sage handbook for the usmle step 1 class of 2013

Handbook of

SAGE ADVICE: yoUSiMLE Step 1 Edition

Hints, tips & insider information from the class of 2013 to the class of 2014

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WELCOME Congratulations! You’ve made it to second year and are well on your way to taking the next steps to becoming a physician. Second year is a whirlwind experience. You begin to integrate the basic science knowledge from first year as you deepen your understanding of the pathophysiology of disease. And, in case you have forgotten, there is also the quintessential right of passage. It’s otherwise known as the beloved USMLE Step 1 exam. As third year students, we know how you’re feeling. Trust us, we were there less than one year ago! We were the first class required to pass the USMLE Step 1 in order to continue onto clerkships. The whole process is kind of a nebulous thing, and it can be an unsettling experience for many. For this reason, we’ve created this Handbook of Sage Advice to guide you through the process. As a class, we performed above the national average, with a class average of 226 and a 93% first time pass rate. It is our hope that by sharing our learning styles and tips with you, your class will beat that score! There are many resources to consult. As OHSU students, this one has been crafted just for you. Please feel free to hunt any of us down with your questions. We are more than happy to help! As you go through this process try to stay as positive as possible. Surround yourself with a solid support network that will cheer you on throughout the year and help you to reach your final goal. Make study goals with classmates and reward yourself. For example, organize weekly coffee dates to review a pharmacology topic while sipping extra special lattes, or planning a vacation at the culmination of this experience. Finally, the text of this handbook will be passed on to members of your class in hopes that it will be updated and passed on to the class after yours. The class of 2006 started the Handbook of Sage Advice, and it is a valuable tradition to carry on. If you would like to be in charge of this project for the Class of 2014, please contact Shelley Engle. Warm Wishes,

Valerie Carlberg, Erin Chamberlain, Erin Conner, Nick Esmonde, Amy Harlow, Lauren Moneta, Laurel Murphy

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TABLE OF CONTENTS

Quick Reference Guide – pg. 4 Getting Organized – pg. 5 Registering for the Exam – pg. 5 Resources and References – pg. 5 The Mock Board – pg. 9 Studying: When to Start and How to Study – pg. 9 Days Prior to the Exam – pg. 13 Test Day Logistics – pg. 13 After Test Day – pg. 15 What to do if You Don’t Pass – pg. 15 Things We Wish We Would Have Known – pg. 16 Appendix: OHSU Student Study Schedules – pg. 16

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QUICK REFERENCE GUIDE The Official USMLE Website

• http://www.usmle.org/ National Board of Medical Examiners (NBME)

• Register for the board via this website • Provider of self-assessments and the mock board used at OHSU

o These questions may seem “easy,” but scores correlate remarkably well (+/- 10 points) with real USMLE scores

• http://www.nbme.org/ o https://nsas.nbme.org/nsasweb/servlet/mesa_main (self-assessments) o https://apps.nbme.org/ciw2/prod/jsp/login.jsp (registration page)

Prometrix • Register for your test date and location at this website: http://www.prometric.com/USMLE/step1

Dean’s Office & Dr. O’s USMLE Page

• Shelley Engle, Executive Assistant to Dr. Molly Osborne: 504-494-5708 or 503-494-8228

• http://www.ohsu.edu/xd/education/schools/school-of-medicine/academic-programs/md-program/student-affairs/usmle-exams.cfm

OHSU Wiki Page for the USMLE

• http://www.ohsubooks.com/objectives/index.php?title=USMLE_Step_1_Links_%26_Resources OHSU Library

• List of resources: http://www.ohsu.edu/xd/education/library/upload/USMLE_PrepResources.pdf • USMLEasy QBank: http://www.usmleasy.com/

Mike Wilson

• Free online subject-based review lectures and handouts taught by a former OHSU med student • Via the ohsubooks.com: http://www.ohsubooks.com/usmle/ • Via Dr. O’s page & ozone: https://ozone.ohsu.edu/som/usmle/step_one/index.cfm

o Username & password are the same as OHSU email

Learning Strategies • Sue Orchard Pys. D., OHSU Office of Student Access (OSA), Center for Diversity and

Multicultural Affairs Mackenzie Hall 1115 • 503-494-0082, [email protected]

Student Health Services • 503 494-8665 • If you are feeling anxious or overwhelmed, you are not alone and Student Health Services has been

working with students for years to help them work through this time successfully and confidentially.

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Peer Mentoring from the Class of 2013 • Valerie Carlberg, [email protected] • Erin Chamberlain, [email protected] (she utilized the DIT program) • Erin Conner, [email protected] • Nick Esmonde, [email protected] • Amy Harlow, [email protected] • Lauren Moneta, [email protected] • Laurel Murphy, [email protected]

GETTING ORGANIZED

Good organization is key to keeping your head on straight and tackling the USMLE beast of an exam. The following topics will be covered in more depth throughout this booklet, but here is a simple checklist to get you started:

1. Set a goal - Aim HIGH and work towards your goal! Regardless of your scores to date, this is your fresh opportunity to shine! 2. Register for the exam 3. Assemble resources 4. Make a schedule 5. Study, study, study! 6. Tackle the exam 7. Party like a rock star

REGISTERING FOR THE EXAM

You can register for boards beginning around October/November. First go to the NBME web s i t e (see Quick Reference Guide) and print an application. For the application, you will need a passport sized photo and will also need to have the Dean’s Office certify your enrollment and place an official seal on your application. The exam costs $525 and must be paid at the time of application, so budget for this (We are super sorry if you are reading this too late, and we failed to tell you earlier). Mail your application form and prepare to wait patiently for several weeks before being given permission to register for an official test date. The application allows you to register for a three-month block (April-May-June, June-July-August), however you must wait to receive your scheduling permite and USMLE identification number until you can register for an official date. Once they email you your scheduling permit, you can schedule your test date via the Prometr ix web site (see Quick Reference Guide). Scheduling is on a first-come, first-served basis. It is best to get this done early so that you get your first choice for a test date.

RESOURCES AND REFERENCES

We surveyed Med12 and Med13 to see which books, QBanks and teaching courses were most useful (table below). Everyone agrees that First Aid (FA) is the golden book to study. Quality is more important than quantity! It is better to have a few key resources and know them well, than to have many resources and know them all vaguely. Supplement with topic-specific books only for areas of weakness (see list of top 6 books below). And, annotate from your topic-specific books into one source, most likely FA, so that you will have one resource to study from in the end. Also, check the OHSU library to preview these books.

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Med12 & Med13 Resources and References Survey Results: Title Description What Our Class Thought (N = 92)

First Aid

The “bible” of USMLE Step 1 preparation. GET IT! Annually updated student-to-student review book. The best $40 you will ever spend during this entire adventure.

Used: 95% Didn’t Use: 0% Recommend: 87%

First Aid Question Book

1000 Q organized by subject. Corresponds to FA. Available on reserve at the BICC.


Lippincott's Pharmacology


Micro Made Ridiculously Simple

mnemonics, humor, summary charts and illustrations make it easy to remember all those bugs!


Lange Micro and Immunology


BRS Path

Outline format. Study questions at the end of each chapter. Less favored than Goljan Path.


BRS Phys

Outline format. Study questions at the end of each chapter. Best physiology review book available.


Goljan Path (Book)

Bullet point review book with color pictures. Blue margin notes are high yield. Corresponds to Goljan audio lectures. 350Q online.


High Yield Anatomy


High Yield Embryology


High Yield Neuroanatomy


High Yield Behavioral Science


High Yield Histology


BO

OK

S Kaplan Review Course Books

More in-depth than FA for some topics. Corresponds to Kaplan Q Bank.


Que

stio

n B

anks

Kaplan Q Bank

>3000 Q. Explanations reference FA. More questions than USMLEWorld, but, arguably, also less difficult than USMLEWorld. If you liked Kaplan for the MCAT, this may work well. If you did not like Kaplan, consider another resource. There is also an app for the iPhone. You will have completed 1000 questions before you know it.


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USMLE World Q Bank

>2000 Q. Layout is EXACTLY like the real test. Questions are more challenging than other QBanks and explanations are more thorough. Do them timed and randomized for more realistic USMLE experience.


Other Q Bank

USMLEeasy is free via OHSU library. Easier QBank; however, the more questions you do, the more practice you have!


Goljan Audio A series of audio lectures by a pathologist. Integrates pathology and basic science concepts. Presents topics as they will appear on exam. 16 topic areas, ~35 hours. Cannot be purchased; ask an upperclassman for them. Follow along with book. “Goljan is gold! Listen to it, love it, learn it.” Lauren Moneta, Med13


DIT

• ~$800 for an organized online review course (video lectures). Starting in March, emails with 15q and review material will be sent 2x weekly for a total of 34 weeks. During boards study time, daily lectures (75 hours total) structure your day. Good for the student who needs someone else to structure their schedule. If you are nervous about the cost and are not worried about structuring your own time, many free resources (Mike Wilson) are equally as useful. Not good i f you rely solely on the lectures and don’t make time for questions during your study block. National Student Mean: 222. DIT Mean = 230s. 98% first-time pass rate. 25% of DIT Step 1 students score above 243.


Ele

ctro

nic

Res

ourc

es

Mike Wilson's Reviews

Free and funny online video courses! See Quick Reference Guide to locate. Best: biochemistry, pharmacology, microbiology biostats.


*A more comprehens ive l i s t , in c lud ing pr i c e s , can be round in the back o f FA. FA-Specific Tips:

• It can be helpful to use FA during CSF and BBOD of first year, but don’t stress if you haven’t picked one up until second year.

• As an MS2, follow along with your courses so that you are comfortable with every detail in FA. • Buy the newest edition of FA when it is released in Dec/Jan, as there are year-to-year variations and

the notes you made early in first/second year will likely not apply to the USMLE-style questions. • Consider having your book 3-ring punched and placed in a binder so you can add valuable self-made

study guides or high-yield sheets from other resources. This will make it easy to remove sections at a time for quick study (at the gym, while following along during class) without carrying a large book.

• Correct errors, as there are sure to be some (google “Fist Aid 2012 corrections”) • A good goal is to have read this book once or twice prior to the boards study period, so that you will

know it well and just review as needed while doing questions. • The best annotations are those that will help you distinguish between right and wrong USMLE

answers. Some students find it helpful to review FA and QBank explanations simultaneously, writing questions and brief explanations in the margins of FA. This achieves two goals: 1) reviewing corresponding content in FA relevant to the QBank questions 2) documenting the question/explanation in FA for review during future passes through FA. Other high-yield annotations include the blue-colored margin notes from Rapid Review Pathology and RR Biochemistry.

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Topic Specific Recommendations: The best way to assess your strengths/weaknesses is to take practice questions and see if your level of understanding matches the style in which USMLE questions are written. Biochemistry, Pharmacology, Pathology, Physiology, and Microbiology are all high yield areas to focus your study!

• Behavioral Science: FA and Mike Wilson cover biostats wonderfully. If you need more help with ethics questions, Kaplan’s Review Book has a few good charts with general rules regarding physician-patient relationships and ethical/legal issues.

• Biochemistry is very important for the USMLE Step 1. Vitamin-oriented questions are all over the exam! Even if you did not do well in CSF, you can master this material as a second year! In fact, it may make more sense as you tie in the clinical relevance with basic science. If you consider biochem a weakness, here is a great way to tackle the subject matter:

1. Watch Mike Wilson’s onl ine l e c tures and follow along with the worksheets 2. Redraw Mike Wilson’s Biochem Love Sheet (Valerie Carlberg has an updated one with

corrections and every vitamin coenzyme and disease process… and she will share these with anyone & everyone!)

3. Buy and review Rapid Review Biochemistry by Pel l ey (see below) AND do all of the online questions with this book

Outline format designed for the boards (vs CSF) & shorter read than Lippencotts Free corresponding online questions (~350) are a great way to test concepts Everything is tied to clinical relevance, making it easier to appreciate Key points are highlighted in the margins for quick review

• Anatomy & Embryology are covered in First Aid and in the QBanks. There isn’t a section specific to anatomy, but it is somewhat low yield to spend a lot of time reviewing outside resources.

• Microbiology & Immunology are very well covered in FA. Mike Wilson is another great resource for micro. Microcards by Sanjiv Harpavat are great for partner/self quizzing. And, if you are a visual learner, Garland Science (via you tube) has excellent, short video depictions of T and B cell maturation. http://www.youtube.com/user/garlandscience

• Pathology is not well covered in FA. Rapid Review Pathology by Gol jan and the Goljan audio f i l e s are the best way to cover this material. Start Goljan early in the year and absorb his voice while doing mundane things around the house, while driving in the car, or while working on your fitness.

• Pharmacology is great to review over and over and over throughout the year. 1. Start by mastering the pharm at the end of each chapter in FA. The Toxins & Antidotes

and Drug React ions sec t ions o f FA are some o f the highest y i e ld pages o f FA. Know them co ld!

2. Do LOTS of practice questions. 3. Use flash cards to quiz with friends. Lange Pharmacology Flash Cards were the best of

ALL the flashcards Valerie Carlberg looked through (including BRS, pharmcards, Kaplan, pharmnemonics, etc.) Each has a clinical vignette on the front, making them great for solo/partner quizzing. Concise, pertinent info on the back and much more condensed than many other cards. Lacks a few drugs, but hits all the major ones

• Cardiovascular, Endocrine… and the rest of the system-based topics are best covered in FA. BRS physio logy is the next best resource if you are weak in one of these, and it offers a concise outline format and helpful diagrams. There will be audio questions on the exam for heart murmurs and any good QBank will have examples of these.

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Self-Assessments & Score “Predictors”: Take the NBME CBSSA (Comprehensive Basic Science Self-Assessment) and NOT the CBSSA or CCMSA. https://nsas.nbme.org/nsasweb/servlet/mesa_main Take these as if you are taking the real exam: timed and completed in one sitting. Each costs ~$50 ($60 with “expanded feedback”), takes ~4 hours, and is accessible for 30 days after purchase. They are non-refundable; thus, it is best to buy each one just prior to taking the exam. You don’t want to buy four and only take one! Feedback is immediate with regard to stronger/weaker areas of performance; however, you will not be given the answers and explanations to questions (even if you pay the extra $10 for the “expanded feedback”). The computer interface is not as representative of the real USMLE exam as some of the QBanks, so don’t be surprised if you can’t find the timer or calculator on the self-assessment. It WILL be there on the real exam. Some say the self-assessments predict your real score within a 10 point (+/-) range. There are numerous websites and equations that tout score prediction, but these are at-best, widely variable.

THE MOCK BOARD This is a four-hour exam written by the NBME and administered by TSO staff on a Thursday or Friday in early March. Everyone must take this exam, but it will not count towards any formal evaluation at OHSU. Most people will recommend that you don’t study for this. However, if you have been preparing, it will be a measure of your areas of strength and weakness. It is meant to gauge your preparedness, but some may argue that it’s a good way to kick up the panic level and get everyone in study mode. With the exception of few, MOST EVERYONE will feel pressure to increase their USMLE study after receiving the results. It takes approximately one month to get the results. For Med13, the results were placed in sealed envelopes in our mailboxes. You can likely expect the same. Some will fail. Some will pass. You will hear rumors that your score will only improve 35-40 points; however, your ultimate USMLE score really depends on your efforts between the Mock Board and the final test day. It is possible to improve >50 points on your final exam if, AND ONLY IF, you put in the effort! Average Mock Scores for OHSU:

• 2013: scaled score 60 +/- 8… equivalent to 175 +/- 20 • 2012: scaled score 58 +/- 8… equivalent to 170 +/- 20

National Mean in 2013 was 70 +/- 8… equivalent to 200 +/- 20 Minimum Passing Score for USMLE Step 1 is 188

STUDYING: WHEN TO START AND HOW TO STUDY The Big Picture/ Second Year at a Glance:

Second Year Circulation 9 wks Aug 29 – Nov 4

Metabolism 6 wks Nov 7 – Dec 16

Winter Break 2 wks Dec 17 – Jan 1

Neuroscience & Behavior 8 wks Jan 2 – Feb 29

HGD 6 wks Mar 1 – Apr 20

Spring Break 1 wk Mar 24 – Apr 1

Blood 4 wks Apr 24 – May 18

USMLE Study Period 5 wks May 19 – Jun 24

Transition to Clerkship Jun 25 – 29

Clerkships Begin Jul 2

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When to Start Studying & How to Budget Your Time: As you might guess, this varies from individual to individual. Give yourself as much time as YOU think you need, try not to measure yourself against your classmates.

• Some students start reviewing in December/January; others start around Spring Break or closer to the study period. Most will say that the earlier you start, the more prepared and less stressed you will feel. Enjoy your winter break! After winter break, get organized and start slowly by reviewing FA and doing questions. Pace yourself so you don’t burn out. At the latest, get everything organized by Spring Break. Buy your books, pens, highlighters, and flash cards. Start annotating in FA or making flash cards from the Rapid Review section at the back. You can purchase a QBank with the option of waiting to activate if until later. ABOVE ALL THINGS, do not s tress your f e l low c lassmates out by bragging about how much you’ve been s tudying!

• Print a blank calendar from December – Test Date and keep track of your progress. Even if you have done something small (i.e., taken and reviewed 5 board style questions, reviewing 10 pages in FA, listening to 30 minutes of Goljan) make note of it on your calendar. It will help boost your confidence when you sum your efforts, and it keeps you goal oriented.

• You have a total of five weeks of dedicated study time after the conclusion of 2nd year. Make a goal of what you would like to accomplish during that time (i.e., review FA one, two, or three times (?), start and complete a whole QBank vs. finish a QBank, take a vacation after boards, etc.). Ask yourself how many hours you can realistically study in one day and over the course of weeks without burning out. Determine whether you need a day off each week to recoup or if you have any important functions to attend. Then, schedule your test date around these goals. The majority of Med13 completed their study time in less than five weeks, with many people leaving time for a much needed vacation before clerkships. As a rule of thumb, it is best to keep the five weeks for studying and not try to do many outside activities (family vacations, get married, have a baby) during this time. The goal is to study once and ACE the boards, so give it you all during these 5 weeks!

How to Study:

• Outline your goals (USMLE score, what you’d like to cover prior to the study period) in December/January. Set reasonable goals and give yourself flexibility/ catch up time to ensure that you meet your goals (i.e., 1 hour per day during non-exam weeks, # of questions to cover prior to the study period, first pass through FA, etc). It’s okay if you don’t study every day or don’t meet your weekly goals prior to the study period, but having goals is a great motivator.

• Select your review material(s). A general recommendation is to review First Aid simultaneously with your corresponding courses throughout second year. Annotate in FA, but make sure to purchase the new edition in December, as there are changes every year. Also, keep in mind that the annotations you add for courses may not apply to the USMLE style of questions, so save your major annotations until 2-3 months prior to your official boards study period. You can always refer back to the old FA copy and annotations as a secondary resource.

• Identify your weaknesses and tackle them prior to the study period. For example, if you are weak in biochemistry, review and annotate from Rapid Review Biochem into FA between Dec – study break. Or, pair with a partner and review system-based pharmacology weekly/bi-weekly.

• Come to class 5 minutes early to review the question of the day. Don’t forget to review the answer key thoroughly! This tradition started with Med13 and you would be surprised how much you learn from these. It is a great way to become comfortable with USMLE question style.

• DO QUESTIONS! This is the number one “learning” tool for the USMLE Step 1 and all future board exams. It seems counter-intuitive to do questions prior to studying, but it really will allow you to become familiar with 1) how questions are asked 2) what you are expected to know 3) where you perform strongly/weakly. Aim to complete AT LEAST one QBank (see Resources & References for

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suggestions). If you finish one QBank, consider repeating incorrect questions until you’ve “perfected” them all, or purchasing a second QBank. There is no such thing as too many questions, but REVIEWING AND UNDERSTANDING the answers to questions is more important than going through more questions quickly. It takes twice as long to review questions as it does to take them, so budget your time wisely!

• Take self-assessments or full-length practice exams. The first one will be the Mock Board. Then, it is useful to take at least one (NBME CBSSA, or QBank - see resource guide) about half-way through your study period. This will tell you whether or not you are on track to pass and it will help you develop your ability to take a LONG test – which is different from knowing the material. The exhaustion you feel at the end of these long days should not be dismissed. The real exam day will also be exhausting, but learning to be resilient and to not dwell on single questions for too long is also critical. There is no magic number of tests that you should take; just remember that it is equally important to be able to answer questions for seven hours as it is to know the secondary messengers in cell signaling cascades.

To Study Alone… or To Study with Classmates: Again, this varies for every individual. If you studied alone throughout first and second year AND are happy with this style AND are happy with your scores to date, you likely study best alone and should primarily stick with this method. The converse applies if you studied with a partner/group. If you are not happy with your study habits to date, try addressing them early in the year to see if another style works better for you. Regarless of whether you study with/without someone, it also is important to keep human contact and have someone who can let you vent your anxieties once a day. If you’re studying alone, consider styding in a location where you will have this opportunity.

• Advantages/Disadvantages with studying solo: Goals are individualized and you can cover topics you know well quickly while spending time on personal tough spots. Avoidance of others that may stress you out. But, you must be self-motivated.

• Advantages/Disadvantage with studying with a partner (or group): Opportunity to quiz/teach each other material. It is helpful to have someone with whom you can cross check your understanding of material and challenge one another. Having a partner also motivates you to set goals/schedules together. Even if you are a hold out solo studier you will be tired, frustrated and full of hate for step 1. Studying with a classmate or even having a family member quiz you can pump you up, help you focus, and bring you back to reality. However, by focusing on a partner’s/group’s needs, you might spend time on topics you know well or miss topics that you don’t understand. And, you might get stressed if surrounded by your peers.

Study Schedules: A study schedule is important for many reasons. This schedule should be a written plan that describes the activities of each and every day between the last day of the Blood course and the day of the exam. Reasons to consider (read: YOU SHOULD REALLY DO IT!) creating a study schedule include:

1. It minimizes the amount of extraneous thinking you need to do during your study month. By having an idea of what each day will look like, it helps to make efficient use of your time and to wake up each day with a focused goal. It also makes you feel okay that you are taking time off every now and then, because if you don’t schedule it, you will be too stressed to enjoy any breaks you take.

2. It gives you a sense of accomplishment. The amount of material that you have to cover is tremendous – but it is do-able. Crossing off days on a schedule helps you feel like you are making progress and that you do in fact know something about galactosemia, even if you don’t remember studying it.

3. It helps you inter-relate your study materials. For example, you can use your Renal Day to study First Aid for that section and then do 50-100 questions on that topic to cement that material in your mind. Or, you can break up your days to include both easier and difficult topics.

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4. It helps you to budget time. You should always include ample time to review your QBank answers, including all of the correct and incorrect answers. You should pay special attention to your own habits and why you chose incorrect answers. It is quite illuminating and helpful when you really try to pay attention to this issue.

You can create your own schedule based on your goals and what you have to accomplish. Or, you can take other students examples and edit them (See Appendix: OHSU Student Study Schedules). If you wish to make a custom schedule, here is a reasonable approach:

o Set your goals for the study period (# questions to cover, # times to review FA/other review books, # times to listen to Goljan, daily exercise, etc).

o Calculate how many days are in the study period and divide your goals among the days. o Break up study time with question time. o Plan to study 8-10 hours per day (+/- depending on progress) o Make adequate time to review questions. It often takes twice as long to review questions

as it does to answer them. This is one of the most important points of the study period, as the explanations (particularly with USMLEWorld) help you to understand the reasoning behind each correct/incorrect option.

o Leave “catch-up” room or flexibility in your weekly schedule in the event you didn’t meet your weekly goals or to identify and address weak topics as they arise.

o Take a self-assessment (NBME CBSSA, see resource guide) half-way through your study period. If you have met your goal, continue the great work and raise the bar! If you are not meeting your goals, address your weak areas and take another self-assessment in one week. Some discourage taking a self-assessment in the days leading up to the exam, as it can cause anxiety.

o Rest during the two days prior to your exam (see Days Prior to Exam below). Get a massage or do something relaxing. Review pharm flash cards or key details (toxins/antidotes), but no major studying!

Lippincott’s General Guidelines for Creating a Study Schedule:

o www.lww.com/medstudent o 28 days, including days leading up to exam and days off. o 24 full study days after subtracting wrap up days (2-3 days) prior to the exam and scheduled

days off (1-2 dyas).

Allocation of days by subject: • Pathology 4 days • Physiology 4 days • Pharmacology 4 days • Micro/Immunology 4 days • Biochemistry 3 days • Behavioral Science 1.5 days • Gross Anatomy/Embryology/Cell

Biology/Histology 1.5 days • Neuroanatomy 2 days

Allocation of days by system: • Nervous 3.5 days • Cardiovascular 3 days • Respiratory 2.5 days • GI 2 days • Renal 2.5 days • Endocrine 2.5 days • Reproductive 2 days • Musculoskeletal 2 days • Heme/Lymph 2 days • Basic Concepts/General 2 days

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Eat, Pray, Love (?)… or Eat, Exercise, Sleep (during the study break) • Balance is important during the study period!!! If there is something you do now to keep you sane

during medical school (i.e., working out every day, drinking coffee every morning) continue to do this during the study period. Also, drink coffee on exam so you don’t go through withdrawal.

• Make it positive! Study in a place that motivates you, have a loved one/friend quiz you, reward yourself when you meet a goal, open a fortune cookie daily, decorate a study binder. Recognize how much you have learned! Read it here: YOU ARE AWESOME & YOU CAN DO THIS!!!

• Schedule time for exercise, meditation, something to relax you daily! • Good nutrition and sleep are just as important as study time. If you can, plan simple meals for the

week and prepare them on Sunday. Removing the thought process of “what to eat/cook” for every mealtime frees up that thought process for solving QBank questions!

DAYS PRIOR TO THE EXAM

One week: Have the bulk of your studying done by 1 week prior to your exam. Leave this week for going over weak areas and doing a quick refresher over First Aid. You don’t want to add stress to this week by having areas that you haven’t covered yet.

• Continue doing questions in your QBank and going over them. (25-50 questions/night) • Re-read First Aid over 4-5 days: try to break it up into even blocks but remember that some of the

sections can be pretty dense; especially biochem, micro, and neuro. Look over your notes, go over diagrams, and make sure that the especially high yield info is solid.

Two days: Be finished with your studying and review. Get a good night’s rest because chances are that you are not going to sleep the night before the exam. Take this opportunity to rest. One day: REST! You’ve been working hard and your brain will need a break. Plan to take this day off and only do some light studying.

• Sleep in, eat a good breakfast, exercise. Do whatever you need to do to help yourself relax!! • Go over the Rapid Review at the back of First Aid. Go over flash cards or any areas that you feel

weak in but don’t overdo it. Don’t study more than 4-6 hours. • Plan what you’re going to eat and when you’re going to take breaks. Go to the store and get

whatever snacks you need. Make sure you know where you’re going and how much time it will take you to get there. Make sure you have your ID and scheduling permit.

TEST DAY LOGISTICS Thinking about the logistics in great detail for the day might seem silly, but running around like a chicken with your head cut off the morning of the exam is also silly. Plan ahead and be ready for excellence! The night before your test: Find your scheduling permit, ID and lunch. Double-check your alarm clock. Make sure you have comfortable clothes for sitting all day and layers in case you get chilly—no big coats allowed in the test room.

What to bring: The essentials are your scheduling permit that you print from the internet and two forms of identification that contain a recent picture and a signature (drivers license and passport are good back-ups, but you can live dangerously with only one).

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Getting there: Go for a drive-by (or bus or bike) so you know how to find the little hidden offices that are the testing centers. There are two in Portland, so make sure you know which is yours. If you are taking the test on a weekday, keep traffic in mind.

Before the test: You sign up as you arrive and they call your name to get fingerprints and take your permit. If you are early, listen to ‘Eye of the Tiger’ on repeat to pump yourself up!

What goes in your mini-locker: You can store food, water, keys, phone, watch, coats, hats and anything else you need on breaks. You can bring study materials but those aren’t allowed near the test room. Keep in mind that this is a small locker (it won’t fit a large backpack).

What goes in the test room: You, empty pockets, earplugs that are out of the box (no joke, people were sent back to their lockers for chapstick and earplugs in a box). You really can’t bring anything into the testing room with except the clothes on your back. We’re NOT kidding! If you’re sweating bullets you’ll just have to pretend you’re somewhere tropical because you can’t take off that sweatshirt. You can’t have anything on your head! Not a hat, a hood or an oversized hairpiece – the monitors have to be able to see your head at all times.The center provides you with a headset (for any cardio murmurs), dry erase paper, marker and eraser. Also, no jewelry or watches are allowed. There will be a clock on the computer to keep track of your time (the interface is very similar to USMLEWorld). Lastly, you will write your permit number on the paper and use it to sign on to your computer after breaks.

The test!: The test administrator turns on your screen and the computer gives you the rest of your instructions. You can do the tutorial at your computer at home to add time to your official test-day break time. Do it! If you get to test day and want to click through things again, you can also use the time to collect your thoughts and take deep breaths. Then, the real blocks start and you are on your way to conquering step one! There are 7 one-hour blocks. They tend to blur together but just get into your rhythm and go with it. You are going to knock them out! Take your breaks just as a chance to walk around for a little bit—even if it is just to the bathroom and back. Speaking of breaks…

Breaks: YOU ARE IN CHARGE OF MANAGING YOUR BREAK TIME. You have a given amount of time for the whole day (45 minutes +/- tutorial time), so budget how much time you’d like for each break and lunch. The computer will tell you when your time for a block is up and then a countdown of break time remaining appears. The break-time screen has to be up before you can leave your computer. You will have to give your electronic fingerprint EACH AND EVERY TIME you leave and enter the test room. Take a walk around the building, stretch and eat during breaks. You are allowed to use your phone if you aren’t talking about test-y matters or participating in ‘unauthorized assistance’.

Lunch: Bring your lunch and keep it simple. There isn’t a microwave or anything like that available. The center might have a water cooler.

Dress rehearsal (optional): You can register for a practice test at your center for $52 and take a shorter, no-pressure version of the big kahuna. These exams are the same as the NBME self-assessment, so be sure to take one you haven’t done yet. The software is close, but not identical to the real thing (see resources for more info on the NBME Self-Assessments), and they give you are given a score upon completion. Taking a practice exam at the testing center allows you to become familiar with the test site and to ask any questions prior to the real test day. Keep in mind that others may be taking their exam, so you need to be courteous! This is an optional experience and many people don’t take this opportunity but still perform splendidly on the exam and have fifty extra dollars for post-exam fun! To schedule a practice exam, go to https://apps.nbme.org/CBTPSRegistrationWeb/jsp/usmle_CBTPS_registration.jsp

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Official statements/Rules: http://www.usmle.org/bulletin/testing/

Special Accommodations: If you need these, start planning early and talk to the Dean’s office about making arrangements. http://www.usmle.org/test-accommodations/

AFTER TEST DAY

CELEBRATE! CELEBRATE! CELEBRATE! CELEBRATE! CELEBRATE! It is absolutely normal to have mixed emotions about the exam when you finish. It is VERY NORMAL to feel as if you have failed, because you’ve just had an exhausting day at the end of two exhausting years. Fret not, my pets! Even those who have done very, very well, also expressed feelings of doubt when leaving the testing center. So, regardless of how you think you did, celebrate your efforts the evening of the test. You deserve it!

WHAT TO DO IF YOU DON’T PASS

Requirements: Students are required to take and record a passing score for USMLE Step I prior to entering the third year clerkship year. All Students must take the exam prior to starting the Transition to Clerkship course. MD/PHD and MD/MPH students are required to take and pass the USMLE Step I prior to being eligible to enter graduate studies or clinical curriculum.

Steps After Notification of Non-passing Score: Students who receive a non-passing score may complete their current clerkship rotation or take an incomplete. When the EdSA office is notified of a non-passing grade the student will be put on a Leave of Absence which will begin the first day of the next rotation. They will be given an automatic one year leave of absence to achieve a passing score on Step I and must pass the exam before they can reenter the clinical curriculum. It is recommended that the student take the exam within six to seven weeks of the start of the LOA. This allows approximately three weeks for the grade to be calculated and sent to the EdSA office. If a student does take the exam within six or seven weeks of the start of the LOA, it will allow them to finish in four years, and not take an extension. The student will have a very tight fourth year schedule, but will be able to finish with their matriculating class.

When the Director of Student Records is informed of the non-passing grade, the Director will vacate the students’ third year schedule, and notify the clerkships that the student has been pulled from the upcoming clerkships. When the Director of Student Records has been informed of the passing grade, the student will then request a time to meet with the Director to create a new third year schedule.

During this leave year, students can decide to be registered for the Basic Science Review Course for a maximum of two terms to remediate USMLE Step I or Step II CK/CS. The student must be registered for an approved board study course to be eligible to be registered for the Basic Science Review Course JCON 602A. Credits from this course do NOT count towards fulfilling graduation requirements. Students must seek approval from the Associate Dean for Student Affairs prior to registration. If they do not pass USMLE Step I within that year, they will be subject to a dismissal hearing by the Student Progress Board.

If a student wishes to reenter the curriculum before the one year leave of absence is completed, the student must make the request in writing prior to the start of the next clerkship.

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THINGS WE WISH WE WOULD HAVE KNOWN

1. Past Doesn’t Necessarily Predict Future – MCAT scores and medical school course grades DO NOT DEFINE your ability to do well on USMLE Step 1. If you did well before, you should feel confident in your ability to do well again. But, don’t get cocky and fail to prepare. Conversely, if you were less than pleased with prior performances, but are motivated to do well and seek the guidance to help you reach your goals… YOU CAN DO IT!!!!!!

2. Scores: A Number is a Number, but a Phsycian is a Human. - USMLE scores do not predict the quality of doctor you will become. Even though they are highly emphasized for matching into certain specialties, they do not determine - with absolute certainty - your ability to match (this applies to both great and less than great scores). Set a goal, but don’t let it limit your dreams!

3. Budgeting – Think about the materials you want to study for Step 1 and budget in advance. The financial aid allotted for these materials does not cover what most people purchase and certainly doesn’t cover any of the fancy prep courses.

4. Registration – By the time we were told us to register in early December, it felt like a scramble to get everything ready and some of the test dates had already filled up. Do this early, save yourself the stress.

5. QBanks - “I was really glad I used this [USMLEWorld] prior to the exam. The questions on the actual Step 1 exam are no harder than what you’ll find in here. It tracks your progress and shows your percentages in each area.” – Amy Harlow, Med13. This sentiment was echoed by numerous Med13 students and is a clear bias of the editors of this Handbook that USMLEWorld is a superior QBank.

6. Review Books – “I didn’t really end up using any review books (although I did buy them…) but if you’re going to get them, read through them prior to your actual USMLE study period. Most likely you won’t have time to sit and read review books (unless that’s your preferred method of study)” – Amy Harlow, Med13.

7. Stress Management – We all hate to discuss our vulnerability, but the truth is that this is a stressful time for most, if not everyone, preparing for the exam. Help is available – either from peers in the classes ahead of you, from the Dean’s Office, or from Student Health. “I’m glad that I dealt with stress early on [December] by recognizing my increasing level of stress and anxiety, and how this was beginning to impact my performance in all aspects of life. I’m glad I decided to consult my physician in Student Health about these issues and felt that I was better able to tackle the exam when June rolled around.” – anonymous, Med13.

APPENDIX: OHSU STUDENT STUDY SCHEDULES

Erin Chamberlain’s Schedule Using DIT:

• Sunday-Friday o 6:30 wake up o 7-7:30 run o 8:00-5:00 DIT o 5:00-6:00 run o 6:00-7:00 PIMP study group over dinner o 7:00-10:00 QBank

• Saturdays: practice tests, corrected them, and relaxed

sage handbook for the usmle step 1 class of 2013

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