USMLE STEP 1 AND 2(CK)

ALL you need to know!

DR. FARAZ KHAN LUNI
Usmle step 1 score 99 (266)
Usmle step 2 score 99 (263)

I am writing this to guide my juniors so they don’t face the problems that we faced during
the preparations for our steps. Remember that studying for USMLE is a very customized
and there is no fixed formula. I am just mentioning my method and you may adjust it as
you feel suitable

Which books to use for step 1?

 Kaplan Lecture Notes (Along with DVDs)

 Kaplan 100 cases of ethics
 Epidemiology and Biostatistics for the USMLE (Appleton and Lange)
 Goljan Pathology
 Original First Aid
 Kaplan Q bank series (Not Q book)
 Uworld Mcqs (ONLINE!!!)
 DON’T use High yield series, Grey’s, Harper, Guyton, Ganong!!!

How to study?

Hard work pays off but smart studying pays off even more when you are studying for the
USMLE. In this regard MCQs will help you a lot in understanding the pattern of the
exam and in giving an understanding as to what to focus on. Just giving senseless reads
again and again will not help you get a better score. Make a study timetable and stick
to it! Sleep well and take out time to relax and exercise. This is important because
preparation for your steps takes months to complete, thus sitting home for a long time
decreases your efficiency and causes mental fatigue. Having a fresh mind will keep you
focused till the end and will avoid burn out.

Please do not over prepare. I recommend three reads and giving the exams. Giving
more reads than four is senseless and will cause you to get fatigued. The points which
you have not picked in the first read will also not be picked in the eighth read too. So
three good reads are better then multiple turbo reads. You do not have to remember
each and every line!
Do not just memorize buzz words. Instead of just remembering Mallory bodies,
understand that they are eosinophilic fibrillary substance in the liver cells. So understand
these words as much as possible rather than remembering them. The USMLE newsletter
says that they are giving more and more clinical scenario based questions now and there
much less simple questions. So understanding is even more important than plain Ratta.

It is my personal experience that a person who gets a 99 and person who flunks, all do the
same books. So doing extra books will not help you get a better score. It’s how you go
about studying that matters. So don’t study High yield series, Grey’s, Harper, Guyton,
Ganong unless you want give your exam on your 50th birthday.

.
Step 1 subjects

 Pathology (Very Important)

 Microbiology
 Behavioral Sciences (Our weakness)
 Pharmacology
 Immunology
 Physiology
 Biochemistry
 Genetics
 Anatomy (According to me it’s the least important subject. So don’t waste too
much time on it)

Patho:-
I have mentioned the subjects of Step 1 above. According to me Pathology is by far the
most important subject. If you ace it then you’re definitely scoring in your 90’s.

Micro:-
It seems hard to retain but they best way to retain is to do MCQs. Only after repeatedly
solving MCQs will you know what to focus on and remember it too.

Behavioral Sciences:-
This subject is our Achilles' Tendon. We International Medical Graduates and especially
Dow/Smc students don’t do as well in it. So I recommend that you also study “Kaplan
100 cases of Ethics” and “Epidemiology and Biostatistics for the USMLE (Appleton and
Lange)”. These are small books which won’t take much time and are very interesting too.
Pharmacology:-
I wrote the name of the drugs in each class and wrote their important points and side
effects on a separate piece of paper. There were some newer drugs which were mentioned
in Kaplan Mcqs and Uworld but not in Kaplan Books so I added these drugs in my notes
too. These notes took less time to revise and may be important for people who fear
pharma. People who are confident may not need to go through this hassle.

Biochemistry and genetics:-

First aid will help a lot in learning the reactions in biochemistry and the genes in genetics.

Anatomy:-
With the exception of Neuroanatomy which is very important, I don’t advise that you
waste too much time on anatomy. You do not need to study extra books like high yield
which is a waste of time. You may keep the Netter Atlas side by side when you study the
limbs if you want to be more efficient, but I recommend nothing more.

So as I mentioned, I gave three reads as follows.

First read
 Kaplan Series
 Kaplan 100 cases of ethics
 Epidemiology and Biostatistics for the USMLE (Appleton and Lange)
 Goljan Pathology
 DVDs

The first read is the slowest and the one in which you build your concepts. Don’t worry if
you don’t remember anything by the end of the first read. That’s normal. Go over the
books and do the DVDs side by side. As you go through the DVDs make additions to
Kaplan but do not write each and every word. I used both Goljan(old edition) and Kaplan
for pathology. I recommend that you do the DVDs only once with the first read and do
not need to repeat it again with the next read as they are time consuming. You can watch
the DVDs on software like Power DVD which has the option of speeding up the lectures
which results in the lectures being completed in less time. Some people I know didn’t do
DVDs and got good scores so it’s up to you as to what u decide.

A lot of softwares like Power DVD have the option of capturing frames and I used it for
saving the slides and reviewing them later. When I viewed the Kaplan Patho DVDs, I
also saved the slides they displayed. As I saved them I numbered the saved slides and
wrote the explanations and identifying points. Some people with high 99 hated Kaplan
Patho book and DVDs so they only used Goljan Book. I personally did not use the Goljan
Audio lectures so I cannot comment on it.

Also I did not find Microbiology DVDs very appealing so you may skip them if you
want. As I mentioned previously, study what suits you in the end. I only went through the
CT/MRI/Xrays from Netter atlas, the few ones given in the end of the chapters. I didn’t
go through Webpath and I think the slides from Kaplan DVDs and the ones in First Aid
are more than enough for the exam.

Second read

 Revise all the books (you may not read Kaplan 100 cases of Ethics and
Epidemiology and Biostatistics for the USMLE in the later reads if you think you
have gotten the hang of it
 Don’t waste time on DVDs in the second read (Some people who don’t go
through Kaplan 100 cases of Ethics and Epidemiology and Biostatistics for the
USMLE just go through the important chapters of Behavioral sciences DVD)
 Kaplan Q bank
 Original First Aid (I recommend that you get the original one and not the cheap
print as the slides and pictures are useful)

In the second read you should start Kaplan Q bank which will give you an idea on
what to focus on and about the high yield topics. Note down the points which you feel
are not covered in the Kaplan lecture notes. Start First Aid during this read but don’t
use it religiously. You won’t understand First Aid till you have your concepts which
will be made by Kaplan. So First Aid is a very important book but not your only
book.

Third read

 Revise Kaplan + First Aid

 U World Online (www.usmleworld.com )
 Sample exam (www.usmle.org)

In the third read you should start UWorld online. This is the most important part of
polishing your preparation for your exams. The software used in this is almost exactly
the same as in the real exam so you are simulating the real thing. The information
which is not covered in Kaplan or First Aid will be covered in UWorld. Subscribe to
the $99 package which lasts one month and select all the subjects, subspecialities for
each block. Give each block in one hour (timed mode) to make it as similar to the
exam as possible. Write down the important points as you read the explanations of the
MCQs as you will not have time to go over all the MCQs again. Try to schedule your
UWorld as close to the USMLE as possible. This is because you will be in practice
and constant practice helps you with your time management. Also all the information
is still fresh in your mind so don’t delay the exam unnecessarily.
The time taken for Step 1 preparation is variable. If you are studying at home and
only preparing for Step 1 then it should take you 6 to 8 months. It is variable among
people doing their house jobs as it depends on how tough your rotations are but I gave
my Step 1 within two and half months of finishing my house job.

Day before the Exam

Stop studying by 6 pm. If you have not studied anything for 8 months then a few
more hours won’t do wonders for your scores. Your concepts have been made by now
and last minute studying is useless so relax!!!! Watch a movie, a football match and
take your mind off the exam. Stay away from position holders and people who freak
you out about the exams. They will tell you that they have studied everything that is
to study under the sun and make you feel like an idiot. That’s the last thing you need
when going to give your USMLE exam. Sleep early and do not study till late. You
need a fresh mind for the long exam the next day. Don’t cross question yourself. My
friend while trying to sleep the night before was figuring what type of sleep he would
be going into, whether it is REM or non REM and what the EEG pattern would be
like. Before he realized his sleep pattern it was time to go give the exam

Don’t use long acting sedatives (Valium) to go to sleep as they affect you the next
day and you will be groggy and sleepy. Go see the Prometric centre at least a day
before so you don’t have to freak out the day of the exam in case you don’t find the
centre. Take the exam tutorial on the USMLE site so you do not have to waste time
going over the tutorial on the exam day. It is exactly the same as the one in the exam.

Exam Day

Reach the Prometric centre early. Go use the restroom if you have not already. The
last thing you want is a full bladder during the exam. Don’t study on exam day or in
exam break and take juices, snacks or what ever you like that day. The most
important is to take a leaflet of Panadol Extra which is a lifesaver!! Take it as soon as
you think that the headache is about to hit you

The step 1 exam has eight blocks of which the first block is the tutorial and the next
seven blocks are questions. In the end is an optional survey about the exam
experience. You have 40 minutes of break time and if you skip the tutorial you have
15 min extra added to the break time. In case you finish a block early, the time will be
added to your break time but remember the time for each block will remain the same
and will not increase. I recommend that you don’t skip the tutorial completely; there
is an option for checking the headphones and adjusting the brightness and contrast for
your screen. Use those and check your mouse if it’s working properly. If there is any
problem then inform the people at Prometric who will then allot you a new computer.
Each of the blocks in Step 1 had 48 MCQs when I gave the exam but now they will
have 46 MCQs.

In step 2, it’s the same drill but you have 9 blocks, the 1st block is the tutorial and the
rest 8 are the questions. In each block there are 44 MCQs.

How to attempt questions?

I had this technique which I used during my O and A levels and continued in my
USMLE too. I read the last line of the question first so I knew even before reading the
question as to know what was asked. Then I looked at the options. After that only, did
I start reading the whole question from the beginning. There is also an option of
highlighting the question and crossing out the options. You can practice this
technique when you solve your online UWorld and give the sample exam.

Don’t waste too much time on one question. If you don’t understand a question just
tick on any option and flag it. There is no negative marking and you may get the
question right by chance so never ever leave a question unanswered. When you
have time in the end you can return to the flagged questions. If you spend too much
time on one question then you may end up leaving questions in the end which you
may have easily solved.

Make sure that you manage your time properly. In my step 2 there were 44
questions so I made a mental note that the first 11 questions should be done by 15
min, 22 questions by 30 min and so on. Try to be ahead of these markers as the last
few questions may be the most time consuming.

When you are attempting a question, just remember that most of the information that
the USMLE requires you to know is in Kaplan and UWorld. So if you don’t get a
question then it’s most likely that you have not understood what they are trying to
ask. Most of the time it is what you already know but you can’t understand what they
are trying to ask you.
 USMLE STEP 2

The subjects tested in step 2 are

 Medicine (Most important)

 Pediatrics
 Obstetrics and Gynecology
 Surgery
 Psychiatry

Step 2 is an exam in which the grades of Dow/Smc people generally fall as compared
to step 1. I would recommend that you should attempt step 2 within 3-4 months of
step 1 because a lot of background knowledge from Step 1 will still be fresh in your
mind and help you in step 2.The syllabus is much shorter than Step 1 and takes less
time. Like in step 1, studying smartly is the key. Beware of mistakes in Kaplan as
there are a lot of minor mistakes here and there so do not take in every word of
Kaplan blindly. If you suspect an obvious mistake then just double check it from
another book.

What to study?
 Only Kaplan Series
 UWorld Mcqs

That’s it!!! You do not have to study anything else. I do not recommend even the
DVD’s because the ones available are the old ones (2001) and a lot of
recommendations have changed since then. If you really want to do DVDs then you
can do Cardiology and Gynecology. I do not recommend First Aid and Kaplan Qbank
for Step 2.

How to study?

As for Step 1, three reads of Kaplan is more than enough. For those who dare, two
reads may also be sufficient. This time however I suggest you solve U World with the
first read. Practicing UWorld with the first read will let you understand the pattern
and identify high yield topics. This way when you give your second and third reads
you will know what to focus on. Everyone gets whipped in U World in Step 2 so
don’t worry about that. As I said before, use it as a learning tool and not for
evaluation.
 FAQs

 Should I give my steps during my MBBS?

This is a very personalized decision. If you think that you can get a good score
then sure, go ahead. Just remember you have only one chance to give your steps
and you cannot give it again to improve your score. Only time you can give it is
when you fail or after 7 years as the results are valid for 7 years.
Step 1 can be given during MBBS but I do not recommend attempting Step 2
during this time especially for Dow/Smc students. The reason is that we only
study Step 2 subjects in final year so it’s not smart to give the exams before you
have gone through the subjects properly in college. People from AKU do give it
and get good scores but their syllabus is different from ours so their method of
attempting steps does not apply to us.

 Should I give Step 1 first or Step 2?

I would recommend that you give Step 1 first especially for people from
Dow/Smc as Step 2 is generally not our strong point and we score better in Step 1.
The subjects studied in Step 1 will help understand the Step 2 subjects much
better.

 Whether to do house job or not?

The knowledge and experience you gain during your house job does help you a
little bit in the exam especially in Step 2 but it wont cause a dramatic increase in
your grades. Those with green cards can skip their house jobs if they want but I
recommend Pakistani nationals (especially guys) to do their house jobs. There are
too many ifs and buts in the process so better secure the Pakistan option.

 Old edition or new one?

Try using the new edition of books

 Not a good enough score on U world?

I know people getting 65% on U world getting a 99 in Steps and others with
UWorld scores of 80’s also getting a 99. So there is a wide variation. Just use it as
a learning tool rather then a prediction tool
 Are USMLE Step 1 studies good enough to pass FCPS?

All my friends who were preparing for Steps passed their FCPS. I just did an
MCQ book for FCPS a few days before the exam and I passed. So yes it’s enough
to pass FCPS

 Whether to do NBME?

I never did it as I heard it predicts your score accurately. So if I got a good score, I
would be overconfident and if I got a bad score I would be under confident. Thus
I never used it.

 Whether to do UWorld sample exam?

Same problem as above. It predicts your score and I don’t like to have my score
predicted.

 Should I delay my exam?

If you have given three reads, solved all the MCQs and done everything properly
then postponing your exam is senseless. Only postpone it if you feel you can do
something different this time.

 How to attempt Audio/Visual questions and ones with slides and CT scans/MRI
etc?

People panic when they see an audio visual question. Just keep your nerves. In
some ways these questions are easier than other questions because they have one
extra hint in the shape of the audio visual clip to help you find the answer. When
you encounter such questions don’t look at the audio visual clip or the photo first.
Go straight to the question. When you read the question you will have a pretty
good idea what to look for in the audio visual clip. When you hear/see it then you
will be merely confirming your answer.

ACKNOWLEDGEMENTS

I would like to thank my friend Dr Ahmed Jawad from AKU who had guided me
along the process of my Steps. Also I would thank Dr Syed Ali Hamid, Dr
Mohammad Ali Khan, Dr Isra’a Khan and Dr Rida Ashraf for going through this
document and for honestly sharing their tips and methods of studying.
I hope this information will help you in your Steps. I will keep on updating this
document and get the feedback of various other people with good scores and add their
views too. So you may check the updates on the website www.pakmeds.com . In
addition my friends and I will upload more helpful information like CS tips,
Dow/Smc friendly program lists and other information which will be helpful to you.
Take care and best of luck for the future.
Dr. Faraz Khan Luni,
Dow Medical College,
Batch of 2008.
20 June 2010.