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USMLE, Step 1

It's important to be strategic and purposeful when preparing for the USMLE (United States Medical Licensing Exam), a three-step exam necessary for medical practice.  Step 1 of the exam tests your knowledge of basic science in terms of clinical practice. You succeed with a thorough understanding of the science learned in Phase I of medical school and the ability to extrapolate and interpret key concepts to correctly answer the clinically based multiple-choice questions.

Course notes and textbooks are good first references. Concept mapping or otherwise systematically organizing your notes while learning will help tremendously when organizing your study for the boards. Learning for understanding throughout Phase I is vital. Board review books are a good organizing tool for double-checking that the most important concepts and topics are covered and understood. Working with a compatible study group can also improve deep learning and help with "chunking" of key concepts for better retrieval. Practice test questions as often as possible, using both the book form (such as NMS) and computer-based format (such as Kaplan). Questions should follow the clinical vignette format since that is used by USMLE, but for Step 1 the focus is still on basic science knowledge.   

Your scores on the CBSE/shelf boards can guide your study plans by calling attention to areas where knowledge is weak.  Threshold scores are: CBSE 1--45; CBSE 2--53; and CBSE 3--55.  Contact your faculty advisor with questions about your performance, or make an appointment with Cheri Koinis, Manager, Student Learning Support at 272-8028, ckoinis@salud.unm.edu, or Pam DeVoe, Curriculum Development Specialist, Center of Excellence, 272-1419, pdevoe@salud.unm.edu to discuss your study strategies.

Strategic Study for the Boards

The following comments were excerpted from SOM presentations by Lawrence "Hy" Doyle, learning specialist from the UCLA/Drew Center of Excellence, to MS I and MS II classes, February 10-11, 2004.

Ø     Make a study schedule.  Four months before your exam, lay out a specific study schedule focusing on range of topics (not depth of topics) as covered on USMLE, Step 1:  anatomy, physiology, biochemistry, microbiology, pathology, behavioral science, and pharmacology. Organize study topics according to what's clinically relevant.

Ø     "Spiral" the study material. Look over each topic a number of times. Remember to cover the range of topics, not each topic in depth.

Ø     Track study progress. If you're not satisfied with the progress you're making, especially comparing test and CBSE scores, consider changing your study method to a more effective strategy. Seek advice and monitor you're progress.

Ø     Pair the different content areas when studying to include a fact-domain with a process-domain. For example, study pharmacology with biochemistry; anatomy with physiology.

Ø     Orient your study strategy toward clinical practice.  Review the basic medical sciences with a goal of improving your "clinical reasoning" skill. Preparing for Step 1 can be an excellent overall review of the basic sciences in preparation for the clinical sciences portion of your medical education.

Ø     Study a moderate amount of time (6 hours per day) almost every day (5-6 days per week), rather than saving serious studying for one-two days per week. Study in 50-minute blocks of time with breaks in between to ensure adequate concentration.

Ø     Divide related information into conceptual groups or "chunks" with 4 information bits or less to each. This "chunking" aids memory and retrieval. Review each day.

Test Taking Tips

Ø     Practice positive self-talk. Be aware of what you are telling yourself while taking exams.  When necessary, directly stop the negative self-talk and replace it with positive self-talk.

Ø     Don't change answers. Track and analyze your answer changing pattern using a resource such as Kaplan's Qbank. What percent of the time does changing an answer result in a correct to incorrect response?  Your initial instincts regarding test questions are often correct.

Ø     Create an "error log" to track your pattern of incorrect responses on practice tests and course exams. This will help you distinguish errors due to lapses of content knowledge, misreading of the test question, misreading of the answer choices. 

Ø     "Follow through on your own logic," when answering test questions.

Ø     Recommended process for answering test questions:  Read the "stem" first, then read the answers, then the case study. Practice eliminating one "distractor" answer at a time when doing practice exams.  When you can eliminate all but two answers choose according to your gut instinct.  Read carefully.   Practice with many test questions, become very familiar and comfortable with the style--including the computer based format.

Ø     If you take a full simulated exam, do so at least one month or more before the actual exam. It's a long exam, you want to be energized and ready.

Ø     Remember: Boards are examples of mind-body exams, you should be functioning well to perform well, including rest breaks, good eating habits, sleep, and exercise as well as concentrated studying.

Resources:

• Phase I faculty, and your faculty advisor.

• Pam DeVoe, M.A., Curriculum Development Specialist, Hispanic & Native American Center of Excellence, BMSB B81, 272-1419.  Learning strategies and information on Step 1 review programs. Details of the 2004 Center of Excellence sponsored, USMLE, Step 1 review program will be made available later in fall semester.

• Cheri Koinis, M.Ed., Manager, Student Learning Support (SLS), HSC Library Room 125, 272-8028.  Advice on study skills, time management, and test taking strategies & concerns about test taking. Information on review programs, and appropriate referrals.

• The Office of Cultural & Ethnic Programs (OCEP), BMSB 106, 272-2728. Houses the student library of textbooks and USMLE review materials. Open to all UNM SOM students.

• The HSC library has review books in the stacks, and on reserve. 

October 2003

Contact the Hispanic and Native American Center of Excellence
University of New Mexico School of Medicine
(505) 272-1419

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