m.. She goes to the gym and exercises for a bit, then eats and meets with a friend at 7:30 p.m. They watch some review videos together, phones off and away, pausing when they seem distracted. She finishes at 9 p.m. She goes home, showers, and then looks over her Qbank results to plan what to focus on for her “catch up” day. She looks over her plan for the next day, organizes her stuff, cleans up a bit, then sits down to watch some TV. Bright lights off at 11 p.m. Sleep by midnight. (more…)

Question Digestion: A Guide to Breaking Down Step Questions


By Tim Durso

Question DigestionAs someone who recently took Step 1, I can officially say that there is no way to properly emphasize how important it is to have a strategy in place for attacking questions with consistency. I DON’T EVEN THINK WRITING IN ALL CAPS IS ENOUGH!

In all seriousness, trust me when I say that developing a question taking strategy is a key component to success on test day. Now, I know what you might be thinking, “Tim, I’m in medical school. I can read. Questions have words. Mad reading skillz + words + medical knowledge = 280+ no problem.” My first reaction is… do you always read blog posts with this much internal monologue sass? My second reaction is to point out that, if that were true, then the Step 1 average would be higher than the 230 it currently is. What will follow is my general outline for approaching each and every question I come across, Step or otherwise. (more…)

Annotation Nation


By Tim Durso

Annotation NationOne of the greatest challenges in studying for Step 1 is deciding what information is worth trying to remember. In an ideal world, you’d be able to memorize every bit of information you come across the first two years of med school, but if you could do that you’d be playing blackjack in Las Vegas with Tom Cruise instead of cramming your brain full of lysosomal storage diseases (that’s a Rain Man reference for those less movie-inclined). One of the best ways to machete your way through the thicket of medical knowledge out there is to annotate your handy-dandy version of First Aid (see here for the latest and greatest version).

While everyone agrees that annotation is an essential part of the sacred rite that is Step 1 studying, everyone seems to have a different approach. I’m going to try to help analyze some of these different approaches, and hopefully you’ll come away with a better understanding of what might work for you in your preparation. To accomplish this, I’m going to borrow elements from the famous children’s tale of “Goldilocks and the Three Bears.” If you haven’t heard of this story, call your parents and ask them why, and then Google it before reading further. (more…)

Start Early and Do Lots of Questions: Acing COMLEX and USMLE Prep


By Ryan Nguyen

Many osteopathic medical students at the beginning of their second year struggle to come up with a game-plan to prepare for the COMLEX Level 1 and USMLE Step 1. With a disturbing number of resources and study plans to choose from, how can students determine what strategy will maximize their board scores?

Early in my second year, I scoured the depths of the internet pouring over the study schedules and tips of past test takers. I was looking for “the one,” a study schedule that would get me the scores of my dreams. The dirty secret to success? There was no one study plan that triumphs above all. While they all varied in their day-to-day plans, study plans from top scorers all echoed the same two principles: start preparation early and do lots and lots of practice questions.

This post is dedicated to when to start preparing and how many practice questions to do. (more…)

Study Timing: How Soon Is Too Soon?


By Tim Durso

Study Timing - How Soon Is Too SoonThere’s one age old question that inevitably creeps into the forefront of the (admittedly neurotic) mind of many medical students during the pre-clinical years:

“When should I start studying for Step 1?”

For a question that seems so universal, the answer is far from it. I’ll give you my perspective on the issue, and granted it it’s a sample size of one (great time to review study power in your handy-dandy copy of First Aid), but it’s a strategy that put me in a position to exceed even my own expectations on test day. (more…)

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