Mind On Med Ultimate Guide to Studying for USMLE Step 1 and COMLEX

A couple of months ago I asked a few of my favorite online medical students to answer a few questions about their experiences preparing for Step 1 and COMLEX. They gave me some very insightful answers, so I wanted to share them with you. This post is simply to create a comprehensive answer to the question we all have as second year med students, holymaterialexcessiveness how do I even begin to prepare for this? Believe me when I tell you that these 4 students have amazing advice & guidance. I’ll answer the same questions from my point of view in another post. For today, though, let me introduce you to my guests:

            

Step 1: June 14            Step 1: June 24             Step 1: Early June         COMLEX 1: May 27

Blog: APM                   Blog: MD2B                  Blog: Lancet                 Tw: @endlessrant

Tw: @astupple             Tw: @grecoa3               Tw: @michaelbmoore

 

I’m ecstatic with my score.

 

I am very happy with my score. I originally set my goal around average – which is 220 or so. After taking a few practice tests, I realized I could aim a little higher and ended up surpassing the new goal as well. I used this score calculator online. It factors in UWorld, NBME, and practice questions to give a score estimate and I found it very helpful for setting my goals.

In general, I am very happy with my score. It wasn’t perfect, but it wasn’t ugly either and really, unless you are shooting for something super-competitive, that should be your goal. The test is a reflection of how serious you are and the effort you are willing to put into a task, but it is also a measure of your ability to answer arbitrary arcane of standardized multiple choice questions on a specific day in May, June or July. For me, it’s like running a marathon in under 4 hours – not going to get you into the Olympics. It’s my best. In retrospect, that sounds like a total rationalization, but hey…it’s my rationalization.

Yes & No. Going into the exam I had determined a score range that I would be happy with. My actual score ended up being the literal bottom of that range. When I got my score, I started laughing. One point less & I would have been in tears. So yes – I’m happy, but (as always) I would have liked to done better.

 

No formal prep classes. My school had a week of formal review in late May provided by one of the prep companies with a wonderful live lecturer. I was happy with it and the videos provided with it were good, but if you hadn’t done a lot of prior prep-work it wouldn’t have saved you.

Doctors in Training. I highly recommend it. I was reluctant to use it, because it’s essentially a guided tour through First Aid, but it really keeps you going at a fast pace for 15 days (the length of the program).

 

I used two books: Goljan Pathology and First Aid, and supplemented with the classic textbooks from each supporting discipline. Goljan Pathology is not for everyone, but it is worth taking a serious look to see if it suits you. I found it ideal because it was clinically applied pathology, written with STEP 1 in mind. I did all of USMLE World, taking time to read through the explanations. Also, I listened to the Goljan audio recordings of his STEP 1 review several times through during the year to learn pathology in general.

I predominantly used First Aid for Step 1 and UWorld question bank. I also used specific books for weak areas – Rapid Review Biochemistry, BRS physio (super high-yield) and Microbiology Made Ridiculously Simple.

Book: First Aid for USMLE Step 1 Resource: Kaplan Q-Bank (on PC/Android/iPad). A note on Qbanks, your choice of Qbank is not as important as your discipline in using them. If you are a MSII you should be deep into a Qbank – start as soon as you can and use it often. A month with the best Qbank is not going to make up for lost prep time.

First Aid for Step 1 + Saverese OMT Review = The complete COMLEX study package. Practice Questions – COMBank & COMSAE

 

I studied non-stop for five straight weeks after second year was over. Prior to that I thoroughly read through Goljan and First Aid once with friends as a study group before the end of second year classes. We started this before Christmas break, meeting roughly once a week. The group wasn’t a huge time investment and it paid off tremendously because, when full-time studying came, I knew where to look to sharpen areas that I’d become rusty on.

I ended up studying for 4 weeks and a few days. After formal lectures ended the school gave us a maximum of 6 weeks to study for the test. I tend to get distracted very easily when I’m studying, so I knew that a schedule would be important to keep me on track. I would wake up around 7 and get to the library by 8. I would study until lunchtime, when I would walk back to my apartment and grab some food and take care of other errands. I’d get back to the library around 1 and study until 5 or so, when I usually took a class at the gym. At night I’d eat dinner and do a set of practice questions out of UWorld, and get to bed around 11 or so. I used a systems-based approach to studying. Our curriculum was systems-based, so it made sense to me to review the material the same way I learned it in the first place. I didn’t even start studying for the USMLE until our last class ended in May. Instead, I focused on the coursework and doing well on my tests, since these covered each topic more in depth than Step 1. You only have a few weeks to study before the exam, which isn’t nearly enough time to re-learn everything from the start of 1st year, so learning the material well the first time through is key.

 My school did not give me time to prep – our classes ended a week before our mandatory live prep course. I tried to get 2-3 hours of prep a day regardless of my class schedule. I would use the review materials/Qbank pertinent to the organ system/specialty we were studying at that point. It’s not as hard as it sounds.

I started studying concurrently with classes in January 2011. This might seem early, but I consider myself a slow reader & my weakest subjects were biochem & micro (2 BIG subjects & sections of FA). I used the Taus Method where you annotate each section of FA using a review book. Study time varied by week & topic I needed to cover, but I aimed to put in 4 hours/week of board prep on weekdays & at least 4 on the weekends. I then studied for 2 weeks after classes ended. During that time I’m guessing I studied 10-12 hours/day.

 

The day before the test, I broke the rules and did some reading. Personally, I feel more relaxed just reading stuff. That way, I don’t have to convince myself that it’s okay not to do any preparation. I’m not a hyper-focused person who’s too neurotic to relax, it’s just that I prefer to read over material rather than not.

I still had some questions left to do in UWorld, so I finished them early in the day. I spent the day packing to go home for a few days, cleaned my apartment, hit the gym, and went to bed early.

I reviewed my ultra-high-yield/most commonly asked questions…Brachial Plexus, Dermatomes, Cranial Nerve Exams, Characteristic Drug Side Effects/Reactions. Mainly for nerves and to give me something to do.

I got a massage, ate a great lunch, watched Inglorious Basterds & reviewed FA. Everyone says “Don’t study!” I disagree. Don’t try to learn anything new, but do set a cut off time – mine was 6pm. I went to bed at 11pm.

 

Take some time preparing a lunch that will be tasty, you’ll actually want to eat, and that’s easy to store in a 1 cubic foot nonrefigerated locker. Figure your lunch out the day before and don’t forget napkins and all that. Also, pay attention to what foods make you tired an hour after eating and avoid those.

I took the exam early in the morning (it’s an 8 hour exam). I recommend taking lots of sugary snack and caffeinated drinks, because it’s a marathon of a day. The exam has a tutorial section and a lunch break built in, but you can skip both. I wouldn’t skip the tutorial, because there are a few ways that the test software differs from the practice tests. Also, the lunch break can be split up. I took breaks in between each of my exam blocks to stay fresh.

Bring snacks, one for each break and your own water. Sounds dumb, but make sure you do it. Make it tasty, but not too tasty, with a good mix of complex and simple carbs (Power Bar). If you need caffeine, re-caffeinate at lunch. A day long test is as much a physical challenge as a mental one.

Make sure to have a snack during your breaks. You won’t be hungry during your break, but you will be 15 minutes after it ends.

 

The one thing that I regret is not taking more full-length practice tests. I don’t think I ever sat for 8 hours straight during my preparation and the fatigue definitely got to me on tst day. I consider myself kind of tough, used to working 8 hour days and longer, but I was surprised at how my focus was off. If I were to do it again, I would have done two or three 8-hour practice sessions, just like the regular test day; get up at 6AM, make a quick breakfast, and then go to a room and do nothing but questions for 8 hours. It sounds awful just writing it, but considering all the work invested, this time developing test stamina might have had a big impact. Last comment: I would seriously consider not taking ANY notes or doing ANY highlighting. Just read and do questions. Your brain is amazing, and trying to force it to remember stuff with notes and highlighting just gets in the way.

Most of my classmates took about 5 weeks to study, and began Monday after our last final exam; this gave them a week or so afterward to travel and relax before third year began. Hands down, the best decision I made was taking a week off to go on a trip BEFORE I started studying. Most of my classmates thought I was crazy, but when I came back I was fresh and relaxed. My other biggest strength when it came to studying was that from the beginning I wouldn’t let myself get freaked out by what everyone else was doing – some friends would literally do nothing but eat, sleep, and study. I didn’t get bent out of shape about it, because I just can’t study that way. I made sure to take time for the gym, and my favorite TV shows. I took weekends off from studying and did fun things. I think it helped keep my mind clear and stress level down.

Great question. I waited until January before my test to make a freaked out OCD schedule for my prep. I wish I had done that sooner.

QBanks – if you are only taking the COMLEX, a 3 month subscription to COMBank is all you need. The questions are indicative of what’s on the actual test. If you think you want to take the USMLE as well, then stick with UWorld & get a 1 month subscription to COMBank. Take a practice test. There are several available on the NBME website for $50 each and they are definitely worth it. They are made of retired questions and it is exactly how the actual test will be (but only 200 questions instead of 400). My suggestion is to take one about 2 months before your exam so you have a baseline & then another 1 month before so you can see how you would do on a real exam. The downside to the COMSAE is that you don’t get an answer key. They score it for you & give you a breakdown, but not explanations so they aren’t really helpful for learning – just assessment. I took 2 & my actual COMLEX score was 60 points more than what COMSAE predicted.

What Is USMLE Step 1, Anyway?

I’ve been tweeting things like USMLE, Step 1, ginormous exam, boards and ohmygoshimfreakingout a lot lately and today it occurred to me that a good number of my followers are not in medicine and may have absolutely no clue what I’m talking about. I wrote a little about USMLE in my Medical Education in the US post, but I thought I’d share a bit more detail about the reason behind why I won’t be tweeting next Friday, as I’m sure my absence will be painfully obvious (addicted, me? oh, stop it).

Original Photo Courtesy of Flickr Creative Commons User: WaltStoneburner

United States Medical Licensing Exam – Step 1
There are 3 Steps taken over the course of one’s medical education, the first, which is what I am about to take, is after your second year* of medical school. This exam is basically a final over what you learn your first two years.

Cost:

$525 for the exam itself, additional if you take a review course. Most choose to take some sort of review course, but not everyone. A good chunk of my classmates chose Doctors In Training, which is basically as inexpensive as they come at $770 (or approximately the amount of money I have spent on caffeine and ibuprofen in the past 6 weeks).

Length:

322 Questions divided into 7 blocks of 46 questions
60 minutes alloted per block, 15 minutes for tutorial, 45 minutes for break time
Total – 8 hours

Subjects:

  • Anatomy
  • Biochemistry
  • Histology
  • Physiology
  • Neuroscience
  • Psychiatry
  • Genetics
  • Pathology
  • Microbiology
  • Pharmacology
  • Molecular Biology
  • Immunology
  • Statistics
  • Epidemiology
  • Medical Ethics

Scoring:
Passing: 188
National Average: 221 with a Standard Deviation of 24 (for 2010 test-takers)

So, you just have to pass, right? Right.


Well, kind of…


We are required to pass in order to progress on to third year, this is true. However, the score on this exam is heavily weighted for residency applications. There are a lot of other things that go into residency apps but…let’s just put it this way…Step 1 is not the one you want to blow.


When you finish Medical School you do a residency in your chosen specialty…assuming you are accepted into it. Here’s some average USMLE Step 1 scores for US Seniors accepted to various residency programs in 2009:

  • Dermatology – 242
  • Family Medicine – 214
  • Emergency Medicine – 222
  • General Surgery – 223
  • Obstetrics/Gynecology – 220
  • Orthopaedic Surgery – 239
  • ENT Surgery – 241
  • Pediatrics – 219

Average scores will obviously vary from program to program, with those affiliated with bigger name hospitals and research institutions tending to have averages that are a bit higher.

The problem with quoting all these averages and determining the score you “need” from them is that most second year medical students have no idea what they want to go into and, to avoid not being competitive for something they end up enjoying, are under a lot of pressure to get the best score possible (which, I mean, we’re medical students…I think it’d be safe to say we’d all put that pressure on ourselves even if we were planning to graduate and become Stay-At-Home-MDs).

So, that’s what I’m up currently up against and it’s also the reason I’ve been using Twitter to study with other nerdy med students by tweeting things like “Acid Fast organisms, go!” and discussing everyone’s responses. So, if you’re not a geeky medical nerd in your 2nd year of med school and you’re still following me come June 17, thanks, you’re kind of awesome.

Next Friday, while my sister-in-law is delivering our brand new little niece (with the help of a talented Obstetric surgeon who was likely sitting right where I am not so long ago), I’ll be clogging my external auditory meatuses (quick med geeks, name the associated embryonic structure!) with squishy earplugs, parking my rear in a chair for 8 hours and praying that my contact doesn’t fall out**. Happy thoughts welcome!

Now, if you’ll excuse me, I have some studying to do…

Original Photo Courtesy of Flickr Creative Commons User: Wysz
*Some schools have recently gone to a slightly different schedule, where the first 2 years are condensed to 1.5 years…I’m not sure when they take their exam).

**True Story: My contact fell out the day of my med school interview at the school I now attend. I had to leave the presentation (being given by the Dean of Admissions, no less) to go to the admissions office and find someone to take me to where all the interviewees luggage was stored. Then I had to shift through 40 people’s stuff to find my suitcase, rummage through random clothes & shoes until I got to my extra contacts (look at me thinking ahead – extra contacts, check) and then find a bathroom so I could wipe the scary black streaks created by mascara and contact solution off my very red cheeks.