Reader Submitted Corrections

The following is a list of corrections/suggestions that the readers of this site have submitted.  Thanks for contributing.

Miscellaneous

1. P.92, Collagen synthesis and structure
   1. In both Lipp Biochem (p47) and High Yield Histo (ch 5- p 45)say that both hydroxylation and glycosylation occur in the RER as does formation of the of procollagen (triple helix) from pro-alpha-collagen. In First Aid it says Glycosylation and procollagen formation occurs in the Golgi.
2. P. 109, Lipoproteins
   1. diagram of chylomicrons. Shouldn’t have Apoprotein A–A is found only on HDL particles.
   2. On second reading, perhaps CM do contain Apo A, but HDL seems to be the main location of Apo A.
3. P.139, Stains
   1. PCP appears also on page 139, and should be changed to P. jiroveci
4. P.155, Microbiology – Virology
   1. +ss RNA virus mnemonic

                                                              i.      Flava-flav is having a Retro Toga-Corona party in Pico Cali

1.       Flavivirus

2.       Retrovirus

3.       Togavirus

4.       Coronavirus

5.       Picarnovirus (no envelope)

6.       Calcivirus (no envelope)

1. P.158, Viral Vaccines
   1. MMR, with the R [Rubella] being in bold type, is indicated as being an egg based vaccine.  However, measles and mumps are the egg based vaccines, while Rubella is from lung fibroblasts
2. P.171, Protein synthesis inhibitors
   1. I changed the 50S mnemonic to: chloramphenicol, erythromycin, lincomycin/clindamycin, Linezolid. I did this because as you noted, lincomycin/clindamycin are in the same class, and they don’t mention linezolid, which is important as a 50S inhibitor used to treat MRSA.
3. P.201, Tumor nomenclature
   1. Benign: mature teratoma (women)
   2. Malignant: immature teratoma (women), mature teratoma (men)
4. P.250, Cardiovascular therapy
   1. positive inotropes raise cardiac ouput (the + sign and the down arrow are confusing)
5. P.303, Basophil
   1. in TAIL the I is not “Iron deficiency” but is “Iron Overload”
6. P.333
   1. It should mention that PAN is NOT associated with granulomas like Wegeners; also that PAN lesions favor branching points of arteries; Lastly, the last line under Churg-Strauss syndrome stating “often seen in atopic patients” should be followed by commonly has new onset or worsening of asthma preceding symptoms of vasculitis.
7. P.372, Neuromuscular blocking drugs
   1. Everything I have read says there is no pharmalogical antidote to succinylcholine (especially not an acetylcholinase inhibitor like neostigmine, which is what is written under phase II of the depolarizing NMJ blocker succinylcholine).
8. P.426, Lung relations
   1. The figure of the trachea and bronchi is confusing.  The right lung bronchus is shorter, wider and more upright when compared to the left main bronchus.  The figure has this relationship reversed.  See Gray’s Anatomy.

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How to Prepare for the USMLE: How Early Should I Start?

I have received a version of the following email half a dozen times in the last few weeks concerning when in the first two years of medical school it is best to begin preparing for the USMLE. Here is one response.

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Hello,I wanted to thank you for that information regarding studying for the BEAST!. It is well informed and I loved the reasons behind your study schedule. I am going to start my first term at SGU this coming august. With your experience the past two years is there any advice that you can give me. Does using first aid while studying for exams help to prepare for USMLE. Is it too early to even use it as a reference. Also doing well in the classes help drastically on your performance in the exam. Did you find that having done well made you recall alot of things that you found on the exam or is the details very nitty that it isn’t and needs to be refreshed within the 6 weeks. Wanted to know if it would be a wast of time to use the First aid as a supplement and note margin for my regular classes to be familiar when it comes time too kick but those 6 weeks. Again, thank you for the information.

Knight

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Hey Knight.As far as advice goes about starting early, I have only this: I couldn’t do it. It takes a certain amount of pressure and dread to study effectively for the USMLE, and that’s not just going to be absent, it’s going to be appropriately focused on your other courses. I’m sure you could annotate the FA during these classes, but you’ll soon find that the breadth and depth of your SGU classes will simply dwarf what’s in the FA. The best advice I could give is to work as hard as you can for as long as you can in your classes. While the game of getting A’s isn’t all there is to your education (and you will feel at times that you are learning stupid things to do it), I can think of no better long-term preparation for the USMLE. Those members of my class that have scored the highest were all very strong students from front to end in Grenada and not for being especially intelligent, but instead for their consistent hard work.

The extra mile here is tutoring. I tutored Anatomy, Biochemistry, Neuro and Physio. In this way, I had a full year’s exposure to each topic instead of the four month term. This was invaluable. What many people found while studying for the USMLE, I discovered in tutoring: it’s only the second time around that all the connections fall into place and the interrelationships become intuitive. I was a much stronger student for it.

In a nutshell: don’t buy a First Aid until it’s time (around 5th term, I’d say), do your absolute best in every class, regardless of how innane the material, and tutor with a friend for every class that you can. That, if done, should fetch you a fantastic score.

All the best, topher.

How to Prepare for the USMLE: What Did You Do Each Day?

This comes from an email from two students in my year but a term behind at SGU.

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Hey Toph!
I hear you are having an amazing time on your trip, it is probably coming to an end pretty soon so enjoy the last days! It’s coming close to board studying and Jess and I were wondering how you and Kelly actually studied together. Jess and I are using the same schedule and plan to get together every 3 days or so, and we were thinking about asking questions, buzz words, that kind of thing. We just wanted to see how you boys did it.Talk to you soon, hope all is well.

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We sat across from each other; nothing else. We were on the same schedule, so each day we would open up our books and start reviewing on our own. Any time I had a question about something, I would ask Kelly and vice versa. If either of us found something interesting, we’d share it. If either of us thought of an interesting question to ask the other, we would. It also helped that we were hunting for errors, and this made the work slow but deep as we covered everything in full (since I tried to verify every fact in the FA).At lunch or dinner, one of us might ask the other, “Okay, please explain ovulation to me.” This was always great exercise. At night we would eat with his family and then go our separate ways: me to the basement, him to the study. Throughout the entire process, we were writing our own review notes and inserting them into the FA for quick review in the last week and this has also always been great exercise. Every three days or so we would finish a topic and then go through all of the UW questions on our own. We would mark the interesting ones and include them in our notes. Sometimes we would ask each other how-in the hell-did you answer that one correctly? In this way, we learned the way that each other thought. Kelly goes by instinct; I go by Random Access Memory.But most of all, we did everything that we had always done. Kelly and I had been studying together for two years already and we both did well in school. There was no reason to think that it would be any different and it wasn’t. I was up till 1am or 2am each night and we were both up and at the library by 8:30am, so they were long days. But they were fun days, because you get to see every puzzle piece again only this time (after two years) you know what the fucking picture on the box is supposed to be. It’s amazing how much everything starts sliding into place.

You’ll do fine, just stay on schedule. Never break schedule. Worship the schedule. Hope it helps, toph.

P.S. Kelly never broke the schedule while I broke it all the time. I once spent an entire day on antiarrhythmial drugs, which you just shouldn’t do. I put off viruses, protazoa and fungi, cranial neoplasms, and a host of other topics due to time. Looking at my USMLE summary, these were where I lost all my points.

See you in 6 weeks!

The complete list of all the corrections/suggestions for the First Aid is now available for download as two Word documents in the First Aid section. All of the individual sections are updated as well.

I have cobbled together the best of my advice into a 6-week guide for the Boards. Expand or contract according to your whim.

I’m off to Asia, so I will be slow to respond to comments, suggestions and the like. I will read them all eventually, so please keep them coming. Thank you, everyone, for contributing. Everything here is better for it.

And with that, I am off!

Prepare for the Boards in Six Weeks

All of this information is contained in the USMLE GUIDE.doc so that you can take it with you and not worry about your internet connection. I post all of it here for those that do not have Microsoft Word and so that people can find it through search engines. Hope it helps.

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A word on this guide:

I just finished my second year at St. George’s University School of Medicine. Figuring out what you are going to do for the Boards is a pain in the ass and gets people nervous that they do not have a plan. Many of them sign on to Kaplan or Falcon for this reason. I would like to prevent as many people as possible from signing up for those courses for those reasons, as they are expensive and you are poor. I want you to have a plan, an idea of what to expect, and all of that free. I hope this helps.

A word on advice:

I am wary of most advice. It is often unqualified, and by this I mean that I do not know why I should believe in your expertise. Did you score well and are you willing to tell me the score behind this advice? Are you like me in that we learn, memorize, and study alike? What works for Peter may fail for Paul and it is good to keep this in the back of your mind as everyone begins to tell you what you should and should not do. The other problem that I have with a lot of advice is that I am not told the reason behind the conclusion. It is easy to say, “Just do questions”, but it is much harder to give a well thought out argument to support your advice. There may be an excellent reason, but many people do not think to ask for it or to give it. Also, it takes a fair bit of time.

If someone says that there is a lot of Embryo on the test, please kick him in the face. That sort of advice (even if it ends up being true) is worthless for planning. The most frustrating part of this whole experience is that n=1 and it is hard to draw conclusions from a sample size that small. You will wonder if you did it correctly, how you would have scored if you changed blah blah, and so on. That leads us to why I am writing this:

Medical school is great because it is the end of decisions. Decide to go to medical school. Three and a half years later: decide what kind of doctor to be. Three to five years later: decide which job to take. That is three decisions over ten years and medicine is great that way. I was so tired of making decision about how to study that I wished someone had done it all for me. This guide is meant to be a turn-off-your-brain and do-as-I-say outline so that you can save yourself from all of that. It is the guide that I wish someone had made for me.

A word on irony:

I am aware of the irony that I am writing a little guide filled with advice while not offering my score, telling you about myself, etc. What I can give is my reasons for each decision so that even if you do not end up following it, you at least see the problem of planning and studying as manageable. If you are interested, when I get my score I will post it and at that point, you can decide to continue using this guide or decide to forget everything written here. Deal? Now on with the show…

THE SCHEDULE

I am assuming that you are taking six weeks to study for this test. If it is shorter or longer, I have structured this so that it is easy to change according to your unique schedule. This schedule is built using the newest edition of the First Aid for the USMLE Step 1 (Systems based) as I think it is the best game in town and damn near everyone seems to own it. We need a calendar, and we need to divide it into two main sections: cramming and pre-cramming.

CRAMMING

Cramming is undervalued. I took an incredibly long time to prepare (9 weeks) so that I would not have to cram because (cue lame music) I wanted to really understand the material. Fair enough, but the last two weeks are for cramming. You can realistically cover two topics each day. Anything more and you are skimming. I have good reasons for each of these choices, but first you should just take a look at what we will call “the cramming”.

The day before the test, you will be tired of studying (more so). This is when you are most vulnerable to total mental collapse. A friend described it to me: “I opened up Micro to look over viruses once more before the test and I realized that I had forgotten how to read. It was as if my head had exploded onto the table and I could not pick it back up again. I postponed the test a week after that.” To avoid this, I advocate taking a half-day and seeing a movie. It was one of the few things that I did that worked.

Before you start this final sprint, take a day off. You have earned it. I think you should begin with Biochemistry because the meat of this subject is in the underpinnings of other diseases. A good look in the beginning will help you interpret things later on and will reinforce the pathways that actually matter. By putting this first, you effectively study it all week. It is a big topic, so it gets two days. Molecular genetics and Immuno cover some similar ground (signaling) and this is a nice lead in to Micro. I will make the same argument about Micro, that putting it this early means that you study it with every system to come, reinforcing the pathogens. It is big, so also earns two days.

Cardio and Heme/Onc are thrown together because of the pathology. For similar reasons, I have placed them next to Musculoskeletal. As you will find, the vasculitides are covered in Musculo, not in Cardio or Heme/Onc, so these three topics are overlapping in the First Aid which is why I have grouped them. Cardio, Heme/Onc, Gastro, and Musculo are also grouped because chances are that one of these topics is a strength for you, so going through that subject quickly allows a weakness in the others to expand into that day.

Neurology and Psychiatry are next to each other for the association. Neuro, unfortunately, is just too big to group with a second large topic, so this is as good a place as any to split up Behavioral with Psych (they pair naturally) and Biostats with Neuro. Renal and Respiratory are not as big as the other sections and this should make for a somewhat easier day. These are grouped together in hopes that you finally sit down and learn Acid/Base compensation. After two years, it is time.

Embryology is tricky. Most of it belongs with Reproduction and Endocrine while the rest is spread out among all the systems. The best advice I have is that you study the Embryology for each system in the morning before getting into the thick of each subject and save the Repro/Endocrine stuff for the end. That it is a hodgepodge also makes it a natural move to group it with Basic Pharmacology and Basic Pathology. These sections are short and represent a little bit of everything. If you give it a good read, it can pull topics from earlier in the week together and is not too stressful to be studying up to test day.

And with that, use the last day before the test to print out your permit, print out the directions to your testing center, and look over some topics that you had to skip. Try to force yourself to stop studying by midday and do something non-medical that night like watching a new movie with a friend. The night before my test I caught 300, and it was great to think about something other than pathways for at least those two hours.

PRE-CRAMMING

That was cramming. Now, onto pre-cramming. Since we have six weeks and I just stole the last two weeks for cramming, that gives us exactly 30 days to prepare. Remember that you are not preparing for the test during this period; you are preparing for “the cramming”. If you do not cover everything in a section in the time allotted, it will not be the end of the world. You will get another crack at it, at which point not getting to it will be the end of the world. Ready for the suck? Seriously, stay optimistic.

If you are a numbers person, we have 30 days to cover 329 pages of the First Aid, which works out nicely to 11 pages a day. This is a lazy way to weight things, but who cares? I have gone to the trouble of counting each page per section for you, and arranged the following. Here is the first two weeks.

We start out with something general and familiar: the basics. Most of the connections in this section went over my head and I did not pull them together until the end, but it is nice to have the early exposure and to ease into this whole thing before the real subjects start. This brings us to Biochemistry. It is big and intimidating for a lot of students and three days does not seem like enough, but it has to be just three days. First, we give it two full days in the last two weeks of cramming. Second, the other subjects need to be given time and are likely higher-yield.

It does not let up as Biochemistry feeds into Immunology and Microbiology. Again, three days is not enough to cover Microbiology, but the other subjects need to be covered and we give Micro two full days during cram week. Behavioral science and Biostatistics are meant to be your first break. The ground of Behavioral science will be touched again during Psych, and Biostatistics is not that big. You can either take half the day off or use the extra time on Micro. As always, make sure you are not seeing anything for the first time during “the cramming”.

Embryology is just not big enough to get its own day and should be learned in pieces with each system that follows. What is important for now is the developmental aspect. You can combine it with the first day of Endocrine (as I have done) or group it with Reproduction, does not really matter so long as you get to it. I think these three topics together makes each of them stronger, and this might be the first time you really understand the menstrual cycle.

The second two weeks begin the systems. I was taught subject-based, but for the type of thinking that makes for good test scores, the integration that comes with doing Anatomy, Physiology, Pathology, and Pharmacology together just cannot be beat. If your school taught this way then this is old hat for you, but for me it was a shock to see all the new connections.

We begin with the Cardio/Heme/Onc/Musculoskeletal combination for the reason I described earlier. Cardio looks big in the First Aid and the pharmacology of Heme/Onc can be intimidating. Just remember that “screw it, I’m just not going to know that” is a perfectly good assessment for some of the material and if you can make peace with that, you will be less stressed. It probably will not be on your test anyway. Or you fly through these sections and earn a day off.

Gastrointestinal is there because where else would you put it? Renal and Respiratory go together with their acids and bases, and this brings us to the skull. Psychiatry is a new section with the First Aid and I think they have done a good job. It may bleed over into Neuro (as far as BRS and other review books go) but the two of them together get four days now and two more days during “the cramming”.

All together now:

If you are taking less time or more time, you simply shave or add a day here and there from one of the blocks in the first four weeks. I do not think it is a good idea to steal or add days from “the cramming” as this is a period favored by the gods. Why not add? “The cramming” is the period where you realize that everything you are reading is the last time you will get to see it before the test, and this is a shocker if you have not prepared for it. Cramming is also useful in the short term, and once you extend that period past two weeks, I think it is a hard argument that your short-term memory is still holding onto the lessons in the first days. Just my advice, but then again I could have done poorly and you should ignore all of this. You can access this calendar online. The dates used are from May 20^th, 2007 – June 30^th.

QUESTIONS

Which QBank is the best? USMLE WORLD. But that would be shitty advice, right? I could just cut and past the whole thing here, but I would like to keep this file manageable. Please read my evaluation of free questions and Qbanks available online.

BOOKS

Everyone is chasing after that magic bullet: the high-yield book. My experience was that few books can pull this off well and that most try to be miniature textbooks and are unmanageable in the time you have (HY Cell and Molecular by Dudek, HY Neuroanatomy by Fix) or are bare bones and do not help you make many connections (BRS Path). After spending a good chunk of change on these review books, I should have just covered the material in the First Aid using my own textbooks. Most of what you read you will not have to look up (because you learned it) and the things you do look up will be surrounded with full explanations. Anything less than a full answer is annoying and wastes time (if, like me, you tend to dwell). If you have played it correctly, you should also have old review notes from your courses and it is always easier to remember what you used to know instead of starting from scratch with everything. By the end, I was using Golan’s Principles of Pharmacology, Robbins’ Basic Pathology, and the Merck Manual. The Pathology BRS by Schneider and Szanto was useful as an outline (which I used to focus on Robbins) but the questions for each chapter are absolute crap. Costanza’s Physiology BRS was good in parts and her questions were reasonable, but there are a few uncovered topics.

FIRST AID

I tip my hat to Graham Azon of Over!My!Med!Body! for this piece of advice: put the First Aid in a binder. I took my copy to an Office Max, had the spine cut off and the book three-hole-punched, and put it into a 1.5” binder. Best move I ever made. I was able to take separate notes and include them exactly where I needed them and I was able to take my notes from previous courses and include them (my roommate expanded the book to fill two 1.5” binders). It is hard to overstate the advantage of having everything you need in one place.

THE EXAM ITSELF

It is hard to anticipate the pace of this test. When doing timed questions in preparation, there were instances where I would finish with 10 or 20 minutes left. I thought to myself, “Self, you’re going to have plenty of time to look over questions in each block”. I was wrong. On test day, I had around 10 questions marked per block that I wanted to give a second look and two minutes to do it. It was unexpected and unsettling, and for this reason I wished that I had taken the NBME practice test at the center. It is worth it just to remove the final few unknowns for test day.

The clock counts down for each block while you move up the list of questions. Unless you are willing to do the calculation (even subtraction can be stressful), it is hard to know how fast you need to move to finish. For pacing purposes, I ended up starting each block with question #50 and ending with #1. This way I knew exactly how many extra minutes I had to devote to problems as I went along and it helped me gauge whether I had to come up with an answer now (because I was falling behind) or could mark it for later (since I had a seven minute cushion). I would do this again.

I am thankful for the advice I received from a stranger: “You are going to walk out of the test with incredible relief that it is over. This will be mixed with some despair since you will think that you failed. It is over. You did not fail. Everyone feels that way.” He was right, and every one of my friends has echoed it. I went from relief, to defeat, to anger that I had not done better. A week later, I feel “okay”. When you go through it, remember that you are not the first, not the last, and it is normal.

Hope it helps, topher.

Dopamine

Kelly and I are sitting next to each other, each in our own cubicle. Our tests are different, our questions are different. After 9 weeks of 12-hour-a-day studying, we’re ready for everything and anything.

Kelly starts his block and sees an easy one:

Q: Which of the following amino acids is involved in the synthesis of Dopamine?

That’s easy. Phenylalanine to Tyrosine to L-Dopa to Dopamine to Norepinephrine to Epinephrine. He knows the name of each enzyme, the cofactors necessary, what symptoms you would see with a block at every step, and where the Cu2+ comes in to play. He prepared for questions this stupid. This is a joke. He looks down at his options:

A through J.

Chemical structures!

***

“Topher, I came so close to just tapping you on the shoulder and making you look at that question. I didn’t really care if they kicked me out and I forfeited my test, it was just that ridiculous. What do they want from me? Answer me that. What do they want from me?”

“I think they want you to fail, Kelly.”

“It’s not even clinically relevant. That’s what kills me. Even if I knew that, it doesn’t make me a better doctor.”

“You’re wrong, man. You just killed a patient.”

post coitus

If someone receives multiple blood transfusions and becomes hypocalcemic, it’s because there are chelating agents in stored blood products. If an astronaut is in space for 30 days, his muscle and bone mass will start to decrease and he’ll lose calcium to his urine. If a woman comes in with uncontrolled diabetes and hypertension, eats red meat three times a day and is an alcoholic, the best thing you can do is form a “therapeutic alliance.”

If a grandmother insists that you treat her grandson with chamomile tea, do not sit her down and show her your diploma to remind her that “you are a doctor, and she is just a grandmother.” Also, don’t tell a patient with poor lung function that continuing to smoke is “a complicated and roundabout form of suicide.”

These are the lessons that I learned yesterday while taking the USMLE. It was long, the breaks were short, and I felt rushed with every question. It was challenging and fun.

I really don’t like not knowing my score.

The best thing about the whole thing is it being over.

I don’t ever want to take a test like that again.

Thank you, everyone, for the well-wishes.

The Unexpected Suck of the Last Week

So I felt pretty good about my preparation. I had kept to my schedule, more or less. I had kept current with questions, spent as much time as I needed to on special topics like acid/base, PV Loop, etc. And through all of this, I never felt too upset if I had to leave a page or two from each section for later, so that I could “come back to it when I had the time.”

And that’s exactly as it’s gone. There’s just one problem with this system: it fails in the last week. I never anticipated the change, but there came a point about a week before this coming test when I realized that every time I was reviewing something, it was the last time I was going to see it before the test. After spending two months looking over everything with a sort of focused laziness, I had set up a pretty stressful situation.

The reason I wanted to take so much time to prepare was to completely avoid this stress. Sigh.

So now, reviewing is an exercise in abuse. Oh yeah, I remember not remembering that fact that I’m not going to remember in a second or two. Hope to God that isn’t on the test. Repeat. Repeat. Repeat.

It’s the feeling of losing. I set out to hold everything in my head, and reviewing is just hammering home that no matter how much I prepared, it was just going to keep falling out, falling out. Every reread line re-remembered is testament.

I feel like I’ve stepped into the ring, seen my opponent, and gone four out of the five rounds. He’s stronger, faster, bigger. Through the blood, I can barely make out that he’s joking with his coach; that he’s not tired. The judges are looking at the girls with the placards, sharing cigars, not worrying about the last round since no effort on my part could change the ruling that is so cemented. I look at my coach.

“Coach, this fight is over. I can’t beat this guy. I’ve already lost.”

“I know, kid. But that doesn’t matter. Rules is rules. You have to fight the last round even if that means he kills you.”

With three days left, I stagger up. I slap my gloves together hoping the thud stirs some lost adrenaline. My legs change places not from heart, but from habit. I meet him in the middle and tense for the blow. The futility.

Operation: Urgent Knowledge

The test is a week away. I expect the next few days to be a blur, filled with stomach pits, flipping pages, nervous questions and highlighters. But we’re professionals, and we’re comfortable with the worry.

We started on January 4th. That was two months and a handful of days ago. We’ve put in (conservatively) 600 hours for this one test. This one test with its terrifying 350 random questions. This test with the two-year scope.

I have developed personal relationships with the authors. I think Glasner is a genius, that Dudek mailed it in, that Sczanto and Schneider have the worst questions imaginable, and that Costanzo has more than a few blindspots. Fadem needs to get an MD. The Merck is my bedrock; the Robbins is my quick consult; the First Aid is my rough guide.

The boys at WebPath, Tulane’s Pharm, and UW keep me honest. I can pretend to know so much more than I do, and it’s these guys that call me on the bullshit. That, and all the people reading the First Aid Errors that point out mistakes I’ve made. Thanks, to everyone.

And thanks to everyone that had something encouraging to say when I felt that thing were going to shit, that I was fucking it all up, and I just wanted it to be over. Shortly after I changed scenery, changed my routine, and found my stride.

I’m writing this down so I don’t forget that no matter how rough it feels in this next week, I was in the right place when it started. Over all the tests, Kelly and I have developed a program. When Grenada was invaded by American forces after the communist coup, the operation was named “Urgent Fury”. Dorks, we know, but we’ve always tried to bring that silly intensity to the last week of studying before any test. And so we’ve named it “Operation: Urgent Knowledge”. During this period, all knowledge is urgent and will be memorized urgently. Tomorrow, it begins and I’m giving myself a moment to reflect on it all.

I have a line of sight to the finish, and goddamn it feels better than I thought it would.

How to Prepare for the USMLE: Should I Take a Prep Course?

“Should I take a prep course?”

Shrug. I don’t know if you should or shouldn’t. The best I can do is tell you why I didn’t. Comprehensive review courses make a few implicit promises that include:

1. Structured lecture, pacing of material, routine
2. A community of other serious students
3. A one-stop-shop for your review materials
4. Some diagnostic component
5. Confidence that you’re studying the right way

If you’re thinking about taking the Kaplan course, this is more or less what you’ll get. A great many of my classmates went this route and chose the Step 1 Prep Retreat which includes a full-service hotel setting and costs $5,599. That’s a lot of money. I could have chosen to take out a “bridge” loan for $6000 to cover it, but I decided to make damn sure that it was worth it before I added to my debt.

Could I accomplish everything the review course was offering on my own? The structured lecturing was out of the question. I didn’t go to class for the first two years, so taking a live lecture course made little sense for me. I’ve written about it before, but believe me when I tell you that my ears are stupid. I’ve never been the type to sit passively and absorb information; I instead need to be actively involved by rewriting the material (time-consuming) or teaching it.

As far as the pacing goes, I got a hold of the Kaplan lecture schedule just to see how much weight they gave to each section. Then, I just picked something upon which to base a schedule (First Aid), looked at how many days I had to study, and made one for myself. It wasn’t that hard to do. Sticking to it is often a pain, but chances are that every time I want to fall behind my study partner is keeping pace. At this point, my competitive nature takes over and I buckle down.

Daily routine has been incredibly important and we screwed it up. Trying to find a good place to study is hard in the winter when all the public libraries keep banker’s hours and all the academic ones are for students only. Having to sneak in, find parking a mile away, and worry about freezing to death all got in the way for us. Eventually, we found a great library and have been going there every day from 8am-6pm, but we wasted about four weeks trying to find it. So far, wasting that time has been one of my biggest mistakes. Things would have been so much easier if I was the type that could get work done at home.

I couldn’t exactly get a community of students around me, but I thought that might be a good thing. As it stands, I struck a deal with my roommate: I’ll make you study if you make me study. We shook on it and things have been going well for six weeks now. I recently spoke with a classmate of mine at the Kaplan Retreat in Alabama and found out how different it is.

“Kaplan Spring Break 2007! WOO!” I was afraid of that, to be honest. So many medical students reliving their dorm days sounds like a recipe for distraction. “We all wake up for eight hours of lecture with an hour break for lunch and by the end of it, we’re too tired to do anything else. We either spend the rest of the day watching a movie, going to the hotel bar, or lifting weights and relaxing in the indoor pool. It’s pretty great.” All that’s missing is a few testimonials about all the hot singles waiting for your call and a 900 number. I’m glad I passed.

As my roommate Kelly put it, “This is two months of your life where you make yourself a deal: life is going to suck, you’re going to work, you will have no fun so that after it’s over you don’t have to regret any of it.” Sounded good to me.

Being on your own outside of a class also means having to figure which books to get. There’s a great book called The Paradox of Choice that I recommend, but the nuts and bolts of it is that by having so many options and having the time to compare them against each other, we end up paralyzing ourselves and no matter what we choose (even if it’s better than what we would have chosen without all the options) we’re more unhappy with it. Such is life when buying review books. I thought I had a handle on it but have since learned that the books everyone else thinks are great I think are shit, and that no matter what happened I wouldn’t have had the time to find the “right” ones anyway.

So if you get the Kaplan books when you take the Kaplan class, you’ll probably be really happy with them. I have been unhappy with mine because I can compare them against other books to see their strengths and weaknesses. Ignorance is bliss. If I had to do it all over again, I might have just gone to Amazon.com, looked at a list of books I should buy, and then done so without questioning.

As far as the diagnostic component goes, I started studying for the USMLE thinking that the Kaplan QBank was the only game in town. I’ve since discovered quite the opposite and ended up going with USMLE WORLD. You have to wonder how many people never investigate and end up going with Kaplan classes because of how famous the Kaplan QBank is.

The last one is a doozy: confidence that you’re studying the right way. I struggled with this one before beginning. Ultimately, I looked at my last two years in school and decided that I had done enough things correctly that I could fake my way through preparing for the Boards. It also helped that I found the Step1Blog and talked to a few successful people a year ahead of me that also studied on their own. I’ve tried to figure out the best way to cover the material and I’ve failed at it more than a few times but I’ve also had some success and now I’m in my stride. Good thing since the test is now three weeks away.

In all, I’ve lived at my roommates house rent free, paid for gas, spent $500 on books ($200 of which I wasted on the Kaplan Lecture Notes), $200 on warm clothes because Cincinnati is freezing, and spent $700 to register for the actual exam. That comes to the grand total of $1500. What am I doing with the extra $4000 that I didn’t spend on a course?

My own Kaplan Spring Break 2007!

• Flight from Midwest, USA to Bangkok, Thailand on March 27th.
• Canon D60 digital camera with two Sigma lenses
• Northface backpack (I will be living from this)
• Flight home, May 8th

WOO!

Return to USMLE Step 1 page.