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Step 1 Study Guide For the Class of 2010 University of Colorado at Denver Health Sciences Center School of Medicine

Office of Student Affairs

!"a#inations are for#ida$le even to the $est prepared% for the &reatest fool #ay as' +*#ore than the (isest #an can ans(er) *Colton

A Special than's &oes to the follo(in& class of 200, students for their (or' &eneratin& the survey data and their (or' in helpin& develop the study &uide fro# -those results -200, .i/ 0ilson 1osh Sy'es 2ate .ane 3his docu#ent (as edited $y 4rian Harry% 4ar$ara 0ilson% and Shin 5a#aya% class +of 2010 3he infor#ation contained in this hand$oo' (as &athered $y the Office of Student Affairs as (ell as $y current6for#er #edical students at the University of Colorado School of Medicine and is #eant to serve as a &uide+ Gracious per#ission has $een &iven to use the infor#ation in the hand$oo' $y the follo(in& entities allo(in& our +students to $enefit fro# their (or' Albany Medical College Baylor College of Medicine Boston University School of Medicine Boston University School of Medicine Brown Medical School Case Western Reserve University School of Medicine Creighton University School of Medicine Dartmouth Medical School Educational Commission on oreign Medical !raduates Emory University School of Medicine "efferson Medical College "ohns #o$%ins University School of Medicine &ec% School of Medicine of the University of Southern California University of California' Davis' School of Medicine University of California' (rvine' College of Medicine University of (owa Carver School of Medicine )oyola University Chicago Stritch School of Medicine Mayo Medical School Mercer University School of Medicine Mount Sinai School of Medicine of *ew +or% University Rush Medical College of Rush University Medical Center Saint )ouis University School of Medicine ,he Brody School of Medicine at East Carolina University -anderbilt University School of Medicine Wayne State University School of Medicine +ale University School of Medicine www.usmle.org www.nbme.org www.$re$/usmle.org www.studentdoc.com 0

-3a$le of Contents $age (ntroduction to the USM)E Ste$ 1 / Studying for the USM)E 2 Sam$le Schedules 10 Study Resource (nformation 13 Class of 0445 Board Survey Results 16 Class of 0414 Board 7re$aration Calendar 08 re9uently As%ed :uestions 06

7ntroduction <&' so you=re a$$roaching the end of your second year. #aving gone through about a thousand $ages of 7ath' and countless lectures of Micro' you are so ready for a ma>or brea% from the boo%s' right? Well there=s still one hurdle to cross before you reach the $romised land of clinical medicine@ Ste$ ( of the USM)E' or Athe boards.A Although this eBamination can seem $retty intimidating' a logical and well thought out a$$roach to studying hel$s the great ma>ority of students. So first and foremost' don8t panic9 Believe it or not' our students do very well on the Boards and if you have done well in the first two years' you should loo% .at this as nothing more than a review session 3his &uide is #eant to provide a fra#e(or' and so#e si#ple su&&estions for studyin& for Step 1+ :e#e#$er% these are ;ust su&&estions and no one approach to studyin& is ri&ht for everyone+ 3he 'ey to success is to thin' a$out the topics and issues that need to +$e covered% #a'e a realistic study plan% and then do your $est 0hat is the USM.! Step 1 ,he three Ste$s of the USM)E assess a $hysician=s ability to a$$ly %nowledge' conce$ts' and $rinci$les' and to demonstrate fundamental $atientCcentered s%ills' that are im$ortant in health and disease and that constitute the basis of safe and effective $atient care. Results of the USM)E are re$orted to medical licensing authorities in the United States for their use in granting the initial license to $ractice medicine. S,E7 1 assesses whether you understand and can a$$ly im$ortant conce$ts of the sciences basic to the $ractice of medicine' with s$ecial em$hasis on $rinci$les and mechanisms underlying health' disease' and modes of thera$y. Ste$ 1 ensures mastery of not only the sciences that $rovide a foundation for the safe and com$etent $ractice of medicine in the $resent' but also the scientific $rinci$les re9uired for maintenance of com$etence through lifelong learning. ,he USM)E Ste$ 1 is s$lit into a variety of sub disci$lines' similar to the curriculum of most medical schools. Within each subto$ic' an attem$t is made to test %nowledge on A*ormal 7rocessesA' AAbnormal 7rocessesA' D7rinci$les of ,hera$yA and A7sychosocial' cultural and environmental considerations.A ,he basic disci$lines include to$ics in biochemistry and molecular biology' cell biology' genetics and develo$ment' $athology' $sychiatry' $hysiology' $harmacology' microbiology' immunology' and statistics. ,he *BME further s$ecifies the to$ics to be tested within $hysiology' including systems biology Eneurobiology' immunology' general .E.$hysiology' etc USM.! Step 1 <uestion For#at .A,here is only one 9uestion format for USM)E Ste$ 1@ ASingle 9uestion best answer

Studyin& for the USM.! Step 1 USM)E Ste$ 1 is usually considered the hardest of the USM)E eBams to do well in. As a result' this is the test that everyone studies the most for. ,he basic techni9ues for studying for @USM)E Ste$ 1 are straight forward .Sam$le 9uestions. Sam$le 9uestions. Sam$le 9uestions .1 . ocus on your wea%nesses .0 .Study for the USM)E as you study your medical school course .; :evie( Courses6Options &ee$ in mind that there are also many review courses that can hel$ you organiFe your studying if you are willing to s$end the time and money. (f you feel you may benefit from a review course' the best thing to do is to as% someone who has ta%en these courses to see what they are really about. &a$lan offers a range of $roducts that can hel$ one $re$are for the boards. ,hese include :CBan% E 0444 test 9uestions that simulate the boards formatC a web based $roductG' (ntense 7re$ Elive lecture review done in three wee%s which also includes over 1444 eBam li%e 9uestionsG' Med7ass Evideo set lecture series that also includes over 1444 board 9uestionsG' and other web based $roducts EWeb7re$' :reviewG. ,he strength of the &a$lan assets is the simulated tests' which have very similar 9uestions to the boards and have a format that is similar to the boards. Many students find the :CBan% 9uestions to be $articularly useful' as they $rovide the o$$ortunity to simulate the setting that will be encountered on test day with a com$uterCbased eBam. &a$lan also offers a series of review boo%s are $art of the above $ac%ages. As% other students who used them if they found them to be effective. ,he www.%a$lan.com site offers more s$ecific details about any of their .$roducts (f you are loo%ing to attend a live review course' our office has had success referring students to these E;G locations listed below. <ur office is not endorsing these $rograms over other .$rograms 7ASS 7rogram' Cham$agne' ()' 018C;86C6416' htt$@HHwww.$ass$rogram.net (nstitute for 7rofessional 7re$aration' University of Missouri &ansas City' www.um%c.eduHi$$ alcon Review' Dallas' ,I www. A)C<*RE-(EWS.com =0hat are students tellin& us a$out their strate&ies for studyin& Most Effective ,echni9ues Attend classK ,his is where you learn about clinical medicine. +ouLll be grateful D J M.you did neBt year MKUse $ractice eBams D J

Doing tons of sam$le 9uestions and understanding all the right and wrong answersN D J M.studying with one or two $eo$leN using only one review boo% for each to$ic !oing through review boo%s' ta%ing notes on stuff to memoriFe and doing D J M.9uestions M.Concentrated studying in a grou$ for allotted time D J MKStay away from stressed out classmates D J M.Ma%e a realistic schedule and stic% to it D J M.Do 9uestions in bul%D J ,a%e a $retest to identify your areas of wea%ness. ,hen' create a study D J M.guideHschedule based on your needs' not the needs of your study grou$ )east Effective ,echni9ues *ot $aying attention to the material in the course then trying to learn it later on D J M.your own M.Drin%ing too much coffeeN going over all the notes from the first two years D J M.)istening to other $eo$leLs advice as to what was im$ortant to study D J M.#ysterically running around in des$air D J ,rying to study from too many boo%s. Stic% to one ma>or resource su$$lemented D J M.with smaller s$ecific sub>ect boo%s M.Studying with too many $eo$le D J =0hat topics are #ore6less e#phasi/ed on the $oards While some of you have started studying already' some may not even be sure what is on the eBam everyone is so nervous about' so letLs start at the beginning. Ste$ 1 covers material from the following categories 'anatomy J 'behavioral sciences J 'biochemistry J 'microbiology J '$athology J '$harmacology J '$hysiology J .interdisci$linary to$ics' such as nutrition' genetics' and aging J ,he above material is tested as basic science 9uestions' or as 9uestions referring to individual @organ systems. ,he general brea%down is !eneral $rinci$les 24OC/4O (ndividual organ systems 34OC24O @,he individual organ systems are hemato$oieticHlym$horeticular J nervousHs$ecial senses J

s%inHconnective tissue J musculos%eletal J res$iratory J cardiovascular J gastrointestinal J renalHurinary J re$roductive J endocrine J @,he test can also be bro%en u$ into normal vs. abnormal $rocesses *ormal structure and function 24OC;4O Abnormal $rocesses 24OC;4O 7rinci$les of thera$eutics 02OC12O 7sychosocial' cultural' occu$ational and environmental considerations 04OC14O Ste$ 1 has a$$roBimately ;24 multi$leCchoice test items' divided into seven 34Cminute bloc%s' administered in one eightChour testing session. ,he current $assing score is 162. ,his .corres$onds to answering 34C84O of the 9uestions correct for the eBam ,he most heavily em$hasiFed sub>ects are >hysiolo&y% >atholo&y' Micro$iolo&y% and >har#acolo&y. 7athology is $robably the most im$ortant single sub>ect' since it ties in all of the other to$ics. By devoting the a$$ro$riate time and energy and utiliFing the right resources' con9uering all of these sub>ects will be well within your reach. Also' don=t forget the basics of 4iostatistics' as sensitivity and s$ecificity and $ositive and negative $redictive values are favorites for the USM)E. "ust %nowing these will be worth several eBtra 9uestions answered .correctly =Ho( i#portant are sa#ple ?uestions and practice e"a#s !enerally s$ea%ing' doing $ractice 9uestions and eBams is definitely hel$ful for many reasons@ it directs your em$hasis towards certain to$ics' identifies your strengths and wea%nesses' and gets you in the right frameCofCmind for ta%ing this eBam. Many $eo$le have found it hel$ful to do 02C24 9uestions each night to review the sub>ects they studied earlier in the day. As the test day a$$roaches' you should definitely ta%e some longer test bloc%s bac% .to bac% to build u$ your mental stamina for test day 5aplan@s <A4an' has been a favorite of students here and all over the country. (t is favored for $roviding a good simulation of a com$uter based test ECB,G and for having a com$rehensive database of 9uestions. With the $ro$er $re$aration' youLll find your :CBan% scores and confidence $ea%ing as you near test day. ,wo other 9uestion ban%s that are highly recommended in irst Aid are USM.!:" Step 1 <#a" 3est 4an' and USM.! Steps 12B Step 1 <uestion 4an'. Both are less eB$ensive than &a$lanLs :CBan%' although :CBan% has .a longer history with the USM)E Ste$ 1

Most of our students cou$le $ractice 9uestions with irst Aid for the USM)E Ste$ 1. ,he <ffice of Student Affairs also has a $lethora of other Ste$ 1 study $re$ guides which you may .chec% out Regardless of how you a$$roach it' $ractice 9uestions of the $ro$er caliber will be a big hel$ in your review' es$ecially in regard to timing and mental endurance. Also' if you count yourself among the com$uterHtestingC$hobic' it may be wise to get some other com$uter .testing resources >ust to get used to reading off a screen rather than a boo% =0hat is the testin& day li'e ,here is no denying the fact that the testing day is long. "ust be sure to remind yourself that it KKused to be two days ,here are seven oneChour bloc%s of 24 9uestions' and you are allotted eight hours to com$lete .the test (n addition to the eBam bloc%s' your test eB$erience begins with a 12 minute com$uter tutorial. #owever' this is identical to the one on the CD sent in your $ac%et' so it is best to s%i$ it on test day and ta%e the 12 minutes as brea% time. (f you do this' you begin with 1 hour .of brea% time' which you are able to ta%e between sections at any $oint during the day Some $eo$le com$lete a cou$le of sections at a time and then ta%e a $rolonged brea%' while others choose to ta%e a 2 minute brea% at the end of each section. +ou can always access a screen on the com$uter which tells you your total time remaining both for your current section and for the test day as well as how many sections you have left' so time management .is not a ma>or issue as long as you $ay attention Remember' for the eBam' you are not allowed to have any of the following with you during @the eBam mechanical or electronic devices' such as cellular tele$hones' $ersonal digital assistants J E7DAsG' calculators' watches of any ty$e' electronic $aging devices' recording or Nfilming devices' radios Nouterwear' such as coats' >ac%ets' head wear' gloves J Nboo% bags' bac%$ac%s' handbags' briefcases' wallets J Nboo%s' notes' study materials' or scratch $a$er J .food' candy' gum' or beverages J +ou can have food and drin%s outside of the eBam room' or in your loc%er for brea%s. Bring high energy food and drin%s to the eBam so you can have little snac%s throughout the day to .%ee$ your energy u$ and avoid eating big meals that will ma%e you tired When you come to the eBam' you need to bring your scheduling $ermit and a form of legal @identification '$ass$ort J

'driver=s license with $hotogra$h J 'national identity card J 'other form of uneB$ired' governmentCissued identification J .EC M!Cissued identification card J 7#portant 2ote@ +our name as it a$$ears on your Scheduling 7ermit must match the name on your formEsG of identification eBactly. (f the name listed on your Scheduling 7ermit is not .correct' contact your registration entity immediately Applyin& to ta'e and schedulin& the USM.! Step 1 H!o to htt$@HHwww.nbme.org .1 MClic% on DE*,ER *)ES S(,E .0 Clic% new first time user and create a login name and $assword .; When a$$lying for Ste$ 1' you must select a threeCmonth $eriod' such as "anuaryC ebruaryC March or ebruaryCMarchCA$ril' during which you $refer to ta%e the eBamination. A Scheduling 7ermit with instructions for ma%ing an a$$ointment at a 7rometric ,est Center will be issued to you after your registration entity $rocesses your a$$lication and determines your eligibility. ,he Scheduling 7ermit s$ecifies the threeCmonth eligibility $eriod during which you must com$lete the eBamination. During $ea% $eriods' allow u$ to a$$roBimately four wee%s for $rocessing of your a$$lication. <n recei$t of your Scheduling 7ermit' you are .able to contact 7rometric immediately to schedule a test date htt$@HHwww.$rometric.comHdefault.htm @Remember +ou must have your Scheduling 7ermit before you contact 7rometric to schedule a J .testing a$$ointment A$$ointments are assigned on a AfirstCcome' firstCservedA basisN therefore' you should J contact 7rometric to schedule your eBam as soon as $ossible after you receive your .Scheduling 7ermit +ou may ta%e the test on any day that it is offered during your assigned eligibility J .$eriod' $rovided that there is s$ace at the 7rometric ,est Center you choose .7rometric ,est Centers are closed on ma>or local holidays J ,his means sign u$ early because the $rocess ta%es time P but remember P you can only sign Ku$ siB months in advance :eschedulin& 7eo$le have different thoughts on whether this is wise to do or not' but regardless' if you are going to reschedule' be aware that you (ill have a reschedulin& fee if you do it less than C +$usiness days in advance

>uttin& 3o&ether a Schedule <bviously' the more time you $ut into studying' the better the results you will most li%ely see. So if you are organiFed enough and willing' s$end as much time as you feel necessary' and .sim$ly alter the schedule we are suggesting based on your own desired $re$aration time &ee$ in mind that this time of studying is really >ust a com$rehensive review of material that you already %now. +ou will not learn many things for the first time' though you will notice that as you synthesiFe information they may seem new since you finally ma%e sense of themK At first it may seem as though you need to go through everything again and this may very well be true' es$ecially for biochem' but the rate at which you relearn things is 9uite ra$id' so .don=t $anic As you $lan your study time' it is im$ortant for you to establish your goals for the boardsCto borrow terms from irst Aid' do you want to >ust $ass' to beat the mean' or to go for the gold. +our decision will be im$ortant in deciding how intensely you a$$roach your studies. ,he following is a schedule for someone who wants to do well' but who wants to have a .reasonable study schedule for about ; wee%s @Before we begin' let=s >ust lay out a cou$le of general $rinci$les Ma%e your schedule and stic% to it. Many have benefited from a$$roaching studying for J the boards as a >ob. 7unch the cloc% for a set number of hours $er day and then' $rovided you actually wor%ed in that time' let yourself leave it behind when the time .is u$ (nclude brea%s in your schedule. Schedule an hour a day for eBercise' time to hang with J friends and family' or whatever else you want to do. +our motivation level and .overall efficiency will be enhanced by ade9uate rest $eriods .!et $lenty of slee$ and good nutrition J Remember that First Aid for the USM.! Step 1 is your &old standardK Before you J study each sub>ect' s$end a brief time reading over the high yield facts in irst Aid' and return to it again when you are finished to em$hasiFe the im$ortant tidbits. 99952O0 3H7S 4OO5 72S7D! A2D OU3 (f you used a review boo% during the class' use it now. ,here are so many boo%s from J .which to choose' so if you have one with which you are familiar' use that one Be sure to hit the large' im$ortant sub>ects E$ath' $harm' micro' $hysio' and biochemG J more than once during your $re$arations. #it them hard in the beginning for two days or so' and then come bac% at some $oint in the last wee% for a 1 day s$eedy' thorough .review. +ou will be amaFed how much you $ic% u$ that second time through


As has already been said' use $ractice tests to your advantage. Schedule them into your J evening time or use them whenever you get tired of studying during the day. As the test a$$roaches' try to do several bac%CtoCbac% one hour bloc%s to ready you for the .eBam Don=t com$letely blow off any sub>ect. (t is silly to miss some easy $oints in something J li%e Biostatistics when the information can be $ic%ed u$ in >ust a little bit of time. At .the minimum' at least read the highCyield facts in irst Aid <ne last time for em$hasis CC es$ecially during those last cou$le days' be sure to come J .bac% to irst Aid


Sa#ple Schedules ,he sam$les below may or may not be re$resentative of what will wor% for you. 7lease use .these as a way to thin% about creating your study schedule Sa#ple Schedule D1 EDay wor%ing@ 15.2 days P 02.2 days Enot counting days off and review Co##ent !sti#ated 3i#e ,his schedule does not differentiate betw basic science and systemCbased studying 3o
Actually tested and fairly easy 9uestions you need to cash in on' but you have a boo%' adem EBRSG' which is short and has .9uestions 7erha$s the most tedious of the sub>ects review early E1C0 daysG and late E1C0 daysG' saving the 9uestions for the later time. )i$$incott is a heroic effort' but an eBcellent resource' $articularly if .you used it before Hi&h yield. 7erha$s the most im$ortant sub>ect. Again' review early and late. &now CostanFo' .shoc%ingly effective #onestly low yield. ,he focus should be on clinically useful stuff@ which fractures relate to which nerves' winging of the sca$ula' etc. Radiogra$hic images can be em$hasiFed but generally stic% to the basicsN i.e. you see an BCray with fracture at the midshaft of the humerus' what nerve is at ris%? &*<W the $asic ICrays in #igh +ield Anatomy Don=t neglect it' but don=t blow it out of $ro$ortion. irst Aid stuff .highCyield Enormous volumes of material. Remember to thin% categorically. +ou have to %now your autonomics. &now ma>or side affects if they are bad' i.e. .agranulocytosis' cardiotoBicity Sorry guys' it=s in there' even the worms' but not enough to >ustify slaving over them. &now the $arasites in irst Aid. ,ry to combine micro with your antibiotics review' they are related in real life and sur$risingly on the .boards too airly good yield. !lance over immunoC deficienciesCin irst Aid the day before the eBam. .7rinci$les more than details <ne of the bigChitters on the eBam' should also be a bigChitter in your $re$. Another sub>ect you want to hit both early and late. ,he BRS to 1.2 days 1

Behavioral Scie

days ;C/


days /


days 1C1.2


days 4.2 days ;C/



days 0C;


days 1C0


days /C2


$ath boo% ESchneiderG is a timeC .tested favorite