Friday, January 30, 2009

25 Things You Should Know About Your USMLE Step 1 Exam Day

Preparing for the USMLE Step 1 exam is quite stressful. By the time exam day rolls around, your head is jam-packed with all sorts of facts and mnemonics. Who has room for basic logistical details? Here are some things I wish I had known about the exam day before I actually took Step 1.
  1. Map out the route real well the day before. If you can, drive out to the site beforehand. Keep in mind that traffic patterns might be different in the morning.
  2. Eat a good breakfast. 
  3. The test center I went to was set up with a lobby with lockers with a small hallway that connected to the two rooms with computers where I actually took the exam.
  4. Items that you CANNOT bring into the testing area (the rooms with the computers) are: cell phones, PDAs, calculators, watches of any type, pagers, recording or filming devices, radios, coats, jackets, head wear, gloves, book bags, backpacks, handbags, briefcases, wallets, books, notes, written materials, scratch paper, food, candy, gum, or beverages. No iPods!
  5. However, you can store these items in the lockers provided. The lockers to keep your stuff are pretty small (1 cubic foot). Don't bring more than you need to.
  6. Be prepared for any temperature. 
  7. Wear layers. If it is cold, you'll be fine. If it is warm, you can peel the layers off. On my day, the room was easily 85 degrees F because the A/C in the building had broken down.
  8. Wear comfortable clothes and shoes
  9. You cannot take your own earplugs, although this rule might have changed.
  10. If you wear contacts, you might want to consider wearing your eyeglasses instead. Remember, you're going to be staring at a computer pretty intently for 7 hours. 
  11. While you can bring a book to study during the breaks, don't! This will just stress you out even more without really adding anything to your test-taking skills. 
  12. Do NOT look up answers to questions you're unsure about during the break. What's the point? If you got it right, nothing changes. If you got it wrong, it'll distract you the rest of the day.
  13. If you really must bring something, try First Aid for the USMLE Step 1, Pharmcards, or some general review sheets. 
  14. You have an hour of break time, but do not feel you need to use all the time up. The sooner you get done, the sooner you can get out of there and celebrate!
  15. There's a lot of time wasted at the beginning, photographing you and signing you in.
  16. Make sure to bring a passport, driver's license, or other government ID to sign in!
  17. You'll probably see a few familiar faces and a few unfamiliar ones. You can try making small talk if you want, but most people are not really up for it.
  18. The proctors really have no idea about any of the Step 1 test content. 
  19. The room itself is filled with only computers, chairs, and test-takers. There are proctors, but they typically sit outside the room, and monitor the examinees view closed-circuit camera. 
  20. Not everyone at the test center will be taking Step 1. On my day, I saw an intern I knew taking Step 3 for example.
  21. Pack a light lunch, something that does not need any special heating or storage. I think I had a Coke, PB&J, and some fruit. Water would probably be a better choice, but I like Cokes no matter what colas do to my kidneys!
  22. Don't expect to be done with Step 1 before 5pm, but some people are able to finish as early as 3pm.
  23. If you can, arrange for someone to pick you up after the test. You'll probably be somewhat fatigued and it's nice to not have to worry about driving, especially through rush hour traffic. 
  24. The test bulletin states "There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends," but in reality, they can either wait in that lobby area or just outside in the parking lot. The "they" should be one person though. Celebrate elsewhere after you finish!
  25. Any other concerns? Check out the USMLE Step 1 2009 Bulletin or links to other Step 1 resources including other examinees' experiences.

Tuesday, January 27, 2009

How To Relax While Studying For USMLE Step 1

Studying for USMLE Step 1 can be quite a stressful experience. Medical school up to that point has been all about structure. Your professors tell you what to read, how to read it, and when to regurgitate it. Although everyone procrastinates, they at least have some framework by which to judge how far they have procrastinated. Then, all of a sudden, Step 1 rolls around, and the structure disappears. You have several weeks of dedicated 'study time', but how to use it effectively? Deciding on a USMLE Step 1 study schedule in some ways is the most important part of your overall USMLE Step 1 study strategy, moreso than figuring out which subjects are important, or which qbank to use

However, what is often easy to overlook when making that schedule is to budget time for relaxing. I could quote random statistics here about the importance of relaxing, but I'll spare you - just know that your studying will be more effective the more relaxed you are. As with anything, you must be balanced in your approach, but I think all too often medical students err on the side of relaxing too little rather than too much. 

But Scrub, you say, I feel stressed when I try to relax because I know I should be studying! Well, it happens, but to combat that "relaxation guilt," I suggest doing something I like to call productive relaxation. The idea here is to find things that you find relaxing that are simultaneously also productive in another manner. Below, I'll go through some ideas for productive and non-productive relaxation. 

Productive Relaxation

This was probably my favorite way to relax while studying for Step 1. I built in an hour or so every evening to work out. Exercise is clearly productive by itself, and the benefits were quite plentiful. First, it got me away from the desk and up / active. I also used to meet up with friends, so it let me socialize. Studying for Step 1 is quite a sedentary and solitary activity at times, so this killed two birds with one stone. Furthermore, when I returned to my desk later that night, I often felt refreshed and revitalized. Although I like playing basketball, my first choice of exercise was often running on a treadmill, watching TV. It's easier to schedule and be more consistent about this kind of exercise. If you can, try to get a treadmill that faces a TV which you can control totally. If so, just pop in your favorite TV show or movie on DVD, start running, and lose yourself in what's happening on-screen. Heh, or for the more hardcore of you out there, I suppose you could get those Goljan podcasts and listen to those as you run, but if that's your idea of relaxing... shoot, you need more help than I can offer! Doing simple exercises in your room can also be helpful. I think I got an abs ball around the time of Step 1, and I imagine a yoga mat couldn't hurt either. With these, just pop an abs workout or yoga workout DVD into your laptop, and you can do a quick workout to burn off some stress in between qbanks.

I am not a cook by any means, but I do think Step 1 studying was the first I started to think about teaching myself to cook in a more serious way. Cooking is clearly productive, as you make yourself a snack or meal. The action helps you take your mind off of your studying, and you end up learning a valuable skill. Plus, hopefully you end up with something yummy at the end! If you want to try a few very, very simple recipes, might I recommend trying:
For the more adventurous, check out the bestselling cookbooks on Amazon.

Organize / Clean
While I am definitely not a Type-A neat freak, I do see the value of an organized and clean workspace, especially when you are studying for a major exam like USMLE Step 1. Using a study break to clean and organize is a good way to take your mind off of the books for a while, and end up with a clean work area. I know I went out and got a nice silver / metal desk rack to help organize the papers on my desk, which has served me well. Another item that some may find useful is a book stand, like this one which is designed for textbooks: Fellowes Book Lift Copyholder. While I typically do not use one, one of my friends who's an MD/PhD does, and he seems to really like it.

Non-Productive Relaxation

Listen To Music
While I was exercising, if nothing good was on TV and I was sick of Goljan, I would listen to music. I often listened to music during the lighter parts of my studying as well. It's pretty easy to just crank up the LINK iPod and take little breaks when songs you like come on. Everyone has their own taste in music of course, but I think one way to judge how much you like a song is its "overplay" rating. Basically, the rating is the number of times you have to hear a song before it is overplayed. A song which will never be overplayed for you is a "Hall of Fame" (HoF) song. Some of my HoFs are:
Heh, given the nature of the rating system, some of these may drop off the list down the road, but give 'em a listen, maybe you'll find something you like.

Hang Out With Friends
Heh, not too much to this one, but it's definitely relaxing =)

Take A Nap
Now, naps can be a dangerous thing, but a well-timed 10-20 minute power nap can do wonders for your energy level. I would actually recommend only using this one when absolutely necessary, and not really building naps into your routine, but I think it's good to know when to take a nap and not just force yourself to blindly continue studying at 8pm when it's too early to really sleep but you just feel that tired. Studying for USMLE Step 1 is a draining process at times, so just letting go and letting your mind wander for a few minutes can be quite beneficial to your overall studying effectiveness. When in doubt, nap it out?

Hope you found some of these ideas useful. Even if you did not, I hope you find something that helps you relax while you study, and I hope you really do take it to heart that it is OKAY to relax while you study for USMLE Step 1!

Wednesday, January 21, 2009

How To Register For USMLE Step 1

This is a guest post by Medliorator, editor of

Registering for USMLE Step 1 is a multi-step process that will take up to two weeks. After the initial registration on the website, you will have to have your school's registrar verify your enrollment and good standing. Only after the verification will you be able to schedule your exact test location and date. In order to ensure you get your ideal location and date, it is suggested that you begin this process three to six months prior to when you want to take USMLE Step 1. 

What You'll Need To Register For USMLE Step 1:

  • Social Security Number
  • Visa / Mastercard number and expiration date
  • 2 x 2 photo of yourself

How To Register For USMLE Step 1:

1) Click "first-time user" at NBME's examination services website.

  • Enter SSN, idenitification, and medical school information
  • Enter your name as it will appear on the identification card you intend to bring with you to the test

2) NBME will email an ID number & temporary password.  Write down your USMLE ID# somewhere for reference.  Login to the examination services website with the temporary password.  Click Apply for USMLE. 

3) Skim the first page, check the box at the bottom of the page (Check this box to certify …therein), and click NEXT.

4) Follow the instructions, and have a Visa/Mastercard ready for the $495 registration fee.

5) Print a 2 x 2 picture of yourself as well as the Certification of ID and Authorization Form.

6) Affix the photo to the form, and check the appropriate box above the signature field at the bottom before signing.

7) Turn the form in to your medical school's NBME official or registrar.

While awaiting the next step, bookmark Prometric's website as you'll likely visit them later when the time comes to select a testing date.

Medliorator is the editor of, a content aggregation service for self-improving medical students

Sunday, January 18, 2009

My USMLE Step 1 Study Strategy

I've been busy traveling for residency interviews, but I figured I should take some time to talk about my own strategy for studying for USMLE Step 1. While others have already posted study guides, I figured I would add my own two cents in, not because I have any revolutionary new ideas on how to study for the Step, but rather because I think there are a few suggestions I have that could make things a bit more efficient for you. Although I took the exam in early 2008, I feel this advice will be quite applicable for those of you taking USMLE Step 1 for years to come (haha, until they change the exam structure up, as they always do about every 10 years).

Before I get into this, I should note that I am simply describing my own experience and what worked and did not work for me. I hope you take away something useful from it, but do not feel that there is only one way to study successfully for the Step. Everyone comes into this with different strengths and weaknesses, depending on their medical school's basic science education as well as their own aptitude and experiences. Everyone also has their own learning style: some people are visual learners; others, aural. Another thing that people are less likely to admit, but is clearly true: while we all want to score well on the Step, not everyone shares the exact same goal as far as their score goes. Read as much advice as you feel necessary, but do what feels right for you, first and foremost. As for general advice on what subjects to study and how to budget your time, I feel these have been discussed quite well elsewhere, so check out 21+ Online Resources for USMLE Step 1.

Kaplan Test Prep (

My Daily USMLE Step 1 Study Schedule

If you do look at other sites, you'll see there are various study guides for people who have 4, 6, or 8 weeks to study for the exam. What some sites don't mention though is that the hours you're willing to study per day matter as well. Some people can go 8 hours straight; others can only be highly productive for an hour or two. Personally, I aimed to do three 3-hour chunks per day. I'd study one topic from roughly 9am to noon, take an hour break for lunch, study from 1 to 4pm, take 2-3 hrs break to exercise and eat dinner, then do practice questions from 7 or 8pm until I felt tired. Some days were better than others, but I think I averaged around 9 hrs a day, which seemed appropriate to me. I also took a half day or whole day off each week to catch up with friends and family. It is key to schedule in breaks in order to maintain your health and sanity. Jam-packing your schedule with unrealistic study expectations will only demoralize you later on when you cannot keep up.

My Six Week Strategy For USMLE Step 1

Due to the structure of my school's curriculum, in theory I had up to 10 weeks to study for the Step. However, in reality I probably spent about 7.5 weeks studying, and really peaked around the 6th week and plateaued after that. Sometimes I wonder if my score actually went down due to that extra 1-2 weeks of studying just because of burnout! Anyway, based on the general advice for Step 1 I found online as well as talking to upperclassmen friends who had recently taken the test, my basic strategy was to read through First Aid for the USMLE Step 1 in order to get comfortable with all the general topics covered in the exam. Some students try to start studying by picking a topic area and delving into it. 

I understand the rationale behind this, but the reason I avoided it is that there is so much information out there, you easily start to feel overwhelmed as you study one area, which leads you to become demoralized. By studying First Aid initially, not only did I get a general refreshed on all the major topics covered on the exam, but I also felt more comfortable in judging the depth to which I needed to study particular subject areas. Since the questions on the exam are integrative, having reviewed all the subjects was often helpful when I took practice tests, as I got more questions right as compared to studying one subject alone, which helped build my confidence. I budgeted about a week for this, which was sufficient for me.

After going through First Aid, I prioritized each major subject area covered in Step 1, and covered them week to week, starting with the subject I was least comfortable with, biochemistry. As I mentioned above, I'd spend about 6 hours per day studying the subjects, and then spend the rest of the time doing practice from Kaplan Qbank and then later on, USMLE World. While I do not want to belabor what subjects to study and how much they appear on the exam, I feel that in general, memorizing First Aid in its ENTIRETY and doing LOTS of practice questions from one of the qbanks is sufficient to get a great score on the Step. You don't need any fancy combination of books or vast detailed knowledge about esoteric zebra diseases. Just know the basics really really really well. That's it! But, of course, no one would feel comfortable studying just one book and doing questions so we all use other resources. If you're interested in the books I found useful, check out Books For USMLE Step 1.

Prep for the USMLE with Kaplan Medical! Enroll Today

I repeated this pattern of studying for particular subjects for about 6 weeks, but I made sure to reserve the last week before the exam to go through First Aid again. Doing so really helped solidify all the material in my mind. Also, as I had been taking notes in First Aid as I did review questions, I had a much richer resource to study from during that last week, and did not have to waste time hunting for notes in other resources. The day before the test itself, you really should try to just relax, watch a movie, hang out with friends. If you really feel the urge to study, just do some light review in order to calm your nerves and build your confidence. Do NOT try learning tons of new things. The rapid review section at the back of First Aid is good for this in my opinion.

The USMLE Step 1 Aftermath

After taking the test, I felt pretty good about my strategy and I think it prepared me well to answer most of the questions on the exam. There is no perfect strategy out there, and the test will always throw some real curveballs at you. But, don't worry, many of these questions are experimental and will not affect your actual score. Focus on answering the questions you know you should be able to answer and you'll sail through. The best part about taking the Step is that no matter how the test went, you have a great reason to CELEBRATE afterwards! All those weeks of hard work will have paid off. Go out and reconnect with all those parts of your life you put on hold!

If you have any specific questions about how to study for the Step, feel free to comment below or contact us.

Updated 2015-12-18

Monday, January 12, 2009

Which USMLE Step 1 Qbank: Kaplan or USMLE World?

After my last post discussing tips for using Kaplan Qbank for USMLE Step 1, I realized that a major dilemma I had before even using the qbanks was: Which qbank should I use to prepare for USMLE Step 1?

The qbanks I looked at all had fairly similar features: 2000+ questions, data / trending to let you track your performance, FRED-like software that simulates the FRED software used during the exam, and more. With all these features looking the same, how does one choose between them?

Prep for the USMLE with Kaplan Medical! Enroll Today

Well, my first thought was to ask friends and upperclassmen who had taken the exam already and had used qbanks. Not a bad idea, but I soon realized that most people had used one qbank, liked it, and didn't have time to use another one. Since the qbanks were pretty much the same, the Kaplan users would recommend Kaplan, the USMLE World users would recommend USMLE World, the USMLE Rx users would recommend USMLE Rx, and so on. However, since very few people had ever tried out the other products how could they truly give good advice about which one was better?

Another way to approach the problem was try to figure out who had scored well, and then use whatever product they used. There are two problems with this though. First, people aren't always willing to tell you their scores, so how would you know if the advice is coming from someone who truly benefited from the software or not? Second, if someone scores well, you cannot tell if they did so because the qbank really helped them, or because they are just that smart and would have scored well regardless of which qbank they had used.

After thinking through all this, I ended up buying both Kaplan and USMLE World. I structured my time so that I would definitely get through at least one of them (in my case, Kaplan), and then tried to get through as much of the other on as I could in the time I had left before my Step 1 exam date. Because I actually used both qbanks, I think my perspective is relatively unique.

So, which one did I like better? Honestly, both products were good and lived up to their advertised features. The main differences I noticed were:
 interface and question style. 

Interface: While both employ a FRED-like system, Kaplan's interface is Web/Flash-based. It looks more polished than USMLE World, but sometimes the highlighting / strike through functions can be a bit buggy. The USMLE World program requires a separate program that you download onto your desktop and then use outside your browser. It looks less like the actual FRED software in terms of user interface, but functions more reliably if you want to highlight or annotate.

Question Style: This is the main difference between the two qbanks. The Kaplan qbank tends to have more esoteric questions. Either the questions focused on relatively rare diseases, or the question would focus on very small details about commonly tested diseases. Depending on your study style, this could be either a positive or negative. I liked the fact that such exposure broadened my knowledge base as well as forced me to learn things that I thought I knew well to an even greater degree, but sometimes I knew the degree of detail was much more than I needed to know for USMLE Step 1. The USMLE World questions were "easier" and more straightforward. The style was more similar to what was on the actual exam, although I felt the questions were a bit longer than the real test. That being said, I don't think I broadened my knowledge base as much with USMLE World since it did not cover those rare diseases as much.

If you're interested in checking out either product, Kaplan costs $109 for 1 month, $149 for 2 months, and $189 for 3 months. USMLE World costs $99 for 30 days, $135 for 60 days, and $185 for 90 days. You can get both for up to 6 months for more money, but honestly you will not really use it effectively for more than a 3 month time span (and really, just 1 month). To try Kaplan, check out their 10 question sample USMLE Qbank Challenge:

Prep for the USMLE with Kaplan Medical! Enroll Today

For USMLE World, go to their website: USMLE World Step 1 Qbank.

Do you have any more questions about specific features of either Kaplan Qbank for USMLE Step 1 or USMLE World Step 1? If you already have taken the test and used these products, what was your experience?
Updated 2015-12-18

Thursday, January 08, 2009

Kaplan Qbank for USMLE Step 1 Tips

In the last post 21+ Online Resources For USMLE Step 1, I mentioned that I would try to avoid duplicating information that was already out there on the net. However, I noticed that, while many sites advocate for one question bank (or "qbank") or another, less advice exists on how to maximize your learning when you are going through a QBank. There is more to it than simply clicking the right answers!  Most of these are common sense, but hopefully they will be useful.

Many students use a qbank to help quiz themselves prior to taking USMLE Step 1. The most popular ones I know of are Kaplan Qbank, USMLEWorld, and USMLERx (by the writers of First Aid for the USMLE Step 1). The tip below will work with any of these, but since I used Kaplan Qbank, I'll use it as an example. This post is not intended to be a full Kaplan QBank review, but more of a guide on how to get the most out of the qbank.

The Kaplan Qbank contains roughly 2200 questions in 50 question blocks. The blocks can be taken according to subject, or with the questions in random order. For Step 1, be aware that the questions will be in random order. Each 50 block section must be completed in one hour, as is the case with the USMLE Step 1 blocks. Some people preferred to study a subject, and then do review questions on that topic. I preferred to do random question blocks, as it simulated the real test, and helped me keep touch with older material. I also worried that doing subject blocks would give me a false sense of security, since I had just studied that same material.

Prep for the USMLE with Kaplan Medical! Enroll Today

Regardless of your study style, the key here is to budget an extra 60 to 90 minutes for each block after you complete it. Don't just look at your score, but instead, take the time to look at the detailed explanations for each question regardless of whether you got it correct or not! Then, make sure to annotate First Aid for the USMLE Step 1! This is KEY! Doing so diligently every day that you study will give you a comprehensive review guide by the time the your USMLE Step 1 exam date rolls around. Furthermore, if you store tidbits of information in one place, it makes it MUCH easier to look up later. Otherwise, you will waste a lot of time trying to review information in multiple resources. Think about it: by the time you get through all your studying for Step 1, you will have consulted at least 3 books frequently, and probably 7-10 more books as well. How will you remember where that crucial explanation was written? Ah! If you had just written it down in First Aid, you'd know where it is!

Hope that helps! If you don't have a QBank already, check out the Kaplan QBank Challenge, which is a set of sample questions:

Prep for the USMLE with Kaplan Medical! Enroll Today

In my next post, I will address the pros and cons of the two qbanks I had direct experience with, Kaplan Qbank and USMLE World. Got any other tips for USMLE Step 1 or using qbanks?

Updated 2015-12-18

Sunday, January 04, 2009

21+ Online Resources For USMLE Step 1

Before embarking on writing a huge USMLE Step 1 guide, I decided to ask myself: what online resources already exist for USMLE Step 1? I recalled looking for stuff online, and I knew I had previously written about books for USMLE Step 1. However, in the past, when I went looking for resources, I searched in a very focused, found what I wanted, downloaded it, and forgot about the rest of the internet.

This time, I didn't want to reinvent the wheel and write all about a test I already took when others may have already done it for me. And, lo and behold, they have. However, the information is all over the place, so hopefully this post will help by categorizing this stuff. The categories are: USMLE Step 1 Guides/Forums, USMLE Step 1 Mnemonics, USMLE Step 1 Links, USMLE Step 1 Books, and USMLE Step 1 Online Resources (ie miscellaneous links). Most links are self-explanatory, but in some cases, I'll leave a comment so you know what I think of the site/contents.

USMLE Step 1 Guides / Forums

USMLE Step 1 Mnemonics

USMLE Step 1 Link Pages

USMLE Step 1 Books (Online / Print)

USMLE Step 1 Online Resources
Kaplan Test Prep and Admissions (

Given that so much already exists online on how to study for Step 1 and what books to use, I think I will focus my posts on more specific issues that come up while studying for Step 1, as opposed to how to study for the test itself. You'll find all you could ever want or need in the links above!

Updated 2015-12-18

Thursday, January 01, 2009

USMLE Step Exams And Residency In 2009

Happy new year! I hope everyone had a happy holiday season. As this blog enters a new year, I have decided to try to shake things up. In the past, I posted whenever I felt about topics that caught my eye. However, most of my time was spent in formatting the post, which left relatively little time for commentary. Hopefully you all still found it enjoyable, but reflecting back on how I blogged, I've come to a few conclusions. 

First, much of the information I was blogging about had already been covered ad nauseum around the "tubes." Second, since I posted whatever I wanted and whenever I felt like it, each post seemed fine to me, but taken as a whole, the blog lacked focus. Third, the blog did not have the volume of traffic to justify my style. Some people don't care to be read when they blog, but if so, why post online? You could just write in a paper journal or a Word document, right? So, if I'm going to invest the time in a blog, I should care about gaining readers and providing something valuable in exchange for their time.

To that end, in the coming year of 2009, I am going to focus more on a few main topics. Since many of my friends are taking USMLE Step 1 this year, I will be doing some posts in the next few months, detailing my advice as well as describing my experience taking the exam. For those of you who have already taken Step 1, perhaps you could comment and contribute your insights to help make the posts better. Also, since I will be taking USMLE Step 2 CK and USMLE Step 2 CS in the coming months, I will tackle those subjects as well. Finally, since Match Day looms near, residency-related posts will also likely be put up here. 

Anyway, that's my two cents for the new year. Thanks again for stopping by and reading. If you have any suggestions or ideas for posts/topics (or heck, want to submit one yourself), contact me at scrubnotes[at]gmail[dot]com. Happy 2009!


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