A Resource for USMLE Step 1 PreparationCompiled by the Office of Medical Education Tulane University School of Medicine 1430 Tulane Avenue, SL-6 New Orleans, LA 70112 Phone: 504-988-6600 Email:
[email protected] USMLE – What is it? In order to become a licensed physician in the United States, individuals must pass a series of examinations sponsored by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams that must be passed in order to become eligible for medical licensure: • • • • Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), usually taken during the fourth year; Step 2 Clinical Skills (CS), usually taken during the fourth year; and Step 3, typically taken during the first year of post graduate training. Step 1 assesses whether you understand and can apply important basic science concepts to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. Step 1 is constructed according to an integrated content outline that organizes basic science material along two dimensions: system and process. Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine. There are two components of Step 2: Step 2 Clinical Knowledge (CK) is constructed according to an integrated content outline that organizes clinical science material along two dimensions: physician task and disease category. This is the computerbased, multiple-choice portion of Step 2. Step 2 Clinical Skills (CS) uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues. Implementation of the clinical skills examination began in June 2004. USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States. Step 3 assesses whether you can apply medical knowledge and understand biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care to patients. Requirements for licensure in each state are set by the state's medical licensing boards, but there is a nationwide sixattempt limit for each component of the exam. Each state board may determine the maximum number of times that a person may take each Step exam and still remain eligible for licensure. In Louisiana, applicants have six attempts to pass USMLE Step 1, four attempts to pass USMLE Step 2 and four attempts to pass USMLE Step 3. All sections of the exam must be taken within a 10-year span. But what we're really here for is to talk about preparing for Step 1. Step 1 is your first BIG hurdle. And make no mistake about it, this is a VERY important test. An excellent performance on Step 1 can definitely help you when it comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options. A failure on Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue. 3 Step I: Basic Information How is Step 1 scored? When you take Step 1, the computer records your responses. After your test ends, your responses are transmitted to the NBME for scoring. The number of test items you answer correctly is converted to a three-digit score. On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 220 to 240, and the standard deviation is approximately 20. Your score report will include the mean and standard deviation for recent administrations of the examination, and you can see performance reports from past years at http://www.usmle.org/performance-data/. In the past, applicants received both a 3-digit and a 2-digit score, but as of April 2013 the USMLE Composite Committee (the governing body of the USMLE program) directed staff to discontinue reporting of the 2-digit score due to confusion surrounding its interpretation and use. The Step 1 exam contains 322 multiple-choice items administered in 7 blocks of 60 minutes each. The number of questions per block on a given examination form may vary but will not exceed 46. Blocks of items are constructed to meet specific content specifications. As a result, the combination of blocks of items creates a form of the examination that is comparable in content to all other forms. The percentage of correctly answered items required to pass varies from form to form. However, examinees typically must answer 60 to 70 percent of items correctly to achieve a passing score. What is the minimum passing score? The USMLE program provides a recommended pass or fail outcome for all Step examinations. Recommended performance standards for the USMLE are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments will be posted at the USMLE website. Effective January 1, 2014, the minimum passing score for Step 1 is 192. What is Tulane School of Medicine policy on USMLE exams? Step 1 Exam • • USMLE Step 1 must be passed by November 1st of the third year. Students not passing Step 1 are required to take a leave of absence until a passing score on Step 1 is achieved. The Committee on Academic Performance and the Senior Associate Dean for Student Affairs may recommend a delay in a student sitting for Step 1 until a study program is satisfactorily completed. All students are required to pass USMLE Step 2 CK and Step 2 CS prior to graduating medical school. Students not passing both Step 2 CK and CS by April of their fourth year of medical school will be required to take a leave of absence until passing scores on both Step 2 CK and CS are achieved. All senior students must sit for USMLE Step 2 CS and Step 2 CK before December 31st of their senior year in order to be allowed to participate in the Match. This motion was passed in order to assure that every Tulane senior participating in the Match will be allowed to graduate and begin residencies on time. You will still be required to have passing scores on both parts of Step 2 in order to graduate, but will have until June to do so. This will allow for retakes if necessary. A student may accumulate a maximum of 24 months of leave for the purpose of meeting the USMLE requirement. Step 2 Exam • • • After 24 months, if USMLE Step 1, Step 2 CK and Step 2 CS are not passed, the student will be dismissed. 4 this message will include instructions for accessing the electronic scheduling permit using the registration entity's interactive website. • Print out the application authorization form. Prometric test centers are located throughout the U.prometric. If you must reschedule outside the approved eligibility period. About a week later. PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. Once you submit the online form. In the yellow LOG IN box. you will receive a second email from them notifying you that your scheduling permit is available. you may schedule your test online at www.PLAN AHEAD! No fee is charged for changing testing appointments 31 or more days prior to the first day of the scheduled test. and USMLE exams are not necessarily offered every day the centers are open. You MUST bring it with you to the test center on the day of your test. Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs). a part of The Thomson Corporation. you will indicate a 90-day eligibility period during which you plan to take the exam. provides scheduling and test centers for the computerbased components of USMLE. you're ready to mail it in to the address listed on the bottom of the form. You will not be allowed to take the exam without your scheduling permit. Please note that May through July is one of the busiest periods for these testing centers because of the large USMLE demand during that time . • After that.S. How do I apply for Step 1? Where do I take the test? Thomson Prometric.com for any available test date that is within your approved 90-day eligibility period. Go to http://www. As part of the application. Not all Prometric centers are open on weekends.html.org/students/licensing. you will receive a link to the Certification of ID/Applicant Authorization form. click on "First-time user" and follow the instructions. Payment is also required at this time (the 2014 fee is $580). You do not have to get a passport photo taken—the Office of Student Affairs has printed copies of your white coat ceremony picture. you will receive an email from NBME notifying you that your application is complete. Click on the link that says “NBME Licensing Examination Services Website”. which will require your signature and a picture. you will need to reapply and pay an additional fee (see following page): 5 . In Louisiana there are centers in: • Alexandria • Baton Rouge • Bossier City • Lake Charles • Metairie How do I schedule my test? Once your application has been processed. • Bring the form to the Student Affairs Office (Murphy Building 15th floor) to attach your white coat picture and request an authorized signature and school seal placement.nbme. Once you've gotten your permit.The initial application for Step 1 is done on the Internet. etc. a group of pharmacology questions. China. The Step 1 test day lasts 8 hours. The 8 hours includes the test itself as well as break time. etc. but there is only ONE BEST answer. Asia (including Hong Kong and Pakistan). Step 1 includes only SINGLE BEST ANSWER questions.25 minutes per question.histology. so don't expect a block of pathology questions. most frequently used multiple-choice format.Appointment Change Fees Table for Computer Based Examinations The date that you change your appointment 31 or more days before (but not including) the first day of the scheduled test date Prometric Testing Region Step 1 Step 2 CK Step 3* All testing regions No Fee No Fee No Fee Fewer than 31 days and more than 5 days before (but not including) the first day of the scheduled test date All testing regions $50 $50 $50 US and Canada Africa. gross pathology. Thailand Europe (including Israel). Latin America. CT images. During each block you can answer questions in any order. and change answers. you will no longer be able to review questions or change answers in that block. 6 . Some questions will include pictures . Once you have exited a block or the time for that block has expired. Australia. Indonesia. Korea. which means you will have about 1. Examinees are required to select the best answer to the question. These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. Middle East (including Egypt).org for current information. Other options may be partially correct. India. Taiwan Japan $110 $124 $221 5 or fewer days before (but not including) the first day of the scheduled test date $268 $302 N/A $304 $491 $342 $552 N/A N/A Please note that these fees are subject to change at any time—always check http://www. The exam consists of 322 multiple choice questions arranged in seven 60-minute blocks of 46 questions each. What is the format of the test? *Most score reporting of Step 1 results occurs within 8 weeks of testing. This is the traditional. go back and review questions in the block. Don't panic if your first block happens to be a more difficult one. The questions are random. • • • • Some blocks are harder than others.usmle. a scheduling permit will be issued to you within seven business days. they do not include any multimedia items. ** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. 7 . Those who are eligible to register for a Practice Session may take only one session per exam registration and must take it in the same testing region as your Step 1 exam. Please note that Practice Sessions are not available on major local holidays or during the first two weeks of January. cultural. Some practice items may include multimedia files. 2. The NBME offers a breakdown of the content areas on the test: SYSTEM** • • 25%-35% General principles 65%-75% Individual organ systems • • • • PROCESS* 20%-30% Normal structure and function 40%-50% Abnormal processes 15%-25% Principles of therapeutics 10%-20% Psychosocial. you will receive a printed percent correct score. The $75 fee for the practice session must be paid directly to Prometric by credit card at the time you schedule your appointment. NBME also publishes a more detailed outline of the topics covered on the Step 1 exam.5 hours and is divided into a brief tutorial section and three 1-hour blocks of 46-50 multiple choice test items each. If you register for a practice session. You can practice by downloading materials from the USMLE website (http://www. Practice Sessions are available at Thomson Prometric. The Practice Session is a maximum of 3.Can I practice taking the test? You should acquaint yourself with the test software well before your test date(s). When you complete the session. You can schedule a practice test at a Prometric Test Center. including navigation tools and examination format. prior to beginning the test. The NBME software has over 100 practice test items and a software tutorial. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system specific. however. See the USMLE website for the most up-to date information. occupational. You'll find the complete outline of what's on the Step 1 exam at the end of this book in Appendix A. and environmental considerations * Percentages are subject to change at any time. A brief tutorial on the test day provides a review of the test software.html).usmle. test centers. since ALL of the items written by NBME are copyrighted. In fact. such as video or audio clips. Once your Step 1 application has been processed and you have received your Scheduling Permit. It does not provide an opportunity to practice. The Practice Sessions use the same sample test materials that are available on the USMLE website. and test center staff is not authorized to provide instruction on use of the software. Do not schedule a Practice Session using your permit for the actual Step examination. you should be a little leery of anyone other than NBME who claims to have "actual USMLE questions".org/practice-materials/index. you are eligible to register for a Practice Session for that examination. a part of The Thomson Corporation. 1. What's on the test? The NBME's Comprehensive Basic Sciences Exam is the closest thing to the real thing that they will let anyone see. Practice time is not available on test day. Use this as an outline to make sure you are covering all of these topics in your study plan. NO NEW SAMPLE TEST MATERIALS ARE PRESENTED AT PRACTICE SESSIONS. This is a critical step in successful Step 1 preparation. recall. the information you need may be buried 8 . Many students in the past who have taken longer than 6 weeks to prepare later said they felt they took too much time and actually lost ground with their studying. Allow a few moments to think. use them. There are skills that you can learn to help you answer these kinds of test questions. MAKE a study schedule and stick to it. Mark choices that match best 6. Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. Some people seem to instinctively know how to answer multiple choice questions correctly. STUDY smart. If there are other methods that work for you. and to anticipate possible answers 4. but you can do it using material that you have LEARNED. based on that. Those who are good at multiple choice questions focus on the stems. others of us not so much. LEARN the material you are currently studying in your classes. Four to six weeks should be plenty of time to prepare for Step 1. Assemble key clues into a mental "snapshot" of the patient 2. 5. figuring out an answer you consider to be a high probability response. Explain concepts out loud to a study partner. Mark the best answer Kaplan's experts say that people who are bad at multiple choice questions focus on the choices rather than the stems of the questions. OTHER STEP 1 ADVICE The ways in which USMLE exams are similar to medical practice: 1. Rule out choices that don't account for all findings 7. More detailed information about study schedules can be found in the following section. 2. do it.Step 1: Preparation Several things have been proven to help students prepare to do their best of Step 1. If you always feel that your performance on multiple choice tests doesn't equate with your mastery of the material. not the choices. you must find key information 2. 1. Compare the given choices to your anticipated answer 5. Here's how Kaplan recommends approaching vignette styled multiple choice questions: 1. KNOW how to approach multiple choice questions and PRACTICE. ALLOW enough time to prepare. Understand precisely what is being asked 3. Analysis of our own students over the years shows that you get the most "bang for your buck" by studying for 6 to 9 hours per day for 4 to 6 weeks. practice answering questions by explaining why the right answers are right and the wrong answers are wrong. If concept mapping works for you. 3. This is a very inefficient approach and one that tends to result in more mistakes. Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study. 4. It is the purpose of the testing agency to see how adept you are at taking partial information and. You can't do that with MEMORIZED material. you might think about having your test-taking skills analyzed. but not too much. This will help keep you focused on what is important to know and show you how you will need to use the information on the test. For example. insufficient practice with questions 3. Once you know your percent correct score for each subject. Make a study schedule. 6. you will be taking long practice tests under test conditions that cover all the completed subject areas. BUT . 7. you should be spending at least 20% MORE time reviewing Physiology than Micro. create your own condensed summaries of the key material so you can review this right before test day. As you finish a subject. where do I start? 1. passive studying 2. Plan time during the final 2-3 weeks to do nothing but review your own summaries and take increasing numbers of simulated test modules of 50 items each under timed conditions (one hour per module). You can use your profile report from the Comprehensive Basic Science Exam or can use the Kaplan diagnostic test if you have taken it. Here’s some advice from Kaplan’s Judy Schwenker: 1. if Physiology is 20% lower than Microbiology. So if you have finished Anatomy and Physiology.3. and gives you a more accurate picture of your preparedness. By the end. NBME. you must first look at your own diagnostic test results and prepare your schedule with more time allotted to weaker subjects. It also gives you good practice for the mental stamina and pacing needed on test day. build mental stamina. you would do a 100item test under timed. When you prepare your own study schedule. 6. 5. not understanding the material 4. 4. Diagnostic tests are available from Kaplan. inappropriate test day strategies 5. look over some questions on the material before you start your review. and less time to stronger subjects. The first thing you need to do is take some sort of diagnostic test to see where your areas of strength and weakness are. Take a comprehensive test to begin as a measure of where your recall is right now. This helps keep the earlier material in memory. Lots of sample schedules are out there and two are included later in this guide. and a variety of other online sources that are listed later in this guide. because otherwise you will end up taking overly detailed notes and they won’t help at the end. This is the final “get it all fresh in mind. 2. As you begin to review a subject. Individual study pace also needs to be factored in. use the information to decide the relative amount of review time to put into each area. test mode assessing those 2 areas. 3. Self-assessment. misreading or misinterpreting questions So. As you move through the material. 20-30 pages per subject are a decent size to shoot for. and intensive test practice” phase.please remember that these schedules were made by individual students and the schedules reflect those students' individual circumstances. there are distractions there is time pressure you must use probabilities to make decisions you’ll never know it all situations won’t exactly fit what you’ve learned Mistakes most commonly made when preparing for Step 1: 1. 4. as some accomplish more per study day than others. 5. which should lead 2. 9 . use the QBank to create and take a test with maybe 50 items from each subject that you have completed up to that point. memorizing. Review the tutorial at http://www.html. Tips For The Day Before The Exam 1. Knowing that you do not know something gives you more sense of control on the exam and makes you less likely to panic when you encounter the material and/or waste time on questions you are not likely to get correct. Take a walk in the fresh air. 5. This is the time to drill yourself on essential information. Look over your summary notes one more time. This will get your circadian rhythms coordinated with the exam schedule. you will be accustomed your body to shutting down during the critical exam hours. Our experience has shown that students who are doing 70% or better on our full length simulated exams (or comparable practice tests created with Qbank or IV Qbank) by their test dates DO PASS. Do not nap between 8:00am and 5:00 pm. you should be tapering off your studying and getting into mental and physical shape. This is not the time for cramming new material…but time to organize and integrate what you already know. The key is to practice recall. You can see where you should park. Become familiar with the interface. the location of key information on the screen and how to navigate between screens. What you need to know is probably already in your head.usmle. If you walk into the exam familiar with the exam. If you do decide to do this. It will be indicated on your exam entry ticket. be advised that based on feedback from message boards. You should be getting a sufficient amount of sleep. No one can know everything that is asked on this exam. For most people that means at least 6 to 7 hours a night. limit yourself to reviewing your own notes and flashcards. Have a good meal. If you haven’t done so already. If you feel you must study. 4. visit the Prometric Test Center where you will be taking the exam. If you get up at the same time each day. 8. Doing practice questions is a good way to reinforce your recall skills. phrases and concepts. you will find it easier to get sleep the night of the exam as well. This will ensure you know how to get there and how much time you should allow for the commute. 6. 3. 2. otherwise. not simply read over the material again. Review keywords. By getting into a proper sleep-wake cycle. You need sleep. 1. Wake up every day at the same time you will need to on the day of the exam. 10 . you will find it easier to fall asleep at night. You may also choose to take one of the NBME self-assessments. it makes you a more efficient learner when you are awake. 7. so this is a good level to aim for. Your task now is to train yourself to access it when you need it. Find time for exercise. The change of pace will refresh you and the physical activity will help you relax and sleep at night. Additional Advice from Kaplan Tips for the Week Before During the last few days before the exam. Take the day off from studying.org/practice-materials/index. Work on making what you know more accessible. Take some time each day to relax. Use them to clarify your understanding. and see what the computer set-up is like. Get out of bed at the same time you will have to get up the next day. Sleep is an essential time for your brain to consolidate what you have learned. Be honest with yourself about what you do and do not know.right up to 2 days before your actual test date. This is your day to relax and gather your strength before the main event. Form 1 seems to be the most reliable. you will not have to use any of your valuable break time to do this on the test day. Get yourself onto the right time schedule. consider a hot bath or warm milk. you need to consider after each block if you want to take a bathroom break. Remember that you will need to sign in and out when you take breaks. Make sure that you have checked out the basics for the exam: • Have you worked through the USMLE tutorial? • • Do you know where the Prometric center is. Go shopping. as well as any personal items like eyeglasses. To help you sleep. 3. for example. To cope with fatigue. don't forget to pack a lunch! 4. it will be marked as an irregularity in your testing session. Listen to your favorite music. 5. The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. Therefore. and how to get there? Do you have alternative transportation if. Start with the beginning of the question block and work your way to the end. refreshed. Do whatever you like. you will need to schedule breaks. Remember that you have a total of seven hours to complete 322 questions. Go see a good comedy or an action movie that will allow cathartic release. and a total of one hour to be used throughout the day for breaks and lunch. and talking with colleagues will remind you that you are not in this by yourself. You'll need to blow off some steam anyhow. Kaplan’s Tips for Test Day… 1. Be sure to do some physical activity. Just taking a walk for an hour will help relax you. 3. Have some fun. The flow experience is a state of optimal concentration and maximal performance. This includes photo identification. 6. make arrangements with friends as back up. your car does not start? • Do you trust your alarm clock to wake you up in time? If not. While you're at it. You should also be aware that if you leave the exam room during a block. scheduling permit and confirmation number. 11 . 2. Spend time with a significant other. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized. Our recommended schedule for the exam is: Question Block Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Break time at end of Block No break 5 minute break 5 minute break 30 minute break No break 10 minute break Done! This allows you 10 minutes extra to use as needed. • Layout what you'll need for the exam before you go to sleep.2. and on time. Get a good night's sleep. Avoid taking sleeping medication as it may leave you groggy in the morning. Go for a walk. You have worked hard and deserve it. You will be given a locker to store your personal items and then assigned a computer station. You want to be sure to wake up rested. Call your friends and classmates and make some plans to celebrate. Limit your use of the marking feature to no more than two or three questions per block. marking causes you to not give a question your full attention the first time around. but not helpful. Checking almost always leads to changing and tends to reduce your score. they’ll probably just show you a blood smear. make sure that you have entered an answer for every question in the block and then. go back and "check" only those answers that you have previously marked. but you may want to double-check yourself on a few questions. especially if you mark a lot of them. bring coffee too. try not to become overwhelmed with all available resources. you are not likely to know it later. 5. Monitor your time. Know how much you have left. Sit. Relax. and move on to the next question. If you pace yourself throughout the block. Deal with each question as you come to it. you will always tend to remember those questions you get wrong.” “Get one good review book and one good question bank and really learn them. If you fall behind. If you change an answer. stick to a schedule. Do not skip any questions. Used correctly. ‘buzzwords’ are not typically used on Step 1. try to relax and not think back over the exam.” “The last week/few days before Step are very distracting – don’t give yourself too much time to study. Remember. Of course you should answer each question as you come to it. take a break. your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. for example. Another piece of important advice: BRING FOOD TO THE TEST. answer it as best you can. you are most likely making it wrong! Your first impulse is usually the correct one. you will never see them again. not the ones that have passed. The desire to recall questions is strong. and mentally prepare yourself for the next block of questions. Skipping around wastes time and can end up confusing you. The marking feature lets you return to review and reconsider questions if you have time left over." “Have a planned study schedule that you stick to.4. Be cautious about changing answers. During the breaks between question blocks. 4-6 weeks worked for me. Stay with it unless some clear insight occurs to you. You simply may not have time to go back and look at questions you have marked. "I'd recommend studying no more than about 5 weeks. Be prepared mentally for the anxiety the week before the test – focus on easier subjects to 12 . Focus on relaxing and making the most of your break. Any more and you will start forgetting things you learned earlier. Work on your pacing from the beginning of the question block. If you finish a question block with time left over. Rather than use the words ‘smudge cells’. you’ll have a hard time getting through everything and still being able to review material. Also. Pick a couple for each subject because in my experience you cannot absorb it all. I caution you to take what your classmates say about their exam with a grain of salt. 9. marking will help you revisit questions where you have a high probability of getting the answer correct. AND HERE’S SOME PREP ADVICE FROM SOME OF OUR STUDENTS…. Those questions are in the past. 7. Use First Aid as a scaffold – it really is helpful for recall association. Focus on the questions to come. 8. because every exam is different. In general. If you have a spare moment. relax.” “Start early. Misused. Don't try to use too many sources. so you do not find yourself rushed at the end. you should not be squeezed for time at the end. If you don't know it when you come to it. If you are used to having caffeine. Check your watch every 10 questions to make sure you are on the correct pace to finish. 6. During my actual exam.” 13 . You know what they are trying to ask you.review. I recalled information from first year lectures.” “Do as many questions as possible.) to improve your confidence will allow you to avoid second-guessing yourself or over stressing during the actual exam so that you can figure out exactly what the question is trying to ask.” “Confidence in your own knowledge is very important going into the exam. I wish I had started to use ‘First Aid’ the first semester of first year. Whatever you can do (practice tests etc. I focused on my med school courses and did very little specific boards study other than the question bank.” “The best advice I got was to take every course seriously. the problem is that questions are worded in such a way that it is often difficult to know exactly what the question is asking. from as many resources as possible. I also wish I had started the question bank first year and that I would have used it during the first and second year courses. You can remember more than 3 weeks of information. doctorsintraining. incorporating active learning principles. live lecture-style preparation. call Kaplan for current pricing and more information. TX is also available some years. 6 – April 13. Live Question-Based Review: 12 hours of guided USMLE question-based review. and pathology slides and has a corresponding study guide. Bundle packages (including access to Kaplan’s QBank) are available. Unfortunately some programs schedule their courses at times of the year that don’t coincide with most first-time test takers’ preparation efforts. charts.com/Medical-Licensing/ KAPLAN LivePrep: Structured. graphs. check the company websites for the most up-to-date information.399 6 month access: $3. Class dates: Jan.499 9 month access: $6. 12/13 Class of 2012 students who utilized it recommended it. check their website for current details. Costs and dates are always subject to change.899 High Yield: 50-hour fast-paced online review.999 Classroom Anywhere: Over 240 hours (14 weeks) of live online lectures.699 6 month access: $5. 7 week course: $3.Resources Review Courses Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. OnlinePrep: Web-based course with access to approximately 200 hours of online video.699 14 week course: $5. here is the information on some review courses that are available. 3 month access: $2. $799 *Most programs also include access to assessment tests and simulated exams. *Must call Kaplan for current pricing and more information. but it takes place during May.$4. A three-week live course in Galveston. http://www. 2014 (6:00-9:00 PM EST) . Part 2: Videos Focused high-yield videos.999 CenterPrep: Review video lectures at your own pace at a Kaplan center. Nevertheless.com Part 1: Questions and Video Answers You will receive 34 sets of 10 short-answer questions three times a week posted to your dashboard. The course contains more than 800 images.399 LivePrep Retreat: 6-week live lecture retreat in a hotel setting. Pathology (2 sessions) Pharmacology (2 sessions) Biochemistry (1 session) *2012 cost was $299. Cost: $799 (plus tax and shipping) *This program is fairly popular with Tulane medical students.kaptest. Previous retreats have taken place in Atlanta and Chicago. but several noted that it requires a great deal of study time (feels “drawn out”) and is best used as a review of First Aid. illustrations. 14 . Free Live Online seminars and practice exams are also offered by Kaplan. DOCTORS IN TRAINING http://www. 3 month access: $3. 65-75 hours. Offers excellent. daily Q/A sessions. Live Online Review: Over 275 hours of live classroom instruction accessible from any device with internet access. please e-mail your tips to ome@tulane. Price: $549 Self-Study Online Review: Over 325 hours of live instruction optimized into 115 hours of streaming video lecture material.299 Live Online Integrated Cases: 30 hours of live online case-based review over 6 days. USMLE World.000 questions).com/ 1 month: $119 2 months: $159 3 months: $199 6 months: $299 12 months: $399 15 . If you have any other suggestions for efficient ways to use question banks. Many students suggest obtaining access to one question bank (Kaplan and USMLEWorld are the most popular choices) and using it concurrently with course studying for the year before Step 1. and two NBME exams. Includes an interactive eBook. There is a free online demonstration.FALCON PHYSICIAN REVIEWS http://www. organized into 10.to 40-minute modules.900. hard copy study materials and books. *Prices vary by city location. They also offer “cruise reviews”. detailed explanations with figures and tables. 6-months of USMLE World Q Bank. Requires time commitment. Includes full set of Becker textbooks. subscription to QBank of your choice. Questions are representative in style and at times content to those on the actual exam. iPhone and Android accessibility An excellent bank of well-constructed questions that closely mirror those found on Step 1. Features a number of test customization and analysis options. Questions demand multistep reasoning and are often more difficult than those on the actual exam.edu. cities. NORTHWESTERN MEDICAL REVIEW http://www.falconreviews. IL. Prices range from $580 . Reading the often detailed explanations is time well spent. Price: $4. QUESTION BANK Kaplan Medical (QBank) http://www.com DETAILS Internet-based question bank providing tailored CBT-format exams (over 2. Unfortunately. question bank access. and two NBME exams.com Options include short-term live lecture review courses (3-15 days).northwesternmedicalreview. the program does not allow other application windows to be open for COST 1 month: $99 12 months: $299 USMLE World http://usmleworld. then buying another to use for intensive preparation before the test (USMLEWorld is more difficult and perhaps better suited for this use). or USMLE Consult. Question Banks Practice questions are a key component of USMLE Step 1 preparation. private tutoring. clinical vignettes and case students. Visit their website for more information. 30 hours of integrated cases.$1. Live review courses last between 3 and 15 days and typically take place in East Lansing. Test content and performance feedback are provided by organ system and discipline.kaplanmedical.S. video library access. Package includes over 300 hours of live lectures. access to USMLE World QBank for 3 months.com Live: 7-week intensive review offered in several U. MI or Chicago. Remember that you can easily get overwhelmed by using too many resources as you study.usmle-easy. Mobile companion app available for iOS and Android-based devices. Premium Review offers a Robbins Pathology test bank featuring 500 USMLE-style questions as well as the Scorrelator that predicts your USMLE Step 1 score. so pick out the few that seem to work best with your style of studying and learning and go with them.edu so that it can be included in our list of resources. Users can see cumulative results both over time and compared to other test takers. Question stems occasionally rely on “buzzwords”.reference.com 1 month: $99 3 months: $149 Till You Pass (≤12 months): $199 USMLE Easy http://www. USMLE Consult http://www.usmlerx. Users can see cumulative results both over time and compared to other test takers. the proportion of questions covering a given subject area does not always reflect the actual exam’s relative emphasis. Provides detailed performance analyses. However. Many questions are shorter and more obscure than those on the actual Step 1 exam.usmleconsult. What works for one person may not work for 16 . *USMLEasy Lite (25% of questions) is available for free through AccessMedicine (see Online Resources). A well-priced question bank that offers Step 1-style questions accompanied by thorough explanations. Offers concise explanations with links to Student Consult and First Consult content. Each explanation includes highyield facts and references from First Aid. A question bank based on the PreTest series. please send it to ome@tulane. Questions are more straightforward than those on actual exam. making it more straightforward than other question banks. If you find a book or website that you find helpful. Some obscure material is omitted.com A solid question bank that can be divided according to discipline and subject area. Most useful to help memorize First Aid facts. Useful as a supplemental review after other resources have been exhausted. *This is a very popular resource among Tulane students. Users can track questions completed as well as customize tests.com 1 week: $39 1 month: $79 3 month: $169 Other Study Resources There are many more websites and books available than those that are listed here. 1 month: $75 2 months: $115 3 months: $135 1 year: $395 USMLE Rx http://www. Step 2 CK.co m NBME Self-Assessment Services http://www. researchers. must be registered for an account at lww.exammaster2.medicalmnemonics.med. Free.com DETAILS Innovative online resource that provides students.another. Try it for yourself . clinicians. case files. A number of books are available for check-out in the Office of Medical Education library. thousands of images and illustrations. Basic exam: $50 Expanded feedback version: $60 Lippincott’s 350-Question Practice Test for USMLE Step 1 http://bit. move on to something that does. so be careful about using a book just because someone else said it worked for them.html WebPath: The Internet Pathology Laboratory for Medical Education http://library.org/students/sas /sas. Free.if it doesn't fit you.com/wdsentry/tulane. Register at http://www. Participants will receive a performance profile and a score interpretation guide immediately after completing a self-assessment. Review mode and test mode available.ly/1aRYORB Database of Medical Mnemonics http://www.utah. For selfassessment and study there are over 1300 examination items.com. Online Resources ONLINE RESOURCE AccessMedicine http://www. non-profit.nbme. A free. Medical students and graduates may find them to be useful tools as they prepare for USMLE Step1. interactive self-assessment. a comprehensive search platform. The material presented in these self-assessments is provided by the NBME for educational purposes only. There are more than 20 tutorials in specific subject areas. and the ability to view from and download content to a mobile device.edu/WebP ath/ Free. Books • First Aid for the USMLE Step 1 (McGrawHill Medical) • Appleton & Lange Review for the USMLE Step 1 (McGraw-Hill/Appleton & Lange) • Blueprints Step 1 Q&A (Lippincott Williams & Wilkins) • Board Review Series (Lippincott Williams & Wilkins) • • • • High-Yield Comprehensive USMLE Step 1 Review (Lippincott Williams & Wilkins) High-Yield Pathology (Lippincott Williams & Wilkins) Kaplan QBook NMS Review for Step 1 (Lippincott Williams & Wilkins) 17 . COST Free for Tulane students through Matas Library subscription (can be accessed from the library website through the “databases” link). and all health professionals with access to more than 60 medical titles from the best minds in medicine. 350-question comprehensive USMLE practice test. PDA version available. Library Resource ExamMaster: free for Tulane students. updated content.htm.accessmedicine. residents. diagnostic tools. Contains over 2700 images with text that illustrate gross and microscopic pathologic findings along with radiologic imaging associated with human disease conditions. online searchable database of medical mnemonics to help remember the important details. and Step 3. These questions have been written and reviewed to provide excellent diagnostic practice. Systems-Based Review for USMLE Step 1 (Lippincott Williams & Wilkins) Underground Clinical Vignettes (Lippincott • • • • Williams & Wilkins) USMLE Road Map Series (McGraw-Hill Medical) USMLE Step 1 Made Ridiculously Simple (MedMaster Inc. but you also need to have a starting point. You’ll find a sample 28-day study schedule at the back of this book in Appendix B. Remember you must create your own study schedule based on YOUR individual needs. Again. Study Schedule 18 .) USMLE Step 1 Recall: Buzzwords for the Boards (Lippincott Williams & Wilkins) USMLE Step 1 Secrets (Mosby) Mobile Applications • Cram Fighter (iPhone) • Kaplan Mobile QBank (iPhone) • Skyscape USMLE Step 1 Recall (Several) One of the biggest pieces of advice that students and experts alike give surrounds the idea of developing and sticking to a study schedule. or what topics need to be studied more. everybody has their own idea of what works for them and what doesn't.• • • • • Platinum Vignettes (Elsevier) Rapid Review Series -USMLE Step 1 (Mosby) aka Goljan’s Robbins Review of Pathology (Saunders) Step Up: A High-Yield. post-translational processing.APPENDIX A: NBME OFFICIAL LIST OF STEP 1 TOPICS GENERAL PRINCIPLES • gene expression: DNA structure. mutation-selection equilibrium principles of gene therapy genetic testing and counseling genetic mechanisms acute inflammatory responses (patterns of response) o acute inflammation and mediator systems o vascular response to injury. founder effects. and disposition of proteins(degradation). regulation. including mediators o principles of cell adherence and Biochemistry and molecular biology Biology of cells • Human development and genetics • • • • • Biology of tissue response to disease • 19 .including protein/glycoprotein synthesis. and processes/functions related to Golgi complex and rough endoplasmic reticulum • structure and function of proteins and enzymes • energy metabolism • • • • • adaptive cell responses and cellular homeostasis intracellular accumulations mechanisms of injury and necrosis apoptosis mechanisms of dysregulation o cell biology of cancer. channels. glycolipids. modifications. intra/extracellular sorting. replication. gap junctions. and function. including cytoskeleton. exchange. organelles. and epigenetics • gene expression: transcription • gene expression: translation. including genetics of cancer o general principles of invasion and metastasis. and receptors principles of pedigree analysis o inheritance patterns o occurrence and recurrence risk determination population genetics: Hardy-Weinberg law. including cancer staging cell/tissue structure. extracellular matrix. ethnicity. consultation. including coping mechanisms psychodynamic and behavioral factors.• • migration microbicidal mechanisms and tissue injury o clinical manifestations chronic inflammatory responses reparative processes o wound healing. granulation tissue. related past experience family and cultural factors. angiogenesis. OCCUPATIONAL. and gender adaptive behavioral responses to stress and illness maladaptive behavioral responses to stress and illness interactions between the patient and the physician or the health care system patient adherence (general and adolescent) establishing and maintaining rapport data gathering approaches to patient education enticing patients to make lifestyle changes communicating bad news “difficult” interviews multicultural ethnic characteristics 20 . scar/keloid formation o regenerative processes o GENDER. and interactions with the family • • • • • • • personality traits or coping style. ETHNIC. including birth • cognitive. and repair. AND ENVIRONMENTAL Progression through the life cycle. and social and through senescence interpersonal development • sexual development • influence of developmental stage on physicianpatient interview Psychological and social factors influencing patient behavior • • • • • • • Patient interviewing. hemostasis. including socioeconomic status. thrombosis. fibrosis. motor skills. CULTURAL. language. INCLUDING PSYCHOSOCIAL. AND BEHAVIORAL CONSIDERATIONS AFFECTING DISEASE TREATMENT AND PREVENTION. including occupational exposures • physical and associated disorders (including temperature. porphyrins. organic solvents. carnitine. and storage of energy at the whole-body level • assessment of nutritional status across the life span. radiation. burns. protein. purines. smoke inhalation. decreased atmospheric pressure. including disorders related to amino acids. and professional behavior • • • • • • • • • consent and informed consent to treatment physician-patient relationships death and dying birth-related issues issues related to patient participation in research interactions with other health professionals. and carbohydrates 21 . agricultural hazards. and acid-base balance disorders Inherited metabolic disorders.Medical ethics. heavy metals. other “boundary” issues ethics of managed care organization and cost of health care delivery Nutrition MULTISYSTEM PROCESSES • generation. including impaired physician and patient safety sexuality and the profession. essential nutrients. increased water pressure) chemical (including gases. hypoalimentation • • • • functions of nutrients protein-calorie malnutrition vitamin deficiencies and/or toxicities (including megaloblastic anemia with other findings) mineral deficiencies and toxicities Temperature regulation Adaptation to environmental extremes. jurisprudence. principles of poisoning and therapy) • Fluid. fatty acids. including calories. vapors. electrolyte. expenditure. high-altitude sickness. including principles. replication. replication. outbreaks. replication. distribution.and dose-effect relationships. including structure/function of all components of signal transduction pathway such as receptors. dosage intervals • mechanisms of drug action. overdosage. toxicology • mechanisms of drug interactions • regulatory issues • signal transduction. and infection control 22 . microorganism identification. and nonimmunologic lab diagnosis Bacteria • • • • • • • • • • • • • • structure processes. and genetics oncogenesis antibacterial agents structure processes. and genetics antifungal agents structure processes. structure-activity relationships (including anticancer drugs) • concentration. General principles metabolism. and genetics antiparasitic agents Viruses Fungi Parasites Prions Epidemiology. and genetics oncogenesis antiviral agents structure processes. replication. ligands • cell cycle/cell cycle regulation MICROBIAL BIOLOGY AND INFECTION Microbial identification and classification.PHARMACODYNAMIC AND PHARMACOKINETIC PROCESSES • pharmacokinetics: absorption. types of agonists and antagonists and their actions • individual factors altering pharmacokinetics and pharmacodynamics • mechanisms of drug adverse effects. excretion. and behavioral considerations affecting disease treatment and prevention. and environmental • emotional and behavioral factors • influence on person. probability • disease prevalence and incidence • disease outcomes • associations • health impact • sensitivity.QUANTITATIVE METHODS • scales of measurement Fundamental concepts of measurement • distribution. and society • occupational and other environmental risk factors • gender and ethnic factors 23 . ethnic. variability. occupational. predictive values Fundamental concepts of study design • types of experimental studies • • • • • Fundamental concepts of hypothesis testing and statistical interference • • • types of observational studies sampling and sample size subject selection and exposure allocation outcome assessment internal and external validity confidence intervals statistical significance and Type I error statistical power and Type II error For all systems: Gender. cultural. including psychosocial. central tendency. specificity. family. leukemia. and immunologic disorders o infections of the blood.HEMATOPOIETIC AND LYMPHORETICULAR SYSTEMS Normal processes • embryonic development. and perinatal changes • organ structure and function • cell/tissue structure and function o production and function of erythrocytes. O2 and CO2 transport. dysproteinemias. fetal maturation. and endothelial cells o autoimmunity and autoimmune diseases o anemia of chronic disease o non-immunologically mediated transfusion complications. transport proteins o production and function of platelets o production and function of coagulation and fibrinolytic factors • repair. transplant rejection • traumatic and mechanical injury • neoplastic disorders (including lymphoma. multiple myeloma. regeneration. including acquired o nutritional anemias o cythemia o hemorrhagic and hemostatic disorders o bleeding secondary to platelet disorders and disorders of primary hemostasis • vascular and endothelial disorders • systemic disorders affecting the hematopoietic and lymphoreticular system • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the hematopoietic and lymphoreticular systems • congenital and genetic disorders affecting the hematopoietic and lymphoreticular systems Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the hematopoietic system o blood and blood products o treatment of anemia. amyloidosis) • metabolic and regulatory disorders. and changes associated with stage of life Abnormal processes • infectious. hemoglobin. reticuloendothelial system. inflammatory. drugs stimulating erythrocyte production o drugs stimulating leukocyte production o anticoagulants. thrombolytic drugs o antiplatelet drugs o antimicrobials and antiparasitics o antineoplastic and immunosuppressive drugs in the clinical context of disease • other therapeutic modalities 24 . limbic system and emotional behavior. including primary and metastatic • metabolic and regulatory disorders • vascular disorders • systemic disorders affecting the nervous system • idiopathic disorders affecting the nervous system • congenital and genetic disorders. trophic and growth factors o brain metabolism o glia. control of eye movement o sensory systems. language. including metabolic • degenerative disorders • paroxysmal disorders • disorders of special senses • psychopathologic disorders. myasthenia gravis and muscle channelopathies. taste. and immunologic disorders (including demyelinating disorders. and cerebellum o autonomic nervous system o peripheral nerve • cell/tissue structure and function o axonal transport o excitable properties of neurons. and perinatal changes. inflammatory. including definition of brain death Abnormal processes • infectious. hypothalamic function.and postsynaptic receptor interactions. balance.CENTRAL AND PERIPHERAL NERVOUS SYSTEMS Normal processes • embryonic development. blood supply. circadian rhythms and sleep. including proprioception. basal ganglia. neural crest derivatives • organ structure and function o spinal cord. and spinal reflexes o brain stem o brain. and their evaluation o early-onset disorders o disorders related to substance use o schizophrenia and other psychotic disorders o mood disorders o anxiety disorders 25 . hearing. cerebral ventricles. storage. processes. including neural tube derivatives. release. memory. including gross anatomy and blood supply. axons and dendrites. including gross anatomy. including brain and spinal cord. and disorders of the eye and ear) • traumatic and mechanical disorders • neoplastic disorders. pain. myelin o brain homeostasis: blood-brain barrier. including channels o synthesis. cerebrospinal fluid formation and flow. and olfaction o motor systems. and changes associated with stage of life. fetal maturation. cognition. reuptake. vision. choroid plexus • repair. regeneration. and degradation of neurotransmitters and neuromodulators o pre. and elders o other disorders • drug-induced adverse effects on the central and peripheral nervous system • neurologic pain syndromes Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the nervous system o anesthetics o hypnotic sedatives o psychopharmacologic agents o anticonvulsants o analgesics o stimulants. botulinum toxin o neuromuscular junction agonists and antagonists o antiglaucoma drugs o drugs used to decrease intracranial pressure o antimigraine agents o drugs affecting the autonomic nervous system. antineoplastic drugs. and antiparasitics o drugs used to treat cerebrovascular disorders o treatment for substance abuse disorders • other therapeutic modalities 26 . multiple sclerosis.o somatoform disorders o personality disorders o physical and sexual abuse of children. adults. Alzheimer type. amphetamines o antiparkinsonian drugs and drugs for dementia. including all general autonomic pharmacology o antimicrobials. and restless legs syndrome o skeletal muscle relaxants. thermal regulation. and mycobacterial infections o immune and autoimmune disorders • traumatic and mechanical disorders (including thermal injury. and structural disorders • vascular disorders • systemic disorders affecting the skin • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the skin and related connective tissue • congenital and genetic disorders affecting the skin and related connective tissue Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the skin and connective tissue o anti-inflammatory agents o emollients o sunscreen o retinoids o antimicrobial and antiparasitic agents o cytotoxic and immunologic therapy and antineoplastic drugs • other therapeutic modalities 27 . decubitus ulcers.SKIN AND RELATED CONNECTIVE TISSUE Normal processes • embryonic development. regulatory. and immunologic disorders o bacterial infections o viral infections o fungal infections. effects of ultraviolet light and radiation) • neoplastic disorders o keratinocytes o melanocytes o vascular neoplasms o other • metabolic. inflammatory. regeneration. fetal maturation. and changes associated with stage of life or ethnicity • skin defense mechanisms and normal flora Abnormal processes • infectious. including barrier functions. dermatophytosis o parasitic infections. including mycoses. ectoparasitic infestations. eccrine function • repair. and perinatal changes • organ structure and function • cell/tissue structure and function. osteodystrophy. skeletal muscle o exercise and physical conditioning • repair. tendons. joints. strains. repetitive motion injuries. and changes associated with stage of life Abnormal processes • infectious. sprains. and perinatal changes • organ structure and function • cell/tissue structure and function o biology of bones. and impingement syndrome) • neoplastic disorders • metabolic.MUSCULOSKELETAL SYSTEM Normal processes • embryonic development. inflammatory. joint injuries. gout. regulatory. and immunologic disorders • traumatic and mechanical disorders (including fractures. fetal maturation. dislocations. and structural disorders (including osteomalacia. and pseudogout) • vascular disorders • systemic disorders affecting the musculoskeletal system • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the musculoskeletal system • congenital and genetic disorders affecting the musculoskeletal system Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the musculoskeletal system o nonsteroidal anti-inflammatory drugs and analgesics o muscle relaxants o antigout therapy o immunosuppressive and antineoplastic drugs o drugs affecting bone mineralization o antimicrobial and antiparasitic agents • other therapeutic modalities 28 . regeneration. osteoporosis. pulmonary hypertension. regulatory. viral infections. and immunologic disorders o infectious diseases infectious diseases of the upper respiratory tract pyogenic infectious diseases of the lower respiratory tract and pleura. fetal maturation. and pleural effusion) • systemic disorders affecting the respiratory system • idiopathic and degenerative disorders • drug-induced adverse effects on the respiratory system • congenital and genetic disorders affecting the respiratory system Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the respiratory system o decongestants. and metastatic tumors) • metabolic. gas exchange o pleura o nasopharyx and sinuses • cell/tissue structure and function. mucolytics o bronchodilator drugs o anti-inflammatory and cytotoxic drugs o antimicrobial agents and antiparasitic agents o antineoplastic agents o pulmonary vasodilators • other therapeutic modalities 29 . and changes associated with stage of life • pulmonary defense mechanisms and normal flora Abnormal processes • infectious. and structural disorders • vascular and circulatory disorders (including thromboembolic disease. pleura. lower airway and lung parenchyma. regeneration. perfusion. and associated complications other infectious diseases of the lower respiratory tract o immunologic disorders allergic and hypersensitivity disorders autoimmune disorders o inflammatory disorders pneumoconioses acute and chronic alveolar injury chronic obstructive pulmonary disease restrictive pulmonary disease • traumatic and mechanical disorders • neoplastic disorders (including upper airway. inflammatory. including surfactant formation.RESPIRATORY SYSTEM Normal processes • embryonic development. pulmonary edema. cough suppressants. and perinatal changes • organ structure and function o airways. alveolar structure • repair. including mechanics and regulation of breathing o lung parenchyma. including ventilation. expectorants. systemic hypotension and shock. antineoplastic. including responses to change in posture. valves o cardiac cycle. vascular smooth muscle. cor pulmonale. inflammatory. including systemic. and blood volume. heart sounds. biochemistry. coronary. pulmonary. microcirculation. mechanics. antimicrobial. metabolism. and immunologic disorders • traumatic and mechanical disorders • neoplastic disorders • metabolic and regulatory disorders (including dysrhythmias. thrombolytic agents. low. myocardial infarction. and lymph flow (including mechanisms of atherosclerosis) o neural and hormonal regulation of the heart.and highoutput heart failure. oxygen consumption. blood vessels. and antiplatelet agents o inotropic agents and treatment of heart failure o immunosuppressive. regeneration.CARDIOVASCULAR SYSTEM Normal processes • embryonic development. fetal maturation. systolic and diastolic dysfunction. ischemic heart disease. and changes associated with stage of life Abnormal processes • infectious. cardiac conduction o hemodynamics. and perinatal changes • organ structure and function o chambers. systemic hypertension. exercise. and secretory function o endothelium and secretory function. and antiparasitic drugs o drugs to treat peripheral arterial disease 30 . and blood volume o circulation in specific vascular beds • cell/tissue structure and function o heart muscle. and tissue metabolism • repair. and dyslipidemias) • vascular disorders • systemic diseases affecting the cardiovascular system • congenital and genetic disorders of the heart and central vessels • idiopathic disorders • drug-induced adverse effects on the cardiovascular system • degenerative disorders Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the cardiovascular system o coronary and peripheral vasodilators o antiarrhythmic drugs o antihypertensive drugs o measures used to combat hypotension and shock o drugs affecting cholesterol and lipid metabolism o drugs affecting blood coagulation. gastrointestinal. angiodysplasia. and changes associated with stage of life • gastrointestinal defense mechanisms and normal flora Abnormal processes • infectious. antimicrobial. vasculitis) • systemic disorders affecting the gastrointestinal system • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the gastrointestinal system • congenital and genetic disorders affecting the gastrointestinal system Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the gastrointestinal system o treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux o drugs to alter gastrointestinal motility o fluid replacement o pancreatic replacement therapy and treatment of pancreatitis o drugs for treatment of hepatic failure and biliary disease o anti-inflammatory. fetal maturation. including GI hormones o salivary. including benign and malignant • metabolic and regulatory disorders (including motility disorders. ischemia. including alimentary canal. intestinal. regeneration. proteins. liver and biliary system. anal fissure. cholelithiasis. hepatic secretory products. and colonic diverticula • neoplastic disorders. motility. inflammatory. hemorrhoids. salivary glands and exocrine pancreas. immunosuppressive. and processes o synthetic and metabolic functions of hepatocytes • repair. nutritional disorders) • vascular disorders (including portal hypertension. bile salts. and antiparasitic drugs • other therapeutic modalities 31 . and immunologic disorders • traumatic and mechanical disorders o malocclusion o hiatal hernia o obstruction o perforation of hollow viscus and blunt trauma o inguinal. and perinatal changes • organ structure and function.GASTROINTESTINAL SYSTEM Normal processes • embryonic development. and digestion and absorption • cell/tissue structure and function o endocrine and neural regulatory functions. malabsorption. and abdominal wall hernias o esophageal. thromboses. esophageal varices. hepatic failure. including enzymes. pancreatic. femoral. antineoplastic. antineoplastic. electrolyte. urethra o glomerular filtration and hemodynamics o tubular reabsorption and secretion. including renal metabolism and oxygen consumption. fetal maturation. antimicrobial. and perinatal changes • organ structure and function o kidneys. ureters. inflammatory. immunosuppressive. and antiparasitic drugs o drugs used to treat lower urinary tract system • other therapeutic modalities 32 . and changes associated with stage of life Abnormal processes • infectious. and immunologic disorders o infectious disorders upper urinary tract lower urinary tract o inflammatory and immunologic disorders glomerular disorders tubular interstitial disease • traumatic and mechanical disorders • neoplastic disorders.RENAL/URINARY SYSTEM Normal processes • embryonic development. bladder. regeneration. hormones produced by or acting on the kidney • repair. including primary and metastases • metabolic and regulatory disorders o renal failure. and acid-base disorders o drugs used to enhance renal perfusion o anti-inflammatory. including transport processes and proteins o urinary concentration and dilution o renal mechanisms in acid-base balance o renal mechanisms in body fluid homeostasis o micturition • cell/tissue structure and function. antidiuretic drugs o drugs and fluids used to treat volume. acute and chronic o tubular and collecting duct disorders o renal calculi • vascular disorders • systemic diseases affecting the renal system • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the renal/urinary system • congenital and genetic disorders affecting the renal/urinary system Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the renal and urinary system o diuretics. lactation. including ovulation. fetal maturation. trophoblastic disease) • metabolic and regulatory processes (female and male) • prenatal and perinatal counseling and screening • systemic disorders affecting reproductive function • disorders relating to pregnancy. and immunologic disorders (female and male) • traumatic and mechanical disorders (female and male) • neoplastic disorders (including female reproductive. the puerperium. implantation. including all gonadotropin-releasing hormone antagonists o abortifacients o antimicrobial and antiparasitic agents o antineoplastics o restoration of potency • other therapeutic modalities affecting the reproductive system o 33 . and gestational hormones • reproductive system defense mechanisms and normal flora Abnormal processes • infectious. sex steroids. fertilization. breast [including fibrocystic changes]. progesterone replacement. including gametogenesis • organ structure and function o female structure (including breast) and function o male structure and function o intercourse. male reproductive. labor and delivery. other methods of contraception estrogen. the puerperium. and perinatal changes. gestational uterus. postpartum disorders of the fetus idiopathic disorders drug-induced adverse effects on the reproductive system degenerative disorders congenital and genetic disorders affecting the reproductive system male reproductive tract fertility drugs androgen replacement and antagonists o gonadotropin-releasing hormone and gonadotropin replacement.REPRODUCTIVE SYSTEM Normal processes • embryonic development. orgasm o pregnancy. including hypothalamic-pituitary-gonadal axis. inflammatory. intrapartum. placenta • cell/tissue structure and function. and the postpartum period Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the reproductive system and management of normal reproductive function o female reproductive tract fertility drugs oral contraception. treatment of menopause stimulants and inhibitors of labor estrogen and progesterone antagonists stimulators and inhibitors of lactation o o o o • • • • obstetric problems complications affecting other organ systems disorders associated with the puerperium antepartum. parathyroid. thyroid. and metabolism o peptide hormones o steroid hormones. thyroid.ENDOCRINE SYSTEM Normal processes • embryonic development. inflammatory. adrenal medulla o pancreatic islets o ovary and testis o adipose tissue • cell/tissue structure and function. posterior and anterior pituitary gland o thyroid gland o parathyroid glands o adrenal cortex. including hormone synthesis. including vitamin D o thyroid hormones o catecholamine hormones o renin-angiotensin system • repair. and changes associated with stage of life Abnormal processes • infectious. adrenal disorders) • vascular disorders • systemic disorders affecting the endocrine system • idiopathic disorders • degenerative disorders • drug-induced adverse effects on the endocrine system • congenital and genetic disorders affecting the endocrine system Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the endocrine system o hormones and hormone analogs o stimulators of hormone production o inhibitors of hormone production o hormone antagonists o potentiators of hormone action o antiobesity agents o nonhormonal therapy for endocrine disorders 34 . action. pancreatic islets. adrenal cortex. fetal maturation. and immunologic disorders • traumatic and mechanical disorders • neoplastic disorders (including pituitary. regeneration. neural crest. pheochromocytoma) • metabolic and regulatory processes (including diabetes mellitus. secretion. pituitary. pancreatic islet disorders. and perinatal changes • organ structure and function o hypothalamus. hypothalamus. parathyroid. mechanism of MHC I and MHC II deficiencies. type III hypersensitivity o type IV hypersensitivity o transplantation risks and rejection. host barriers to infection. including T-lymphocyte receptors. and function o granulocytes. cell receptors o T lymphocytes. including distribution of MHC I and MHC II on different cells. type II. cell activation and proliferation. host defense mechanisms. and molecular biology of complement o function and molecular biology of cytokines • basis of immunologic diagnosis Abnormal processes • disorders with alterations in immunologic function o abnormalities in adaptive immune responses o deficiencies of phagocytic cells and natural killer cells o complement deficiency o HIV infection/AIDS o Non-HIV infections of lymphocytes o systemic diseases of immunologic function o systemic disorders affecting the immune system and the effect of age on the function of components of the immune system • immunologically mediated disorders o type I. including positive and negative selection during immune development • structure. including monoclonal and polyclonal antibodies other therapeutic modalities 35 . hemolytic disease of the newborn • drug-induced adverse effects on the immune system. including transfusion reactions o isoimmunization. including genetics • cellular basis of the immune response and immunologic mediators o antigen processing and presentation in the context of MHC I and MHC II molecules. immunoglobulins. function. cytotoxic T lymphocytes. including development of antibodies and memory B lymphocytes o structure and function of lymph nodes. including B-lymphocyte receptors. and memory T lymphocytes o B lymphocytes and plasma cells. and the genetics of MHC o regulation of the adaptive immune response o activation. mucosal immunity o immunogenetics o Rh and ABO antigens. mast cells. macrophages. production. accessory molecules. cell activation and proliferation. dendritic cells. including Jarisch-Herxheimer Principles of therapeutics • mechanisms of action and use of drugs that specifically affect immune function o vaccines (active and passive) o antiretrovirals o o • immunomodulating and antineoplastic drugs biologics. natural killer cells.IMMUNE SYSTEM Normal processes • development of cells of the adaptive immune response. Sect. the role of 2 hrs HMG CoA reductase) and its regulation. and note trouble areas to focus on. and role of triacylglycerols for storage of fatty acids.19. Key figure are 20. I –VII Metabolism Steroid Hormones Chapter 20. Study figures 20. galactose. 19. Est.14.nbme. 20. Shim reactions an focus on G6PD deficiency 1 hr Day 3 Objective Lipid Metabolism Continue Biochemistry Assignments Chapter 17 & questions Phospholipids &Glycolipids Skim Chapters 18. Bookmark figure 6. Learn about the test.20 Gain senses of what these are. relationship to glucose metabolism. Review mobilization of and oxidation of fatty acids.12.org General overview of Read Through Section First Aid material to be covered Introductory Material from First Aid.20 . its regulation.7 to memorize the glycogen storage disease Know the start and end points.16 Know the major enzymes deficiencies in 1 hr steroid synthesis and know where steroid 36 receptors act in the cell.2 and refer to it before studying each biochemical pathway. Review Lippincott’s Figure 6. Know where the electron transport chain and oxidative phosphorylation occur and how they fit into the overall metabolic scheme. but do not 1 HR memorize structure of pathways. using figures 18. Finally. Time 3 hrs 4 hrs 2. VII Lippincott’s Biochemistry Details Est. place in overall 1 hr metabolism. Spend more time on glycogen metabolism. carefully review eicosnoids.APPENDIX B: 28-DAY SAMPLE STUDY SCHEDULE FROM TULANE SCHOOL OF MEDICINE Day 1 Objective Self Assessment General Overview & Begin Biochemistry Assignments Source Details Complete 150 sample questions. Use Figure 13. Understand synthesis and role of bile salts. Time Focus on roles of pancreatic lipase and bile 3 hrs salts. Focus on start and end points. and regulation. Study it by comparison to glycolysis. Review biology of lipoproteins and their role in atherogenesis.4 Review Cholesterol synthesis (esp. Review the main classes of cell receptors and signaling mechanisms.5 hrs regulation. 13 & questions Source Lippincott’s Biochemistry Glycolysis Gluconeogenesis Citric Acid Cycle Hexose Monophosphate Chapter 7 & questions Lippincott’s Biochemistry Chapter 8 & questions. Know 1 hr the reactions & regulation unique to gluconeogenesis. 20.2 again! Biochemistry Chapter 9 & questions Chapter 10 & questions Lippincott’s Biochemistry Lippincott’s Biochemistry Source Lippincott’s Biochemistry Details Est. Understand the role of ATP.5 hrs Complete sample test materials Download from for NBME www. 12. Time Review the digestion of sugars and disorders 3 hrs of fructose. 20. and how to best use First Aid as a resource. Day 2 Objective Structure & Metabolism of Carbohydrates Continue Biochemistry Assignments Chapters 11. and related disorders. Sect. hormonal 1. 19 Lippincott’s Biochemistry Lippincott’s Biochemistry Cholesterol & Steroid Chapter 20.10. Focus on related disorders instead. Fatty acid metabolism: know where synthesis occurs. and Skim Section II Basic Metabolism Chapters 5 & 6. focusing on figure 17. and sample Lippincott’s questions at end of each Biochemistry chapter. Energy yield and various fates of pryruvate. and lactose metabolism. Understand transamination and oxidative deamination. 15 Glycoproteins Nutrition and Vitamins Chapter 27. as well as vitamin D. Know the daily energy requirements and 3 hrs vitamin deficiencies. then move on.10.16 Day 5 Objective Assignments Heme.17 Emphasize relevant disorders. hemoglobin. Chapter 23 Serotonin. and the metabolic aspects of diabetes mellitus.7.5 and 23. glucagon. 25. levels of protein structure. Time spent on these topics will be VERY WORTHWHILE Details Est.15. 28 Continue Biochemistry Source Lippincott’s Biochemistry Lippincott’s Biochemistry Lippincott’s Biochemistry Lippincott’s Biochemistry Details Est. and 7.2.18 Understand differences between de novo and 2 hrs salvage purine synthesis. 5. 22. Histamine and Catholamines Gylcosaminglycans and Skim Chapter 14. Time Synthesize the information you’ve reviewed 5 hrs this week by studying insulin. Details Est.12 and 15. 6. but don’t memorize Pathways. etc.9.) Also. Focus on figures 23. and collagen.2.Day 4 Objective Protein & Enzymes Continue Biochemistry Assignments Chapter 1-4 & questions Source Lippincott’s Biochemistry Digestion of Dietary Chapter 21 Proteins and Nitrogen Lippincott’s Biochemistry Metabolism of Amino Chapter 22 Acid Carbon Skeletons Lippincott’s Biochemistry Details Est. 3. Focus on 1 hr figures 22. Start building buzzword 10 hrs associations with characteristics of each organism and how is identified (with a special stain.4. 4.29. 29. For enzymes. Time Focus on the porphyrias and bilirubin 1 hr metabolism. types of enzyme in clinical diagnosis. 21. Time Rely heavily on charts. Focus on absorption of vitamin B12 and pernicious anemia. time spent with Qbank questions here will be golden Nucleotide Metabolism Chapter 29 Day 6 Objective Assignments Ingrative Metabolism Chapters 24. Don’t get too bogged down in details – just study figures 14. culture medium. 21.6. Focus on figures 28. Know different types of adrenergic and 5 hrs cholinergic receptors cold. Study figures 3. Learn the various pancreatic proteases and 2 hrs how they are regulated. Spend more time on urea cycle and ammonia metabolism focus on figures 21.2.3.14. Time Study general principles of pharmacology. the fed/starved states. 2 Source Lippincott’s Biochemistry Lippincott’s Biochemistry Chapters 3 – 7 Day 8 Objective Bacteria Begin Microbiology Assignments Chapter 1 – 15 Source Clinical Microbiology made Ridiculously Simple Day 9 Continue Microbiology 37 . focus on appreciating (not memorizing) the Michaelis-Menten equation. & 26 Finish Biochemistry Source Lippincott’s Biochemistry Day 7 Objective Pharmacokinetics & Pharmacodynamics Autonomic Drugs General Pharmacology Assignments Chapter 1. Study figures 29.7 Know what they are and know the related 1 hr disorders. Time Become familiar with basic properties of 4 hrs amino acids. Study purine degradation and the Pathophysiology of gout and ADA deficiency. and 28.10 Details Est. 2 hrs Specific agents will be covered with relevant organ systems. Porphyrins.11.12. 0. read. review and continue to do Qbank questions to keep building buzzword associations.5 hr differences between necrosis & apoptosis Distinguish mechanisms and histological 1 hr characteristics of acute vs. types of embolism. read.5 hr autoimmunity. and collagen vascular disease Distinguish between tumor suppressor genes 1 hr & oncogences.5 hr Focus on immune deficiency disorders. know mechanisms of carcinogenesis. and the properties of malignant cells. review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiviral agents.Objective Antibiotics Assignments Chapter 28 – 33 Source Lippincott’s Pharmacology Fungi Chapter 20 Antifungal Chapter 34 Details This is high yield material. read. Quickly review 0. Time 6 hrs 1. review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations. Clinical This is high yield material. Time 6 hrs Antiviral Parasites Chapter 37 Chapter 30. read. Clinical This is high yield material.5 hr Day 12 Cellular Biology 38 . Microbiology Est. 36 1 hr 3 hrs Day 11 Objective Review Immunology Immunology & General Pathology Assignments Part VII Source Medical Microbiology & Immunology: Examination and Board Review BRS Pathology BRS Pathology Details Excellent.5 hr Review vitamin deficiencies to refresh biochem memory 0. review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiprotozal and antihelminthic agent. 31 1 hr 2 hrs Antiparasites Clinical Vignettes Chapter 35. particularly Pharmacology mechanisms of action.5hr 1 hr Day 10 Objective Viruses Finish Microbiology Assignments Chapter 22-29 Est. concise summary of immunology Est. Pharmacology particularly multi-drug regimens Underground Good for group study and another way to Clinical Vignettes – keep sharpening buzzword recall. Time 4 hrs Cellular injury Inflammation Chapter 1 Chapter 2 Hemostasis Chapter 3 BRS Pathology BRS Pathology BRS Pathology BRS Pathology Genetic Disorders Chapter 4 Immune Dysfunction Chapter 5 Neoplasia Chapter 6 Environmental Chapter 7 Pathology Nutritional Disorders Chapter 8 BRS Pathology BRS Pathology Focus on mechanisms of cellular injury and 0. Lippincott’s This is high yield material. 0. Source Details Clinical This is high yield material. chronic inflammation Know coagulation cascade. review and Pharmacology continue to do Qbank questions to keep building buzzword associations. 1 hr and types of shock. read. electrophysiology. 30. 1.31.5 hrs Cardiac Pathology Chapter 10 BRS Pathology 39 . 30. 1. and other ECM components. and fetal circulation.22.19. Time Know mechanisms of DNA repair.11.Objective Assignments DNA. Time 3. 15 viscera High Yield Gross 3 hrs Anatomy BRS Cell Biology & Be able to distinguish arteries and veins in 1 hr Histology cross section. blood pressure regulation.6 Tissue Day 13 Objective Cell Physiology Embryology Cellular Physiology & General Embryology Assignments Chapter 1 Chapter 1-4 1. Day 15 Objective Cardiovascular Physiology Cardiovascular System Assignments Chapter 3 Source BRS Physiology Details Est. Proteins Chapter 30 – 33 Source Lippincott’s Biochemistry Cell Membranes Chapter 1 Details Est. Also understand the stages of fetal lung maturation.5 hr Extracellular Matrix Chapter 4 1 hr Epithelia & Connective Chapter 5. Study this chapter thoroughly 1. Frank-Starling curve and condition.16. volume loss. different 3. Est. after-load. mechanism of translation. BRS Cell Biology & Review types of epithelia and locations of Histology each. 32. action 1 hr potentials.5 hrs cardiac cycle. Review connective tissue focusing on bone histology 0.5 hrs Good opportunity to identify weakness in organ system areas. basement Histology membrane composition. response to exercise. 11 Thoracic Anatomy Chapter 12 (Also use Netter’s Atlas for reference ) Histology of thoracic Chapters 11. and RNA Histology import/export mechanisms.2.5 hr Nucleus Chapter 2 Cytoplasm Chapter 3 0.9 BRS Cell Biology & Know properties of membranes and 1 hr Histology membrane proteins BRS Cell Biology & Know contents of nuclei. and molecular biology techniques. BRS Cell Biology & Review organelles and function Histology BRS Cell Biology & Know different types of collagen.5 hrs Source BRS Physiology BRS Embryology Birth Defects Exam Chapter 17. Know stages from zygote through embryo. Understand pre-load. 18 Diagnostic Test BRS Embryology Board Simulator Series Body Systems Review Source BRS Embryology Details Est. Understand architecture of the gas diffusion barrier in the lungs. altitude. 30. 2 hrs Day 14 Thorax Details Know the congenital cardiac abnormalities.5 hrs types/roles of RNA. Time Review hemodynamic. Focus on figure 30. 3 hrs Review 3 Germ cell layers and their derivative tissues.5 hrs Objective Assignments Embryology of thorax Chapter 5. RNA. Time Know mechanisms of ion transport. in addition to vascular supplies. midgut. 2 hrs 1. & Lymph Nodes Lippincott’s Pharmacology Volume 1: Cases 1-19.5 hrs 2 hrs Chapter 13 Chapter 20 Chapter 38 Volume 1: Cases 74-102 BRS Pathology Lippincott’s Pharmacology Lippincott’s Pharmacology Underground Clinical Vignettes – Patho-physiology Source BRS Embryology Day 18 Objective Embryology of Gut and Body Cavities Gastrointestinal System Assignments Chapters 10. angina. and hyperlipidemia 1 hr 5 hrs Day 16 Respiratory System & Begin Hematology Source BRS Physiology BRS Pathology Details Est. WBC. Time Know varies lung volume measurements. Volume Underground 2: Cases 52-66 Clinical Vignettes – Patho-physiology Chapters 10. Time Know Patho physiology and lab differentiation 2 hrs of various etiologies of anemia Distinguish between leukemia & lymphoma. Know which structures are derived of foregut. portal blood flow. platelet 3 hrs Day 17 Objective Anemia Hematopoietic & Lymph reticular Neoplasia Hemorrhagic Disorders Drugs affecting coagulation Anticancer Drugs Clinical Vignettes Finish Hematology Assignments Chapter 11 Chapter 12 Source BRS Pathology BRS Pathology Details Est. hindgut.5 hr Good opportunity for group review 2 hrs Objective Assignments Respiratory Physiology Chapter 4 Respiratory Pathology Chapter 14 Respiratory Pharmacology Clinical Vignettes Chapter 22 Histology of Bone Marrow.5 hrs 1. 16 Details Est. and bile flow BRS Physiology Understand innervations of gut and gut hormones Source BRS Pathology BRS Pathology Details Study this chapter thoroughly Study this chapter thoroughly Day 19 Objective Gastrointestinal Pathology Hepatobiliary and Exocrine Pancreatic Gastrointestinal System Assignments Chapter 15 Chapter 16 Est. Understand RBC.5 hrs understand acid – base disorders. arrhythmias. Spleen. Understand liver Histology structure. HTN. 21 BRS Pathology Lippincott’s Pharmacology Study this chapter thoroughly Know drugs used to treat CH.Vascular Pathology Cardiovascular Pharmacology Chapter 9 Chapter 16–19 .5 hrs 0. 12 (and a BRS Cell Biology & histological atlas for further Histology review Familiarize yourself with lymph nodes architecture and understand the spleen.5 hrs malformations.5 hrs 1 hr Abdominal Anatomy Chapter 3 (Also refer to Netter’s atlas) Histology of GI Tract Chapter 6 GI Physiology Chapter 6 High Yield Gross Anatomy BRS Cell Biology & Know layers of gut wall. and 1. Time Understand rotation of gut and related 1. Time 2 hrs 2 hrs 40 . Study this chapter thoroughly 1. Know how to diagnose and correct each disorder. 1 hr 1. 2 hrs Understand different types of each. Know classes of oral hypoglycemic and side effects. BRS Cell Biology & Know the maturation sequence of 3 hrs Histology spermatocytes and ovarian follicles.5 hrs 2 hrs Underground Good opportunity for group review Clinical Vignettes – Patho-physiology Source BRS Embryology BRS Physiology Lippincott’s Pharmacology Lippincott’s Pharmacology Underground Clinical VignettesPatho-physiology Board Simulator Series-Body Systems Review Source BRS Embryology Day 22 Objective Histology of Endocrine System Physiology Insulin and oral hypoglycemic Steroid Hormones Clinical Vignettes Endocrine System Assignments Chapter 13 Chapter 7 Chapter 26 Details Est. and 83-103 Know the different types of testicular cancer. but great explanations. 19. uterine cancer 1. 9. Know the anatomy of the nephron. 5 Perineum Histology of GU Organs Chapter 18. 1 hr and the biology of BPH and prostate cancer Understand cervical.GI Pharmacology Clinical Vignettes Chapter 24 Volume 1: Cases 40-73 Lippincott’s Know GI drugs as well as antiemetic Pharmacology Underground Good opportunity for group review Clinical Vignettes – Patho-physiology Source BRS Embryology High Yield Gross Anatomy Details 2 hrs 2 hrs Day 20 Objective Embryology of GU Genitourinary System Assignments Chapter 6.5 hrs Study this chapter thoroughly 1.5 hrs worth the time to push yourself a bit and solidify the material you’ve learned. 14 Est. Time Review structure of endocrine organ. Know the anatomy of the nephron. Details Know bronchial arches/clefts and their derivatives. Time 3 hrs Anatomy of Pelvis and Chapters 4.5 hrs Know different types of insulin and their half 1. Day 23 Objective Embryology of Head Neck. 10 41 . 20 Know the maturation sequence of 3 hrs spermatocytes and ovarian follicles.5 hrs Day 21 Objective Renal Physiology Diuretics Renal & Urinary Tract Pathology Male Reproductive Pathology Female Reproductive Pathology Clinical Vignettes Endocrine System Assignments Chapter 5 Chapter 23 Chapter 17 Chapter 18 Chapter 19 Volume 2: Cases 30-51. Time 1. Well 1. Understand the transition from neural plate to mature CNS. 1 hr Good opportunity of group review 2 hrs Chapter 27 Volume 1: Cases 25-38 EXAM Body System III – Test 1 Tough questions.5 hrs 1. 13. Know fate of Est. & Nervous System Nervous System Assignments Chapter 7.5 hrs lives. and use 1 hr an atlas for additional pictures. Time 3 hrs. Know hormonal axes 2. Source BRS Physiology Lippincott’s Pharmacology BRS Pathology BRS Pathology BRS Pathology Details Est. 8. Exam 2 hrs Day 27 Objective Clinical Vignettes Behavioral Science & Biostatistics Assignments All cases Source Details Underground Clinical VignettesBehavioral Science Lippincott’s Pharmacology High Yield Est. 40 Agents and Autacoids Day 26 Objective Dermatologic Pathology Musculoskeletal Pathology Clinical Vignettes Musculoskeletal System Assignments Chapter 21 Details Est. Also review anesthetics and analgesics. 14. 10 Anti-inflammatory Chapters 39. BCC) 1. 1. Head & Neck Anatomy Neuroanatomy Chapter 8 (also refer to Netter) Chapter 1-23 High Yield Gross Anatomy High Yield Neuroanatomy Source BRS Physiology BRS Pathology Details Understand Synaptic transmission and axonal conduction Know types of CNS infection. 4 hrs 42 .Underground Good opportunity of group review. Time 1 hr 3.5 hrs 2.5 hrs Day 25 Objective Embryology Musculoskeletal System Assignments Chapter 15 Est. and 96. Good opportunity of group review. Chapters 8. Time Focus on malignancies (melanoma. 2 hrs 6 hrs Day 24 Objective Neurophysiology Neuropathology Clinical Vignettes Nervous System Assignments Chapter 2 Chapter 23 Volume 2: Cases 45-61. 13 Read entire book 3 hrs Understand sensitivity.5 hrs 2 hrs 2 hrs Anatomy of Limbs and Chapters 1. 15 Est. tumors. Source BRS Embryology High Yield Anatomy Lippincott’s Pharmacology Source BRS Pathology Details 3. 7 (also use Back Netter) Histology Chapter 7. 8.5 hrs Chapter 22 BRS Pathology Volume 3: Cases 9-18. PPV.neural crest cells. Anatomy Cases 40-56. specificity. Pharmacology Parkinson’s.Clinical Vignettes84 Patho-physiology Body Systems II – Test I Board Simulator Series-Body Systems Review Touch questions. 6.10. 104. Also Anatomy: Cases 62. SCC. Time 3 hrs Psychotropic Drugs Biostatistics Chapter 9-12. but great explanations. NPV. Well worth the time to push yourself a bit and solidify the material you’ve learned. and vascular disorders. Time 2 hrs 2 hrs 2 hrs Neuropharmacology Underground Clinical VignettesPatho-physiology Lippincott’s Review drugs used to treat epilepsy.5 hrs and refer to a dermatology atlas so that you can differentiate between them. 11. odds ratio. Chapter and case numbers may differ based on the edition of the books you are using. and is meant to serve as a framework for you to build your own individualized study plan. directions to center.Biostatics Be prepared to calculate risk. please contact the Office of Medical Education. 4 hrs NOTE: This is a sample schedule only. etc. lunch. 43 . ticket. Day 28 Final Review Exam Logistics Rest & Relax Final Review & Exam Logistics Review Any Remaining Topics and finish practice questions Prepare exam bag-with ID. If you need assistance preparing a study schedule. APPENDIX C: 5-MONTH SAMPLE STUDY SCHEDULE (LATE APRIL TEST DATE) Time Frame December Week 1 Week 2 Week 3 Week 4 Week 5 January Week 1 Week 2 Week 3 Week 4 Week 5 March Week 1 Week 2 Week 3 Week 4 Content Topic to Review Pages in First Aid November: Begin studying during Thanksgiving break Heme/Onc & Pulmonary Cardio & Immunology Renal Biochemistry Microbiology Microbiology GI & Embryology Path. & Musculoskeletal Neuro Endo & Repoductive 46 pages 52 pages 30 pages 52 pages 60 pages 60 pages 54 pages 60 pages 44 pages 42 pages February – Psychiatry block in progress Behavior & Psych Practice questions CBSE Exam Custom Shelf Exams 34 pages This sample schedule is meant to be used as a framework for you to build your own individualized study plan. 44 . challenge yourself to complete a set number of question bank items per week (or even per day as you get closer to the exam). in addition to First Aid readings. Many thanks to Taimur Khan and Ryan Roach for their assistance in creating this sample schedule. Pharm. Score 270 260 250 240 230 220 210 200 190 180 170 Score 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 Number of Questions Completed % of time studying Qs vs. score Series1 Linear (Series1) 270 250 Score 230 210 190 170 150 0 20 40 60 80 100 % of studying doing questions 45 .APPENDIX D: TULANE STUDENT USMLE STEP 1 OWL CLUB SURVEY RESULTS Questions Completed Vs. Number of Respondents 10 15 0 70 60 50 40 30 20 10 0 2 59 Pathology 5 Physiology 3 Cardiology 6 Microbiology Inflammation Biochemistry Pharmacolo… Neurology Infectious… Renal 9 12 3 14 10 1 2 14 1 1 1 4 7 4 1 1 5 Number of Respondents Endocrine Anatomy Pathology Heme/Onc Biochemistry Neurology Ethics Biostatistics Pharmacolo… Which subject do you wish you spent more time on? Studying which subject was most beneficial (i.e. most represented on the test)? Genetics Pulmonary 46 . Score Distribution 270 250 230 Score 210 190 170 150 130 110 C/O 2010 C/O 2011 Class C/O 2012 Class Median Min Max C/O 2010 224 148 265 C/O 2011 232.5 173 264 C/O 2012 225 142 263 47 .