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Step 1 Overview: What to Do Now Reena Karani, MD, MHPE Shashi Anand Nelson Pe Nancy Yang Karen Hu

Objectives

• Provide an overview of Step 1

• Relay registration information and deadlines

• Overview of Step 1 timeline

• Review Step 1 resources, including the Department of

Medical Education’s Step 1 Board Review Course

• Review the student survey information collected from upper

classmen

What is Step 1? 1

Step 1 Lingo: • USMLE (United States Medical Licensing Examination) –“a multi-part professional

exam” that MDs are required to pass in order to practice medicine in the US

• NBME (National Board of Medical Examiners) –“ develops and manages the USMLE”

• Prometrics – Testing site

Gestalt of Step I

• Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy

• Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning

General Information • Step 1 is first in sequence of Step 2 CK and CS and Step 3

• Step 1 is a one-day examination.

• You must complete testing within 8 hours.

– The testing day includes 308 multiple-choice items divided into 7 blocks of 44 items;

– 60 minutes are allotted for completion of each block of test items

– There is also a minimum of 45 minutes of break time and a 15-minute optional tutorial.

– Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

HANDOUT: Step 1 Exam Content

Icahn School of Medicine

Class of

2011

Class of

2012

Class of

2013

Class of

2014

Class of

2015

Class of

2016

Class of

2017

Icahn 229 231 235 235 232 239 235

National 221 222 224 227 228 229 229

210

215

220

225

230

235

240

245

Aver

age

Step

1 S

core

s Year Over Year

ISMMS Step 1 Scores Average Vs. National Step 1 Average

Registration for Step 1 2

Step 1 Fees for 2016

$600 for exam

Cost of study materials varies

For more information about Year 2 Cost of Attendance review the Cost of Attendance Budget Worksheet http://icahn.mssm.edu/files/ISMMS/Assets/Education/Grad%20School/MD%20COA%20Budget%202015-2016_v2.pdf

For questions about how to manage your budget through out the year, please reach out to Enrollment Services

Timeline

• Plan on registering soon so that you can get the date

you want

• Choose the 3 month eligibility period: April, May,

June [ April 1, 2016 – June 30, 2016] • You must take the exam before Infocus 5 (June 27-

July 1, 2015) which is the official start of Third Year.

Latest date is: June 26th, 2015

• Try to plan for a week’s vacation before Clinical Skills

Week

Registration Process – 3 Stages

1 – Set up USMLE Account • Set up USMLE

Account at NBME site

• Follow instructions for first time user

• Submit and you will receive an USMLE ID and password

2 – Part A • Log into the

NBME website

• Complete Step 1 app online and print out form

• You have the opportunity to pay online here

• You must select a three month window

2 – Part B • Bring part b of

application to front desk of 1330 with a photo

• Registrar mails in apps every day

3 – Schedule Exam • Once your app

is registered and approved, you will be notified by email that you can access yoru permit on the NBME site

• Sign up at prometrics site for the date you want

HANDOUT: Signing up for Step 1

The top part is pre-

populated

This section is for the

registrar to fill in

Check the box

authorizing the NMBE

to process your

transaction

Make sure to sign it!

Registration for Step 1 PHOTO DON’TS

Registration for Step 1 Scheduling Exam with Permit

• You will get an email to let you know your scheduling permit (takes up to 4 weeks)

• Once you have permit you can go to prometrics site to sign up for exam.

• Prometric schedules testing appointments for Steps 1 up to six months in advance

• Complete and turn in certification/authorization form by December 5th – That way you will receive permit in January to sign up for a June date

Test Dates / Locations

• Available on a first-come, first-serve basis

– Early birds tend to get first choice

• Prometric will attempt to find a test seat within TWO weeks (+/-) of preferred date and within 50 miles of

the preferred location

– Preferred Date – e.g., June 5, 2016

• Exam window

– May 22- JUNE 5 - June 19

– Preferred Location – e.g., Manhattan 1 Penn Plaza #1728

• Brooklyn, Queens, Long Island (Garden City, Westbury, Melville)

• You can change your test date but a fee may be charged depending upon how much notice you provide

when making the change. A fee schedule is posted on the USMLE website. If you reschedule, your

rescheduled test date(s) must fall within your assigned eligibility period.

Prometric Test Centers in NYC • 5844: PROMETRIC TEST CENTER

675 THIRD AVENUE SECOND FLOOR NEW YORK, NY 10017

• 5879: PROMETRIC TEST CENTER 1 PENN PLAZA SUITE 1540 NEW YORK, NY 10119

• 0040: PROMETRIC TEST CENTER 1 PENN PLAZA 17TH FL, SUITE 1728 NEW YORK, NY 10119

• 0019: PROMETRIC TEST CENTER 95-25 QUEENS BLVD. 11TH FLOOR QUEENS, NY 11374

• 5203: PROMETRIC TEST CENTER 111 LIVINGSTON ST. 11TH FLOOR BROOKLYN, NY 11201

• Prometic Website: https://securereg3.prometric.com/siteselection.aspx

Accommodations Needed

• Start the process now!

• This information is available from NBME Test

Accommodations section of this website.

• You must submit your application for the Step and

your request for test accommodations with required

documentation at the same time.

• Should you need accommodations, reach out the

interim Disability Officer – Joy Colelli –

joy.colelli@mssm.edu

Step 1 Preparation and Support October 26, 2015 at 3pm - Step 1 Session (during InFocus 3) • How to sign up for Step 1, Study skills and strategies to use now Thursday November 17th 1pm Optional Workshop: Study Strategies with Dr. Sicular

December 4, 2015 • First part of Step 1 Application due to Front Desk at Anbg 13-30

January 13, 2016 at 2:30 pm in 13-01 - Deeper Dive into Step 1 Preparation (Class Meeting) • Study Tips and Resources, Understanding your learning style, Making a study plan, Student Panel, Wellness

January 15, 2016 - Register for Step 1 date online

Monday January 25th 1 pm: Optional Workshop - Tackling the Step 1 Question with Dr. Sicular

Throughout the Spring Semester - Study Plan and Strategy Workshops

May 9 - 27, 2016 - OPTIONAL Step 1 Review Course - Dates to be confirmed June 26, 2016 - Must take Step 1 by this date June 27 - July 1, 2016 - InFocus 5

What now? 1. Register 2. Learn about resources 3. Know your learning style

3

Register and Review!

• Register now

• Review Step 1 Content:

http://www.usmle.org/pdfs/step-

1/2015content_step1.pdf

Attend Optional Strategy Sessions Thursday November 17th 1pm

Study Strategies

Tuesday, Monday January 25th 1 pm:

Tackling the Step 1 Question

Overview of Dr. Sicular’s Course � Course course is designed around questions:

• Dr. Sicular reverse engineered the course after personally doing over 10,000

questions and making sure the course has the high yield info

� Relates subjects to each other: explode the question!

• Example: What does the tongue look like with Scarlet Fever? → Strawberry Tongue → What else has this appearance? → Kawasaki → How do you treat Kawasaki? → Aspirin → Why should kids not get aspirin? → Reye’s Syndrome → What lab is elevated in Reye’s → Ammonia → What biochemical genetic diseases have elevated ammonia levels? → Urea Cycle disorders → ………

� Covers subjects extensively but outline what is high versus low yield info � Review mechanisms wherever possible, but use mnemonics and memorization

techniques when mechanisms don’t help.

� Length of course: 3 weeks, 5 days a week, 3-4 hours per class in the mornings

May 9 - 27, 2016 - Optional Step 1 Board Review Course with Dr. Sicular

Organization of Course • Designed as 27 Lessons • First few lessons cover Basic Science (i.e. Cell synthesis,

Biochemistry, etc)

• Rest of course designed as Organ-based (Cardiology,

Neurology, Liver, Pancreas, etc) rather than Section-based (i.e.

Pharmacology, Microbiology, Pathology, etc)

• Pauses are taken throughout lesson for interactive questions

• Prior to course will send out syllabus, Powerpoints and extensive notes

Resources: Books, Guides, Study Locations, Courses

• Books: First Aid, Goljan Rapid Review of Pathophysiology , BRS and HY series

• NBME Exams – half-length, timed practice exams available on-line on the NBME

website that cost $50 each

(available at http://www.nbme.org/Students/sas/overview.html)

• Qbanks, BRS and Lippincott flashcards, Goljan audio files

• Courses: Doctors in Training, Kaplan course

• Study Locations: Annenberg (library, 12th and 13th floors), NY Academy of Medicine,

NY Public Library, Home!

Blackboard

Determine your Learning Style • When choosing location of test center: take the test proximal to where you are

studying

• This is a different style of studying

• Think about how you learn best

• Plan a schedule for your studying and do your best to stick to it

• Talk to upper classmen and start collecting your resources early and try to use

them during 2nd year so you’re familiar with them

Step 1 Prep Survey Results 4

Survey Info

• Google form sent to every Class of 2017 student

• 75 respondents

• Some questions optional, multiple responses allowed, etc.

When to start? “When did you start using Step 1 studying materials for…”

(n=75)

“When did you start using…”

Pre-dedicated study time

• How much time did you spend on Step 1 studying unrelated to

class? – 1-2 hrs/day (68%)

– >3 hrs/day (21%)

– Did not start studying until dedicated (11%)

• How did you study? – Exclusively by myself (81%)

– Sometimes by myself, sometimes in study group (12%)

(n=75)

Dedicated study time

• Where did you live? – Aron Hall / usual apartment (57%)

– Parent or relative’s house (37%)

• Where did you study? – Home / apartment (52%)

– Library (28%)

– Small group rooms (10%)

(n=75)

In hindsight...

Changing your test date

• Was dedicated study time long enough? – Yes - 56%

– No - 44%

(n=75)

How people felt about changing their test date

Takeaways:

• Case by case basis - mixed feelings about impact on scores, but most do not

regret changing test dates

• Reach out to your faculty advisor to discuss your situation if you are worried

about it

• As always, consider talking to mentors, upperclassmen, etc.

Dedicated study time: the day to day

• # hrs studied per day • # hrs for breaks (TV, work out,

family, friends, etc)

(n=75)

Resources

We asked students about a

variety of resources

(Courses, Books, Qbanks,

practice tests)

How helpful was it?

Essential

Very Helpful

Somewhat Helpful

Unhelpful

Making a schedule

Most loved resources for learning: First Aid, Sketchy Micro, and Pathoma

The survey also inquired about Firecracker, Anki, Picmonic, Kaplan Pharm, Goljin Rapid Review and audio tracks,

Step Up, Kaplan MedEssentials, Class Notes, subject books, and Serge to Success, but each were not used by a

majority of respondents - consider asking mentors about them specifically

If you could only use 4 resources:

Started but stopped using

Prep courses

Most did not use prep courses, but many of those who did attend

the Sinai Step 1 Board Review course found it to be helpful

QBanks

Comments:

• “Don't focus on the percentages,” “don’t get disheartened,” and “try not to

interpret your scores”

• “Start early.”

• “Give yourself time to redo missed questions”

Qbank performance over time (using UWorld as an exemplar)

• To reiterate:

• “Don't focus on the percentages,” “don’t get disheartened,” and “try not to interpret your scores”

(n = 71 and 73, respectively

QBank modes

Practice tests

Most helpful: NBME, UWorld, and Prometric

(n=67, 48, and 48,

Somewhat helpful: Kaplan and Rx (but not commonly used)

(n=8 for each)

Practice tests - Comments General:

• “Helped me identify weak points”

• “Good for score prediction”

• “Built stamina”

• “Helped with timing during the exam”

• “Some [NBME] questions reappeared on the real exam”

Suggestions:

• “Helpful to do one per week leading up to the exam”

• “Do two back to back to build endurance and simulate the real exam

length”

Caveats:

• “NBMEs are not for studying[/learning] since explanations not available”

• Can be time consuming, so balance with studying/learning time

• As always, maintain perspective!

Flashcards Anki vs. Firecracker

Anki ● Free

● Customizable

● Can change study intervals

● Can download decks online

● Useful to make cards for Qbank

?s

● Can use app off wifi/data

Firecracker:

● Focused on minutia

● Save time by not making your

own cards

● 27 students purchased, but

stopped using

(n=75)

Sinai classes

(n=75)

The cost of Step 1 studying

How much did you spend on Step 1 related expenses? (excluding the cost of the exam)

(n=75)

The Day Before

Studying

Not Studying Things People Did Other than Study:

• “Watched True Detective”

• “Went for a hike by myself. Got bit by a tick. Fortunately, no Lyme as of

now.”

• “GOT A MASSAGE” x2

• “Long walk and lots of music”

• “Yoga”

• “Went to Luke’s Lobster”

• “Panicked?”

• “Cuddled”

Themes:

Exercise, time with friends and family, relaxing time alone, good food, lots of

sleep

The Test

Caffeine

(multiple responses allowed; percentages are of total responses

Food

(multiple responses allowed; percentages are of total responses

Overall Timing

Breaks

Walking out of the exam...

Takeaway: feeling bad afterwards is common and doesn’t necessarily mean that

you did poorly. Try to stay positive and move on.

Before and After

Step 1 Scores

Score Distribution • 74/75 respondents answered this question

“I am happy with my Step 1 score”

Thoughts about the future

Health & Well-Being

Step 1 studying is going to be tough... but you’ll be okay!

Did you ever feel like things were not going as planned?

• “always behind,” “running out of time”

• “would never learn everything”

• “bad practice tests”

• “was not improving”

• “forgetting everything”

• “like the whole time”

How did you deal when things weren’t going as planned?

• “powered through,” “regroup and move on,”

“studied the anxiety away”

• “hung out with non-med school ppl,” “ignored

classmates”

• “ate cookies”

• “realized there were certain things I just wouldn’t

get to do”

• “spoke to older classmates”

• “step 1 is not the end of the world”

(n=75)

Work/life balance

(n=75)

Comments/Advice: • “Chill.”

• “You have to keep living your life”

• “Get enough sleep, eat well, take breaks, exercise”

• “Be around normal people”

• “Don't compare strategies with people in your class. Everyone is different,”

so “do what feels right for you”

• “You WILL break down at some point. That’s fine. It happens to everyone.

Just take a break and re-group.”

• “Have one activity that you do and one person you talk to a day”

• “Sometimes you need a cuddle”

• “Find a dog and pet it”

• “Go outside once in a while”

• “It's going to suck, but you'll make it!”

• “Good luck :)”