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Commonly Asked Questions about Step 1

How important is the score on Step 1?

For better or for worse, residency programs do look at your USMLE scores as part of their evaluation of resident candidates. It is however just one aspect of your application, which will also include your clinical evaluations, letters of recommendation, basic science grades, and Dean’s Letter. The more competitive the specialty (i.e., Neurosurgery, ENT, Radiology, Dermatology), the more likely the scores will be used to screen students for interviews. If you are leaning towards a particular field(s), ask residents or attendings about the relative importance of Step 1. Overall, just keep in mind that while your score does matter, it is only one of many criteria that will help determine your success in matching at the residency of your choice, so keep things in perspective.

When should I start studying?

The truth is that you started studying for Step I the first day of medical College, since this exam is basically a cumulative exam of the first two years. According to a survey of students from the class of 2012, many suggested slowly incorporating Step 1 studying into your FCM studying, mainly by using First Aid (more on that later). In terms of focused studying for the boards, however, most students find that 4-5 weeks with 10-12 hours of dedicated studying/day is sufficient.

Review Courses

Keep in mind that there are also many review courses (Kaplan, Princeton Review, etc.) that can help you organize your studying if you are willing to spend the time and money. If you feel you may benefit from a review course, the best thing to do is to ask someone who has taken these courses to see what they are really about. Kaplan offers a range of products that can help one prepare for the boards. These include Q-Bank (over 2300 test questions that simulate the boards format - a web based product), Intense Prep (live lecture review done in three weeks which also includes over 1000 exam like questions), MedPass (video set lecture series that also includes over 1000 board questions), and other web based products (WebPrep, QReview)

The strengths of the Kaplan courses are the simulated tests, which have very similar questions to the boards and have a format that is similar to the boards. Many students find the Q-Bank questions to be particularly useful, as they provide the opportunity to simulate the setting that will be encountered on test day with a computer-based exam. Kaplan also offers a series of review books are part of the above packages. Ask other students who used them if they found them to be effective. The site offers more specific details about any of their products.

What topics are more/less emphasized on the boards?

This question is very important, as it will determine how much time you should spend reviewing each subject. Among first year classes, the most heavily emphasized subject is Physiology. There are also a fair number of questions in Neuroanatomy/Neurophysiology, Biochemistry and Behavioral Sciences, so spend a decent amount of time on these subjects as well (see scheduling section below for more detail). Anatomy, Histology, and Embryology are considerably less emphasized in Step 1, so spend less time studying them but please, please, please do yourself a favor and do not ignore any subject altogether.

As for second year courses, spend the most time with Pathology, Microbiology, and Pharmacology. Pathology is probably the most important single subject, since it ties in all of the other topics; don't be daunted, though, because the preparation you have received in going through FCM and Pathology in the second year has provided you with a strong foundation when it comes time for Step 1 prep. By devoting the appropriate time and energy and utilizing the right resources, conquering all of these subjects will be well within your reach. Also, don't forget the basics of Biostatistics, as sensitivity and specificity and positive and negative predictive values are favorites for the USMLE and are easy points!

How important are sample questions and practice exams?

Students widely agree that doing questions is the single most important aspect of your Step 1 preparation. Generally speaking, doing practice questions and exams has been helpful to many students for several reasons: it directs your emphasis towards certain topics, identifies your strengths and weaknesses, and gets you in the right frame-of-mind for taking this exam. Additionally, it gets you accustomed to taking a computerized exam, with most Qbanks having identical formats to the Step 1 exam. Most students aim to do 50-100 questions each night.

USMLEWorld and Kaplan Q-Bank are two favorite question banks for students here at Jefferson and all over the country. Both question banks provide a good simulation of a computer based test (CBT) and for having a comprehensive database of questions. Kaplan Q-bank was the preferred source up to two years ago, then USMLEWorld started to gain favor. Many students prefer USMLEWorld because the answer explanations often incorporate diagrams, charts, helpful mnemonics, etc. to drive home key points. The questions from both sources are often more difficult than the actual USMLE Step 1 questions, so do not be discouraged if you are not scoring as highly as you wish to on your practice tests. With the proper preparation, you'll find your question bank scores and confidence peaking as you near test day. There are also review books out there with practice exams, but none of them are exactly on par with the actual Step 1. Appleton-Lange tends to be more nitpicky, First Aid4cd Question Book is a good supplement to your question bank, and NMS and Board Simulator Series are both a little more challenging than the boards. A disc containing a sample test is sent with your confirmation packet, and though reportedly slightly less challenging than the actual Step 1, it is also very useful in preparing you for the computer format.

Regardless of how you approach it, practice questions of the proper caliber will be a big help in your review, especially in regard to timing and mental endurance. Also, if you count yourself among the computer-phobic, it may be wise to get some other computer testing resources just to get used to reading off a screen rather than a book. Other possible question sources include: Full Length Practice test for the USMLE by Stanley Zasler, Underground Step 1 questions, and full-length practice tests by NBME.

How has computer testing changed the exam?

Many people have wondered about how administering the test on computers has changed the boards experience. Though there was much concern among students about the transition from paper to computer, there have been few complaints about the computer format. In fact, many find it much easier to point and click than to fiddle with finding the answer booklet and filling in the bubble.

For those of you who like to circle every word in the question or cross off every wrong answer choice, you will be given a dry erase board, though you may be surprised at how readily you adjust to life without a pencil. There are also relatively easy mechanisms to review unanswered questions or to mark a question that you want to return to, and you should familiarize yourself with these beforehand by using the CD practice test and tutorial, which can be accessed online and also received in the mail.

If you have had little experience with computers, it would probably be a good idea to use computer based testing resources in your studying to familiarize yourself with the basics of answering questions on the computer. Also, as mentioned already, there is an online practice test that you can access once you register for the exam that mirrors the format of the actual exam and will help you be more comfortable as you approach the test. For the motivated or concerned, it is also possible to schedule a practice exam at the Prometric center to familiarize yourself with the test site. It costs about $42 to schedule this exam, but many students find it very helpful to take the practice test a week before your actual exam.

What is the testing day like?

There is no denying the fact that the testing day is long. Just be sure to remind yourself that it used to be two days!!

There are seven one-hour blocks of 48 questions, and you are allotted eight hours to complete the test.

In addition to the exam blocks, your test experience begins with a 15 minute computer tutorial. However, this is identical to the one online, so it is best to skip it on test day and take the 15 minutes as break time. If you do this, you begin with 1 hour of break time, which you are able to take between sections at any point during the day.

Some people complete a couple of sections at a time and then take a prolonged break, while others choose to take a 5 minute break at the end of each section. You can always access a screen on the computer which tells you your total time remaining (for your current section and for the test day) as well as how many sections you have left. So, time management is not a major issue as long as you pay attention.