Tuesday, June 01, 2010

My Take on the Boards (Step 1)

I took Step 1 on April 21st and though I've been meaning to put this post up for awhile so that the information is really fresh, I definitely needed a mental vacation from the boards! Now that I've had all of research month to rest up (while doing a little research on the side :)) I'm ready to share my wisdom (I hope?) on what I thought went well for me during Boards studying and what didn't.

THE MATERIALS
I like you, if you're reading this for advice, struggled for a LONG TIME on what resources are better and definitely bought some books out panic. Name any book, I've probably agonized over whether to buy it. So here is my final list of books that I actually USED in order of importance:

  1. FA for the USMLE Step 1 - my best best friend for studying for boards, know this well (I went through it in its entirety at least 4-5 times) and you've done 75% of the work in my opinion. A lot of my classmates, including me, tore out the binding and put it in a 3 ring binder and just took notes on other books and stuffed it in this binder in the relevant organ system. Everything listed below is a supplement to this book, FA is like the bible, other books are just good to fill in the gaps. All my house mates got nice tabs to separate the FA sections, good for fast flipping and finding random sections that come to mind. You will memorize this book, you will dream/have night terrors about its different sections etc., thats how well you should know it.
  2. BRS Pathology - excellent succinct description of the pathology you are responsible for, a great supplement to the FA section on Pathology, made notes in FA from this book. Good short questions at the end of each chapter.*Goljan vs. BRS Path: I hear good things about Goljan Pathology but for me, volume is a huge obstacle and BRS is simply a smaller more compact book without too much unnecessary detail (which I hear Goljan has). I actually got a Goljan in my boards books panic, but didn't open it more than 2 times, it simply wasn't my style (its important to figure out what works early on so you're not studying the same thing out of two different resources, that's a waste of time).
  3. BRS Physiology- loved this book to really pound physiology concepts into my head. good supplement to FA. I thought the endocrine physiology was really helpful here.
  4. Online Q banks- I got USMLEWORLD AND USMLERx for two month subscriptions each. I didn't finish either but I don't think it hurt me at all, and I didn't beat myself over trying to finish them. I thought USMLEWORLD was nice and challenging and USMLERx hit some of the more basic concepts home. I did 75% of USMLEWORLD and 30% of USMLERx and mixed it all up when I was doing organ systems. If I had to do it again.. maybe I'd just do 2 months of USMLEWORLD.
  5. FA Cases for USMLE Step 1- Really nice way to wrap up FA concepts in a patient based and USMLE question thinking way. I really loved this book as a nice break from memorizing FA and just applying the concepts you learned in patient scenarios.
  6. BRS Pharm Cards- loved these short succinct cards for all the drugs. I think flash cards are important for testing that you know drugs when they are all mixed up. *BRS vs. Lippincott Pharm Cards: I definitely thought BRS cards (big print, simple take home points) were better than the complex Lipponcott ones (smaller print with pathways and tons of other non vital info).
  7. Microbiology Made Ridiculously Simple- Definitely a good way to remember clinical pearls related to Micro bugs and drugs which are heavily represented on Boards. I just went through this book alongside FA in two days.
  8. Lippincott MicroCards- definitely helpful but NOT absolutely necessary because they have so much detail. I appreciated the little case vignettes that tested you on each microbe that could be found on the front of the cards.
Not Necessary, but helpful to look at if you have time:
  1. ***Robbins and Cotran Review of Pathology - at first I didn't even consider buying this book but was VERY HAPPY I did in the end. It's a question book and a good complement to online Q banks because it emphasizes the top path questions you will get in different organ systems. I picked up some really tough questions on the actual test that I only know because I did questions from this book!
  2. HY Embryology (first edition!!)- short and sweet, some nice illustrations
  3. HY Neuroanatomy- too detailed in my opinion, but had some nice head xrays, CTs, and MRIs and illustrations.
  4. Abbas Immunology- good for some basic review on immuno concepts. Don't read the whole book over again.

Wish I didn't buy:
  1. Lippincott Biochemistry- In my freakout during biochem review I bought this. It has some nice diagrams but in the end I focused on learning just what was in FA and did fine on biochem.
  2. HY Gross Anatomy - too detailed
  3. BRS Behavioral Science- too detailed
THE ATTACK PLAN
I had made a day to day schedule (click to see!) for what I would focus on for the boards. FYI, Pitt gives us 7 weeks to study, some schools may give more or less. The 7 weeks includes and "ICS" course where we have to be in school for 2 hours everyday for the first 4 weeks but that didn't really impede my studying. Our school also allowed us to take as many CBSSA diagnostic tests as we wanted, but it was traditional to do one at the beginning and one 1-2 weeks prior to your test date to assess how you stand in topic areas.
As you make your calendar you have to decide what's important to you/your weak spots as you go along. Schedules can sometimes be adjusted but it helps to get one from an upperclassman and adjust as you need to.

The way I tackled organ systems/topics-
  1. Read the FA section to get a handle on what is important
  2. Read the BRS Path and Phys sections, make notes on anything that is not in FA, do questions at the end of those chapters, do 20-50 questions from an online Qbank
  3. Look through the pharm cards (I separated them all by category, make notes on them from FA) test yourself on them.
  4. Read any other books you have that may supplment that subject, takes notes in FA (i.e. for Micro, reading Micro made ridiculously simple)
  5. Read FA section over again with all your consolidated notes from other sources/books
  6. Do 100 -200 practice Qs on online Qbank
  7. repeat #5 and #6 if you still have some time or know you have weak areas in the FA section
  8. Repeat #1-7 for every single section of FA. There are some sections you don't have to do that much work for like Behavioral Science and Anatomy, those can be done in a day or so each.
  9. Towards the end, start doing passes of several FA sections and mixing those types of questions together on online Q banks.
  10. Repetition and Testing your knowledge are key. Continually do practice questions and reread parts of FA you are weak on. That's why I had a second and third pass through FA. There is simply just so much info towards the end you gotta keep seeing it to keep it in your head.

A few days before:
I panicked hardcore. I didn't do very well on my second diagnostic CBSSA and I only had 10 days to improve my score. I didn't sleep well or eat well, I was a ball of anxiety and an emotional wreck. Acknowledge that this can happen and realize what you need to do mentally to move on and keep studying. For me, that meant I had to calm down and just reread sections of FA instead of trying to complete the online Qbanks which I originally had planned (getting questions wrong towards the end was really getting me depressed and upset, so I ended up just reviewing old questions). I was really upset I had to change my original plan, but I decided to stick to my decision and that worked well for me in the end. I did a whole day dedicated to all the pharm which was helpful for me to tie together interactions and get a good look at the big picture. I also focused on trouble areas, that I had been bookmarking all along, the day before my relaxation day so that I could feel more comfortable to have that troublesome material recently in my memory for the test.

The day before:
I studied trouble areas and skimmed through FA cases (hit the big concepts like congestive heart failure, lupus, etc.) took some good relaxation time the day before the test, drove to the test site, worked out, packed snacks for the test day, and slept decently well that night.

Test day:
I've never taken a prometric computer test before so the whole signing in and out for breaks was novel to me. You will probably have a ton of energy in the first few sections so coast with that if you can. I took 2 minute breaks at my desk and just put my head down because I didn't want to waste time signing in and out. By the 3rd or 4th section I made myself take some 5 minute breaks. But seriously, I was coasting with adrenaline from the time crunch of trying to complete 48 questions per hour that the sections fly by. I took a 12 minute lunch break and did some 5 minute breaks between each section until the end.

Looking back on this all and with my score report in hand, I was really happy with how I did on the test! I improved 89 points from my first CBSSA and 34 points from my second CBSSA, proof that you can keep improving your score if you put your head to it! Just remember, it's important to just keep your spirits up and be attentive during the entire test. I definitely caught myself not reading some questions carefully enough a few times as I got more rushed or tired. Don't let one difficult section get you upset and stressed over the others, you never know what questions are experimental you just gotta keep trucking through it!

Plan some sort of celebration when you finish! Whether its just relaxing by yourself or heading out with friends, you deserve it! :) Good luck!

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