How to Break 260 on usmle 1 Jason Kirincic Introduction

How to Break 260 on USMLE 1

Jason Kirincic

Introduction:

Before listing doing any kind of preparation, you have to understand how to study for this exam. The questions usually require 2 to 3 point reasoning skills. You will never be asked a direct memorize-and-regurgitate question. In order to make the inferences (guesses) needed to successfully answer these questions, you have to UNDERSTAND the fundamentals of the subjects you are learning. Memorizing WILL NOT help you on this exam. If you can’t understand a principle, then quickly YouTube/google for clarification.

For example, if a question presents a patient with an artery occlusion and asks about what the intracellular electrolyte/metabolite concentrations are, then you should be able to reason that without ATP the cellular pumps/metabolic pathways will fail and thus arrive at an answer. Or be able to explain the mechanisms to why giving thiazide diuretics to a patient with nephrogenic diabetes insipidus is beneficial…

When reading histology/X-ray descriptions in First Aid or Kaplan, it’s not good enough to just know that osteosarcoma causes a “sunburst pattern” on X-ray. GO look up a picture of the x-ray on google. Usually the exam will not use Buzz Words like “Curschmann Spirals” for asthma, you should know that this means desquamated epithelium. Looking at a histology slide couldn’t hurt.

Be a good detective. Use ALL the clues in the stem to help you arrive at an answer. I like to read the answers before the question stem and then cross out answer choices that don’t match the clues.

I recommend that you take this exam during your 3rd-to-4th year summer so that you can get at least 90% on subjects like pharma/patho/micro. I didn’t think that neurology or internal medicine from 4^th year helped that much. Just make sure that when you are taking your 3^rd year classes that you use the USMLE materials that are listed below instead of the recommended text books. You will find that you will actually have to study less and score higher on school exams when using these “High Yield” resources.

Using the High-yield resources during the school year will take a lot of stress off your back during the summer. If you can manage, try reviewing physiology and biochemistry casually during the 2^nd half of 3^rd year. During summer, you should plan 3 months of 10-12 hours per day. Don’t go over 12 hours a day as this will quickly lead to burnout.

The Question banks are by far the most valuable resources that are out there. They will teach you how to think analytically/conceptually better than any book can. Make sure that you read EVERY explanation and understand why each answer is correct or incorrect. At the very least, doing thousands of questions will turn you into a better test taker, you will be able to process the information faster and be able to pick out the relevant info out of a lengthy question stem.

Exam Registration

To register for the exam you will need to go to the ECFMG website and make an account. This will cost about $45 and take about 1 week. After they make an account for you and give you a username, go back to the ECFMG website and register for the USMLE 1 exam. This will prompt you to pick an eligibility period for which you can sign up for the exam. These eligibility periods last for about 3 months. If you start studying in July (+3 months), I recommend shooting for the October to December period. After picking an eligibility period, you will be given a form (#88 I think) that you need to get signed by Dr Davor Horvat (his office is next to Nika/Jasna on the 2^nd floor of our faculty). This form basically just says that you are a student here. You will then mail this form to the ECFMG offices in Pennsylvania. This period will take about 1 month, so plan appropriately. After ECFMG processes your form 88, they will give you a “pass code number” that you need to use to sign up for the exam on the prometric website. The test center is next to Sveti Duh. You can usually sign up 2 weeks before the date at the latest, assuming that availability is not an issue.

Materials:

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  Comprehensive
  
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    First Aid:
    
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      “tried and true” this is the Bible for the USMLE.
      
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      It has thousands of the most high yield (common) facts that will appear on your exam.
      
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      Buy the new edition that usually comes out every January 10^th.
      
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      Make sure that you understand the physiology/patho etc.. behind the facts. Thus couple this with other resources and write explanations into pages that you don’t understand. You will have to read this 4-5 times to make sure learn everything.
      
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      You can use this during the school year to understand what’s expected of you, but I recommend this more for when you properly start your USMLE studies ( 3 months before the exam).
      
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    Kaplan
    
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      The class costs about $4000!!! But you can pirate the videos off of the internet and then buy the precious lecture notes off of amazon or ebay. They don’t update that much from year to year so you can buy a 4 year old version to save money. DO NOT use the pathology Kaplan book, Goljan/pathoma is much much better.
      
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      Kaplan tends to be a little overkill, so don’t stress if you can’t fit every detail into your hippocampus.
      
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    Q Banks
    
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      Rx-USMLE
      
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        This is the easiest of all the Q banks and should be done during the 1^st month of your 3 month study period. Being tested with questions will quickly help you learn the material faster than just reading a book.
        
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      UWORLD
      
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        The gold standard of Qbanks. Start this during your 2-3months of the 3month period.
        
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      Kaplan
      
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        During your 2^nd/3^rd month, I recommend sitting down with this for 1 day per week and doing 280 questions (about 7 hours). This will prepare you mind for the endurance needed during the real exam and turn you into a machine!
        
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      NBME
      
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        These can be accessed through the NBME website, they are $60 a pop.
        
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        These 200 questions are the closest level of difficulty to the actual exam.
        
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        Try to do 1 of these at the 2month mark and at 3months to check if you’re ready for the real thing.
        
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  Pathology:
  
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    Pathoma:
    
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      Go to pathoma.com and buy the videos/booklet. This is by far the most powerful resource. So many questions can be answered by his explanations and histology slides/ xrays. You can also survive our school pathology course just by using this.
      
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      Learn EVERYTHING that Dr Saltar says. It will show up on your exam.
      
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      Good for school year and during the 3 month pre exam period.
      
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    Goljan Rapid Review:
    
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      This is a comprehensive text that combines pathology/physiology/pathophysiology/internal-medicine/pharma. Use this book during the school year for patho and pathophys. It breaks down each disease to the etiology, the change in physiology, what lab values to look for, and treatment options. The thorough explanations are exactly what you need to be able to answer the USMLE questions.
      
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      The downside is that this book is 400 pages and slow to go through, so make sure that you use this instead of Robbins during 3^rd year.
      
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      If you use this book, you don’t need to study for pathophys during the school year.
      
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      Good for during school year but because of how time consuming it is, only use it to clarify misconceptions during the 3month period.
      
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  Physiology
  
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    BRS physiology and Kaplan Physiology:
    
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      Both are good for during school year ( physio/pathophys) and during the 3 months.
      
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      Try to understand the graphs and figures especially, you will need them to answer questions.
      
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        A typical question is to present a patient with diastolic heart failure and then have you predict what the pressure-volume curve will look like.
        
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  Biochemistry:
  
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    Lang Flash Cards
    
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      Use these in the 3 month period
      
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      Try to focus on the lab values that are listed on the cards, i.e.; knowing that LH is up, FSH is up and testosterone is down in Kleinfelters is extremely high yield.
      
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      Some of the cards are kind of low yield, they go too far into naming different Lysosomal diseases for example. Use First Aid as guidance on what to focus on.
      
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    Kaplan Biochemistry
    
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      Great resource, although it wont help you much during the course at our school.
      
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      Add facts that stump you to the flash cards, as they are more time effective
      
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      Pay special attention to biochemical techniques such as Western Blotting, as they come up commonly as a method of diagnosing and understanding different disorders.
      
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        “What can be used to diagnose a patient with calf pseudohypertrophy, proximal muscle weakness and Groover maneuver?
        
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  Pharmacology
  
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    First Aid
    
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      Actually had the most relevant information
      
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      They like to describe a disease or infection and have you write a prescription to the patient.
      
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      Also like to ask about side effects of drugs and how to address them
      
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        “A patient with a history of asthma that is well controlled with theophylline comes into your clinic with cardiac arrhythmias after suffering from a bacterial infection 3 days ago. Which drug was prescribed for the bacterial infection?”
        
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    Lang Flash Cards
    
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      These are great and should be used during school and 3 month.
      
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      Write down facts from Kaplan pharma onto these cards so that it is more time effective.
      
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    Sketchy pharma
    
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      This uses the memory palace technique. Instead of memorizing facts, you memorize a picture and pull off details from the picture. It makes it easy to stick into long term memory and easy to recall in stressful situations.
      
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      You can pirate these videos or buy them from the sketchy website.
      
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      Great for school and 3 months.
      
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    You can score a lot of EASY points in pharma on the exam, so learn this well.
    
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  Microbiology
  
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    SKETCHY MICRO
    
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      By far the best and really only resource that you need for the exam
      
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    You can also use the Kaplan Micro and First Aid.
    
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    This is another subject that you can get easy points from.
    
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      Kaplan and sketchy are good for school and 3months
      
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  Immunology
  
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    Kaplan Immuno , First Aid and the pathoma portion for immunodeficiency
    
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      Pretty straightforward, they like describing immunodeficiency syndromes and then having you guess what it is.
      
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        Or hypothetically altering a CD protein and asking what would happen to the immune system.
        
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        Or in certain immune deficiencies, what kinds of microorganisms are you susceptible too
        
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      KNOW VERY WELL, organ rejections
      
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        I got a histology slide of chronic organ rejection. You had to guess from the connective tissue.
        
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  Anatomy/Embryo:
  
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    This subject is a bit of a Wild Card, it’s a HUGE topic, but it’s usually low yield. It might only make up 14 out of the 284 questions that you get. So investing a lot of time is not advised.
    
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    You will learn a lot of the highly tested anatomy questions from the Q banks
    
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      “A football player dislocated his tibia, which artery is susceptible to injury” –popliteal a.
      
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    Hopefully from doing the Qbanks, you will become proficient in reading and orienting yourself in a CT scan or Xray. They like showing CT scans of the abdomen with patients that have perforations, calcified pancreas, tumors, necrotic enterocolitis, Mallory Weiss tears, Aortic dissections, heart malformations, renal atrophy/hypertrophy, inflamed gallbladder, inflammatory bowel disease, pyloric stenosis, ischemic colitis, duodenal atresia etc….
    
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    The neuroanatomy is very highly tested, Kaplan neuroanatomy is the best IMO. They will ask about the locations of strokes in the brain based on the symptoms, ask to diagnose a subdural hematoma based on CT, diagnose brain tumors based on CT, histology or gross anatomy. You are guaranteed a question about Brown-Sequard Syndrome or some other spinal cord injury.
    
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    High yield neuroanatomy is another praised resource. I also found it useful during the neuroscience course in 2^nd year.
    
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    Make sure that you know the spinal cord tracts very well, there are a lot of pathology connections that they like to make  syphilis, B12 deficiency, Friedrich ataxia etc…
    
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    First Aid should be enough for the Embryo section, they like asking about Aortic and Embryonic Arches. Or they might make an Embryo connection with pathology like penial hypospadias and ask you what went wrong during fetal development.
    
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  Behavioral Sciences/Epidemiology/ Biostatistics
  
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    Kaplan lecture notes and Kaplan Qbank is the best resource for this
    
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    A lot of the behavioral science is pretty random and gives you hospital scenarios that you have to prepare for:
    
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      “A conservative muslim woman wearing a full hajeeb comes to your emergency room with pelvic pain and vaginal bleeding but she refuses to be seen by a male doctor. You are the only doctor qualified to do this procedure at the hospital. What do you do?”
      
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      “A 16 year old girl with down syndrome comes to your clinic with a 5 month pregnancy. Her parents urge you to perform an abortion, however the 16 year old girl wants prenatal care. What do you do?”
      

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  “While on a party with other medical doctors, you notice your colleague has drank too much. Your drunk colleague than receives a call from a resident at the hospital. It is clear that he is too intoxicated to give medical advice. What do you do?”
  

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  The behavioral science also deals with speaking to patients. Again the only thing that can help you prepare for behavioral science is by doing lots of questions. There is no book resource that can help you. First Aid gives solutions to some of the scenarios but this area is too vast.
  
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  The Biostatistics should be learned by the Kaplan videos and lecture notes and then practice through the Qbanks. First Aid did not do a good job explaining statistics.
  
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  Psychiatry from First Aid is enough.
  

3 months before the Exam:

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  This task is quite daunting and can be overwhelming, therefore I recommend going to USMLExcellence.com and buying the $10 scheduling application for your phone so that you don’t get lost. It will tell you what to study each day and which Q banks to use.
  
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  Basically you study the subject matter in blocks. Do Biochemistry 3 days, Cardiology for 2 days etc… which include reading and then Qbanks to solidify the knowledge.
  
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    Month 1 is focused more on reading/learning while months 2 and 3 are more doing questions
    
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  Try to do UWorld 2 times. You can’t reset this Qbank, so the 1^st time through, “mark” each question so that you can select the option “do marked questions” on the second time through.
  
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  During months 2-3, sit down 1 day each week to do 7-8 hours of Kaplan. After conditioning your mind, the 8 hour long USMLE exam won’t seem so long.
  
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    When doing UWorld the 2^nd time and Kaplan, set the questions to random. Don’t do them by topic.
    
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  You will soon realize that memory loss is a huge problem, you will need to read things 4-6 times for them to stick. Certain subjects like glycogen storage diseases I had to review every 6 days.
  
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    But if you used the USMLE resources during the school year, memory loss won’t be as severe.
    
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    Try to come up with mnemonics or visual memory techniques
    
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  Try to stay mentally healthy and go out with friends or something that you enjoy after your 10-12 hour block per day. Burnout is a dangerous and often inevitable consequence.
  
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    Some people recommend taking 1 day off per week.
    
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  When doing the Qbanks, don’t just memorize the answers. Understand why you got something wrong.
  
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  Try to avoid making flashcards unless absolutely necessary, this tends to be a waste of time and there are thousands of premade versions for free online.
  
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  DON’T study 1-2 days before the exam. It won’t help you and honestly after 3 months your brain will need to recover before sitting through an 8 hour exam. Try to do something relaxing and catch up on sleep.
  
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  The exam is more of a puzzle solving experience than the typical memorize-regurgitate that you are used to. Maybe only 60% of your USMLE will have answers explicitly written in the high yield materials, the rest of the time you will have to apply those fundamental concepts/knowledge you learned the past couple months to make deductions and inferences.
  
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  Good Luck!