The purpose of the USMLE Step 1 is to test your knowledge of Basic Science concepts relevant to the practice of Medicine and to that extent it has been faithful. All questions you will find are related to the basic sciences like pathology, microbiology, pharmacology, etc. However, to emphasize its relation to the practice of Medicine, a lot of the questions are in the form of clinical vignettes. In Step 1, most of the Clinical Vignettes are classical presentations rather than atypical presentations. For more information about Clinical Vignettes, refer to my post here and here
Another thing you’ll notice is that whereas in Step 2 and 3, the cases are usually common diseases, Step 1 cases includes a lot of diseases that are fairly uncommon. The reason is that USMLE Step 1 emphasizes basic sciences and sometimes, important basic science concepts are illustrated by uncommon diseases. For example, Angelman and Prader-Willi Syndromes are fairly uncommon but demonstrates the principle of Imprinting. Small cell CA of the lung demonstrates the concept of para-neoplastic syndrome but is actually less common than squamous cell CA or AdenoCA. So this should guide what you should emphasize on your review.
All USMLE Steps also require you to be able to recall all this information in a minute or so. What you cannot recall, you do not know as far as the USMLE is concerned. So knowing something is not enough, you must be able to recall it too. Increasingly, questions are 2 to 3 step in order to avoid aided recall from the answer choices themselves. (For more about different types of recall, refer to this post)
All this impacts what we have to study, how we study and what steps will be involve in our review in order to be able to do well in the exam. We will continue next time and talk about how we learn and master information and how to apply this in coming up with a study plan for the USMLE.
Know the learning process.
We now have our objective and we know what the USMLE wants us to know and in what form it will test us for that knowledge. The third part is to understand how we learn and accumulate knowledge.
I’ve found the following to be a useful framework for analyzing and understanding where I am in my review and assess my strength and weaknesses. Using this framework will help us not only in preparing our study plan, but also in assessing any problems we have during our review and remedying them. We can divide our review preparations into 3 parts.
1. Knowledge Acquisition (KA) – This is where you put information into your Knowledge Bank (KB) Most new graduates are extremely fine here (Except if you’re one of those who barely made it. Crammed for every test and promptly forgot everything afterwards. Most Old graduates and some IMG graduates usually have problems here. This can impact how long your review period should be and the amount of “hitting the books” you have to do.
2. Knowledge Recall or Review (KR) – This is how well you extract information from your KB. Most new graduates have some problem only here. FA and the QBanks makes a fantastic tool for improving Recall. So people with problems here (New grads mostly) usually give fantastic ratings to FA and Qbank. Other methods to improve recall include flashcards and group discussions. If you have a KA problem, you still have to do KR after you have remedied your KR problems.
3. Test Preparedness (TP) – If you are not familiar with CBT, MCQ or clinical slant to questions, this is where your problem is. Problems with sitting for 8 hour exam is also classified here. Difficulty in answering 2 to 3 step thinking questions and running out of time during the exam also falls here. This is where QBanks are the most effective.
How long, how detailed and how demanding your study plan will depend on where you are standing right now. If you have lot’s of KA’s to do, then you have your work cut out for you. Textbooks may even be in order and not just Study Notes and Outline Notes. If it’s mostly KR, then repetition, repetition and more repetition is the way to go, especially outline notes and Qbanks. If its TP then Kaplan and UW Qbank will be most helpful.
For a more thorough explanation of the learning process, refer to my post here. For a more thorough discussion of KA, KR, TP refer to my posts here.
Know the components of a good study plan
We now discuss the different phases of a complete study plan.
The three phases are as follows
- Learning Phase: This is where you try to learn everything that you still do not know about medical concepts tested in the USMLE.
- Mastery Phase: at this point, you already know the concepts, you just need to put them into immediate recall so that you can recall them in the minute or so that USMLE requires.
- Psychological Preparation: It is important to prepare yourself both physically and mentally for the grueling 7 to 8 hour exam(16 hours for step 3). Failure to do so may mean low scores or worse failing the exam altogether.
Many people tends to skip the learning phase and go directly to the mastery phase by purchasing review books like FA or BRS then use them almost exclusively for their studies. Depending on your goals and your current situation, this could be either a minor problem or a catastrophic one. One cannot master what one does not know. You can’t review materials you do not know. You need to study them.
The longer you are out of medical school the more time you need to spend here. The lower your scores were during medical school, the more you need to concentrate in learning all the important concepts tested by the USMLE.
Even recent graduates who are very good students cannot remember everything they’ve studied and usually there are gaps in their knowledge due to a variety of reasons. (eg. Subject not covered by professor, etc.) Therefore, it still makes sense to realize that there will be concepts you do not know and the best place to prepare for them is during the learning phase. This is especially crucial because you should not schedule your exam before you finish your learning phase (a common mistake committed by many). You should only schedule the exam once you are in your mastery phase where the time frame for accomplishing most preparations is more predictable. We will deal with scheduling later.
The mastery phase is what most thinks of when they talk of reviewing and in truth for most people, this is where most of their preparations should be. The main objective of the mastery phase is to get as many information as possible into immediate recall so that one can do well in a timed exam like the USMLE. (Refer to my post on different types of recall here.) Given enough time, one can recall almost anything one has learned and that’s the reason USMLE is a timed exam. It wants to test how much material you’ve mastered rather than how much you’ve learned. Outline notes, Qbanks and Flashcards are the way to go during mastery phase.
Hi,
Thank you for sharing this and for all the valuable information here. I just bumped into your blog last night and have read a few posts. A lot of great insight here and inspiration.
I am an IMG and in this long and arduous journey. Reading others’ experiences and perhaps if we’re lucky, a good advice like this, helps a lot!
Thanks!
All the best to you!
hey,
thanks a lot, for posting all of this information… i certainly know now and i am absolutely overwhelmed by the sheer intensity of the struggle that lies ahead if indeed, i muster all my courage to attempt takin this exam !!! i’m scared shits bout even thinkin bout it ! i have a lotta questions which i wish i could ask u without sounding like a clod but i guess i’d rather reserve them for my seniors who have completed this already !! adios amigo !!
god bless u !
Hi sikha,
USMLE is hard but not impossible. What is needed is proper prep. I, too was terrified when I started contemplating on taking it. But knowledge is power. By knowing all there is to know about the exam, how you are tested, how you are graded, what is tested and the mechanics of the exam itself, it was easier to design a program that will ensure success. Prep right and you will succeed. Most people fail because of improper prep rather than any other reason.
Askdoc
what happened to the ebook? I click on the link and it doesn’t go anywhere
Hi yoojin,
Sorry, I made some fix-ups on the blog software which unfortunately have the side effect of making the download page unreachable. I’ve already fixed it. Thank you for informing me.
Askdoc
Thanks alot for such valued information ..
I am a newly grad from Saudi Arabia .. this blog turned to be my favorite USMLE guide !
as an international medical student I know few things about USMLE; the plan described above helped me alot, now i am more enthusiastic to start studying for the exam.
Hi! Thanks for this guide, it is really helpful!
I had a question regarding the study plan. I’ve taken a whole semester off from medical school to dedicate myself exclusively to study for the exam and hopefuly ace it. I made a plan which dedicates a whole month for Pharma, another for Pathology, and then the crammable subjects towards the final months. The last 3 months I plan on taking a CenterPrep self study course, which hopefuly will help reinforce what I studied during the first 2-3 months. I want to start with Pharmacology, because in my school we didn;t finish covering all the coursework and I can’t recall some things. Nevertheless, is it more practical a systems-based approach to my study or to study the different subjects separately?
Many thanks!
Hi Francisco,
Depends on whether we are talking about the learning phase or the mastery phase. In learning phase, systems-based is good. But in mastery phase you should cover them by subject. If you are only dedicating 1 month to Pathology, then you need to read all the articles in my blog and forum, because it means you haven’t.
Askdoc
Hi, doc, thanks for your reply, I was wondering if you knew of a good q bank or questions book by subject that I could use to accompany Lippincott’s illustrated review of Pharmacology. I’m finding the book very helpful, but could use questions to assess my learning of each chapter. Im trying to find one that preferably covers each of the different pharmacology subjects. Would kaplan Q book be useful!
Many thanks! and thanks for the blog, it’s really helpful to prepare my study plan!.
Hi Francisco,
You are welcome. For Pathology I recommend Robbin’s Review of Pathology question book. For micro/immuno, I recommend Levinson and Jawetz Microbiology and Immunology book by Lange. The questions in the back are good chapter by chapter quiz. For Pharmacology, Katzung and Trevors Pharmacology Review book (not the textbook) have very good chapter by chapter quiz at the end of each chapter. For the rest of the subjects, Kaplan q book would be fine.
Askdoc
Hello !
I can see that the problem with me is in the knowledge acquisition phase.
Could you please go into a little detail on how to tackle “that” situation ?
Thanks !
I forgot to go into a little detail in my previous comment.
I’ll be frank. I was not that great a student. And hence many of my basic medical concepts are weak.
But being an IMG, its important for me to not only pass the USMLE but also get a good score. So, how should I go about the KA phase that you mention.
Kaplan Notes vs. The BIG books ??
Coz what I feel is, there’s not enough time left for me to review all the heavy material in a time period of 6 months or so.
What would you advise ?
Hi Dr. Mehta,
If you are weak on concepts, no choice but to hit the big books. If you know the concepts but find it hard to learn the details, then Kaplan notes may suffice. However, Kaplan notes are not organized for efficient recall. In fact in my prep course, I am forced to write my own notes to cover this deficiency. Initially I just wrote notes for Pathology, but most of my students want me to write notes for all the rest of the other subjects rather than use Kaplan notes. Again, you need to read up on the 3 phases of preparation, learning phase, mastery phase and test preparation phase. It’s posted in somewhere in my blog. You need to do all 3 right if you want to get a good score.
Askdoc.
Thank you askdoc,i read your posts at pre4usmle site as well long ago but didnt know if you had blog as well,glad to find it
.
I read in one reply of yours to one comment here(in blog) where you talking about learning phase and mastery phase.but where actually did you discuss these two i couldn’t find in your blog.kindly direct me to your that blog post.
Regards,
Hi rm,
It’s in the posts about my prep courses. http://blogs.askdoc-usmle.com/june-class-accepting-applications-for-askdoc’s-usmle-step-1-prep-course/
It’s in the middle of the above post.
Askdoc
Hi doc.
I’m having a little trouble on how to proceed with my study plan. As I mentioned in some other post, Im a mexican student who just completed the basic sciences courses. Since my school doesn;t allot time to dedicate to boards prep (unless you wait until you get your degree, 5 1/2 to 6 years), I took the semester off to prepare myself, made my own study plan, and have been following it almost very faithfully (some colleages from school have done similar stuff like that).
I did however also buy a centerprep kaplan course for 3 months starting this month to complement my study prep (as this was the only way I could take a semester off, taking it as if it where an ‘exchange’ program with Kaplan, but I’m at a loss as to if I should start focusing more on the type of prep Kaplan offers, with its personal learning system, or just follow my original study plan, with some review books I already have. So far I’ve covered all Pharmacology and most of Pathology with my own plan (lippincott, katzung, BRS, with robbins review and goljan to complement), and I’m starting on the other subjects remaining.
I took the diagnostic test kaplan offers for the PLS, and came out with a scary total score of 57%. I know I never had the behavioral sciences courses in my mexican curriculum, nor some aspects of anatomy, so some of my weak areas came there. It was only a 3 block, 3 hour exam of 150 qs, so I’m sure it’s not a very accurate diagnosis of my present status, because in the Practice Test offered by Prometric (I know, I blew my confirmatory test to assess my readiness for usmle before I ended my review; it was only later I found out when reading your post) I got a 65%.
So, though I’m worried about having enough time to study the lecture notes on my own AFTER reading them together with the DVDs, should I stick to my original plan with other review books or focus from now on on Kaplan?
Many Thanks!
Hi Francisco,
Sorry for the late reply. Been really busy with preparing my online live lectures for my prep course. 6 live online lectures on Study Methods and Test taking strategy for my September class. Anyway, I have started writing a reply for your question, but it’s become really long and I might expand it to a full post later with full explanation. Anyway the short reply is this. When you use Kaplan, you are actually relying on Kaplan to tell you what you need to study. If you use your own study plan, you are relying on your own judgment on what you need to study. The question you have to ask yourself is how confident are you about your ability to judge what you need to know in order to do well in the exam. When you enroll in a course like Kaplan or in my course, you are using substituted judgment, or substituting Kaplan or my judgment on what to study, how much to study and how to study rather than using your own judgment. Kaplan actually just gives you what to study, not how much to study and how to study unlike in my course.
Anyway, the materials you use will determine what you will study and if that is not enough to get the score you want, then you won’t get it. For example, First Aid is very good study material, but First Aid’s goal is to help you pass, not get a high score. So if you study everything in FA, you will probably pass. but if you just read FA a couple of times, you won’t even learn enough to pass. Kaplan provides enough material for you to get 90′s, probably even 99. But you need to study everything very well and high 99 is probably out of the question. I will go into more detail about this in a full post as this will be a very long discussion. Actually this is the topic of the first of my 6 live online lecture in my prep course. The first topic discusses what to study, how to study and how much to study in order to master Step 1. The other 5 live lectures deals with studying specific subjects, planning your whole prep schedule from the start until you sit for the exam including when to do qbanks, when to do NBME and when to actually schedule the exam and lastly, test preparation strategy including speed building, analyzing test questions to catch tricks, drills to eliminate bad habits exploited by test makers, etc.
As to getting a 57% in the Kaplan diagnostic exam. Well in 2005, I also did the diagnostic exam and I got a measly 45%. But 8 months later, I got a 99 / 256. I also did the Practice test given in the USMLE CD and got somewhere in the 50′s. But was scoring in the 90′s with only 1 to 2 items wrong per block around 3 weeks before the exam. So you see, my statistics was even worse. So it’s not where you are starting from, but what you actually reach that counts. And what you do during the journey makes a lot of difference on where you wind up in the end.
Finally, no you did not blow your confirmatory test. The confirmatory test is NBME assessment test which has six forms for Step 1 and not the prometric exam. The prometric exam is very, very easy compared to the actual exam.
Askdoc
Hi Askdoc,
I am a fresh IMG who graduated last year. I started to prepare for Pathology as my first subject in my step 1 study plan. I have some gaps in knowledge so according your advise i will start by the KA phase.
I chose the following notes: Kaplan lecture Note Pathology (Study note), Goljan’s Rapid review Pathology & BRS Pathology (Outline notes).
my questions:
1. do you think those resources are enough? I am an an average student, a hard worker and committed, and i aim to ace the usmle.
2. shall i start firstly by reading Kaplan thoroughly till i finish it, then go through the outline notes afterwards?
3. when shall i use the Q’s books; side by side with study notes or by the end of each chapter? which Q books you advise me at this stage; Kaplan Qbook or Qbank? or UW?
Thank you very much for all your efforts, I really appreciate you.
Another thing,
I took a general view at the Pathology demo you provided in your prep course. I really liked your study notes as i found them more comprehensive than the Kaplan’s lecture note -at least in Patho-.
As i wrote above i just started my USMLE journey and i am still in the KA phase.
My question: is there a chance i can get the full Pathology 25 chapters online even i am not enrolled in your course? is it free or i need to pay for this, if yes how much is the price?
Thanks again
Dear Askdoc,
sorry to bother again and again.
well, after reading almost everything you wrote wither in blog, forum, and the prep course methodology, i believe you will be my best advisor to prepare for the USMLE step 1 as I liked your systemic approach which really fits my studying way.
I tried to join the November 2009 batch but after submitting my information and before payment I noticed there are only 2 options to choose: either September 09 or October 09 !
there was no November Batch and i am afraid to miss the chance to join this class, i would really like to finish by May 2010.
I tried to email you in private but actually i don’t know how to do that. I would appreciate it if you inform me how to join your course as a student in the November 2009 batch.
Many Thanks.
Dahlia
Hi Dahlia,
I had not been able to update the enrollment site due to pressing work. You are the third person to point that out to me, so I have fixed the enrollment system today. Please read as there are new information about the course beginning with November batch. For example 6 live online lecture are now included with the course. Plus there is a downloadable pdf file for the Suggested Prep Schedule for the course. Plus access to online resources will now be 9 months, although the group chat and lecture sessions will only be for 3 months. You will still have support via pm from month 4 to month 9.
There will be available starting March, an option to enroll in the course only for the notes and online quizzes without lectures or the chat sessions. It will be called guided self-prep course. This was what you were asking about in the earlier post.
Askdoc
hi dr , well im a new img from egypt and want to do usmle but really i m confused by what to take first step1 or 2???? thank u
Hi noha,
It is best to do Step 1 first before Step 2 CK. This is because 40% of Step 2 CK is actually covered in Step 1 review. Therefore if you start with Step 2 CK, after reviewing clinical medicine you have to review Systems Pathology and Pharmacology before taking Step 2 CK in order to do well there. So makes sense to start with Step 1 first.
Askdoc
can some1 can tell me how to contact Askdoc via email? Do not understand the instruction he gave in regards to his calling number+ @+ URL. I need to ask a couple of questions!
Hi Hussayn,
You can contact me by logging into my forum at http://forums.askdoc-usmle.com and pm me. My callsign is askdoc.
Askdoc
Hello Askdoc,
I have tried to contact you by clicking the link you provided, I have sent PMs and email but nothing. Would you mind telling me if I am doing the right thing? thx!
Hussayn,
Excuse me please. I do not spend my time just sitting here doing nothing and giving free advise. I have patients to see. I have a family. And I work for a living. So I suggest you pay somebody so He is at your beck and call. Thank You.
Askdoc.
Hello Askdoc,
I deeply apologise if i have offended you in anyway. It was far from my intentions to do so. I perhaps wrongly explain myself. It is just that I am new to the blogging and forum system. I was not sure if I was doing the right thing or using the right procedure. It was not my intention to offend in that way once again I apologise.
Hussayn.
I forgot to mention that my sole intentions was to ask a couple of questions before I make the decision to enroll in your course. I just wanted to enroll in the course at the right time, then plan ahead in order to enroll and complete the course successfully. I must say that you’re words were a bit Harsh and Hasty towards me…
Hello Askdoc,
I hope we can get pass our misunderstanding. Here is the message I sent you via your forum. I understand that you are very busy. I will understand if you do not wish to reply…but I do hope you will reply since I would like to enroll in your online course. As I read in one of your posts that you prefer to answer via your blog since it could be benefit others…I am very pleased with that.
I must say that I was very impressed with your blog and its stunning truth. I think your advice are good not only for the USMLE steps but also for regular exams. I read almost all the posts since I also want to score 99 on the USMLE step1.
Here is my problem, I have just finished the premed portion of my programme
and I am now going to start on my MD degree in MAY 2010. My school has a
very bad structure when it come to prepare students for the USMLE but it
follows the US curriculum. 2 students scored in the 90 and 1 scored 99 but
most took a year before taking the exam. I was wondering when should I
start preparing for the USMLE. My professors told me it is too early to
start now, I should start after my second semester of MD. Why would you
advise me?
Also Which Q bank shall I use. I read your posts about the USMLE world,
Kaplan Q banks and NMBE but nothing about Exammaster.com or other available Qbanks using a mixture of MCQs and EMQs. I understand those you’ve stated are the most popular.
It is a requirement of the medical schools in my country to pass Step 1 and
2 before graduation, otherwise no degree. Therefore, I must take the exam
even though I have no intentions to practice in the US but the UK. So after step 1 and 2 I have to take the MRCP UK examinations or
Please advise me of what shall I do and when shall I enroll in your course to get the best benefit out of it?
Oh I must say that I will register for the steps as an IMG…
Hi Hussayn,
I have answered your pm at the forum.
Askdoc
Hi askdoc.
I am an IMG. Completed my final year of medical school in march. Plan to give step 1 around mid-november (it may get extended as I am not upto speed as yet). Aiming high 99 (I dont have a option … need to score that).
I have been an above-average student through out (not to boast .. but to give my background to you) and my basic science funda (acc to me) are quite above average.
I have all the review books I know its not required. But collecting books and not reading it – is my hobby haha.
Anyways, now on a serious note, I have completed till now 75% Pathology (once in 3rd year of medical school and once right now with Goljan RR and audios) and Immunology (Kaplan LN and videos – i found both of them amazing).
My need for advices are as follows
1) Can someone gimme a rough study speed and guidance on books from now, so that i am totally prepped by november.
2) I am ready to spend money on kaplan qbank and usmleworld (I know its a must) … but what i mean is that if required, i dont mind signing up for both. My BIG question is (I have read everywhere but cant find a genuine answer to this) – which bank should be subscribed when ? Both are necessary? Should I do kaplan qbank along with my first reading now and solve it subject wise and do usmleworld in last months to judge my prep? PLEASE do advise on this.
3) Obviously aiming at high 99 means, i need to know High-yield info like crazy but also know Low-yield info very well as well. Any advice how to cope up with that? What extra effort needs to be given for that?
4) Where do q books such as Lange Q and A, Kaplan q book, First aid Q and A, Robbins Review of Pathology etc stand in the prep ?
hello sir,
i became graduate on 2010 MAY.i m going to take my step1 at the end of november 2010. may i know how many attempts offered by examination board on step1 exam? eventhough i will go with one attempt i mean to know about this.i attempt step1 know if not satisfied with score whether i have to wait for another seven years? i came to know from someone about this..is this correct information what i got?
looking forward for your reply.!
thanq
Hi satya,
If you attempt Step 1 and you fail, you can retake the exam anytime. If you attempt step 1 and you pass, you cannot retake the exam until after 7 years have passed. But if you do that, chances are you will be unlicensable in many states as most states require you to pass all 3 steps including Step 3 within a 7 year period from the first time you first took the exam or you will not be eligible to be licensed. You can still take your USMLE but you need to research which states do not have this 7 year limitation because only in those states will they accept your USMLE scores for licensing purpose. You can make as many attempts as you like although again your chances of getting a residency or being licensed is nil.
Askdoc