First Aid flashcards

If you are using First Aid for step 1 prep, and you'd better be :), then you would wish to review it more and review it often, right?! 

Those flashcards are organized on a subject basis, a big plus if you are studying that way and didn't finish yet. But unfortunately the flashcards are based on First Aid 2012, in which there were a big errata, so be ware just in case.

Here is the flashcards based on First Aid:
Disclaimer: The creator of the flashcards is Yasmine Gabr and not me.

1. Anatomy

2. Physiology

3. Biochemistry

4. Behavioral

5. Microbiology

6. Pharmacology

7. Pathology

You can use them either in study mode or quiz mode and you can make the card flip automatically in just seconds to train to recall faster.

Flashcardmachine is free on-line and you can also download the android or i phone apps and start studying on the go but the apps are not free :)

Good luck with your test prep.

Question resources for Anatomy, USMLE step 1

Anatomy, as we all know, is one of lowest yield subject especially histology but that is not the case absolutely in the case of neuroanatomy which ranks among one of the highest yield for the exam. But just cause you'd get around 10 or 20 anatomy question from 322 doesn't mean just waste them, it only mean study it smart and dedicate little time for anatomy compared to micro or pharm, not going to say Patho cause that's obvious, Daaaah, if you know what I mean. :)

I'll list the books in the order I see fit:

[A-]
Lippincott's Illustrated Q&A Review of Anatomy and Embryology

Screen-shots from the pdf:

Review:

1. This is the best anatomy question book there is in the market in my humble opinion.
2. The book contains only 420 questions.
3. You can do it either concurrently while doing anatomy in med school or can do it in a period of 2-3 days after you finish anatomy or at the start of your prep.
4. If you bought the book from amazon or from a book store and got the website code, you can do the book on their website in tutor mode or quiz mode.
5. Pictures, lots and lots of pictures. X rays, abdominal CTs, gross pictures... etc. that's the main advantage of the book during review.
6. Long and greasy vignettes, the book has the longest clinical vignettes in a dedicated anatomy book I've seen or heard of, plus the questions are tailored magnificently.
7. The feedback and answers. The answers are written to be long enough to help you not go back to your text but short enough not to waste any precious time.
8. To have a lethal combo for anatomy: Kaplan + Q&A + doing as many questions from comprehensive banks and books as you can.

The link:

Amazon link

[B-]

Gray's Anatomy Review

Review:

1. Well, they say that the book contains 500 question but the book contains more than 900 questions.
2. Most of the question stems are short and the questions are about absolute minute. a major setback in my opinion.
3. The answers are not longer than a paragraph, a good point in my opinion.
   Conclusion about the book: If you have tremendous amount of time DO IT! If you are short on time Lippincott's is the best choice.

The link:

Amazon link

[C]

Pretest:

Review:

1. DO NOT DO IT. I think that I made the point pretty clear.

The link:

Amazon link

Do you need an eye opener in the morning?!

If we used the same screening question we use for alcoholics to screen med students, we will get a predicted answer. We are addicted to caffeine. But how much do we depend on it is the more important question.
"Caffeinism", I could have used methyl xanthinism but found my newly fabricated term really weird, could be really hard to defeat. How can we stop the fuel that keeps us awake night after night studying to know as much as we can.Tremors and nervousness, well that's a price most medical students are willing to pay to get beyond 2 standard deviations or even above the mean for many as the competition is fierce. But once you start getting liters of that black elixir bumped up your body per day, you get alarmed. I need to stop it now. I want to live past my fifties and that life style really isn't helping much. So today, April the forth, I took the decision to end that insane escalation in my daily doses of caffeine and stop it all together, that's really hopeful, or to be realistic only use it in times of need.
Caffeine withdrawal from my system should take 4 to 7 days, and my next exam is on 12th of April so I can totally do it.
To be honest, I'll try to do some exercise during breaks instead of making a cup of coffee. If that didn't work out and help me stay awake to study during our glorious all nighters, I'd totally abuse caffeine again. My step 1 exam is in less than 200 days, a horrifying realization, and if losing coffee would even remotely harm my performance I'd totally go back to it and rethink about decreasing my dose after the marathon of step 1. so how many cups of coffee do you drink a day ?

Study Break: Med school parodies

Today I stumbled upon the best med school parody I've seen in a while.

Thought I'd share it with you to shear you up and take a breathing break from step 1 :)

The lyrics of it is the best and really imaginative. Hope you enjoy it.

HERE YOU GO

Do you like it ?! Share your thoughts and if you like another one, share it as well :)

The triple therapy for Helicobacter pathologi.

If you are just like me in an overseas university that have a completely different curriculum you'd feel what I'm feeling during my prep. I already have 15 weeks for dedicated prep but what to do to strengthen my basics during the last year of basic sciences ?!!

Studying for the boards is like studying pathology and a punch of other small entities along it's side. If my patho foundation is weak the whole exam will turn into a nightmare especially after they announced in the 2014 changes that even normal states will be asked through pathology scenario, so if I can't diagnose it right here goes any of my anatomy or physio knowledge with it.

For a medical school that's not USMLE oriented they can have a really foreign curriculum to what is important and HY in the boards, and trying to parallel both could be really stressing, especially for me.

A year ago, I stumbled on a play list on YouTube where there is a med student explaining how American medical students study. It's really awesome so have a look at it, here is the link for it :

After some trial and error and a lot of modifications here is the plan I study pathology according to:

Resources:

1. Pathoma book and videos
2. Robbins Basic pathology
3. Goljan RR book and audios

How I do it:

1. I'd start every new chapter using pathoma videos on 1.2× speed and go through the whole chapter with pathoma book. That should take an hour or two depending on the chapter, after all pathoma has all of the fundamentals of pathology in 34 hours.
2. Then comes the real studying. I'd start by listening to Goljan audio of the same chapter and then study that chapter at the RR book and take my notes. At first I went at a slow pace like 7 or 8 pages per hour but the speed slightly improved with time.
3. After studying Goljan which is an easier read with a lot of integration and to be honest is more fun than Robbins, comes Robbins turn. I'd dip into Robbins but to understand only with no extensive note taking or a lot of memorization effort.
4. With that done the chapter should be clear by now and to make sure I've covered all the HY items in the chapter I'd go through Pathoma again and repeat the same chapter.
5. Pathoma again fo the 3rd time but now with First Aid, I annotate from all the sources into First Aid but of course Pathoma gets the priority.
6. Dr. Sattar is really fun to listen to and you can listen to him ×1.5 or even ×1.8 if you are familiar with the content. If you have an android phone or tablet, there is that great video player called Dice player that can play the videos with any speed you want and you don't even have to turn on the screen so I can listen to him during walking or running.
7. The chapter is now done, here comes the questions: There are 3 question sources that I'm using during the year: 
• Robbins qbook
• Lippincott's qbook
• Webpath
8. Being done with the questions I'd again return back to First Aid and Pathoma to revise.
9. I still have 3 months till the end of my basic years and I hope that by then I'd have finished all my pathology studying that way to have FA+Pathoma only for the dedicated prep. So here is [Pathoma+Goljan+Robbins] triple therapy for the ulcers you can get from H.pathologi :)

Is prometric practice session worth it ?!

If you're taking your exam soon then you're already considering whether to take the practice test at the prometric center. The test, at least in my country, costs almost 200 $ which is quite expensive, don't you think ?
So let's take a look at it and see the pros and cons:

Pros:

mimic the test day experience exactly.
test the noise canceling headphones.
try layer dressing and the air conditioning.
see the security measures and what they will ask you to do when you're about to enter.

Cons:

$$$

Verdict:

If you're on a tight budget, better use that money to buy 3 or 4 NBME forms that can really predict your score and give you a confidence booster. If you have the money then you'd better take it. Don't worry, if you can't or won't take it you can go to the prometric a couple of days before the exam and see the transportations and ask about whatever you want there. The staff there are really helpful and they will help you.

English skills: Shadowing

Communication skills can be a glowing part in your favor during the USCE and interviews or they can have  detrimental effect on your application. Beside being the no.1 cause of malpractice law suits, mis-communications are really important cause for IMGs to fail CS and reduce their chances greatly.

How can you improve your level, here is a great videos:

Watch it try it out and tell me what do you think about it?
As for me I love to shadow How I met your mother and Novels written by Tess Gerritsen. and you ? 

Practicing USMLE questions

Look at this survey results, No look really close. Even though we have no exact numbers of the correlation can you even doubt that solving as many questions as you possibly can, even if not causing the high score, is associated with a high score. No one who solved more than 7.5 thousand questions during his prep got a score lower than 235. and I mean NO one.

Come to think about it, how many banks should be done to get past this 7500 questions?
The 3 big banks would get you there, but what if you really want to shine and fly? Do you still have others to solve?

Of course you have. You have the NBME forms, USMLE weapon, USMLE consult and Goljan pathology bank. and that's just the on-line materials that are highly recommended.
There are also punch of other highly recommended question books that could dramatically increase your question load and more training that would help you greatly during the exam.

But, how can you manage the time to do all of that. Med school is a time sucker. I can barely get enough sleep, so talking about dedicating time to solve before the dedicated prep time is a dream, or not?

If I managed my time properly I think I'd be able to finish between 15 and 18 K questions in the year before my exam, how is that manageable? That's what I'm about to describe here.

• A 50 question block with feedback should never take you more than 2.15 hours max. If I'm taking more than 2.30 hours in any block I'd really try read faster and try to preserve my comprehension. From the experiences I've read and from advice I got from senior class mates, train yourself for this and you should have no problem finishing exam blocks in 45 mins during the exam. Saving precious time for difficult and more time consuming questions. I'm not suggesting lowering your comprehension for the sake of speed, that would be counterproductive. What I'm merely trying to achieve is train my eye movement patterns to read fast with the same comprehension I achieve when I take my time. Search for speed reading for more info.
• Start with the bank or book you want but leave UW for the end.
• For a start, I use Kaplan + weapon + consult combo. I solve them subject wise and start a subject after I finish a subject in school or after I review it, and solve it simultaneously as I study the next subject.
• Of course add your notes into your FA copy.
• I started out solving a block a day but evolved to handle more over time. but a block a day is a pretty good start, it could take almost 4 hours in the start.

That's what I'm doing for now. I really hope it would pay off .

Who am I ?

Hello there! Well, I'm new to the world of blogs. I'm an international medical student from Egypt. Class of 2018. I'm preparing for USMLE step 1 exam. I mainly started this blog to write what's on my mind about my prep and that long exhaustive journey.

Sorry If i made some English mistakes, it's not my native so bear with me :)

If you are preparing for this exam and you like this blog feel free to re-blog my posts and share them. You can comment or e-mail me and I'd respond as soon as I see it.

With that said, I hope you like my blog and benefit from it.

Question banks

The advice I got from almost all of my seniors was that the no. of questions solved during the USMLE prep time highly correlates with the score.
Searching for the big banks for step 1 I found the banks we all know about and giving each of them a try, I've reached my verdict.

1. UW
Of course this is the number 1 question bank for the usmle, the questions are beautifully written and the answers are long enough to clear the point for you but not too long to waste precious time. The number of 2 and 3 step processing questions are too damn high, with a minority of questions that are either 1 or 4 steps.

2. Kaplan
Why Kaplan is no. 2 and can't make it to the top of the list is their questions quality. The feedback is not as great as that of UW but still good. The real issue here is the questions,  a lot of the questions are 1 step processing, testing really low yield info, concentrating about retrieving some details instead of applying the learned principals. Also a lot of questions are not in a case format or too short compared to the standard 110:140 words per question in the real deal.

3. USMLE weapon
I'm in my full mind and not affiliated with any organizations. For me, weapon tops Rx Qmax.for a variety of reasons actually. Weapon's questions are just as Qmax in terms of practicing FA but the questions are well written, a case format of the appropriate length and the feedback is sufficient yet concise, a trait you'd value greatly when you're preparing and you're short on time, and they throw you the buzzwords, which I think is good in the first run over the materials. The defect was with the low count number of questions, they concentrated on some topics and ignored others almost completely. More than a 20 questions about lysosomal storage diseases with less than 5 about metabolism!!!  While the bank is obviously overpriced, the amount of slides and audio files is the bare minimum. I don't want a description of a murmur, I need to listen to a dummy like the real exam.

4. Rx Qmax
Don't get me wrong, this is still a great source of questions but not number 2 or 3 for me while for others Qmax is no. 2. What really irritates me is how direct the questions are, most of the times they are just a mere recollection of the information. Putting that beside the fact I'm solving it with the course load during the school year!!  The questions are not what I'd call ideal for the step exam.

5. USMLE consult
I didn't really have enough time to try it. The questions were short with short feedback but with extensive references to textbooks. I think if your school offers it for free during the basic years then do it. But if you're thinking about buying it near the exam, you'll be hurting yourself and your score.

6. Goljan pathology bank
Less than 450 questions and since most students have already bought the book then solving them in 3 or 4 days while studying pathology is not a bad idea.

7. usmle easy, score 95 and others
Don't even think about it. You could try them if you want, but when it comes for exam prep in 2014 don't use materials that feels like they've stopped supporting for a decade.

That's my order list of the commercially available questions banks for the usmle. What is yours?

Question resources available for Behavioral.

Ethics:

There are 2 main books for ethics Fisher's and Khan's. Each one of them contains almost 100 high yield questions. So I think Fisher's is a good start, and if you still not confident after finishing it you should give Khan's a try.

Biostatistics:

UWorld has a dedicated bank for Biostatistics for which they require 35$, Those questions are super HY and A++. You must do them and understand not just memorize the way equations are done. The real deal will mutilate the shape severely, that feels terrible huuh!! you bit! It would feel even worse if you're not prepared for this in the pro-metric center, but what the real exams won't do is change the concepts. The same concepts you'll encounter here will be the same in the exam you just have to recognize them and not be thrown away by any new presentation you're giving. That could only be achieved by understanding rather than memorizing. Overall most students reported that those questions were adequate for the step exam.

Behavioral:

There is what is good and what is almost damaging, and those are BRS and Pretest respectively. I've said previously that BRS contains 700 of A+ type of questions, while they are almost exclusively one step thinking, they get the right presentation of the case presented to you clearly. Pretest, at least the copy I've navigated through in the book store and from my peers, really concentrates on obscure details, those that almost no one reported being asked about in the exam, and ignores an enormous amount of other High Yield materials. depending on Pretest would hurt your score rather than help it. My advice do NOT even buy it.

Comprehensive Question Books:   

There are 3 major books and all of them got really good and high yield questions when it comes to behavioral. They are Kaplan, Rx and lange. I intend to do them and I think you also should do the same.

Behavioral science, The silent killer.

Pathology, Pathology, Pathology. All of us concentrate on pathology while studying and give it the lion's share of our study time, and we are correct in that case, and some even subtract the majority of the time that should be dedicated to other subjects to be better at pathology. When you ask yourself what subject you are neglecting the answer will be almost always "Behavioral science".
In my home institution, there is no such course as Behavioral science. I didn't study Biostatistics or psychology or ethics during the basic years, while psychiatry is of course studied during clinical years.
So when it came to studying something I'm not familiar with with no assistance or guidance and with the thought that it's not as important as other subjects, most of my friends, colleges and senior students either consciously or subconsciously neglected in favor of more study hours of other more difficult material. Neglecting Behav has proved itself to be a double edged weapon, as you improve other domain you really go downhill in this particular field and instead of getting a push in your score you find yourself losing even up to 20 precious points.
With that said, how can an IMG handle Behav?!! especially for the first time ever.

• Barbara Fadem Books. This beautiful and brilliant professor has written the 3 most relied upon books concerning Behav for the USMLE, 
• The first one which is called behavioral sciences in medicine is the biggest one of them, with almost 500 pages. In my opinion the book is good but not necessarily for the purposes of the exam. You'll find many lower yield information that is not really crucial in your understanding of the information and would rarely be tested and the book could potentially take more time than you intend to dedicate to the subject. I have the book but I didn't use it much and wouldn't advice you to do so.
• The medium sizes one: BRS behavioral sciences. The pearl for the USMLE. The book is concise with a total of 300 pages. I'd advice every IMG who never took Behav or didn't really grasp it to use this book. The book is written in an easy and fast pace, you'd understand what exactly is she trying to tell you plus tables to contrast similar conditions and materials to really get to the essence of the difference between them. The major plus here is the 700 question that is presented both after each chapter and a comprehensive exam at the end. The chapters are small and numerous so you'd get the feeling that you're achieving a lot by finishing more chapters giving you a positive attitude and motivation to achieve more. Overall I'd advice you to use this brilliant resource.
• The small one: HY Behavioral sciences. This book is essentially the modified BRS book. Some details have been removed and the questions were also treated the same. The tables are still there but a little bit modified. If you are already familiar with Behav, then this is the book for you. If you not, I really think you should stick with BRS.

• Kaplan book: a decent book. A lot of student scoring all over the spectrum have used it and they liked it. But for me I liked BRS more. It's a matter of personal preference after all, use the book that you enjoy to be able to absorb the materials faster and retain it better. So, if you like kaplan more than BRS, It's your choice. Stick with kaplan.

• HY Biostatistics: Both Kaplan and BRS have dedicated chapters concerning Biostatistics. Those are brief but sufficient. If you find a persistent defect while solving then I'd advice to get the HY book and study it. It's highly rated by most students.

• Ethics: Fisher's book of course. The book is simple but clear. Many of what seems complicated situations in the eyes of international students are presented easily and the explanation is clear. Do this. Do NOT do that. Period. The book has like 107 cases and detailed explanations at the end. Those are of an excellent quality. Overall this book shouldn't take you more than 1 day is you are doing it more towards the end of your prep.
• Kaplan Videos made by Dr. Steven Daugherty. I like him, and if I like a professor I really concentrate with every word he says or speaks. You can follow with his lectures along Kaplan, BRS or even First Aid directly. What seems as complicated and non-related materials when read alone starts to make sense when you listen to them from someone who understands what he is talking about. With that said I can only give him A+ rating. 

How I'm using my FA copy

As any student or even a graduate who is preparing for the USMLE step 1 knows, First Aid is the ultimate resource you will use for review, but how lone wolfs, those who are studying alone and can't find others preparing near them and also can't handle preparing with partners over Skype, handle it would be primitive. You'd evolve as you use it more, but that would be slow and with advice that you can get from other students or previous test takers you can jump instead of crawl.
I bought 2 copies of First Aid, the first one was 2013 international edition and the second that I just got is 2014 US edition. I bought them 6 months apart. I've been using 13 since I started my journey and I love the book.

The modifications I did in my copy:

I used the book for a while with the original binding which was quite good, but when I heard about the 3 ring binder book and the spirally bound one I felt like Oh yeah I should totally try this out, so at first I got my book in a 3 ring binder. I didn't like it that much. People who use it say it's amazing for the purposes of adding sheets of paper from other sources and making FA your ultimate resource and while this may be true what really annoyed me was that my copy was now completely rigid, I couldn't cope with a book that is really hard to carry and walk with. I had to open it on a desk or a table and it had to be open to full length!!! That really wasn't my style, I preferred to hold the book and walk around reading, so I said enough with the 3 ring binder and got the book spirally bound.
The spirally bound book was a great idea, first of all you can remove all the pages that won't be studied and you'd get a book that is around 560 pages instead of 700 pages, a pretty big difference don't you think?
I'd really advice you to get it spirally bound and if you want to add pages, you can just use a stabler or glue whenever you desire, right?

Enough said about the binding of the book. What was hindering me a little was how to take the notes in the book. I've never dealt with a book in which I'd write this humongous amount. I was lost at first and just wrote what I though was worth remembering or understanding, Was I right?
I don't think so, I started of reading textbooks, USMLE oriented but still textbooks not review book, and adding what seemed good at my copy and I used a pen, a huge mistake. I started with Biochemistry and took my time but I didn't do any questions or use a review book, I though I could do it and know it all. Boy, I've never been so wrong. Finishing Biochem and starting to solve questions I know what I've done wrong. I've added materials everywhere in my book and now I didn't have any space to add the notes from the questions, that was my first mistake. The second was that I used a pen to take notes, what an idiot. A pen !!! The notes were in blue and I couldn't erase notes I thought was important then but now think I only added very low yield materials or materials that are explanatory. Over time I've changed the way I take notes in the book, I completely think that this is a matter of personal preference, I've changed the colors I'm using and now have a color for specific resources, even high lightening was random at first, but now I have specific codes for it. In essence I'm going to tell you what I'm using right now and what I'm about to use in my newly bought FA 14 copy.

So, Here is it:

1. Notes taken from UW, I haven't solved it during my first run but it will be the first thing to solve and add to the new copy in the second, are written using a 0.4 m RED Pen, yes pen not a pencil as those are permanent and really HY. 
2. Notes taken from Kaplan Qbank are written in a blue pen also, few of them are not really high yield but It's the 2nd best bank, so a pen is pretty good here, I won't really need to erase them later.
3. Notes taken from Rx Q bank are in green, few really as the bank is similar to the book but you can enter a clinical scenario you didn't think could be presented like this, or Consult and Weapon banks. I'm planning to solve the 5 of them in the same order they are listed above.
4. Notes taken from QBooks are written using a 0.5 m Pencil.
5. Notes that are targeted towards explaining something I didn't get are written using an HB pencil, easily erased, either on the book itself or in a piece of paper that I can easily remove once I'm familiar enough with it.
6. Mnemonics are a big deal when it comes for memorizing for some people, I don't really use them or like them that much but some really do. I'm using an orange high-lightening when it comes to an added mnemonic.
7. MEDIA, videos or photos, is becoming increasingly really high yield in the exam and for that I'm using a green high-lightening to indicate I either have LM, EM, MRI, CT, video or whatever saved for this and I should revise them again. I don't print them, I have them on the gallery of my tablet for quick access. 
8. When it comes to mistakes I've made while solving qbanks or books I use the yellow high-lightening but beware UW mistakes are really important so I high-light them with a red color.

So this was how I'm now color coding my book, but what about the space in which I'm writing?! Give yourself enough space to be able to reread what you have read dude. At first I used to write in the tiniest font I can possibly use, a total mistake, organize your book right and write the right stuff down and the 14 edition is spacious, you should manage it :)
I have divided the free spaces into 3 vertical zones in every page, that way I don't waste space but also I have enough space to be able to read my own writing.
Finally, It's a long road but thousands of people are doing it every year, 40,000 :D

BE BRAVE YOU WILL DO IT

Why am I writing

For the American medical students the path is already paved and hundreds have already taken it before, but when it comes from international students the path is not as clear as they'd want it to be. If you are an IMG you'd totally understand what I'm saying. We try to get and absorb information where we can find it, there is no mentors or career advisors at out campuses to guide us through this long and bumpy ride.