Successful Start to USMLE STEP 1 Prep From Someone Who Scored a 274 (Part 1)

Successful Start to USMLE STEP 1 Prep From Someone Who Scored a 274 (Part 1)
First years, listen up! If you want to get a high score on your USMLE STEP 1 exam next year, start studying EARLY. It’s the best way to ensure you will have the time to review the material thoroughly without all that painful (and counterproductive) cramming. Plus, using the right tools and study methods early will help your retention and save you time later.

The average USMLE STEP 1 score is 230. My initial goal was 240. It seemed like the magical number that would at least get me in the door at most specialties. But, when I started getting 250s on my practice exams I tried to push for a 260. This is the first tip I want to share with you. Get a score in mind that you want to achieve and work towards it. You need goals in order to push yourself further. If you surpass your goals then keep moving your target! That will help you achieve the highest score possible. Don’t sell yourself short. Believe in yourself and get the USMLE scores you deserve!

Like I said above, I exceeded my goals because I started early; in August before my second year began. I experimented a bit with different methods but then developed a schedule and a study routine for myself, based on a few guiding principles that I will share with you.

Tip 1

#1 Use resources that will help you learn important topics.

The first principle I used was the idea that we can only remember about 75% of what we see and/or read. Since second year U.S. medical students are not in clinic yet it can be hard to remember everything without actually experiencing it. This concept led me to use multiple resources with different learning modalities. For example, if you read, listen to or watch something, and follow it by answering questions on the topic, you’ll retain the information better. I started using Picmonic for this reason. When I was in microbiology learning about gram-positive bacteria, I learned it using the Picmonic cards. I listened to the audio for each card once I started a new topic, and then during the week I reviewed them right before going to sleep. Fun side effect – you might have some crazy dreams like I did, but it made the facts stick. And that’s the whole point. During the microbiology block, Picmonic was absolutely my best friend.

If you haven’t heard of Picmonic, check it out. It may not be for everyone – everyone’s got their own ways of learning and retaining information – but it helped me immensely to have a starting point for memorizing the topics I needed to learn. For me personally, it worked best for biochemistry and microbiology. My advice is to focus on doing whatever cards you are currently learning in class. They continually add more topics at Picmonic, with more than 1,400+ videos currently, and they are organized to correlate directly with what is in First Aid for the USMLE STEP 1 so you know Picmonic is providing essential information that will show up on the exam. The amount of questions I got right in biochemistry and microbiology was mainly due to Picmonic so I would highly recommend it.



Tip 2

#2 Review the same topics with different resources, and narrow down as you go.

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 second year went along. I’ll explain this in detail later, but I would start with subject books focused on anatomy, biochemistry, etc. BEFORE using a comprehensive review source like First Aid for the USMLE STEP 1. Then, I incorporated Firecracker once I started using the Qbanks, which I describe in my second article.

My medical school was on a block schedule, so during our first year we covered anatomy, biochemistry and cell biology, physiology, microbiology and immunology. In the fall of our second year we covered neuroanatomy and pathology principles including hematology/oncology pathology and musculoskeletal pathology. During the spring of second year, we covered behavioral science, cardiology pathology, pulmonary pathology, renal pathology, gastrointestinal pathology, endocrine pathology, reproductive pathology, and skin pathology.

I spent the fall of my second year getting a much broader understanding of the topics I covered in first year, as well as learning about topics we would cover in the upcoming spring semester. While you may not remember everything by reading all of these books, you will become familiar with the book itself and will be able to use it for quick reference during “dedicated” step study time. Then, when you have to review the topics like, let’s say, the difference between conus medullaris and cauda equina syndrome, you have a general sense of where it is in the book, quickly jogging your memory rather than having to learn it for the first time.

My list of top books to study:

  • Anatomy – High-Yield Gross Anatomy – I read this book during the fall semester and it was a good review of anatomy from the previous year and helped create a solid foundation on which to build. As many have said before, the book has many radiographic images that are helpful. I rarely missed any anatomy questions when I finally got to Qbanks which is at least partially attributed to this book.
  • Embryology – High-Yield 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. If you feel weak in this area, I would definitely pick up this book because it’s a quick read and prepares you well to answer questions on the topic.
  • Biochemistry – Lippincott Illustrated Reviews: Biochemistry Lippincott Illustrated Reviews: Biochemistry – I also read this book during the fall semester and found it extremely useful. Some people think it is too long. However, for what it’s worth, I graduated with my undergraduate degree in biochemistry and I felt this book 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 time.
  • Cell Biology – High-Yield™ Cell and Molecular Biology – I minored in cell and molecular biology so I was really familiar with this book. It was a good refresher and a quick read so not too much of a commitment.
  • Genetics – High-Yield Genetics – This was also a very quick read and had good depth to the topics that were covered in questions. Not a big time-commitment so it was worth the little amount of effort.
  • Physiology – Physiology Board Review Series – This book is the gold standard when it comes to physiology. You really can’t go wrong with this book. Just stick to this book to make sure you are covered for all the physiology basics.
  • Microbiology and Immunology – Review of Medical Microbiology and Immunology – I actually read Medical Microbiology Made Ridiculously Simple (MMRS) but I felt Review of Medical Microbiology and Immunology by Levinson 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 used Picmonic, which has a similar learning style but with much better organization. The parasite review was so much better in Levinson than MMRS. The immunology section in the Levinson book was also short and to the point (but I have a pretty strong background in immunology so its brevity might be viewed as a weakness by others).
  • Neuroanatomy – High-Yield™ Neuroanatomy – This is another great book! It has everything you need to know for STEP and more. I highly recommend it. Plus, like the others in the High-Yield™ series, it is short and does not take long to read.
  • Behavioral Science – Behavioral Science Board Review Series – I know that the last edition of First Aid for the USMLE STEP 1 recommended High-Yield Behavioral Science but it’s just not enough. When I’ve read the High-Yield, I end up constantly going back to 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 Behavioral Science so I regretted not reading this book. I’ve also watched the Kaplan videos on Behavioral Science and highly recommend them. The guy that does them is absolutely amazing and simplifies the subject enough to 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 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 – Rapid Review Pathology – Your test will always be heavy on pathology so it makes sense 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 Rapid Review. 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 the author, Edward Goljan, has everything 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.

That’s it! Those were the books I read during the fall semester to prepare for a spring full of questions and First Aid for the USMLE STEP 1. Each school has slightly different curriculum they will focus on, so each of us will have a slightly different experience. For me, these books covered material that everyone should know after the first two years of medical school. I supplemented with videos behavioral science, pharmacology, and pathology topics because I understood that these topics are usually the most tested. Microbiology is also heavily tested but, honestly, that is mostly just memorization in the end and we had great microbiology lectures at my school, but you may want to supplement your microbiology studies too.

Picmonic was also a great resource throughout this review period. They organize everything by topic (Playlists) so it is easy to focus on the Picmonics that relate to each book as you are reading it. If I had already learned the Picmonic I would review it again but occasionally I would be learning a Picmonic in the topic Playlist that I had not seen before. By reviewing Picmonics by topic area, I made sure that I filled in any gaps that might have existed in my school’s curriculum.


Tip 3

#3 Practice, Practice, Practice

The last principle I want to share with you is that it takes practice. It takes doing something 10,000 times to become proficient. In my case it was 10,000 Qbank questions. They weren’t necessarily all unique questions. Sometimes I reviewed the same question multiple times.

The way I approached each Qbank question was to go through the thinking process of eliminating all the answers for a certain reason. For instance, the first time I saw a question I only knew what the correct answer was but all the other choices didn’t make sense. The second time I saw the question I tried to eliminate all the others based on the information in the stem in order to lead me to the correct answer. This made the question just as valuable the second time around and helped me learn the material more thoroughly.

For more on how I used the Qbanks to study for USMLE STEP 1, check out my second article.

James is a Chief Resident, at Baylor Scott and White in Temple, TX specializing in Diagnostic Radiology. After graduating from medical school at Texas Tech University Health Sciences Center in Lubbock, TX in 2016 he completed his intern year in Internal Medicine also at Baylor Scott and White in Temple, TX. He wants all current med students to know that medical school is a special time where you will grow tremendously as a person and meet many of your future friends and colleagues. James also enjoys playing golf and reading in his spare time.
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