Kaplan's Tips for USMLE Test Day

1. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized.   You will be given a locker to store your personal items and then assigned a computer station. Remember that you have a total of seven hours to complete 350 questions, and a total of one hour to be used throughout the day for breaks and lunch. 

2. To cope with fatigue, you will need to schedule breaks.  Our recommended schedule for the exam is:

  

Question Block               Break time at end of Block 

Block 1                                             No break 

Block 2                                             5 minute break 

Block 3                                             5 minute break 

Block 4                                             30 minute lunch break 

Block 5                                             No break 

Block 6                                             10 minute break 

Block 7                                             Done! 

This allows you 10 minutes extra to use as needed. Remember that you will need to sign in and out when you take breaks. You should also be aware that if you leave the exam room during a block, it will be marked as an irregularity in your testing session. Therefore, you need to consider after each block whether you want to take a bathroom break. 

3. Start with the beginning of the question block and work your way to the end.  The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. The flow experience is a state of optimal concentration and maximal performance. 

4. Do not skip any questions.  If you don't know it when you come to it, you are not likely to know it later. Skipping around wastes time and can end up confusing you. Deal with each question as you come to it, answer it as best you can, and move on to the next question. 

5. Limit your use of the marking feature to no more than two or three questions per block.   Of course you should answer each question as you come to it, but you may want to double-check yourself on a few questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used correctly, marking will help you revisit questions where you have a high probability of getting the answer correct. Misused, marking causes you to not give a question your full attention the first time around. You simply may not have time to go back and look at questions you have marked, especially if you mark a lot of them. 

6. Be cautious about changing answers.  In general, your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. If you change an answer, you are most likely making it wrong! Your first impulse is usually the correct one. Stay with it unless some clear insight occurs to you. 

7. If you finish a question block with time left over, go back and "check" only those answers that you have previously marked.   Checking almost always leads to changing and tends to reduce your score. If you have a spare moment, make sure that you have entered an answer for every question in the block and then, relax. Sit, take a break, and mentally prepare yourself for the next block of questions. Focus on the questions to come, not the ones that are past. 

8. Monitor your time.  Know how much you have left, so you do not find yourself rushed at the end. Work on your pacing from the beginning of the question block. Check your watch every 10 questions to make sure you are on the correct pace to finish. If you pace yourself throughout the block, you should not be squeezed for time at the end.

9. Relax.  During the breaks between question blocks, try to relax and not think back over the exam. The desire to recall questions is strong, but not helpful. Those questions are in the past; you will never see them again. Focus on relaxing and making the most of your break. Remember, you will always tend to remember those questions you get wrong.

Kaplan's Tips for the day before USMLE

1.  Take the day off from studying.  This is your day to relax and gather your strength before the main event. Get out of bed at the same time you will have to get up the next day. If you feel you must study, limit yourself to reviewing your own notes and flashcards. 

2. Have some fun.  Go for a walk. Listen to your favorite music. Go see a good comedy or an action movie that will allow cathartic release. Go shopping. Spend time with a significant other. Do whatever you like. You have worked hard and deserve it.

3. Make sure that you have checked out the basics for the exam:

Ø        Have you worked through the USMLE tutorial?

Ø        Do you know where the Prometric center is, and how to get there? 

Ø        Do you have alternative transportation if, for example, your car does not start? 

Ø        Do you trust your alarm clock to wake you up in time? If not, make arrangements with friends as back up. You want to be sure to wake up rested, refreshed, and on time.

Ø        Lay out what you'll need for the exam before you go to sleep. This includes photo identification, scheduling permit and confirmation number, as well as any personal items like eyeglasses. While you're at it, don't forget to pack a lunch!

4.  Call your friends and classmates and make some plans to celebrate.  You'll need to blow off some steam anyhow, and talking with colleagues will remind you that you are not in this by yourself.

5.  Be sure to do some physical activity.  Just taking a walk for an hour will help relax you.

6.  Get a good night's sleep.  To help you sleep, consider a hot bath or warm milk. Avoid taking sleeping medication as it may leave you groggy in the morning.

Tips for the Week before USMLE

During the last few days before the exam you should be tapering off your studying, and getting into mental and physical shape. 

1. This is not the time for cramming in new material... but a time to organize and integrate what you already know. Work on making what you know more accessible. 

2. Review keywords, phrases and concepts.  Look over your summary notes one more time. This is the time to drill yourself on essential information. The key is to practice recall, not simply read over the material again. What you need to know is probably already in your head. Your task now is to train yourself to access it when you need it. Doing practice questions is a good way to reinforce your recall skills. Use them to clarify your understanding of key details. 

3. No one can know everything that is asked on this exam.  Be honest with yourself about what you do and do not know. Knowing that you do not know something gives you more of a sense of control on the exam and makes you less likely to panic when you encounter the material and/or waste time on questions you are not likely to get correct. 

4. Get yourself onto the right time schedule.  Wake up every day at the same time you will need to on the day of the exam. This will get your circadian rhythm coordinated with the exam schedule. Do not nap between 8:00 am and 5:00 pm. Otherwise you will accustom your body to shutting down during the critical exam hours. If you get up at the right time each day, you will also find it easier to fall asleep at night. By getting into the proper sleep- wake cycle, you will find it easier to get to sleep the night of the exam as well. 

5. You should be getting a sufficient amount of sleep.  For most people that means at least 6 to 7 hours a night. Sleep is an essential time for your brain to consolidate what you have learned. You need sleep; it makes you a more efficient learner when you are awake. 

6. Take some time each day to relax.  Have a good meal. Take a walk in the fresh air. Find time for exercise. The change of pace will refresh you and the physical activity will help you relax and sleep at night. 

7. If you haven't done so already, visit the Prometric Test Center  where you will be taking the exam. It will be indicated on your exam entry ticket. This will ensure you know how to get there and how much time you should allow for the commute. You can see where you should park, and see what the computer set-up is like. 

8. Review the tutorial at http://www.usmle.org/step1/default.htm.  Become familiar with the interface, the location of key information on the screen and how to navigate between screens. If you walk into the exam familiar with the exam, you will not have to use any of your valuable break time to do this on the test day.

How to Start preparing for USMLE Step 1

1. Self-assessment. I think all of the experts agree that the first thing you need to do is take some sort of diagnostic test to see where your areas of strength and weakness are. Diagnostic tests are available from Kaplan, NBME, and a variety of other online sources.

2. Make a study schedule.  Lots of sample schedules are out there and links to them are included later in this notebook. BUT – please remember that these schedules were made by individual students and the schedules reflect those students’ individual circumstances. When you prepare your own study schedule, you must first look at your own diagnostic test results and prepare your schedule with more time allotted to weaker subjects, and less time to stronger subjects. Individual study pace also needs to be factored in, as some accomplish more per study day than others.

USMLE Preparatory Advice from Students

“I’d recommend studying no more than about 5 weeks. Any more and you will start forgetting things you learned earlier. I caution you to take what your classmates say about their exam with a grain of salt, because every exam is different. Also, “buzzwords” are not typically used on Step 1. Rather than use the words “smudge cells”, for example, they’ll probably just show you a blood smear.”

“Have a planned study schedule that you stick to. If you fall behind, you’ll have a hard time getting through everything and still being able to review material.”

 

“Do not use First Aid or the all-inclusive books as the sole study aid. If possible, use the High Yield books.”


“Start early, stick to a schedule, try not to become overwhelmed with all available resources. Pick a couple for each subject because in my experience you cannot absorb it all. Use First Aid as a scaffold – it really is helpful for recall association.”

“The last week/few days before Step are very distracting – don’t give yourself too much time to study, 4-6 weeks worked for me. But be prepared mentally for the anxiety the week before the test – focus on easier subjects to review.”

How do I apply for USMLE Step 1?

The initial application for Step 1 is done on the Internet. Go to www.nbme.org. Click on

“NBME Licensing Exam Services”, then “National Licensing Examination Services Website”. In the yellow LOG IN box, please note you do not have a USMLE ID number yet. Instead, click on “First time user” and follow the instructions. As part of the application, you will indicate a 90-day eligibility period during which you plan to take the exam. Payment is also required at this time.

• Print out the application form which will require your signature and a picture
• Then take the form to the Registrar’s Office and have the school seal put on it.
• After that, you’re ready to mail it in.

USMLE – What’s it for?

In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners.  These examinations are the United States Medical Licensing Examinations, or USMLE.  Currently there are four separate exams which must be passed in order to eligible for medical licensure:   

 

• Step 1, usually taken after the completion of the second year of medical school; 
• Step 2 Clinical Knowledge (CK), usually taken during the fourth year; 
• Step 2 Clinical Skills (CS), usually taken during the fourth year; and 
• Step 3, typically taken during the first year of post graduate training.

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. 

Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.

Step 2 Clinical Skills (CS)  A clinical skills examination was part of the original design of USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations measure skill sets different from those measured by traditional multiple- choice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public. 

Implementation of the clinical skills examination began in June 2004. The clinical skills examination is a separately administered component of Step 2 and is referred to as Step 2 Clinical Skills, or Step 2 CS. The computer-based, multiple-choice component of Step 2 is referred to as Step 2 Clinical Knowledge, or Step 2 CK. 

USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States.

Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.

Requirements for licensure in each state are set by the state’s medical licensing boards.  Each state board may determine the maximum number of times that a person may take each Step exam and still remain eligible for licensure.

But what we’re really here for is to talk about preparing for Step 1.  Step 1 is your first BIG hurdle.  And make no mistake about it, this is a VERY important test.  A very good performance on Step 1 can definitely help you when it comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options.  And a failure on Step 1 can eliminate the possibility of some residencies altogether.  So it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue.

USMLE Step 1 Review Courses

Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. Unfortunately some programs schedule their courses at times of the year that don’t coincide with most first-time takers’ preparation efforts. Nevertheless, here is the information on review courses that are available.

• Marshall University Joan C Edwards School of Medicine, Huntington, WV  – Usually in the month of May.

Course Information:

17 day course 

Approximately 120 lecture hours 

8am - 4pm, Monday - Friday  

Over 20 award-winning faculty with expertise in USMLE Review 

Access to JCESOM USMLE website, including practice exams with feedback 

Space is limited to 100 registrants & guaranteed only after payment is received

 

• Kaplan

Visit www.kaplan.com for more information

Live Prep courses are 6-7 weeks in length.

 

• University of Missouri at Kansas City – Institute for Professional Preparation

For more information visit http://www.umkc.edu/ipp/programs.asp 

 

• A 10 -week, highly interactive program is for students who have a history of difficulty with standardized tests; including multiple unsuccessful attempts at Step 1.  (Usually begins in January)

 

It focuses on clinical correlations in Biochemistry, Physiology, and Pathology, Microbiology and microbiology related biochemistry. These are the fields that typically cause examinees the greatest difficulty.  Other areas included are Anatomy, Pharmacology, Embryology, Genetics, Biostatistics and Behavioral Science.    

         

A typical schedule for Monday through Friday involves an eight hour day.  Some weekend sessions are also scheduled.  This schedule includes a variety of small group interactive instruction led by trained small group facilitators and formal lectures presented by experienced basic science lecturers.  The instructional program strengthens the basic sciences background of all participants.  Computerized examinations permit staff, meeting individually with students, to analyze and monitor students’ progress as they approach their examination.        

The program includes: (a) personalized diagnostics, (b) screening testing, (c) mock boards, (d) pathology case studies, (e) clinical and fundamental pharmacology, (f) computer based testing and (g) the hallmark of our programs, question group

 

• A 4 week course is available for a student wanting a focused review of the high impact topics in a structured, question based format.   (Usually held between May and June)                                                                                                                                      

 

The Summer Program offers an intensive four week review of the General Principles of Pathology, presented by a nationally respected pathologist; critical clinical correlations explained in Biochemistry, Pharmacology, and Physiology and a Behavioral Sciences/Ethics review.  Students interact with one another and the instructors as they sort out concepts that they understand incompletely.  Question-based tutorials help participants to develop the kind and quality of thinking required for success on Step 1.  Daily small group lecture review sessions will aid in organization and retention.  Emphasis is placed on understanding of the common diseases and related treatment regimens.  In addition, the program will provide a diagnostic, selected subject exams, and a mock board.

 

• An 8-week, live lecture program is designed both for first time test takers who desire a review of basic science concepts and for the student who has scored at 167 or above on Step 1 and who is planning on sitting for the USMLE Step 1 in early November.  (Usually held in the months of August to November)

 

Students with a history of difficulty on standardized exams are more likely to be successful with the longer preparation program beginning in January. As with all of our courses, focus on understanding the material covered, practicing appropriate test taking strategies, and applying all skills acquired and content reviewed in a computer based testing environment.  This live lecture program will include a review of Bacteriology, Pathology, Physiology, Immunology, Virology, and Biochemistry. 

 

• Falcon Physician Reviews

For more complete information visit http://www.falconreviews.com/index.htm

Complete review package includes:

Books 

Luxury Hotel Accommodations 

Daily Continental Breakfast and Lunch 

Over 325 contact hours (Step 1) 

Over 15,000 USMLE Type Exam Questions 

Ground transportation to and from the airport. 

Shuttle Service to shopping, movies, and other areas of interest 

Step 1 Programs include information from: Anatomy, Histology, Biochemistry, Microbiology, Embryology, Physiology, Neurology, Pharmacology, and Behavioral Science, plus Clinical Vignettes, Case Histories, Glossy Slides, and Sample Tests.

Unless otherwise noted, all courses are held in Dallas.

 

• Northwestern Medical Review

For more information visit http://www.northwesternmedicalreview.com/index.php

 

(from the website):Northwestern Medical Review offers live-lecture courses in preparation for the USMLE and COMLEX Step/Level 1, 2 and 3 examinations. These courses are designed to allow current medical students or graduating international physicians to pass their examinations in their first attempt or to raise their previous scores to a satisfactory level. Review plans ranging from a 3-day quick review course to a 15-day comprehensive preparation are available.  

 

Courses are taught by distinguished and experienced medical boards lecturers, many of whom have authored best-selling Northwestern Review books or have mastered multimedia TALLP methodology. 

 

Programs are offered at various medical schools or convention sites within the USA, Caribbean Islands, and select sites in Asia and Europe. All courses include complete sets of study materials, eview books, pretests, audio CDs and USMLE web-based question bank access.

 

• Marshall University Medical H.E.L.P Program

FOR STUDENTS WITH DOCUMENTED LEARNING DISABILITIES OR ADHD

For more information visit http://www.marshall.edu/medicalhelp/ 

 

(from the website) The Marshall University Medical H.E.L.P. Program began in 1986 with a vision of helping medical students and physicians with learning disabilities and/or ADHD succeed academically. Since that time, Marshall Medical H.E.L.P. has worked with approximately 600 students from across the United States and several foreign countries.  A five week intensive course is held four times each year in January, March, June, and September, with individual one on one sessions available the rest of the year.  Throughout the intensive program topics such as reading and comprehension, reading rate, learning strategies, memorization techniques, test-taking skills, error analysis, and self-esteem are targeted for improvement.  

                                                                                                                                     

This 5-week course is held four times a year:  January, March, June, and September. 

USMLE Step 1 Resources Guide

There are probably as many more websites and books available than those that are listed here. If you find a book or website that you find helpful, please send it on to me so I can include it in our list of resources. Remember that you can easily get overwhelmed by using too many resources as you study, so pick out the few that seem to work best with your style of studying and learning and go with it. What works for one person may not work for another, so be careful about using a book just because someone else said it worked for them. Try it for yourself – if it doesn’t fit you, move on to something that does.


For online question banks, review books, etc.

• www.usmlesteps123.com
• www.usmlerx.com
• http://www.exammaster2.com/wdsentry/ttuhsc-1.htm
• www.score95.com
• www.boardprep.net/stepone.html
• www.apextesting.com

BOOKS

• NMS Review for Step 1
• High-Yield Pathology
• Step Up: A High-Yield, Systems-Based Review for USMLE Step 1
• USMLE Step 1 Recall: Buzzwords for the Boards
• High-Yield Comprehensive USMLE Step 1 Review
• Kaplan QBook
• First Aid Cases for USMLE Step 1
• USMLE Step 1 Secrets
• First Aid Q&A for USMLE Step 1
• Goljan’s Rapid Review of Pathology
• Robbins Review of Pathology
• Princeton Review USMLE Review
• Blueprints – Step 1 Q&A
• Appleton & Lange USMLE Step 1
• Platinum Vignettes (Elsevier)
• Rapid Review Series - USMLE Step 1

Beginners Guide to USMLE Preparation

Here’s some advice from Kaplan’s Judy Schwenker:

1. Take a comprehensive test to begin as a measure of where your recall is right now. Use the Kaplan diagnostic test if you have taken it.
2. Once you know your percent correct score for each subject, use this information to decide the relative amount of review time to put into each area. For example, if Physiology is 20% lower than Microbiology, you should be spending at least 20% MORE time reviewing Physiology than you put into Micro.   
3. As you begin to review a subject, look over some questions on the material before you start to review. This will help keep you focused on what is important to know and show you how you will need to use the information on the test.   
4. As you move through the material, create your own condensed summaries of the key material so you can review these right before test day. 20-30 pages per subject is a decent size to shoot for, because otherwise you will end up taking too detailed notes and they won't help at the end.  
5. As you finish a subject, use QBank to create and take a test with maybe 50 items from each subject that you have completed up to that point. So if you have finished Anatomy and Physiology, you would do a 100-item test under timed, test mode assessing those 2 areas. By the end, you will be taking long practice tests under test conditions that cover all the completed subject areas. This helps keep the earlier material in memory, and gives you a more accurate picture of your preparedness. It also gives you good practice for the mental stamina and pacing needed on test day.  
6. Plan time during the final 2-3 weeks to do nothing but review your own summaries and take increasing numbers of simulated test modules of 50 items each under timed conditions (one hour per module). This is the final "get it all fresh in mind, build mental stamina, and intensive test practice" phase, which should lead right up to 2 days before your actual test date. Our experience has shown that students who are doing 70% or better on our full- length simulated exams (or comparable practice tests created with Qbank or IV Qbank) by their test dates DO PASS, so this is a good level to aim for. You may also choose to take one of the NBME tests to get a predicted USMLE score. If you do decide to do this, be advised that based on feedback I have gotten on the board, Form 1 seems to be the most reliable. 
7. Don’t study anything the day before. Plan something fun and mindless, because study within 24 hours of the exam actually hurts your ability to recall from earlier reviewing.