How to Prepare for the USMLE: What are they teaching me?

So this USMLE test is supposed to cover everything vital that I should have learned in the first two years of medical school, and aren’t you curious what the hell that is? Some of the facts are suprising, and you just have to wonder why I’m learning this. E.g….


I’m about to turn 25. Whereas before my top five most likely causes of death were by injury, murder, suicide, cancer and heart disease I can soon focus on cancer, heart disease, injuries, suicide and stroke. This is all according to my First Aid book. So what are you telling me, First Aid Book? In my teens and early twenties I was stupid enough to walk into traffic and annoying enough to inspire murder, but now magically at 25 no one thinks I’m worth stabbing because I spend all my time at Applebees working on my pack-a-day habit and emergent diabetes? Where’s the champagne because I feel like celebrating.Hooray, 25!


“Unlike a criminal suit, in which the burden of proof is “beyond a reasonable doubt,” the burden of proof in a malpractice suit is “more likely than not.” I don’t understand why it is this way and why it’s still this way. Accusing a physician of malpractice is a serious and life-altering move for both parties. Should the bar in this arena really be set lower than the standards by which all other disputes are settled?Come on, America. Come on.


First Aid Book poses ethical questions and supplies scripted answers. This one is interesting.

Ethical situation: A terminally ill patient requests physican assistance in ending his life.
Appropriate response: Refuse involvement in any form of euthenasia (physician-assisted suicide). Physician may, however, prescribe medically appropriate analgesics that coincidentally shorten the patient’s life.


I just found out that I have been mispronouncing the APgar score as the AGpar score for close to two years. It’s always embarassing to make mistakes like this. One of the biggest gaffes that people make is to pronounce the condition of incredibly swollen testicles. You’ve all seen pictures of it on National Geographic. It’s caused by a parasite that finds its way into the lymph channels of your leg, scrotum, etc. These channels are responsible for sweeping away any fluids that ooze out of the cells and aren’t picked up by your blod circulation. AND IT IS NOT CALLED ELEPHANTITIS! The suffix -itis generally means “inflammation” of whatever stem precedes it. E.g. Pancreatitis is inflammation of your pancreas. So unless you can point out where the elephant is on the human body, I challenge you to explain how it can be inflammed. It is not ELEPHANT-itis but instead elephantiasis.


There are 58 diseases listed by the CDC where the physician is mandated to report them. The First Aid for USMLE lists only 12. What is conspicuously off the list? Chlamydia, Lyme disease, Botulism, VRSA, and The Plague.


I wish I had fathered a child late in college. That way, I’d be familiar with the developmental milestones from 3 months (social smile; holds up head) to 6-11 yr (reads; understands death). This is just like the time in Biochem and Path where I wished I had diabetes so I would understand insulin and peripheral neuropathy.


Courtesy of First Aid:

REM sleep is like sex: rise in pulse, penile/clitoral swelling, takes longer to complete each time throughout the night, decreases with age.


I’ve learned a lot about myself the last few years.

  • I am easily bored.
  • I am easily frustrated by imperfect things.

The way I used to deal with this frustration was destruction. With a college education, working as a tech in a hospital, I was so bored and frustrated towards the end with having superiors that I did not consider intelligent that I coped by doing the least amount of work possible. Today, I learned that this is an immature ego defense mechanism called Passive-Aggression.

By the time I was in Grenada, frustrated with the lack of information provided to me before arriving on the island, I engaged in a constructive behavior: I wrote the Welcome to Grenada guide and website for future students. Today, I learned that this is a mature ego defense mechanism called sublimation.

It’s nice to put a name to a thing.


I’ve learned that if you want to train your child quickly to clean the dishes and not leave them in the sink, you should reward him each and every time that he does this. Problem is, the second you stop rewarding him he will stop doing it. This is known as Extinction of a Positively Reinforced Behavior after Continuous Reinforcement. If you want him to keep the behavior without rewarding him each time, you have to make it near impossible for him to figure out when he will be rewarded next time. Will it be tomorrow? A week from now? In a few minutes? As long as you randomly reward him, you can maintain this behavior, and this is known as Positive Reinforcement maintained through an Intermittent Reinforcement Schedule of the Variable Interval Schedule type.Sounds fancy, right? Well know I have the idea that if I ever teach a class, I will tell the students that they will be tested at random throughout the course, with no specific midterm or final, and that all tests are cumulative. I’m sure I’ll be hated, but they’ll be paying attention while they grind their teeth (which I’ve learned is called bruxism).


I have learned that too little or too much anxiety is a detriment to learning, and that a medium level of anxiety is optimum for learning new facts and skills. Immediately upon reading this, I look up from my book and tell my study partner that he is going to fail the USMLE. He owes me one.


That’s all for now. Tomorrow I finish Behavioral Science and I’ll offer a review of the Kaplan Lecture Notes, First Aid, and High Yield books for this section.Return to USMLE Step 1 page.

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3 Responses to How to Prepare for the USMLE: What are they teaching me?

  1. KBudd says:

    Hahaha, thank you for writing this — I just finished my short review of the behavioral sciences section, and you definitely helped solidify some of this material for me. And maybe you should tell your friend he’s going to get a 190 next time or something, just to keep the stress on the medium….

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  3. d says:

    Hey toph! Did you get a job in the Us or are you bumming it on a beach somewhere down south? Don’t kill anyone with a needle or anything!

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