Prepare for the Boards in Six Weeks

March 27, 2007

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.


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”.

last-two-weeks.jpg

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.

first-two-weeks.jpg

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.

second-two-weeks.jpg

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:

all-6-weeks.jpg

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 20th, 2007 – June 30th.

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-binder-page.jpg

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.


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.


Errors in First Aid for the USMLE (2007)

January 13, 2007

Apologies to anyone that has been reading this post and wondering why I haven’t done any new work on the First Aid.  This section moved here.  Please change any links that lead you to this page so that you can find the updated version of the errors.

Sorry for any confusion, topher.


How to Prepare for the USMLE: Biostatistics

January 5, 2007

January 4th, the first day of studying and it’s headlong into Biostatistics. Armed with my hand-written notes from 3rd Term, First Aid for the USMLE, Kaplan Lecture Notes: Biostatistics (bought the whole set off of someone for $200, completely unmarked), and the High Yield Biostatistics book I begin Operation Overkill.

I begin by settling into the local medical school library and then lazily looking through my own notes to regain some familiarity, which takes about an hour. I open up the First Aid and carefully read over every concept that they stress, adding Generic Post It Notes to each page to hold extra mnemonics or figures that help me remember what is important. After this, it’s on to the Kaplan Lecture Notes (each source is slowly increasing the level of detail). This takes much longer, maybe three hours to absorb everything with some understanding (finding mistakes along the way, see below). Having started at 9am, I’m now finishing up around 3 o’clock. I don’t feel solid, but I feel competent.

I begin the High Yield Biostatistics. This is the highest level of detail I’ve seen and also the easiest read. I’m thrilled to find diagrams and tables that are much better than the ones I found in the First Aid or Kaplan Notes and they feel like tiny treasures. I love that this author not only offers clear explanations of similar but different terms and concepts, but he then spends some time highlighting why their differences are important. His analogies are amazing the way magic is amazing, and I’m thinking about writing Dr. Glaser an email to thank him (he supplies his email address). The questions at the end of each section are appropriately difficult and after reading the material several times over earlier in the day, this is sort of pleasurable. Biostatistics, pleasurable? Well, yes.

After an hour spent eating dinner (sack lunch swallowed over notes in a hurry), I finished the book around 9pm with all of the questions in each section. And now, after playing on the computer and writing this, I’m going to go through the things I may forget from each source and combine them into one or two pages of notes that I will review in a week’s time and again in the week before the actual test.

**Warning: not high yield to continue reading**

So what errors did I find in these books?

First Aid for the USMLE

Though techinically tomorrow’s material, I found a description of an Advanced Directive on page 70 (2007 Ed.) that I believe is flawed. I think they’re describing a Do Not Resucisitate Order or DNR. Changing “withhold or withdraw” to “withhold or provide” would probably solve this.

Living Will — patient directs physician to withhold or withdraw life-sustaining treatment if the patient develops a terminal disease or enters a persistent vegetative state

I prefer this definition from Prudential:

Living Will: A document which specifies the life-prolonging measures an individual wants and does not want taken on his/her behalf in the event of a terminal illness. Living wills are often used in conjunction with a healthcare power of attorney, which appoints someone to make healthcare decisions on your behalf.

Kaplan Lecture Notes: Behavioral Science

On Page 7, there is a statement that I do not agree with. It states that:

point of optimum sensitivity = point of optimum negative predictive value; point of optimum specificity = point of optimum positive predictive value

This is incomplete, and I need an example to demonstrate it. In the usual square (Fig 1) you have true and false positive results (TP and FP) and true and false negative results (TN and FN). Our shorthand for this is A,B,C, and D. Without going into further detail, Specificity is calculated as D/(B+D) while positive predictive value (PPV) is calculated as A/(A+B). Sensitivity is calculated as A/(A+C) and negative predictive value (NPV) is calculated as D/(C+D). So if Kaplan is incorrect, let’s see if we can demonstrate it.

Assume a population of 100 people, split perfectly down the middle. 50 have the disease, 50 are disease free. We would like to see if a company’s new test can help diagnose this disease. The new device doesn’t work and the results are poor:

  • Specificity = 1/50 = 2%
  • Sensitivity = 25/50 = 50%
  • PPV = 49/98 = 34%
  • NPV = 1/2 = 4%

Specificity is low, Sensitivity is low, and the PPV and NPV are at also low. Well, it turns out we weren’t using the device correctly, and we run the experiment again.

  • Specificity = 1/50 = 2%
  • Sensitivity = 49/50 = 98%
  • PPV = 49/98 = 50%
  • NPV = 1/2 = 50%

According to Kaplan, the rise that we see in Sensitivity should be accompanied by a rise in NPV, and we see this. But without any change in Specificity, we see a rise in PPV. My point, after all of that, is that Kaplan’s statement is incomplete becuase it doesn’t take into account the effect that Specificity has on NPV and the effect that Sensitivity has on PPV, and instead paints an incomplete picture.

Dr. Glasner in HY Biostatistics takes it further:

Whereas the sensitivity and specificity of a test depend only on the characteristics of the test itself, predictive values vary according to the prevalence (or underlying probability) of the disease. Thus, predictive values cannot be determined without prior knowledge of the prevalence of the tests’s charateristics and of the setting in which it is being used.

Long story short: increasing the prevalence of a disease increases the PPV of a test and decreases the NPV of that test, without changing the Sensitivity or Specificity at all. So as I hope you can see, the sentence from Kaplan falls quite short of the truth and would be harmful to just memorize and use come test day.

Return to USMLE Step 1 page.


How to Prepare for the USMLE: Review Books

January 4, 2007

“I need crutches, stat!”

That’s how I feel right now, getting ready for this test. I want someone to have done all of the work, laid out a plan of attack, shown me exactly what I need to know, and have it be easy. All of this exists, of course. I could have signed up for a Kaplan or Falcon course. I would have lived in a hotel for 6 weeks, listened to great lecturers, been fed information in outline format, and taken 2,000+ preperatory questions. It was all laid out.

But it costs several thousand dollars. You may be the type to write that expense off as an investment in your future, but I’m not. I see $6000 as a monument to my laziness because I know I can probably put together a program of my own, it’s just going to be work. I see $6000 as a trip around the world in celebration of doing things the hard way and still coming out on top.

The first piece of real work is picking the best crutch, and for this I turn to what will be my staple: First Aid for the USMLE ($45). Why? Well, the most frustrating thing about this entire process is that I get one crack at it. This is n=1 with zero degrees of freedom and I can draw no real conclusions. I’m left to scrounge for anecdotes, and the reverberating truth about the USMLE Step 1 is that the First Aid book seems to earn a few thousand thumbs-up each year. So we begin there.

In the back of this book is a list of several review books that have been described, reviewed and graded by previous test takers on an A/B/C level. So for two days of my winter break, I drove to the local medical school bookstore and pull every single top-rated book from the shelves. I pulled four books for Physology, Pharm , Path, Micro and so on. I take one subject and read the chapter devoted to it in each book to compare styles of writing. I consider length (shorter is better), number of review questions available in the book and online, and my personal impression. It takes six hours over two days. I’m tired, but I’m happy with the results.

Gross and Developmental AnatomyAnatomy/Embryo/Neuro

Anatomy is a strong subject for me and one of my favorites. I have always written off Embryo, but I figure I’ll give it a fair shake if I can find the time. I have the Anatomy BRS by Chung from first year, but this book gets poor reviews because of its length, so I shop around. I’m able to narrow it down between Rapid Review: Gross and Developmental Anatomy ($35) and High Yield EmbryologyUSMLE Road Map: Gross Anatomy ($25). Road Map is shorter, and the illustrations are so interesting and unique that I’m thinking about the anatomy in new ways, but I can’t ignore the abundance of clinical correlates in the Rapid Review and how much fun it is to read, so I buy it.

As for Embryo, I don’t have the strongest feelings. I pick up all of the books and read through them. I ultimately choose the High Yield Embryology ($25) because it has the highest rating in the First Aid and it has lots and lots of pictures. I’ll probably give myself onefull day to review Embryo, and if I’m going to have to do it, I’d like to be entertained. Neurology is sort of a thorn in my side. I understand the tracts and the geography, but I’m never quit sure where Neuroanatomy ends and Neurphysiology begins. Should I be covering this in Physio, Path, Histo? I throw up my arms and buy the highest-rated book: High Yield Neuroanatomy ($25).

Lipincott BiochemistryBiochem/Molecular Biology

Biochem is another subject where I feel strong, but I’m told that everyone gets kicked in the head on this section. I’m going to be careful. I have the Lipincott’s Illustrated Review of Biochemistry ($45) from first year and it has a high rating, so I’m sticking with it. SGU (when I took the class) did a poor job of preparing my for the molecular genetics, so I’ve decided to pick up a second book for this alone: High Yield Cell and Molecular BiologyHigh Yield Cell and Molecular Biology ($27). After reading a chapter, I think this book will cover my needs. The High Yield series is growing on me.

Histology

Screw Histology. Anything I know about this subject, I’m going to pick up from Physiology or Pathology. I refuse to give this topic its own review book. Immediately after this, I begin spitting on the ground whenever anyone metions Histo.

Physiology

Physiology is one of my favorite subjects. I didn’t use a textbook when I took this course and instead used the amazing handouts that were prepared by our teachers. For a good review of things though, my notes won’t do, and since there seems to be an absolute consensus that Costanza’s Pathology BRS ($37) is the best book on the market. I buy it without batting an eye.

Microbiology/Immunology

These two courses are weak spots for me. When I should have been learning them, I was instead learning Pathology so I have a lot of catching up to do. I hadn’t realized this yet, but not feeling confident in a subject makes buying a review book harder since you don’t recognize which books are hitting all of the important topics. I hem and haw between Clinical Microbiology Made Ridiculously Simple ($24) and the Rapid Review: Microbioogy and Immunology ($35). Both books get high marks on reviews, but I end up going with Rapid Review because it has an Immuno section, online access to Student Consult, and some of the silliness of Ridiculously Simple annoys me

Pathology/Pathophysiology

SGU did a fantastic job of making these courses life or death for me. I’ve spent a lot of time with them and don’t feel so intimidated that I can’t enjoy myself. In the course, we used Robbins Basic Pathology (amazing), Robbins and Coltran Review of Pathology ($42), WebPath (free online site), and the Merck Manual. I have more than enough information from these courses and that’s a problem. I need to keep things simple, so while I plan on doing all of the questions from the Review of Pathology and from WebPath, I also decide to buy the Pathology BRS by Schneider ($35). It gets glowing review from everyone that uses it, and that’s good enough for me.

Pharmacology

Again, one of my weaker subjects and I’m a little bit nervous about it. I’m comfortable with the concepts, but memorizing name after name with it’s idiosnycratic side effects and routes of administration has me sweating. I need some support here, but I also need to keep it simple. I own Lipincott’s Illustrated Pharmacology ($45) from when I took the course and while I didn’t like it as a stand-alone text, it should do fine for review. I also like the layout and portability of Pharmacology for the Boards and Wards ($35) and decide to pick that up as well. Both books have very high ratings and useful tables.

Biostatistics/Behavioral Science

Not my strongest subjects or my weakest, word on the street is that people blow these sections off and it burns them on the test. I have some notes from when I took this class, but it was 3rd term, the same term where I blew off school to work on research and dissections, so I need some help. After looking through both the High Yield Biostatistics ($25) and Behavioral Science ($25), I’m thrilled with how short they are, their ratings, and their readability (one chapter each, in the store). I’m sure that these will do.

So those are the review books that I bought for the USMLE Step 1. The tab, after tax, came to $380. Normally, I’d wince. But for this test, I’m not cutting corners or using old editions. Maybe it’s a dumb move, but it makes me feel better.

Return to USMLE Step 1 page.