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Rock the USMLE Step 1 and Save Yourself Time and Energy - Annotate First Aid Early!

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For better or worse the United States Medical Licensing Exams (USMLE) dictate a significant amount of medical school curriculum. Scores on these exams can have a large impact on a student's ability to "compete" for the best residency programs in the country. Poor performance on the exams can be a huge burden to students despite the fact that there is little evidence that scores on these exams can predict poor resident performance.

Either way you slice it the exams are here to stay, and they are an important part of the medical establishment in the United States. By far the most "important" of these tests, and the one that provides the most angst for med students, is step 1. This exam tests the basic sciences, including both normal physiology and pathophysiology that are learned during years 1 and 2 at most medical schools. The exam has a surprisingly strong clinical bent, which can make it difficult to prepare for, especially if the clinical years have not yet been started.

A simple and affective way to allay any fear of the exam is outlined in the following paragraphs. First, pick up a copy of the step 1 "bible", First Aid for the USMLE Step 1, early in your first year of medical school. As you study during the first two years of medical school take notes in the relevant sections of First Aid. Write down as many facts as you can about each topic. A great idea is to have your First Aid three hole punched at Kinko's. Then you can add blank sheets to any section you need in order to keep your thinking clean and organized.

That's not all! On top of your weekly course work, get in the habit of reviewing one section of First Aid every two to three weeks. This should be done regardless of whether or not you have lots of notes already written in it. I recommend starting with the first section even if that's not the subject you're studying in class. Once you get to the end of the book, repeat the process. This will help you solidify all the material in your mind.

Once it comes time to take step 1 at the end of second year you'll have a fully annotated copy of First Aid! You wont have to waste time going through all your medical school notes, etc. An added bonus is that you'll be able to keep your annotated copy for review of many concepts during your clinical years (and possibly into residency too!).

Here is the play-by-play on how to "rock" step 1 of the USMLE:

(1) Get a copy of First Aid for the USMLE Step 1 early in your first year of medical school.
(2) Take notes like crazy in the relevant sections during each of the classes you take during the first two years.
(3) Review one section every two to three weeks, working from the front of the book to the back of the book.
(4) Repeat this process throughout the first two years of med school.
(5) Take step 1 and kick its butt!

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References and Resources

(1) Brenner AM, Mathai S, Jain S, et al. Can we predict "problem residents"? Acad Med. 2010 Jul;85(7): 1147-51.

(2) Swanson DB, Sawhill A, Holtzman KZ, et al. Relationship between performance on part I of the American Board of Orthopaedic Surgery Certifying Examination and Scores on USMLE Steps 1 and 2. Acad Med. 2009 Oct;84(10 Suppl): S21-4.

(3) Boyse TD, Patterson SK, Cohan RH, et al. Does medical school performance predict radiology resident performance? Acad Radiol. 2002 Apr;9(4):437-45.

(4) de Virgilio C, Yaghoubian A, Kaji A, et al. Predicting performance on the American Board of Surgery qualifying and certifying examinations: a multi-institutional study. Arch Surg. 2010 Sep;145(9):852-6.

(5) Le T, Bhushan V, Grimm L. First Aid for the USMLE Step 1. New York: McGraw Hill, 2009.

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