Introduction

Alpert Medical School Step 1 Handbook

INTRODUCTION
The purpose of this handbook is to provide you with the background information you need to successfully prepare for the USMLE Step 1 examination. In addition to the material in this handbook, you will find a variety of other resources posted on Canvas in the USMLE Step 1 Materials section. There, you will find a self assessment tool, planning calendar, sample study plans, content related material, etc.

You have every reason to feel positive about Step 1. Alpert Medical School students perform very well on this test, as indicated by our students’ success in the residency match. Our curriculum and examinations provide excellent preparation for this test, and we have a robust system in place to provide students who need additional help with that assistance in preparing for the exam.

We wish you all the best as you tackle this challenge and progress towards becoming a licensed physician.

Emily Green, MA Paul George, MD

Assistant Director of Student Affairs Director, Year II Curriculum
A QUICK OVERVIEW
USMLE Step 1 is the first of three examinations students must pass to become a licensed physician in the United States. Step 1 is designed to measure basic science knowledge. It does so through a case‐based, multiple‐choice question approach. A Step 1 score of 188 is considered passing. The current national mean for first time test takers is in the range of 215 to 235, and the standard deviation is approximately 20.

TEST QUESTION FORMAT

The exam is an eight‐hour computer‐based test consisting of seven 60 minute blocks of questions. There are a total of approximately 322 questions with 46 questions per block. Most Step 1 questions begin with a description of a patient. Three to eleven possible answers (usually five) are provided for each question. Although answer choices may be very similar, or partially correct, there is only one best answer. There are also some non-case-based questions that focus primarily on the basic sciences.

Some questions include media clips (audio and/or video) and some include sequential questions embedded in the question base. Sequential questions necessitate a wider range of knowledge around particular cases. Once you have answered the first question, your answer will be locked in as you complete the second question. Some questions embedded in the exam are experimental and non-graded.


REGISTERING FOR STEP 1
It is suggested that students register through the NBME 3-6 months before the date they wish to take the exam. For specific guidelines, and to apply for the Step 1 exam, please review and follow the application instructions at the NBME website (www.nbme.org). Students can also reference the section “How do I register to take the exam?” in First Aid. Starting in November, 2013 the registration fee for the exam is $580.
As you register through www.nbme.org, one of the steps involves completing a Certification of Identification and Authorization Form. This form must be completed and submitted to Janice Viticonte of AMS student affairs (be sure to attach a photo).
Please note that registering for the USMLE Step 1 exam is different than scheduling your USMLE Step 1 exam. When you register for the USMLE Step 1 exam you will be asked to select a 90 day eligibility period in which to take the exam. After registration, NBME will issue you a scheduling permit by email. Once you receive this permit, you will schedule a specific test date through the testing center where you plan on taking the exam.
SCHEDULING OF EXAM RETAKES (excerpt from USMLE.org)

The USMLE Program sets rules on how quickly examinees can repeat the same Step or Step Component. These rules will change for exam applications submitted on or after January 1, 2012.

For exam applications submitted on or after January 1, 2012, the following rules apply to all Steps and Step Components:

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  You may take the same examination no more than three times within a 12-month period.
  
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  Your fourth and subsequent attempts must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam. Attempts at that examination (complete and incomplete) prior to January 1, 2012, the six-attempt limit will go into effect for all exam applications that you submit on or after January 1, 2013. Beginning on that date, all attempts at a Step or Step Component will be counted toward the limit, regardless of when the exams were taken.
  

When you reapply, your exam eligibility period will be adjusted, if necessary, to comply with these rules.
CHANGING YOUR ELIGIBILITY PERIOD

Students may request a one‐time three month extension using a “Step 1 and Step 2 CK Eligibility Period Extension Form” available on the NBME web site.

Important Reminder!!! Rescheduling your 90 day eligibility period does not automatically move or cancel any tests or practice tests you may have scheduled with the testing center.


SCHEDULING YOUR EXAM
The USMLE Step 1 exam is offered at Prometric testing centers (www.prometric.com). In the Providence area, the closest Prometric center is located in Warwick, RI. There are also reasonably close centers in Cumberland, RI, Worcester, MA, and Brockton, MA. The telephone number to register for exams is 1‐800‐MED EXAM or 1‐800‐633‐3926. Should you need to call the facility in Warwick, the telephone is 1‐401‐738‐9172. The facility is located in a plaza at 2346 Post Road, Suite 104, Warwick, RI.
Directions: Take the T. F. Green Airport exit (Exit 13) to the Airport Connector. Take the second exit, which will be Post Road (Route 1). Turn right onto Post Road (South). Continue 3/10 of a mile to the Airport Professional Park on the left‐hand side of the road; first building on left, last door. The complex is surrounded by a red brick wall. The Prometric Testing Center is located in the professional park across from Dave’s Bar and Grill. Enter the center by the last door in the first building.

AVAILABILITY OF TEST DATES AND TIMES:

Students must select a date with Prometric which falls between the start and end dates of their 90-day eligibility period. Test scheduling is on a first come, first served basis so it is important to call and schedule an exam date soon after you receive your scheduling permit. Please note that a scheduling number (obtained from NBME as part of the board’s registration process) is required to schedule an exam with Prometric. Please check with individual testing centers for the days/times they offer USMLE Step 1. Once scheduled, changes to your test date may incur Prometric fees.

DEVELOPING AN EFFECTIVE PREPARATION PLAN
The best preparation for Step 1 is mastering the material in your preclinical courses. That said, it is not unreasonable to begin thinking about Step 1 before that time. By the time the 6 week prep period begins in March, you should have

1. 
   Purchased your prep books and other materials and become familiar with the way in which they are organized.
   
2. 
   Attended the content presentations organized by the Office of Medical Education.
   
3. 
   Developed a fairly detailed study plan for the prep period.
   

Suggested Step 1 Timeline
Summer before Year II	No preparation necessary (low yield for content retention)
August – October	Focus on mastering Year II course material Purchase and become familiar with First Aid (optional) Annotate sections of First Aid that correlate with Year II courses (optional) Purchase the Kaplan Qbank year-long subscription and try out sample questions related to your course work (optional).
November - December	Focus on mastering Year II course material Purchase and become familiar with First Aid (optional) Annotate sections of First Aid that correlate with Year II courses (optional) Attend administration’s “Intro to Step 1” presentation Register for the exam via www.nbme.org Apply for exam accommodations if necessary
January - February	Focus on mastering Year II course material Review Step 1 materials in Canvas Review and purchase Step 1 resources Become familiar with the format of q-bank questions Attend content review sessions Sign up for tutoring if necessary Develop a prep calendar Sign up for prep calendar review by Emily Green and Paul George
March - April	6 week prep time followed by 1 week vacation

TEST ACCOMMODATIONS

Students with disabilities requiring test accommodations should consult Test Accommodations at the USMLE website (http://www.usmle.org/test-accommodations/). However, please note that it is very difficult to get accommodations for Step 1 and it usually takes several months to receive a decision from the organization. Please plan accordingly. Contact your Academy Director with any questions about this process.

Study PLANs

Once your preclinical courses have ended, you will implement a study plan for your exam preparation. Study plans should be individualized. We have provided several plans that have proven effective for students from previous years in the Canvas USMLE Step 1 Materials folder. Most students use these plans as a starting point, then modify them as they work through the preparation process.

Study plan overview:

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  Prep time is usually 6 weeks in length followed by 1 week vacation
  
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  Study plan should include days off and flex days
  
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  Study plan should include time for practice exam(s)
  
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  Daily schedule should include 8-10 hours of studying spread out over 10-12 hours
  
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  Daily schedule should include a balance of content-specific studying and q-bank questions
  

We recommend sitting down with an actual calendar and mapping out your study plan so that you have a clear idea of what you will be doing on any given day during your prep period.

STEP 1 CONTENT PRESENTATIONS

During the spring semester of Year II we offer content presentations focusing on the primary basic science areas from first and second year. These presentations focus on identifying what is generally covered from those areas on Step 1, materials to support studying in those areas and several hints for learning and recalling such content. These presentations are delivered by third and fourth year students who have taken Step 1. Handouts are available on Canvas.

TUTORING

Students can arrange for tutoring through the Office of Medical Education. Tutors can help with preparation strategies and/or with content.

STUDY GROUPS

Many students choose to be part of a study group. Working in a group can help you focus your effort on specific content areas, stay on task, and helps develop test‐taking skills based on your colleagues’ various approaches. Other students find it more beneficial to study independently- either alone or in the same general area as a peer.

PRACTICE EXAMS
Students often have questions about the number and type of practice exams to take. Factors such as content recall, observing clues within cases, and timing within individual questions and within blocks can be self-assessed through the use of practice exams. Generally speaking we recommend that students take 2-3 practice exams during their board preparation time. There are at least five companies offering practice exams, NBME, WORLD, CONSULT, Thomson Prometric, and Kaplan, among others. However, it is also possible to create your own practice “exam” by doing a block of questions from your q-bank in a timed manner.

Commonly Used Practice Exams

Type of Practice Exam	Description
NBME/CBSSA	The NBME Comprehensive Basic Science Self‐Assessments (CBSSA) are 200‐question practice exams (“forms”) that can be taken in two different timing modes. Standard Paced allows up to 1 hour, 5 minutes to complete each of the four sections, and Self‐Paced allows up to 4 hours, 20 minutes to complete each of the four sections. Several of the forms come with enhanced feedback- incorrect answers are identified, however, correct answers are not provided. After each form, NBME provides a performance summary with a breakdown across 19 content and organ system areas, and a three‐digit score in the range of 200‐800. This score can be converted to an approximate USMLE score. An unconverted score of 340 indicates a 95% probability of passing the actual Step 1 exam (Morrison, 2010).
Q-Bank	You can create your own practice exam by generating approximately 336 q-bank questions and taking them in a timed manner.
Prometric Practice Sessions	Prometric administers a three and a half‐hour long practice exam offered by USMLE in the actual exam setting. This is the same 150 question exam that can be downloaded free of charge at the USMLE website (www.usmle.org). Scores on this exam are not predictive- the usefulness of the exam concerns logistical familiarity with the test site. Prometric practice exams must fall within your 90-day eligibility period. Prometric also offers a “test drive” that allows you to visit the Prometric test site for a 30 minute orientation to the site, including lockers, restrooms and computer area. In addition, they will confirm that your documentation and registration materials will be accepted on the day of the actual test. You will also experience ID confirmation, biometric identity capture, image capture and a sample generic test (not using Step 1 questions), where you can practice with the headsets.
USMLE-Sponsored Tutorial	USMLE provides a 15‐minute tutorial on their website [http://www.usmle.org/practice-materials/]. This same tutorial is provided on your test day at the beginning of your exam; by looking at the tutorial online, you can usually skip the tutorial during the actual Step 1 exam, and therefore receive an extra fifteen minutes of break time.

The real question is not how many practice exams to take, but how to approach them in a strategic manner. Thinking through why you are taking them and what you will learn from them will help you decide how many to take and where to place them in your schedule. Practice exams can be helpful tools in the following array of ways:

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  Diagnostic tool- Taking a practice exam at the beginning of your study period can help identify particular areas of strength and weakness. This can be especially helpful if you are taking the exam “off schedule” and further away from your preclinical courses.
  
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  Timing- Exams completed at the standard pace allow you to practice getting through the exam in the time allotted.
  
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  Content review- Seeing material repeatedly through questions can consolidate information and help with retention.
  
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  Schedule adjustment- Practice exams can help identify areas of strength and weakness and help you make any necessary adjustments to the rest of your study period accordingly.
  
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  Study tool- Reviewing material that you got incorrect on a practice exam can be the basis of at least part of your study plan.
  
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  Score prediction- The data shows that a single NBME/CBSSA exam form is generally predictive of actual Step 1 scores.
  
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  Stamina building- An eight hour exam is a marathon. Sitting and concentrating for that amount of time at least once prior to the actual test is good practice. A “double” NBME/CBSSA exam (2 forms taken together during an 8 hour period) 7-10 days prior to your test date is good practice for the actual exam.
  
• 
  Logistical familiarity- The 3-hour practice exam at the Prometric site offers the opportunity for you to become familiar with the environment and practices of the testing site and prevents any last minute “unknowns” from causing anxiety on the day of your test.
  

Be strategic. Before you start putting practice exams into your final boards prep calendar, be sure you know why you are including them and what you plan on doing with the data they generate.

Time of Exam	Type of Exam	Purpose of Exam
Week 1	Single NBME/CBSSA form (particularly one with expanded feedback)	Diagnostic- identify content knowledge areas of strength and weakness to better refine study plan
Week 3	Single NBME/CBSSA form Or ~330 randomly-generated Q-bank questions )	Timing- practice getting through questions in the time allotted Study tool- Review any questions missed and study related material
Week 5	“Double” NBME/CBSSA exam (2 forms)	Score prediction- Assess any risk of not passing exam Stamina building- practice focusing for eight hour period
Week 6	Prometric Practice Exam	Logistical familiarity- Become familiar with the test site and eliminate need to complete the system intro on your actual test date

Possible Practice Exam Schedule A

Possible Practice Exam Schedule B

Time of Exam	Type of Exam	Purpose of Exam
Spring Semester Year II (prior to 6 week prep period)	Prometric Practice Exam	Logistical familiarity- Become familiar with the test site and eliminate need to complete the system intro on your actual test date
Week 4	Single NBME/CBSSA form Or ~330 randomly-generated Q-bank questions	Study tool- Review any questions missed and study related material Schedule adjustment- Use the results to make any necessary changes to your study schedule
Week 5	“Double” NBME/CBSSA exam (2 forms)	Score prediction- Assess any risk of not passing exam Stamina building- practice focusing for eight hour period Schedule adjustment- Use the results to plan your “review period” just prior to your exam

Important Reminder!!! Moving or canceling any appointments you have made with Prometric does not automatically reschedule your eligibility period. Remember, you cannot schedule a test or practice test with Prometric until you have scheduled your eligibility period.


THE DAY OF THE EXAM
The scheduling permit you received in an email from NBME must be printed out and brought with you to the Prometric testing site on the day of the exam. DO NOT JUST PRINT THE EMAIL ITSELF. BE SURE TO OPEN THE LINK AND PRINT THE ACTUAL SCHEDULING PERMIT! Students will not be allowed to take the boards unless they present this permit along with an unexpired, government‐issued photo identification with their signature (such as a current driver’s license, passport, national identity card or ECFMG‐issued ID). If your ID does not contain your signature, you must present another form of unexpired ID showing your signature. Students must make sure that the name on their photo ID exactly matches the name appearing on their scheduling permit.
In Warwick there is often heavy traffic early in the morning, and the testing center requests that all applicants arrive one half hour prior to their designated start time. If you arrive after your testing time, you may be denied admittance to your exam. Please plan accordingly.

RULES OF CONDUCT

The entire testing session, including orientation and breaks, is considered a closed and secure testing session, and the entire test center, including the orientation room and the rest rooms, is a secure testing area. Therefore, the rules regarding unauthorized possession of materials during Step 1 extend to the orientation room and to all breaks.

When you apply to take USMLE Step 1, you are agreeing to follow the Rules of Conduct outlined by the testing center. Please be aware that there are strict rules regarding materials allowed including electronic devices, outerwear, books, food, etc. The center will also inform you about current rules regarding earplugs, headphones, breaks, etc.
The exam day is long. Plan ahead so that you have food, beverages and rest periods. Practice exams can help with this preparation.


OTHER STEP 1 POLICIES
Students in MD2014 and in subsequent classes are required to pass the USMLE Step 1 examination prior to graduation, and will be allowed to take the examination as many as three times. If a student in MD2014 or a subsequent class does not pass Step 1 within these three attempts, s/he will be considered for dismissal from the medical program by the Medical Committee on Academic Standing (MCAS). The MCAS and the appeal process will adhere to current guidelines for students with other academic issues (see Student Policy Handbook; http://med.brown.edu/student_services/handbook.html).
Students are encouraged to check the state licensing requirements in the state in which they hope to practice, as some states may require students to complete their licensing exams within a particular number of years and may require them to pass particular steps within a prescribed number of attempts.

STRUCTURED SUPPORT PROGRAMS
Some students require a more structured preparation program in order to be as successful as possible on Step 1. Below are a number of residential and on-line programs designed to support students studying for Step 1. At this time the administration has only anecdotal evidence to support program claims to help students pass the exam. Please rely on your own knowledge of your study style and skills to help assess the usefulness of these programs. (The administration welcomes any feedback on these programs from students who do end up utilizing them.) Info on these programs below was updated in 2013.

Physician Assisted Student Success (PASS) Program

http://www.passprogram.net/

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  Classroom and one-on-one instruction for USMLE Step 1, 2 and 3.
  

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  Offer 6, 8 and 12 week sessions that run throughout the year
  
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  Locations: Champaign, Illinois (PASS Program Champaign) and St. Augustine, Florida (PASS Program South).
  
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  Tuition: between $3,700 - $10,000 depending on program; housing not included in tuition costs
  
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  4 week program (offered as PASS South only) offers classroom lectures, two one-on-one sessions/week, simulated exams and practice questions.
  

Tuition $3,700 (housing is additional $750-$850)

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  6 week program offers classroom lectures, two one-on-one sessions/week, simulated exams and practice questions.
  Tuition $5,550 (housing is additional $1,225 + $100 security deposit)
  
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  8 week program offers classroom lectures, three one-on-one sessions/week (five in the last two weeks), simulated exams and practice questions.
  Tuition $6,000 (housing is additional $1,600 + $100 security deposit)
  
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  12 week program – the first half of this program is spent in an immersive learning environment. After the first six weeks, students may re-visit any lectures or go into more tutoring. Recommendations where extra help is needed are based on performance. Tuition $10,000 (housing is additional $2,350 + $100 security deposit)
  
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  Guarantee: If you attend the 8 week program and do not pass the USMLE exam, you may return for 4 weeks for free.
  
  

Falcon Reviews

http://www.falconreviews.com/v3/live-overview.html

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  Classroom instruction for USMLE Step 1 and 2
  
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  Offers a seven-week intensive course that runs from spring to fall.
  
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  Locations: Chicago, Dallas, New York, and Toronto
  
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  Tuition: Between $4,499 - $6,499; cost includes lodging, shuttle service and complimentary breakfast and lunch.
  
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  Course offers classroom lectures, a 3-month subscription to USMLE World
  Tuition: $4,499 (for a double occupancy room) and $6,499 (for a single occupancy room).
  
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  Also offer online and phone app programs.
  
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  Guarantee: If you attend 90% of the sessions and use the FALCON study method and do not pass you will receive free tuition waiver on the next regularly scheduled review.
  

Doctors in Training

http://www.doctorsintraining.com/

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  Two-part course available for USMLE Step 1 and 2
  

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  Location: Part I is web-based learning; Part II is in Galveston, Texas from May 9 – 27, 2011
  
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  Tuition: Part I and II is $799 total.
  
•