How to Prepare for the USMLE: Statement of Goals

February 3, 2007

What you want to do with this test, with this opportunity, is up to you. However, if you’ve googled the topic and are reading things like this, chances are you’re not looking to coast with a modest passing score. I, sure as shit, am not. I want to keep as many doors open as I can for my residency interviews and I know that coming from the Caribbean puts me at a disadvantage.

People come down to the school to tell us things like, “The passing score is now 185. If you want a residency program that has empty slots each year like Internal Med or Family Practice, that score is fine. But if you want anything even mildly competitive, don’t show up with anything below 215. Don’t even bother applying. At that point, your best bet will be to sign outside of the match. Remember that there is a difference between having a score good enough for a residency and having a score good enough for a competitive program in that residency. It is always better to have a better score, regardless of your goals.”

In light of all of this, I’m going to state my goals and try to put everything that I’ve written about my preparation into context. When I say that the BRS questions are weak or that for a certain book the topic was covered superficially, I mean that it was weak and superficial for what I want to do. I do not want to just pass the Boards. I don’t even want a high pass. I am locking myself in a library every day to score above the 95th percentile. If you glazed over a subject, feel weak in it, and could use a stepping stool to competency, then the BRS Path (for example) is fine. But if you’re reaching for the brass ring, you should just sit down with Pocket Robbins or the Merck Manual and take the time to really get into it.

Yes. I know that you know a guy that barely studied and got a 99. Yes. There was a guy that did nothing but review the First Aid and he also got a 99. If you’re going to be the kind of doctor whose decisions are swayed by anecdotes like this, then you probably need to review Epidemiology and Study design. As far as I go, I’m not willing to follow their examples because, regardless of what they accomplished, I’m not that guy and you probably aren’t either. So let’s just dispense with the bare bones approach.

Reviewing this stuff (cramming) without achieving deep understanding at each level (internalizing) is like renting an apartment for a month at a time when you know you’re living in the neighborhood for the next ten years. Why waste your money? Instead of paying just enough each month, it’s worth it to go into debt (time-wise) to own it. Every day after that, the investment pays for itself, but you have to make it that first time. I’m not here to rent the knowledge; I’m here to own it, and every criticism I ever make of review materials is in that light.

There are books that I’m going to really like because of their incredible (but necessary) detail or because they are exceptionally well-written. There will be books that I trash for being riddled with errors and grammar mistakes or for being superficial to the point of uselessness. But whatever conclusions I reach, yours may be different because of time constraints (I have the luxury of two months) or learning style (in the eyes and it stays, in the ears and its out the other).

State your goals. Have a plan. Set a Schedule. Buy your books. Pick a QBank. Don’t crack. Have fun.


I think it’s now worth saying that of all the things I’ve done so far, bringing the Merck Manual to the library every day has been the best decision. I left it at home one day because it was taking up too much space. I am never doing that again. Pound for pound, I don’t own anything more useful. In fact, I’ve decided that from now on I will rate everything in units of Merck. Let’s establish a scale:

18th Ed. Merck Manual = 100 Mercks = highest rating.

Dudeck’s HY Cell and Molecular Biology = 1 Merck

“Dudeck” might be its own scale, sort of an inverse to utility… like a feacalith.

Return to USMLE Step 1 page.

Welcome to Grenada, A Student’s Guide for Students

December 4, 2006

I have been silent in this space for a little while now but I have not been lazy. The end of my first two years is 10 days away and I will soon leave the Caribbean for a permanent place back home in the US. I have taken a comprehensive diagnostic test of my skills clinically and academically (both in-house) and I just returned from a trip to Grenada to finish work on a two-year project of mine. These are exciting times.

I’m incredibly proud of the work that’s now over. Coming in at 11,000 words, it’s about as long as an Atul Gawande article with about 1/11,000 of the readership.

Welcome to Grenada, A Student’s Guide for Students” began in April of 2005 as a seven-page introduction to your new life on the island. It has since swelled to include information and advice for the first two years of island living. With our fingers crossed, we hope it eventually has information for the clinical years, interviewing for residency, and a guide to the match (with specifics for FMGs).

The editors believe in the power of honesty. If I told you that everything was perfect, would you believe anything I said? With that in mind, we hope you find our honest take on attending Saint George’s University to be helpful and that by showing you the rust you will appreciate the shine. For more on why we wrote this and our general mission statement, please read the Letter From the Editors.

And with that, I am exhausted. A lot has happened and the telling will all have to wait until I’m sipping egg nog, wearing a ridiculous sweater, and enjoying being the tannest man in the room.

Happy Holidays, topher.