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To: The Class of 2013

From: Rich Levitt
Date: December, 2010
Subject: STEP I Preparation


Many years ago a wise student wrote this recommendation on a Survey of Step I for the
following years class:
Make a plan, then work the plan.
Experience continues to verify this as the most important part of preparation for the
USMLE Step 1. Over the years experience shows that most who perform poorly on Step
1 either: did not make a plan or did not use a plan or did not stay on plan.

A plan will bring you lots of peace of mind, for if it is well put together (for you as an individual)
everything will have a place. This will allow you to focus on each day at a time without
becoming unduly anxious about & distracted by areas you havent yet covered.
Probably nobody will have a perfect plan>some things will take moretime& other things less
time than planned, and things happen...thus: A good plan is flexible!

Writing your schedule plan in pencil or using an electronic scheduler* helps to support flexibility
(you can easily add, remove and replacescheduled items). Some students have used a large
white cardboard calendar with self-stick notes for each day...then when a change was necessary
the self-stick was just replaced.
(*check Cram Fighter at http://ww.cramfighter.com which will help create a portable Step 1 schedule for an
iPhone or iPad at a cost of $4.99)
_____________________________________________________________________________
Since everyone has their own individual learning style, and this document presents a number of
different approaches, as you read through this you might want to make notes in the margin or
highlight those portions you may want to use in your own personal plan.
______________________________________________________________________________
For Starters:
The CBSSA Mock Exam from the NBME
This Comprehensive Basic Science Self-Assessment exam is a series of 4 blocks of 48 questions
from the Step 1 question bank (questions probably retired, though some students report having
seen 1 or 2 CBSSA questions verbatim on their Step 1 exam & the scores correlate highly with
actual Step scores from tests taken with a week of the CBSSA).
It provides a performance profile of 19 disciplines and systems in essentially the same format as
that which you would receive after taking the real Step 1.
Of far less importance for CBSSAs taken early in the study period, the profile comes with a standardized score of
Mean=500, SD=100. Step 1 uses a different standard score (it has recently been approximately, Mean=222,
SD=23).
The CBSSA Profile is presented in bars rather than numbers, just as is the Step 1 profile. This is
so because most questions will draw from knowledge in more than one area (e.g., a question on
ACE Inhibitors will count for both pharmacology and cardiology). Because of the performance
profile being integrated across disciplines and systems, it is best taken some time after the
Reproductive exam is completed ( after February 25th). The Expanded Version will give you a




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percentage missed overall, the number of questions missed in each area, and allow you to look
at each missed question per area (the correct answer is not provided, so as a learning tool it is
less efficient than, say USMLEWorld; its key value is as a study/planning tool).

This planning document will assume that you take the CBSSA within a week of finishing the
Repro course as a tool for creating your plan of study...putting more time and resources into the
weaker parts of your resulting profile, and proportionately less time and resource into your
stronger areas (this plan for differential effort must be kept in the context that path, pharm and
micro are typically more represented among test questions than the other disciplines). For
example, if Physiology and GI and Renal were the weakest on your CBSSA Profile (perhaps
with astericks * on the left side), you would plan to spend more time in GI and Renal
Physiology compared to stronger areas-- whether you choose a discipline-based or system-based
review.

A statistical analysis comparing those of the Class of 2007 who used the CBSSA at the start of
their study planning versus those who used it only later or not at all showed that early use of the
CBSSA contributed 6 points (about 1/4 SD) to their Step 1 score.

I will discuss the use of the profiles in more detail in Februarys noon group planning sessions,
one of which you might attend (dates to come later). Of course you should still feel free to
consult with me individually if you are uncertain about how to implement your profile into your
study plan; this profile will allow you to determine how to get the most bang for the buck for
your time and effort.

In addition to using the CBSSA as a study plan tool, many students report that their initial
CBSSA was a great motivator, as it showed them that much had to be done to prepare them for
passing Step 1 and/or achieving the performance level they desired. Here are a few student
comments on the first CBSSA:
Was useful to order my study of subjectsput my weakest first so I had all the time I needed for them.
It was helpful in that it gave me a general idea of the scope of the test & depth of material I would need to learn.
It reinforces the need to studywas a good thing to jump-start my studying.
I got a good sense of what general topics were my weakest
Though it didnt really tell me anything I thought I already know, it did confirm it so I knew it as more objective reality rather
than just in my imagination.

Although you can take this initial CBSSA either timed or untimed...it is strongly recommended
that you take the initial CBSSA untimed, for your purpose early on is to determine the relative
strengths & weaknesses in your knowledge basefor creating your longer-term study plan, not
how quickly you can access that knowledge; taking it in a timed format will at best tell you
what of your knowledge base you can access relatively quickly, but it will not add much to your
insights into the contents of your knowledge base, much of which will increase in accessibility as
you go through your review; at its worst, an early timed CBSSA could confuse measures of your
knowledge, speed of access to your knowledge, your test-taking skills and your test-taking
strategy.
You can spend as much as 4 hours per block of 50 questions in the untimed mode on the CBSSA,
and you can take those 4 blocks one at a time over a period of days or at a single sitting (there are
46 questions per block on Step 1-a few with heart/lung sounds, etc). The medical school will pay
for your initial CBSSA (Form 6) and a later one (Form 7) if you choose to reply to the email
offerings for a free voucher (initial one sent in February, and the second one sent after ICS ends)




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Concern yourself with timing near the end of your study plan, and use of the second voucher will
provide additional information on timing (timed mode) and provide a focus for your final
preparation for your Step 1 test day. Generally, a second or third CBSSA taken timed a week or
two before your test date can reflect: (1) your readiness for your testing according to your
personal score goal (both the strength of knowledge and speed of your accessibility to your
knowledge base), (2) the identity of the discipline(s) &/or system(s) which can give you the
most bang for the buck during your last 7-10 days of study, and... (3) as a timed exam it would
train (set) your nervous system by leaving a memory trace of the pace youll need to work at to
complete a block of questions in an hour or less.
The USMLE also provides a free shorter Sample Test (3 blocks of 46 questions) which you
can use to check and reinforce your timing/work pace a day or two before your test date; along
with the sample test, a Tutorial is provided to reinforce the Fred V2 software systems
keystrokes youll be using on Step 1. The USMLE provides 15 minutes on your test day to go
over this same tutorial, and if you have already done it on your own ahead of your test day you
can use that 15 minutes as additional break time between your test question blocks-- Then the
only thing you will have to do on test day is to check the headphone function (for heart/lung
sounds). You will be able to access this tutorial and Sample Test on the USMLE website at:
http://www.usmle.org/Orientation/2011/Menu.html. Even if you do not do the Sample Test it is
obviously important that you do the Tutorial before going to your Prometric test site.
If at any time you take a CBSSA and want to discuss it with me, please do not hesitate to request
to do so. I want to help you in any way possible, as much as time permits. If you take a CBSSA
form that is not provided by the school through the voucher system, and want to discuss it with
me, please bring a copy of that forms profile with you to our meeting.

_______________________________________________________________

The thoughts and information that follows can help to structure your thinking towards creating
your plan.Use it as a sort of template; it is not possible to create a single plan that works
equally well for everyone. Keep both your self-knowledge & flexibility at-the-ready!

A general principle which should be taken into account for most people:
Repetition for rote memory content is required for long-term memory for most everyone (key
examples: pharm & micro), though there may be a very few of you with a memory talent
(photographic memory) &/or background experience (e.g., pharmacy training or personal
experience) which allows some content to remain for longer-term retention after only one
exposure. Rote memory generally requires 3 or more separate exposures, and is best spread out
over your study periodsome may start Rx or Micro over the Holiday break, then again during
their review plan, and finally the week before their test day

_________________________________________________________________











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A Sample Study Plan: (Be patient with this...there is no simple way to present this with all of
the alternatives and caveats! It is presented here to start to organize your thinking):

1. General Considerations for a Review Plan> DECISIONS! (Details for Scheduling plans
considered later):

Discipline vs System-based Review
Because the Board questions are more & more clinically oriented each new year, and because the
curriculum is system-based, many students use a systems approach.
Because there are more highly rated discipline books available than system books, and because a
discipline approach provides a different perspective than our Organ System curriculum, a
significant number of students work with a modified discipline plan.
Neither approach is necessarily better for you.

For a Discipline-based Review:

Essentially, schedule time to review one basic science discipline at a time (Rote memory Pharm
is usually an exception as mentioned, and a few work with micro in the same way)also some
students prefer 2 disciplines at a time, dividing time each day between the 2 disciplines.
Disciplines include: Anatomy (includes gross, histo/cell bio, embryo, neuro), Biochemistry
(includes molec., fuel ), Nutrition, Behavioral Science (includes Psych with psychopath & Rx
& therapy, disorders, developmental stages, learning theory, Dr-Patient, ethics, law, biostat/epi),
Microbiology, Immunology, Physiology, Pathology, Pharmacology, and Genetics not
covered previously in Biochem or Path (eg., population genetics). These inclusions conform to
the Performance Profile provided by the USMLE to examinees as a part of an individuals
score report, both for Step 1 and the CBSSA.
After having completed all of the disciplines reviews with practice questions you will have also
completed all parts of the systems, and thus you will then work with systems-based practice
questions (and likely cases also). Here is a Discipline Blueprint, step-by-step, that has worked
well for many-- This sequence is for each discipline:

1.Skim First Aid by chapter (e.g., anatomy is the first piece of each system chapter)
2. Skim the relevant portion of the Student Content Survey
3. Read Review Book Chapter after each system piece just skimmed
4. Do Chapter Questions
5. Mark First Aid/Notes from missed questions or questions guessed correctly ( write only what
was needed to be known to answer the question correctly)
6. Repeat steps 1-4 for each discipline chapter.
7. Cases (after a discipline like biochem or after all parts of a system including Path & Rx)*.
8. Integrated Discipline Test after Discipline Completed
9. Mark First Aid or place notes of errors/correct guesses in your notebook.
10. Integrated System Test after all parts of a system are completed (after path & pharm)
11. Mark First Aid/ notes on missed/guessed questions

* Cases are especially useful for practicing J umps (e.g., cover up the diagnosis and J ump to the treatment).






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For a System-based Review:

The system approach conforms to the (2006 -2010) editions of First Aid, Step Up and the
systems in the Performance Profile of Step 1 and the CBSSA. The systems include:
Cardio, GI/Nutrition, Heme/lymphoreticular, Musculoskeletal/skin/ Connective Tissue,
Neuro/Special Senses, Renal/Urinary, Repro/Endo, and Respiratory.

Behavioral Science, Biochem, Micro, General Pharm & General Path, (& often embryo) are
reviewed as disciplines whether doing a System or Discipline approach. You can follow the
Discipline-Based Review sequence as discussed above.

Pharm, Micro, and especially Path/Pathophysiology are commonly disproportionately highly
represented on the Boards; there is much disparity among proportional content representation
between test takers, perhaps partly due to the different ways students cognitively file their test
experiences in memory (e.g., one student may file cardio drug question experiences in their
Pharm memory files, and another might file the same in their Cardio memory files.
Here is a step-by-step Blueprint that has worked well for many:

Reviewing by Systems Approach (SA) (see System Blueprints p. 20)

1. Skim First Aid & Student Survey Anatomy for the system
2. Read Anat. Review Book Chapter
3. Do Anat. Chapter Questions, especially for neuro & musculoskeletal anatomy.
4. Mark First Aid or your notes on missed questions: just what you needed to know to answer
the question correctly)
5. Repeat #s 1-4 for Embryo
6. Repeat #s 1-4 for Physio.
7a. Repeat #s 1-4 for Path & include Histopath pictures contrasted with Histo pictures.
7b. Review Pharm Connections for each path/pathophys disease presentation.
8. Do Pharm Questions for the system (more for Cardio, less for GI for e.g.); mark errors.
9. Do System Cases*ideal questions to practice J umps**
10. Do Integrated System Test (150 or more questions).
11. Mark errors in First Aid or Notebook (just mark/note what you needed to know to answer
correctly).

*some or all of a systemss cases can be done after each system respectively, or after all systems are completed
(depends on your available time).
** Cases are especially useful for practicing J umps (e.g., cover up the diagnosis and Jump to the
treatment).











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Pharm Planning:
The approaches that have predominated for the heavily rote-memory pharm are connected
most often to the pharm cards and/or the pharm listings at the end of each system in First Aid
(see resource Survey from last years MS2s); otherwise, use recent (2008 or newer) pharm
resources, & focus on mechanisms, interactions & adverse effects/toxicities). Whatever
pharm approach used, keep in mind that spaced repetition produces the best memory for such
large quantities of rote memory information.
(sequence your pharm exposures to your discipline or system order; for example, if you will
be doing the cardio system first, review those drugs first; (many will first do general pharm:
kinetics, autonomics, etc. before starting a system.
Generally based on 3 repetitions per class of drugs (1.before their functional area, 2. within
their functional area 4. after all systems/disciplines are colpleted) focusing on mechanisms,
interactions and adverse effects as just mentioned...tied to their clinical use, of course. For 1.
start by memorizing a few drugs in the same class per day (perhaps first thing in the morning
if thats effective for you), & then 2. go over each drug class again when reviewing the
relevant system or disciplines Pathophys./Path or Micro, etc., and 3. review all drugs again
in the last week or two of your review. Be sure to do lots of pharm practice questions,
especially after completing the relevant system/discipline review (e.g., do a USMLEWorld or
Q-Bank cardio pharm test or other cardio pharm questions after finishing your cardio system
review).

If you use the Pharm Cards:

1.) Organize the Pharm Cards in sections for each respective functional area (eg., rubber-
band the CNS drugs for use with behavioral science, & the same for each organ systems
drugs for use with the pathophysiology of each system or discipline respectively, etc.).
2.) Place a mark on those drug cards which are also in First Aid and additionally mark those
cards which are also in theSurvey from last years MS2s). So, for example, each card might
have either an F for First Aid, or an S for Survey, or both F & S, or no marks. Then,
within each functional area organize the cards so that those drugs which have both F and
S marks are on top, those with either F or S beneath the F & S, and those not in
either F or S at the bottom of the cards of that section. This allows you to attend to the
most high-yield Rx info each time you look at a rubber-banded packet.

General Pharm (kinetics, metabolism, dynamics, regulation, etc) can be reviewed at any
point between disciplines or systems in your schedule, perhaps best using either the first
chapters in Lippincott or Lange (Katzung) or whatever you used last year &/or feel
comfortable with; this area can be a useful brain break between systems or disciplines (as to
rest your brain, not break it!).

Of note>Few students have tried to study pharm as an isolated discipline (like Biochem or
Physiology) and none have recommended it as an isolated discipline study



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Considerations for Scheduling your Sequence of Disciplines/Systems
Generally there are 3 major issues often considered in planning the sequence for a
study/review scheduleconsider:

1.) If there are scheduled faculty reviews you would attend, you would ideally want to try to
place as many of your reviews as practical around the time of the faculty reviews for
concentrated focus & memory reinforcement. If a review doesnt fit when you want it, you
can of course catch it afterwards via podcast.

2.) If a discipline naturally connects to another in sequence (e.g., physiology naturally
precedes pathophysiology/pathology, and Path naturally precedes or connects with the
appropriate pharm), then you can place it at the right connecting point.

3.) If you can distribute the more conceptual / less memory intensive disciplines (e.g.,
behavioral science) so that they act as a sort of change-of-pace (e.g., you might put
behavioral sciences Biostat/Epi, or General Pharm, or General Path between 2 more
intensive areas of yours (a brain break!).



Important Note on using First Aid: First Aid is a well organized presentation of facts most
likely to be tested, but it is generally not a book for reading/teaching, for the facts are not
generally presented in a conceptually connected format. Where conceptual connections such
as found in reading/teaching formats is not needed (pharm is a good example), First Aid is
fine by itself. Otherwise, you should use a review resource which provides understanding and
connections. Most Step 1 questions will require an understanding of the hows and whys,
not just the whats.




Discipline or System Scheduling: General Thoughts

Within the approach you use you will have to work out the level of scheduling detail you will
be comfortable with. Although a Plan appears to be necessary for everyone, the format and
level of your plans detail, the sequence of content in that plan, and the varying amounts of
time allotted to the plans parts can vary significantly from person to person (...different
strokes...).
Here are 3 examples of progressive detail scheduling:
1.) One student may schedule 6 days for physiology-- (no detail specified in the plan)



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2.)Another will want to be a bit more detailed and thus schedule 2 chapters a day in, say BRS
Physiology--
3.)A third student will want an even more detailed plan and thus, for example, schedule Cell
Physio from 3:00-6:00 p.m., dinner from 6:00-7:30 p.m., Cell Physio questions from 7:30-
9:00 PM., etc.
(I am sure you get the idea!)


Time Lines*

* This is about an 8-week sample plan, starting from Sunday, February 27
th
(ay before start
of ICS) and running until about April 17
th
; this allows April 18
th
-April 23
rd
for a test day and
an R&R breakdepending upon whether you schedule closer to the 19
th
or the 26th. Expand
or contract your plan to fit your scheduled test date and personal needs &/or wishes.
Last year 70% of students originally planned a week off (R&R) following their test &
before Pre-Clinical Week began, but after taking another CBSSA about a week before their
originally scheduled test date, about 1/5 of them moved their test date closer to the start of
Pre-Clinical Week. Other situations: Others may not want an R&R break planned at all- &
some others may prefer planning small breaks of, perhaps 3 week-ends completely off. Of
course your CBSSA profile and your self-perceived strengths and weaknesses may result in
time lines significantly different from the examples youll see sketched here. Also, different
thoughts on study schedules will be available from the MS3s at the J anuary 7
th
meeting.

Remember...some will put in more time, some less time than what follows...
Time legend (A full day = 10 hours : e.g., 8-11 AM, 1-5:00 PM, 7:30-10:30 PM). If you
chose a shorter day, adjust accordingly.

This may be a bit too detailed for many, but:
4 weeks of Study Days during ICS + One 3-hour day on your Clinical Procedures day
(only evening study that day) and 7- hour days for the other 4 weekdays (4 hrs. afternoon/3
hrs. eve. Weekends = 10 hours total (all in one day if you take a full weekend day off).
This provides the equivalent of about 16.5 study days during ICS based on the 10-hour
day, and about 20 study days during ICS based on an 8-hour study day. Note: Attending
Board Review Sessions is included here in the study time)

4 weeks of post-ICS Study Days based on six 10-hour days per week (two 3-hour and one
4-hour sessions per day and one day off per week). This provides four 60-hour
study weeks after the conclusion of ICS; this could reflect 3 weeks leading up to a final
CBSSA about 7-10 days prior to your Step 1 test day, and using this CBSSA profile to
plan your last 7-10 days.

_____________________________________________



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As mentioned early on, take your CBSSA at the completion of endocrine/repro... the weekend
before ICS begins...
_____________________________________________

1. Summary of a General Plan for the period from the start of ICS through to the 7-10
days prior to your test day: review your disciplines/systems during the first 6 weeks , then
do a second CBSSA, 2.) Put some extra attention into the weaker areas on the 2
nd
CBSSA,
3.)do integrative practice questions, 4.) review First Aid &/or your notebook which now has
your condensed notes gathered from your practice questions errors & uncertainties during
your completed review weeks, 5.)continue with your repetitive rote memory tasks for Pharm
and Micro, and 6.) do 1 or more integrative timed blocks of 50 questions on World (or Rx or
Qbank or etc.).
6.) Finally a brief stint a day or 2 before your test da: ~1/2 day, with the USMLEs 2010
Tutorial and timed Sample/Practice Test on the web at:
http://www.usmle.org/Examinations/practice_materials.html
You can also read/print out a pdf version and also look over a content outline at:
http://www.usmle.org/Examinations/step1/step1_content.html (Remember, the content outline
does not specify what is high yieldFirst Aid and the Student Survey do that !)


2. Create your calendar:
Start to fill in your calendar (...create one, buy one (e.g., cramfighter.com), use a PDA, use a
large white poster board with stick-ons, or make copies from one of the weekly calendar
sheets you can pick up in the Book Room or from me; when you receive this document in
hard copy there is a weekly calendar sheet attached to the back you can use to make copies.
Within each week you will have afixed schedulefor: ICS / SDL (most report totaling ~3
hrs./day), Clinical Procedures, meals & sleep, exercise, board review sessions you intend to
attend... whatever you need to do daily. Many write in that afore-mentioned hour of pharm
before ICS each morning, but that is not part of the scheduled hour plan sketched above.
You can put all, some, or of course, none of this on a calendar/schedule, but what you do
want to do is to have your study schedule mapped out leaving enough time to take care of
your necessities.

By the way, it can be a good idea to set aside scheduled phone time (after dinner? Before
bedtime?) and let your friends/family know when that is so that you can look forward to that
time and not find incoming calls or thoughts of making calls a distraction from your study
concentration.

This kind of calendar helps reduce the distraction connected to a kind of anticipatory angst
as students think of areas not yet covered, for everything will have its place on your
calendar. (so perhaps if while studying your cardio system you find yourself worrying about metabolic



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pathway problems that connect to Maple Syrup Urine Disease you might just say to yourself, I will get to that
when I study amino acid disorders in my metabolism study plan schedule, now back to my cardio focus.)

As mentioned earlier, plan to begin each discipline/system with a look-over of the relevant
high-yield topics in First Aid and the Class of 2012's Survey in the discipline/system you
are about to review >so that when you begin your review of that topic you will be able to
recognize what is most likely to be high yield and therefore worth extra effort/time as you
review in your resources. Remember you want to get the most bang for your buck, and your buck is
your time & energy investment in preparing for Step 1. Whenever possible, do this for each part of a
discipline/system, not for the whole all at once. For example, you would look over First
Aids carbohydrate metabolism before reviewing it, then look over proteins before reviewing
that area; most find that memory usually works best--the knowledgeis more digestible-- in
this framed fashion.



4. Keep a notebook (computer or hardcopy)or First Aid handy throughout to jot down topics
or facts you judge need more time than the amount of time you have planned will allow.
This permits you to keep moving on, keeping close to your plans schedule and avoiding
getting tied up. Practically speaking, remember that, for example, facts like intracellular
fluid is 2/3 of total body weight will never be worth more than 1 point on the boards, and
might not be on your boards at all, whereas the 6 complications of atherosclerosis have
multiple discipline connections (i.e., multiple point score possibilities) and are thus worth
more time and effort. ((In the scheme of things, how much time is a factoid worth? >move
on!)). Your plan reminds you to move on, and your notebook or notes added to First Aid
assures your doing so safely. It can be helpful to remember that you will not be expected to
be a Nephrologist or a Cardiologist or... etc. at this level of your education...this is Step 1, not
your certification exam!

5. As you work your way through each of your review books, you will recognize the high
yield info (from First Aid and the Survey) and can place extra effort/time on those pieces
relative to the rest of your review. When you finish a disciplines or systems review & have
the time, go back through First Aid and the Survey to be sure you covered all of the high-
yield info for that area; look up elsewhere anything high yield you need to know but didnt
find in your review resource (No single review book is perfect).

6. It is useful to reminds everyone that it is not just memory that is required for strong
performances...remember that you need to know the hows and whys --the concepts-- not
just the what and which (as students say every year, You have to understand, not just
memorize). In this context:
After your review of each system & / or discipline you may want to go over First Aids
Cases for the USMLE Step 1, or you can save them for your last 7-10 days review period.
They are useful to work with by yourself or with friends. These cases prepare you well for



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the JUMP questions you will encounter. In addition to First Aids Cases, the UCV
Pathophysiology volumes I, II, III can be used in the same way; UCVs are briefer & less
conceptual in their presentations, but also can be used in a shorter time period, especially in
connection with your Path review, or if you find you have extra time near the end of your
review period.

7. After each review chapter be sure to allow time to do some przctice questionsthese
allow you to work with and reinforce what you just learned (25-30 questions may suffice in
most cases (fewer in Anatomy, more in Path, for example). Should you be unable to find
enough such questions let me know and I will suggest additional places).




8...after you have completed a discipline or system review take a comprehensive exam in
USMLEWorld or Q-Bank (or at the end of BRS or in A&L or NMS or...) integrating that
discipline or system (anat., embryo, physio, pathophys/path, pharm), and of course go over
the explanations for all questions you were uncertain of or answered incorrectly. Add notes
to your First Aid / notebook as the explanations reveal holes in your knowledge or things
you might worry about forgetting; this will free up your mind to move on to the next area as
you will have scheduled time to review these notes after completing all of your
system/discipline reviews (during your last week or two). Remember, some scores carry
more weight (among disciplines, Path is usually #1, then Pharm, Micro and Physio; among
systems last year: cardio, renal, and then repro/endo). Do maybe twice as many practice
questions for weightier areas. As far as systems go, be aware that on any individuals Step 1
exam cardio or GI or behavioral or_?_ might outweigh the rest since each person is drawing
questions from a very large & integrated Step 1 question bank.



Sequence of Disciplines

Some more choices are necessary...
Often students do Anatomy >gross-(histo) cell bio-embryo-neuro) and Biochem first as
they are the least recent; the last 2 are usually Physio then Path, with some fill-in of
Genetics after completing Pathology (like population genetics, pedigree analysis, etc.). The
vast majority have found it best to skip histo as a separate review and instead pair it with
pathophysiology/histopath since all or nearly all such questions with pictures are on the
Pathology side.

Micro & Pharm, being large rote memory disciplines, might for some be remembered best
with a minimal outside info load between your study of them and taking the boards. So




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doing micro just before or right after physio & path may work well for many. As noted
earlier, Pharm is too big to save for itself as an isolated discipline except for General Pharm
(kinetics, etc); Pharm has to be spread out, and general pharm can be done anytime.

Dont forget to schedule a comprehensive pharm exam after finishing Pathology (Discipline
approach) or after your last system (SA approach); of course, continue to schedule a later
pharm re-review during your last week.


FACULTY REVIEW SESSIONS & ADDITIONAL SEQUENCING CONSIDERATIONS:

With attendance at review sessions as part of your scheduled review time, planning
to look over First Aid or/& the Survey of gross anatomy notes prior to that review, then
attending the review, then doing some topic review questions after each section (e.g.,
questions after musculoskeletal, questions after peripheral nervous system, etc) and going
over First Aid and taking a practice comprehensive gross anatomy exam after all areas are
completed... is all many students do for disciplined-based Anatomy. If you plan to watch a
podcast (e.g. an anatomy review) plan to scan the high yield information before watching
the review. As mentioned, saving Path reviews til later in their review period is
generally more effective allowing review normal processes before the pathological.

Considering all areas of Behavioral Science together, it is a significant weight on
Step 1, but each of the parts can be reviewed in isolation from the others, and thus, as with
General Pharm or General Path, can be used as cognitive breaks for a day or 2
throughout your review. Dont forget to plan a comprehensive Behavioral exam after
the last part is reviewed...just as you will schedule a comprehensive Pharm exam after
the last system is completed.
Since Path is a keystone- an integrator- for the Step 1 Boards, it is well worth all the
time you can give it-- so plan no shortcuts with Path! A useful way to bolster your Path is to
add a couple of hours of practice questions after each system using questions from among:
usmleworld, Qbank, Utah WebPath (http://www-
medlib.med.utah.edu/WebPath/webpath.html), and of course Robbins & Cotrans
Review of Pathology (challenging questions and with pictures & good didactic
explanations), as well as the end-of-chapter questions in BRS Path. Robbins questions are
generally harder than Step 1, so dont worry if you dont perform as well with Robbins as
with any of the others...you will still learn a lot.
Dont forget to do some pharm questions with each path system review (e.g.,
Cardiopharm with Cardiopath). Remember that the First Aid Cases & UCV
Pathophysiology can be especially valuablefor any system & path areas on your CBSSA
Profile which may be asterisked (*) on the left (weak) side of your profile.

Genetics is not presented as a separate discipline in First Aid 2010. Most of
genetics will have been covered in your Biochem (molecular & genetics), Path, & Micro
reviews. Many students may therefore most efficiently save Genetics for last); review those




13
sections (especially molecular), take a comprehensive genetics exam on usmleworld or Q-
bank or PreTest Biochemistry & Genetics (choose topics from the Table of Contents) and
of course Robbins. Lippincotts Biochemistry also has some useful review sections with
some good questions, and a new book, BRS Genetics has what appears to be a good set of
comprehensive questions at the back of the book (a few folders of these questions are
borrowable in the Book Room).



Below is a SAMPLE 8-week schedule for a Discipline Review:
(Remember, that this is not one size fits all!!!)

Notes: although personal time off is not included in this schedule, consider setting
aside the equivalent of a day each week for your self...you might take a whole weekend day
off, or Friday night, Saturday afternoon and Sunday morning, etc.
Also, scheduled exercise time can be a big aid to reduce tension and make your
energy level more manageable internally.
Dont forget to consider using the hour before ICS each morning to review Pharm,
as its not included here as a part of your daily review time, but is a useful first exposure for
your memory development so that when you review the actual area involved it will be a
second exposure; e.g., if you were to review anatomy first and micro second, youd start
with the anti-microbials in the mornings while reviewing anatomy.
Keep in mind that this review time is a review and not your first exposure, and thus a
prime goal of the review is to bring what was learned long ago back into your
accessible/working memory


A DAY Here = 10 STUDY HOURS (Adjust to fit your own needs/wantstime & resources). The detail for
these daily activities in each discipline are found on the Discipline Blueprint on page 21.

Days 1-4: Anatomy (1 day Head & Neck, 1 day musc/skele, 1 day cell bio, 1 day embryo,
Review sessions) with First Aid and the student survey (note: consider planning to
incorporate histo pictures later with your path -histopath-review )
Day 4-5: World/Qbank or xxx Step 1 comprehensive anatomy exam:150+questions
Days 5-7: Neuroscience (as above, First Aid/Survey, review, relevant casesend with
150 questions and repeat with disciplines below).
Days 7-9.5: Biochemistry (as above with cases-- & dont forget Nutrition!)
Day 9.5-10: Biochemistry exam:100 +questions
Days 10-14.5: Behavioral Science +CNS Pharm (3 days psych & CNS Pharm,1 day
biostat/epi) ( day ethics/law & Dr/Pt. ; (Exam adequately covered in the BRS 132 MCQ
Comprehensive Exam at the back of BRS); remember, Behavioral areas can be pieced over time,
but should end with Comprehensive Exam).
Day 14.5-15: World/Qbank Behavioral &/or BRS Comprehensive (150+MCQs)
Days 15-16: Immuno +relevant pharm




14
(maybe Consider adding General Pharm review (kinetics/dynamics/etc), say an hour or 2 most
days during the next week.)
Day 16.5-17: Comprehensive Immuno exam (100 MCQs)
Days 17 -21: Micro (Bugs n Drugs with at least 2 days bacterials, the weightiest area)
Day 22: Comprehensive Micro Exam (150+MCQs)
Days 23-27: Physiology
Day 28: Comprehensive Physio exam (150+MCQs)
Day 29: General Pathology (include 30+ MCQs in Robbins by chapter)
Days 30-36: Pathology +pharm by organ; Goljan or BRS and consider WebPath with pics,
Robbins MCQs; you can also add histo pictures (Wheaters or WebPath, etc) along with
histopath, though it may not be critical to do so.
Day 37: First Aid Path review..possibly using some First Aid Cases or UCV
Pathophysiology.
Day 38: Comprehensive Path exam: 75 MCQs at the back of Robbins, &/or BRS, Q-Bank
(150+questions)
Day 39-40.5: Review all Pharm (especially Micro, CNS, etc)
Day 40.5-41.5: Comprehensive Pharm exam (150+MCQs)
Day 41.5-42.5: review Genetics not covered to date, then take a comprehensive Genetics
practice test (100 MCQs)
Day 42.5-44: Review your notes or First Aid markings-mark those marks you want to
return to if time permits later.
Day 44: Take a CBSSA Exam TIMED and use the resulting profile to identify areas that
could use additional review/practice questions over the next week. Sketch out a 7-day plan
that incorporates that review (especially cases for the weak area(s)- if not done before)
along with doing at least 1 block of integrated practice questions daily and/or going back
over First Aid and keeping your Pharm and Micro active. If your CBSSA score is not in the
ballpark with your personal goals, you can change your test date for an additional charge ,
and as long as it is taken before Pre-Clerkship week
Dont hesitate to discuss with me any concerns/uncertainties (I wont be available the first
week of April)
Days 45-51: Work your last 7-day plan from your CBSSA taken Day 44.

Day 52: First do the Step 1 tutorial on the USMLE Web Site; you should know the FRED V2
softwares keystroke tutorial well from this before you go to the Testing Center>so you can use
that extra 15 minutes testing center time for other things (like an extra or a longer break!). Along
with the tutorial are 150 Sample questions in blocks of 50 which are excellent samples of the real
test questions (you may actually see 1 or 2 on the real test) and which you can use to both practice
the keystrokes and your timing, as well as to continue filling in knowledge holes. Do these
questions timed in blocks of 50....you will want to finish each set of 50 questions in an hour or less,
as you will be training your nervous system to tell you when it senses you have spent enough time
on a question>so you can put down an answer, mark it as a question you can return to (time
permitting), and move on. If you do these practice questions too far out from your testing day, your
nervous system will not retain this timing memory( the USMLE sample questions does not give
explanations...so this is only for training/pacing. Continue reviewing your notes/ First Aid, pharm




15
cards... whatever rote material you have needing re-exposure.
(Time for lunch? Exercise? Movie?_____?)



**Note: it is normally not useful to score your practice tests after completing your last
CBSSA tan the last week or 10 days before your scheduled USMLE test day...scoring
then is most likely to leave you with either diminished or excessive confidence, and in any
case, there is not much you can do about the score this late in the game; rather, consider
using the tests for practice and filling in holes in your knowledge base.




General Motivational Thoughts for a Discipline or System Review

1. It is normally best to take off most of the latter part of the day before your testing day
(assuming you did the Sample Test in the morning)...or at least as much of the day off as
you can bear! Remember, this is a very broad-based exam, and whatever you look at just
prior to the exam will tend to be held in a short-term memory deposit box which will stand
ready to look for useful matches with its contents during the testing day, especially in your
first Block of questions. Rather than setting up a subconscious looking for info in your
test, you want to be as receptive as possible to what is actually presented; it is quite possible
that nothing you look at the day before your exam will appear on your test, so why withhold
active brain space when you want to have as much as possible of your receptive
consciousness available.

2. Depending upon the competitiveness of the residency you will want to enterand you
might not know that yet establish your acceptable criterion. In any case, aim high, as it
will increase your possibilities, and it gives you a safety cushion! Of course things might
change for you with experience and life is unpredictable anyway...
And dont forget that your score will, to a degree, be reflected in the schools performance;
the better the school performs>the higher the stature of the school, & the greater the
schools stature the greater will be its contribution to your future career choices.

3. Since Path, Micro and Pharm are the heavyweights, if 1 or more of these 3 scores are
below your acceptable criterion, or are among the relatively lowest of your recorded scores,
consider taking additional discipline-based practice exams in the discipline(s). If you dont
have enough questions left in USMLEWorld, Rx, Qbank, etc.; the comprehensive discipline
exams in the back of BRS or NMS, or/and the comprehensive discipline exam(s) in
Appleton & Langes Review for USMLE Step 1 can be useful if you havent used them yet
for that discipline; if you can identify major topics within a discipline that are your
weakness, focusing questions there will be most time/effort productive.
Finally, Read #4 at the bottom of Page 18 (Burnout)




16

Here is a SAMPLE 8-week schedule for a System-Based Review. (Adjust to fit
your own needs/wantstime & resources). The detail for these daily activities in each discipline are found on
the System Blueprint on page 20.

(Remember, its not a case of one size fits all!)
As mentioned earlier, arrange the sequencing to meet your individual needs.
Since some disciplines remain as disciplines in a System-based review
(biochem/micro/immuno/behavioral) consider either inserting one of them for a break
between systems, or at a time when you will be attending to a faculty review (live or podcast).
You might follow the 14-step sequence listed on page 5: Each system begins with anatomy,
then physiology, then path +pharm, etc., with practice questions after each discipline.
(Maybe plan the initial Pharmacology review for the morning hour before ICS (not included
as a study hour in your daily plan). Be sure to stay ahead of your systems with your initial
Rx reviews....e.g., review cardio drugs before you get to cardiology, then when you do
cardiopath you will look at those drugs again...mechanisms, interactions and toxicities...and
review Rx with a comprehensive pharm exam after all systems and General Pharm are
completed
__________________________________________________________
A Day = 10 STUDY HOURS (adjust to fit your own needs/wants)
Use the Discipline Blueprint on page 21 to detail those days devoted to disciplines.


__________________________________________________________
Days 1-3: Biochemistry (with Nutrition): do questions after each metabolic areas review.
Day 4: 100 +questions from USMLEWorld or Qbank , or Rapid Review, &/or Coffees
questions
Days 5-8.5 Cardiology: ( day anatomy, 1.5 days physio, 2 days path & pharm, cases,
day system test 150+questions
Days 8.5-12 Renal: (same time sequence as Cardio ... Day anatomy, etc).
Days 13-18 Micro/Pharm: (2 days bacteria, 1 day viruses, 2 days the rest, and 1 day for
integrated Micro exam 150+questions
Days 19-22.5 :Pulmonary (same as renal sequence)
Days 22.5-26: GI (same as renal sequence)
Days 27-29: Immuno (2 days immuno, day immuno with pharm, day test with 75+
questions)
Day 30: Integrated Micro/Immuno Test (150+questions>with pharm also)
Days 31-34 Reproductive/Endocrine (with 150 questions)
Days 34-35.5 Musculoskeletal
Days 35.5-39.5 Behavioral Science (can be inserted by sections: 2 days psych & CNS
Pharm, 1/2 day Biostat/Epi, 1/2 day Law/Ethics/Dr.-Patient, 1 day integrated exam ~150
questions, right after all 3 areas completed).
Days 39.5 - 41 Hematology (1-day review as topics relatively fresh & lower weight;
day100 questions).




17
Days 41-44: Neuroscience with 150 questions
Day 44-45 General Pharm: (30 questions)
Day 46-47.5: Review all Pharm Drugs
Day 47.5-48: Integrated Pharmacology Test (150+questions)
Day 48-49:Genetics: review Genetics not covered to date, then take a comprehensive
Genetics practice test (100 MCQs)
Days 49-51: Review your notes in First Aid/Notebook, look over the First Aid/UCV
Cases you havent worked with yet, and take 1 or 2 integrated practice tests (50+
MCQs) each afternoon; maybe look over some bugs & drugs each evening . (Look over
the notes in this document on page 15 beginning with **Note:
.
Day 52: First do the Step 1 tutorial on the USMLE Web Site; you should know the FRED V2
softwares keystroke tutorial well from this before you go to the Testing Center>so you can use
that extra 15 minutes testing center time for other things (like an extra or a longer break!). Along
with the tutorial are 150 Sample questions in blocks of 50 which are excellent samples of the real
test questions (you may actually see 1 or 2 on the real test) and which you can use to both practice
the keystrokes and your timing, as well as to continue filling in knowledge holes. Do these
questions timed in blocks of 50....you will want to finish each set of 50 questions in an hour or less,
as you will be training your nervous system to tell you when it senses you have spent enough time
on a question>so you can put down an answer, mark it as a question you can return to (time
permitting), and move on. If you do these practice questions too far out from your testing day, your
nervous system will not retain this timing memory( the USMLE sample questions does not give
explanations...so this is only for training/pacing. Continue reviewing your notes/ First Aid, pharm
cards... whatever rote material you have needing re-exposure.
(Time for lunch? Exercise? Movie?_____?)

(see #1 below in General Motivational Thoughts







General (Motivational) Thoughts
(if not read earlier)
1. It is normally best to take most of the day before your testing day off (assuming you did
the Sample Test in the morning)...or at least as much of the day off as you can bear!
Remember, this is a very broad-based exam, and whatever you look at just prior to the
exam will tend to be held in a short-term memory deposit box which will stand ready to
look for useful matches with its contents during the testing day, especially in your first
Block of questions. Rather than looking for info in your test you want to be as receptive as
possible to what is actually presented; it is quite possible that nothing you look at the day
before your exam will appear on your test, so why waste memory space when you want




18
as much as possible of your receptive consciousness available.

2. Depending upon the competitiveness of the residency you will want to enterand you
might not know that yet establish your acceptable criterion; in any case, aim high, as it
will increase your possibilities, and it gives you a safety cushion! Of course things might
change for you with experience and life is unpredictable anyway...
And dont forget that your score will, to a degree, be reflected in the schools performance;
the better the school performs>the higher the stature of the school; the greater the schools
reputation the greater its contribution to your future career choices.

3. Since Path, Micro and Pharm are the heavyweights, if 1 or more of these 3 scores are
below your acceptable criterion, or are among the relatively lowest of your recorded scores,
consider taking additional discipline-based practice exams in the discipline(s). The
comprehensive discipline exams in the back of BRS or NMS, or/and the comprehensive
discipline exam(s) in the Rapid Review series (as well as Q-Bank & usmleworld) are useful
if you havent used them yet for that discipline; if you can identify major topics within a
discipline that are your weakness, Q-Bank, World & PreTest in that discipline will give you
whole sections of topical questions.



BURNOUT

4. If you start to experience Burnout (i.e., when you sit down to study you feel an
overwhelming resistance, if not revulsion, towards the work in front of you, and almost
nothing sticks) you need to take a real break. Take a day off and do everything you like
to do and try not to think about Step 1. It is useless to feel guilty during such a break
because you wouldnt be productive studying anyway! (If you cant think of anything you
want to do, how about exercise??)

I will be here to help you in any way I can.


Take care of each other!














19
SYSTEM BLUEPRINT FOR STEP 1 STUDY




1 2 3 4 5 6 7 8 9
First Aid Anat / Anat. Chapter / anat. Qs / F.A. Embryo / Embryo Read / Embryo Qs / F.A. Phys / Phys Read / Phys Qs /
& Survey*


10 11 12 13 14 15*
F.A. Path / Path Read / Path Qs & Pics / Pharm Connect (First Aid & resource used) / Pharm Qs. / Cases * /


16 17
integrated System Test after system completed / Mark F.A. / Notes






* Always use the Student Survey along with First Aid to identify high-yield content; the survey is
concentrated on the past year only while First Aid broadly reflects recent years.
* Some or all of a systems cases can be done with each system or after all systems are completed; often this
is based on schedule timing



Note 1: Whenever a question is missed or guessed correctly, consider making a note in First Aid or a
notebook for later review

Note 2: Whether using a system or discipline review, there are disciplines to review! (Biochemistry,
Micro/Immuno, and Behavioral)

Note 3: Questions integrating all systems and disciplines most effectively used after all systems and
disciplines are completed (e.g., a second CBSSA)

















20

DISCIPLINE BLUEPRINT FOR STEP 1 STUDY




1. 2. 3. 4. 5.
First Aid by Chapter / Read Chapter / Chapter Questions / Mark FA / Repeat 1. - 4. for each chapter /
& Survey*



6. 7. 8.
Cases* / Integrated Discipline Test after discipline completed / Mark FA / Notes




* Always use the Student Survey along with First Aid to identify high-yield content; the survey is
concentrated on the past year only while First Aid broadly reflects recent years.
*The system Cases can be done after the physio, path and pharm disciplines are completed


Note 1: Whenever a question is missed or guessed correctly, consider making a note in First Aid or a
notebook for later review

Note 2: Whether using a system or discipline review, there are disciplines to review! (Biochemistry,
Micro/Immuno, and Behavioral)

Note 3: Questions integrating all systems and disciplines most effectively used after all systems and
disciplines are completed (e.g., a second CBSSA)