1. Making Your Step 1 Review Effective
January 14th, 2015
Scott Robertson
Regional Medical Programs Director

2. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

3. Program Decision Making
Specialty
Mean US Med scores (2009) Matched
Years of residency
Mean hrs/ week
Schedule type
Salary range
Family Medicine
213 (214) 3
52.5
Uncontrollable
$175k-$220k
Psychiatry
214 (216) 4 48
Controllable
$173k-$248k
ObGyn
220 (219) 61
$251k-$326k
Pediatrics
221 (219) 54
$160k- $228k
Emergency Medicine
223 (222) 46
$239k-$316k
Anesthesiology
226 (224)
$331k-$423k
General Surgery
227 (224) 5 60
$284k- $383k
Neurology
225 (225) 55
$408k (median)
Internal Medicine
226 (225) 57
$184k- $231k
Pathology
226 (227) 45
$239k- $331k
Transitional Year
n/a (236) 1 -
Orthopedics
240 (238) 58
$397k-$600k
Diagnostic Radiology
$377k-$478k
Neurosurgery
239 (239) 6
$287k- $637k
Otolaryngology
243 (240)
53.5
$245k (median)
Dermatology
244 (242)
$313k-$480k
Plastic Surgery
249 (245)
$275k-$499k
Another reason why your USMLE score is important is because many of you won’t discover your real passion until clerkship, which is after you have taken the Step 1 exam.
So lets take a look at some specialty data…..
You can see your salary range, Your mean hrs of work per week and years of residency
What I want to look at now is the Mean Us Med score that matched in So going back to my earlier point that you won’t discover your real passion until clerkship, lets say right now you are dead set on a specialty in Pediatrics. You love kids, you have nieces and nephews and cousins they smell good an make you feel warm and fuzzy inside when they sing the Smurf song.
You have done your home work and you know that the match score for Pediatrics in 2011 was a (221). You know that the overall U.S Senior score that matched in 2011 was Your goal is to achieve a 225.
After your clerkship you have now decided that you no longer like kids and you don’t want to have any of your own any more. But you really enjoyed your time in Plastic Surgery and General Surgery, you have a new found love of having surgical knife in your hand.
Your 225 may not get you into those specialties. You want to obtain the highest score possible to ensure you have the opportunity to choose the specialty you want to make a difference in and not have your score choose for you.
I know it’s a lot to think about. I’m going to now tell you that you can and will succeed. It will take hard work and planning.
So I want to try and change how you view the USMLE Step 1 Exam. It is no longer your first 2 years of medical school condensed into 322 questions over 7 hours of testing period. If you look at it this way, it can be overwhelming and seem like you just have to give it your best shot and what happens. It is an important exam and the great news is that you can conquer it.
Instead I want you to envision the Step 1 exam as a Big Pink Elephant, wearing a poka dot bikini. For you visual learners I’ll help you out. [Click Slide]

4. Program Decision Making
Specialty
Mean US Med scores (2009) Matched
Years of residency
Mean hrs/ week
Schedule type
Salary range
Family Medicine
213 (214) 3
52.5
Uncontrollable
$175k-$220k
Psychiatry
214 (216) 4 48
Controllable
$173k-$248k
ObGyn
220 (219) 61
$251k-$326k
Pediatrics
221 (219) 54
$160k- $228k
Emergency Medicine
223 (222) 46
$239k-$316k
Anesthesiology
226 (224)
$331k-$423k
General Surgery
227 (224) 5 60
$284k- $383k
Neurology
225 (225) 55
$408k (median)
Internal Medicine
226 (225) 57
$184k- $231k
Pathology
226 (227) 45
$239k- $331k
Transitional Year
n/a (236) 1 -
Orthopedics
240 (238) 58
$397k-$600k
Diagnostic Radiology
$377k-$478k
Neurosurgery
239 (239) 6
$287k- $637k
Otolaryngology
243 (240)
53.5
$245k (median)
Dermatology
244 (242)
$313k-$480k
Plastic Surgery
249 (245)
$275k-$499k
Another reason why your USMLE score is important is because many of you won’t discover your real passion until clerkship, which is after you have taken the Step 1 exam.
So lets take a look at some specialty data…..
You can see your salary range, Your mean hrs of work per week and years of residency
What I want to look at now is the Mean Us Med score that matched in So going back to my earlier point that you won’t discover your real passion until clerkship, lets say right now you are dead set on a specialty in Pediatrics. You love kids, you have nieces and nephews and cousins they smell good an make you feel warm and fuzzy inside when they sing the Smurf song.
You have done your home work and you know that the match score for Pediatrics in 2011 was a (221). You know that the overall U.S Senior score that matched in 2011 was Your goal is to achieve a 225.
After your clerkship you have now decided that you no longer like kids and you don’t want to have any of your own any more. But you really enjoyed your time in Plastic Surgery and General Surgery, you have a new found love of having surgical knife in your hand.
Your 225 may not get you into those specialties. You want to obtain the highest score possible to ensure you have the opportunity to choose the specialty you want to make a difference in and not have your score choose for you.
I know it’s a lot to think about. I’m going to now tell you that you can and will succeed. It will take hard work and planning.
So I want to try and change how you view the USMLE Step 1 Exam. It is no longer your first 2 years of medical school condensed into 322 questions over 7 hours of testing period. If you look at it this way, it can be overwhelming and seem like you just have to give it your best shot and what happens. It is an important exam and the great news is that you can conquer it.
Instead I want you to envision the Step 1 exam as a Big Pink Elephant, wearing a poka dot bikini. For you visual learners I’ll help you out. [Click Slide]

5. This is the average number of years you’ll be spending practicing in the specialty you Match to, a little over two years from now. A lot of factors influence what specialty you match to, but your Step 1 score is one of the biggest factors.

6. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

7. First Step: Understand what you need to know and do in order to solve USMLE questions

8. Step 1 Evolution Single Jump, 1980’s
Which of the following is the drug of choice for a patient diagnosed with oral thrush?
A. Amphotericin B
B. Fluconazole
C. Griseofulvin
D. Ketoconazole
E. Nystatin

9. Step 1 Evolution Double Jump, 1990’s
A 28-year-old HIV-positive man complains to his physician of a recurrent whitish film that seems to grow on his tongue and oral mucosa. A germ tube test is positive. Which of the following is the drug of choice for this patient?
A. Amphotericin B
B. Fluconazole
C. Griseofulvin
D. Ketoconazole
E. Nystatin

10. Step 1 Evolution (Triple Jump, today)
1. What is the diagnosis (based on a clinical scenario and laboratory interpretation)? Oral thrush
2. What is the drug of choice? Nystatin
3. What is the mechanism of action of nystatin? It complexes with ergosterol and causes membrane leakage. [ANSWER B]
By the way, this is also an example of a visual question, of which there are more and more on the USMLE. (Visual questions may include Diagrams, CT scans, Path slides, Tables, etc.) Multimedia questions have recently been added (a total of 5 per exam, so not extremely worrisome). Such questions will link to an audio or video clips, such as a heart sound or lung sound, or a video of patient exhibiting cogwheel rigidity. Examples of these clips are on USMLE’s website. Kaplan’s Qbank also features a small number of A/V questions for practice [coming Fall 08.]
So the moral of these three slides is that you may have a good handle on certain basic science information (i.e., what drug is used to treat oral thrush); but the format of the exam questions as they are currently written require you to integrate your knowledge among various disciplines to solve a clinical vignette. Multiple conclusions must be drawn, and a misdrawn conclusion anywhere along your chain of logic will result in an incorrect answer. Note that the majority of questions on the exam are double and triple jump questions. Incorrect answer choices are known as “distracters” and are there for those that misread one or more key elements in the question.
Answer = B

11. Step 1 Evolution (Triple Jump, today)
A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities. Furthermore, she is having a more difficult time recalling the names of common objects. He states that he often finds her wandering around the house with an “absent” look on her face. Which of the following structures is most likely affected in this patient? A B C D E F
A 72-year-old woman is brought to her physician by her husband. He states that she is having trouble recognizing her grandchildren, and is having increasing difficulties in the planning and executing her daily activities. Furthermore, she is having a more difficult time recalling the names of common objects. He states that he often finds her wandering around the house with an “absent” look on her face. Which of the following structures is most likely affected in this patient? A B C D E F

12. Using my Kaplan Step 1 Qbank and other programs EFFECTIVELY!!
Effective Prep
Establish a S.M.A.R.T plan
Spaced Repetition
Active Learning
Question Practice
For Effective Prep you have to establish a S.M.A.R.T plan:
A SMART plan is:
Specific – Measurable – Attainable – Realistic – Timely
Know the Who, What, Where, When, Which and Why of your plan.
Proper study breaks, proper nutrition and yes Proper sleeping habits
Spaced repetition – learning small pieces of information over longer periods of time.
Active Learning - Putting into practice what you just learned. Put it in your own words.
Question Practice – Use exam like questions
Using my Kaplan Step 1 Qbank and other programs EFFECTIVELY!!

13. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

14. To excel on (not simply “pass”) your exam…
Set up a strategic study plan and stick to it
Anticipate that questions can present the basic clinical sciences in a different format than you are typically used to seeing
Review the material in ways that mimic current question demands
Study actively, not passively
Build in tactics to minimize forgetting key information
Focus on understanding, not just memorizing
Know the USMLE testing software by appropriate use of Kaplan diagnostic, Qbank, and sim exams

15. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

16. Getting Started… or Planning Ahead…

17. Speak the Language: Build your test question vocabulary
Glossary of Terms Frequently Used in Test Questions
Term Definition
Abolish To do away with, to eliminate
Absolute value The distance from zero, disregarding + or - sign
Abundant Plentiful, numerous
Account for Explain, justify
Acquire Get, obtain, gain
Acrid A sharp taste or smell
Adjacent Near or next to
Aggravate Irritate, make worse
Alter Change, modify
Amenable Changeable, yielding, pliant
Amplify Enlarge, make bigger
Apparent Visible, evident
Arrest To stop, check or hold
Attenuate To weaken or reduce in force or amount
Attributable to Result from, be caused by
Bear To support, hold up, endure, show or exhibit some feature
Causative agent Cause
Cessation Discontinue, end
Cloying A too sweet smell or taste
Coalesce To grow together, combine as one thing
Comprise To include or contain
Concomitant To accompany or occur at the same time, along with
Concurrent Same as concomitant, but associated with time
Confer To give

18. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

19. 5 + 1 common EARLY preparation mistakes
1. PASSIVE studying – wholly focused on content review or video review or curriculum notes review…
2. Insufficient or INAPPROPRIATE practice with questions
MEMORIZING content, but not understanding
MISREADING, misinterpreting questions
DEVELOPING inappropriate test day strategies
INSUFFICIENT exam-like question practice

20. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

21. The ACTIVE study cycle for all subjects…
Analyze
Remediate
Self Test

22. Review Actively…from the start!
Make summary notes of key aspects
Color code to cluster and highlight similarities/exceptions
Use diagrams and charts to summarize key data
Do questions before and after reviewing
Know “most commons” and “hot topics”
Change study modes frequently to refocus your attention
Use Qbank properly
Work with a question partner
Consider other Kaplan online resources to offer a fresh view of Step 1 topics you find difficult

23. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

24. Use Your Qbank Properly
Begin using timed mode as soon as possible
Cover answer choices initially to focus on question stem information
Look at why, not just what you missed when testing
Look for patterns among your errors, then adjust study to minimize these errors
View questions as a guide to what content to focus on and how to store the material in memory for easier application to questions
Avoid thinking of practice test scores as a judgment on your intelligence
Keep mixing in items on content reviewed previously to better retain and to adjust to random nature of real exam

25. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

26. Try Question Partnering
An activity that can help you identify habits that are costing you points on exams
A nice change of pace from solo reviewing
An opportunity to learn new approaches to solving questions
A chance to provide these same benefits to your partner
An ACTIVE learning technique!!

27. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

28. How many questions is “enough?”
Too many too soon wastes questions and may reinforce incorrect beliefs about the depth / difficulty of the Step 1 subject material
Too few too late will not adequately prepare you for test day – cramming suppresses learning!!
Sources:
Kaplan Step 1 High Yield, Step 1 Qbank, Step 1 sims (2), a 2nd Step 1 Qbank (min. 1 month)

29. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

30. Create an Effective Study Plan
Get organized TODAY!!!
Note important spring school dates and deadlines
Schedule review tasks around those dates
Self-assess TODAY!!
Hard to know where you need to go until you first know where you are starting from! Online Kaplan Diagnostic is your answer!! DO IT – NOW!!
Integrate use of study resources TODAY!!
Print materials like the First Aid pages
Online resources like Qbank, NBME assessments
Interactive resources, e.g. classmates, med advisors

31. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

32. Using Extra / Vacation Time
Link review of 1st year content to topics of current course lectures, such as systemic Pathology
Use extra / vacation time to review 1st year content that doesn’t easily link to current classes WHAT?!?!
Begin using USMLE-style questions at exam pace ASAP
Note problem topics revealed by testing for extra attention once 2nd year classes end
Where will you go for fresh questions for use in final prep period -> Kaplan Sim exams!!

33. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

34. Organize Yourself After 2nd Year Classes End

35. First 2/3 of remaining time:
1. Take first overall assessment early (Kaplan sim #1), rank order
subjects by test results!
2. Complete planned review of all Step 1 subjects!
3. Final subject content review occurs in weakest to strongest order!
Final 1/3 of remaining time:
1. Cycles of practice testing --- identify weak spots - review these
again to refresh + clarify!
2. Refresh highest yield topics + rote during final 2 weeks!
3. Take final overall assessment (Kaplan sim #2); plan last week of
review!
No study the final afternoon and evening before exam day!!!
Allow for final assimilation and accommodation processes!

36. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

37. Final Review - KEY POINTS
Self-assess comprehensively (sim #1) approximately 1 month to six weeks before exam date
Allocate final # days to spend per topic based on sim #1 results, as shown below
Take simulated exam #2 approximately 7 to 10 days before exam date; review completely for final most challenging study review
Optional: take NBME self-assessment ($50 – 4-hour exam)
Assessment Scores
Study Sequence
# FINAL Study Days
Anatomy
70% 7 2
Physiology
45% 1 5
Biochemistry
60% 6 3
Behavioral Science
75% 8
Pathology
50%
Microbiology
Immunology
Pharmacology
55% 4
Plan your last month of review carefully—this is CRUNCH TIME: Your last month of study will go by very quickly, and it’s going to be challenging. This is now the time to re-assess your performance with a diagnostic or simulated exam, and how many days you’ll allocate to each subject
Use your assessment results to guide how you’ll allocate your time.
Ideally the sim exam should be taken 7 days prior to test day, allocating 1 day for taking the exam under test-like conditions and 1 day for reviewing the exam.

38. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

39. Plan Your CURRENT & LAST Month Carefully
Questions* should drive you BACK to study SPECIFICS!
Content
Questions
T o t a l S t u d y T i m e
EXAM
DAY
During your last month, it’s important to remember the proper relationship between content review and question review. After your self assessment it’s time to review content, using questions to help you narrow down remaining weaknesses so that you can continually narrow your focus on the subjects needing further study.
Topical
Question Review
Test Simulation
*Questions do not TEACH…they “TEST!” Always remember that!...

40. Questions* should drive you BACK to study MORE!
*Questions do not TEACH…they “TEST!” Always remember that!...

41. “Whether you believe you can, or you can’t, you're right.” Henry Ford

42. “We estimate that we will see domestic production of medical school graduates functionally surpass our current number of GME postgraduate year one pipeline positions by 2015 or sooner.”
Source: Dr. Thomas Nasco, CEO of the Association Council for Graduate Medical education 41
52.5 78
225
765
2015
Source: New England Journal Of Medicine (

43. NRMP Program Director Survey Results (2014) Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Source: 2014: NRMP Program Director Survey Results (2014). National Resident Matching Program. p. 3

44. Thank you for your attention today! What are your questions?
Scott Robertson
Regional Medical Programs Manager