What to Study for the USMLE – Part I

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This is a really big topic and would probably take at least a dozen posts maybe even two to finish. However, we have to begin somewhere. This is actually the most common question asked in forums. When people ask whether First Aid is enough, should I do Q Banks, do I need Goljan, etc. the question they are really asking is, what should I study for the USMLE. When they scour through exam experiences in forums, spend money on bootlegged CDs or DVDs or decide whether to use the extremely expensive UCV (you know its my pet peeve :mrgreen: ), etc. what they really are concerned about what to study for the USMLE.

The USMLE published guidelines on exam content just adds to the confusion as the list is so comprehensive that you’re better off opening your medical textbooks and starting from there. 🙁 Then, there’s the occasional low yield question not found in textbooks like the PARKIN gene or HPV vaccination that can only be found either in journals or by searching the Internet. 🙄

So in come the reviewers. At first, I shied away from writing about what to study for the USMLE due to the abundance of reviewers. However, I’ve come to realize that the sheer abundance of review material is itself becoming a problem as the poor examinee struggle to decide what review material to use. As it is impossible to go through all available review material (that would be worse than going through textbooks for everything), deciding what to use is becoming a major issue. Even if the examinee knows what he is looking for in a good reviewer (you’d be surprise that a lot do not), he needs to be able to read them first before knowing if its any good, which of course brings us back to the problem of having to go through everything.

Then come reviews of different review materials as pioneered by First Aid and the forums, where examinees ask other examinees what reviewers they should use. Of course, that is still a problem, since all First Aid does is give a rating on reviewers without saying how the rating is done. So it works for some but not for others. Meanwhile, most advise in the forums come from people who have only used one reviewer and in reality is not in the best position to give comparative reviews. Plus different people have different objectives and different criteria on what constitute a good reviewer and so compounds the problem and adds to the confusion.

I’ll try to come up with some guidelines on how to pick the reviewer that is right for you. Plus, I’ll be covering some review materials, of course separately for Step 1, Step 2 CK, CS and Step 3 and their pros and cons. This is a very large topic and I don’t claim to be the expert or have the last word on the subject, but I hope I can help you get off to a good start.

Deciding what to study should be part of your study plan. And as I said in my ebook about “How to Prepare a Study Plan for the the USMLE” (download here) the first thing you need to decide is your objective. Your objective determines what you need to study for the USMLE. What you need to study if you want to just pass the USMLE is different from what you need to study if you are aiming for a 99. So asking around in forums is a bit futile, as depending on the objective of the advice giver, their advice may or may not be suitable for you. When I posted my study advice in prep4usmle (“What to do?”) some people felt that some of what I recommended was overkill, and they were right if you where just planning to pass the exam, but not if you were aiming high. So advice are only just as good as the objective on which the advice is based.

In order to follow the discussion, you need to know what you need to study to score high and what you need if you just want to pass. Please read my posts on “High Yield Content and the USMLE“, “Mastery, Know and Familiar in USMLE Content” and “Mastery, Know and Familiar applied to USMLE review” before continuing if you haven’t read them yet.

The most complete source of concepts are textbooks, which contain most of the concepts tested in the USMLE both high yield and low yield and in the right amount of details needed to master them. If you just want to pass the exams, then study the high yield stuff. However, the question arises, what are considered high yield concepts? The next question, is what concepts do I need to Master, know or be familiar with. Although some really good students are able to judge accurately which concepts to concentrate, unfortunately many do not.

I remember in medical school, during lectures, there was a mad scramble to take notes, with tape recorders overflowing the lectern. Eventually it was agreed that one tape recorder will be placed on the lectern, the notes transcribed and we will just pay to have it photocopied. In fact, the notes were very complete and done professionally. However, before long a lot of us opted to photocopy instead the more incomplete notes written up by a classmate, who eventually became our class valedictorian. Her notes, were incomplete, but you can bet that what she wrote down has a high chance of appearing in the exams and what she did not usually did not. And she always got it in the right amount of detail. So we actually preferred her incomplete notes to the more complete ones. We substituted her judgment for ours, because she is just that much better at it.

So all those review materials we are using are actually a form of substituted judgment, even the Q Banks. We use reviewers to find out what other experts consider high yield and study them, using their judgments instead of ours. Of course, the question is, how reliable is their judgment and second what is the basis for their judgment. For example, First Aid is quite reliable, except their objective is to help you pass the exam, not to ace it, therefore if your goal is to score above average or ace the exam, you just chose the wrong reviewer. First Aid contains most of the concepts tested in the USMLE, both high and low yield, however, it does not contain enough detail for you to master those concepts and you need to do that if you want to score high.

So it is important for you to first decide what is your objective in the exam, and find reviewers that will help you achieve that objective. For example boards and wards, secrets, high yield series, etc. cover only high yield stuff, mostly in minimal details, good enough to pass but not good enough to score high or ace the exam. You read in forums, people recommending materials as good if they’re short and not too detailed and bad if they are long and quite detailed. Such recommendations reflect their own objectives for the exam and you should carefully examine whether such recommendation should apply to you at all depending on your objective. If you just want to pass the exam, recommendations by most real 99ers (I don’t doubt that there are a lot of fake ones) will usually be a bit of overkill.

We will discuss the ideal criteria for choosing reviewers depending on your objectives next time. The criteria are different if you just want to pass, you want to score above average or you want to ace the examination.

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