USMLE Step 1 2006 Computer-based Content and Sample Test Questions GUIDE TO E FFICIENT EXAM PREPARATION
Sunday, November 30th, 2008GUIDE TO E FFICIENT EXAM PREPARATION 12
USMLE Step 1 2006 Computer-based Content and Sample Test Questions
(information given free to all examinees)
2006 USMLE Bulletin of Information (information given free to all examinees)
The USMLE Step 1 2006 Computer-based Content and Sample Test Questions
contains approximately 150 questions that are similar in format and content
to the questions on the actual USMLE Step 1. This practice test offers
one of the best methods for assessing your test-taking skills. However, it does
not contain enough questions to simulate the full length of the examination,
and its content represents a limited sampling of the basic science material that
may be covered on Step 1. Most students felt that the questions on the actual
2005 exam were more challenging than those contained in these questions.
Others report encountering a few near-duplicates of these questions on the actual
Step 1. Presumably, these are “experimental” questions, but who knows!
Bottom line: Know these questions!
The extremely detailed Step 1 Content Outline provided by the USMLE has
not proved useful for students studying for the exam. The USMLE even states
that “. . . the content outline is not intended as a guide for curriculum development
or as a study guide.” 4 We concur with this assessment.
The 2006 USMLE Bulletin of Information is found on the CD-ROM. This
publication contains detailed procedural and policy information regarding the
CBT, including descriptions of all three Steps, scoring of the exams, reporting
of scores to medical schools and residency programs, procedures for score
rechecks and other inquiries, policies for irregular behavior, and test dates.
The NBME also offers the Comprehensive Basic Science Self-Assessment
(CBSSA), which tests users on topics covered during basic science courses in a
format similar to that of the USMLE Step 1 examination. The Web-based information
provided via the CBSSA is intended for use as a study tool and not as an
indicator of Step 1 performance. However, students who prepared for the examination
using this Web-based tool found the format and content highly indicative
of questions tested for the Step 1 examination.
The CBSSA exists in two forms: a standard-paced and a self-paced format, both
of which consist of four sections of 50 questions each (a total of 400 multiplechoice
items). The standard-paced format allows the user up to one hour to
complete each section, reflecting the time limits of the actual exam. The selfpaced
format, however, places no time limit on answering the multiple-choice
questions. Keep in mind that this bank of questions is available only on the
Web. The NBME requires that users log on, register, and start within 30 days of
registration. Once the assessment has begun, users are required to complete the
sections within 20 days. Upon completion of the questions, the CBSSA will
provide the user with a performance profile, indicating relative strengths and
weaknesses, similar to the report profile for the USMLE Step 1 exam. However,
please keep in mind that this self-assessment does not provide the user with a list
of correct answers. Feedback from the self-assessment is entirely in the format of
a performance profile and nothing more. The NBME charges $45 for this ser-
GUIDE TO E FFIC IENT EXAM PREPARATION
13
vice, which is payable by credit card or money order. For more information regarding
the CBSSA, please visit the NBME’s Web site at www.nbme.org and
click on the link for “NBME Web-based Self-Assessment Service.”
DEFINING YOUR GOAL
It is useful to define your own personal performance goal when approaching
the USMLE Step 1. Your style and intensity of preparation can then be
matched to your goal. Your goal may depend on your school’s requirements,
your specialty choice, your grades to date, and your personal assessment of the
test’s importance. Do your best to define your goals early so that you can prepare
accordingly.
Certain highly competitive residency programs, such as those in otolaryngology
and orthopedic surgery, have acknowledged their use of Step 1 scores in
the selection process. In such residency programs, greater emphasis may be
placed on attaining a high score, so students who seek to enter these programs
may wish to consider aiming for a very high score on the USMLE Step 1.
However, a great number of residency programs value other criteria more
highly than a high score on Step 1. For more information, fourth-year medical
students who have recently completed the residency application process
can be a valuable resource.
TIMELINE FOR STUDY
Make a Schedule
After you have defined your goals, map out a study schedule that is consistent
with your objectives, your vacation time, and the difficulty of your ongoing
coursework (see Figure 4). Determine whether you want to spread out your
study time or concentrate it into 14-hour study days in the final weeks. Then factor
in your own history in preparing for standardized examinations (e.g., SAT,
MCAT).
Typically, students allot between five and seven weeks to prepare for Step 1.
Some students reserve about a week at the end of their study period for final review;
others save just a few days. When you have scheduled your date, do your
best to keep to it. Recent studies show that a later testing date does not translate
into a higher score, so avoid pushing back your test date.5 This highlights the importance
of working out a realistic schedule to which you can adhere.
Another important consideration is when you will study each subject. Some
subjects lend themselves to cramming, whereas others demand a substantial
long-term commitment. The “crammable” subjects for Step 1 are those for
which concise yet relatively complete review books are available. (See Section
IV for highly rated review and sample examination books.) Behavioral science
Fourth-year medical students
have the best feel for how
Step 1 scores factor into the
residency application process.
Some competitive residency
programs use Step 1 scores in
their selection process.
Time management is key.
Customize your schedule to
your goals and available time
following any final exams.
GUIDE TO E FFICIENT EXAM PREPARATION 14
and physiology are two subjects with concise review books. Three subjects
with longer but quite complete review books are microbiology, pharmacology,
and biochemistry. Thus, these subjects could be covered toward the end of
your schedule, whereas other subjects (anatomy and pathology) require a
longer time commitment and could be studied earlier. Many students prefer
using a “systems-based” approach (e.g., GI, renal, cardiovascular) to integrate
the material across basic science subjects. See Section III to study anatomy,
pathology, physiology, and pharmacology facts by organ system.
Practically speaking, spending a given amount of time on a crammable or
high-yield subject (particularly in the last few days before the test) generally
produces more correct answers on the examination than spending the same
amount of time on a low-yield subject. Student opinion indicates that knowing
the crammable subjects extremely well probably results in a higher overall
score than knowing all subjects moderately well.
Make your schedule realistic, and set achievable goals. Many students make the
mistake of studying at a level of detail that requires too much time for a comprehensive
review––reading Gray’s Anatomy in a couple of days is not a realistic
goal! Revise your schedule regularly on the basis of your actual progress. Be careful
not to lose focus. Beware of feelings of inadequacy when comparing study
schedules and progress with your peers. Avoid students who stress you out. Fo-
F I G U R E 4 . Typical Timeline for the USMLE Step 1.
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Nov
Dec
2005
2006
Register for USMLE Step 1
Schedule test date and
location
Typical period
to take exam
Expect scores 3–6 weeks
after exam
“Crammable” subjects should
be covered later and less
crammable subjects earlier.
GUIDE TO E FFIC IENT EXAM PREPARATION
15
cus on a few top-rated books that suit your learning style—not on some obscure
books your friends may pass down to you. Do not set yourself up for frustration.
Accept the fact that you cannot learn it all. Maintain your sanity throughout the
process.
You will need time for uninterrupted and focused study. Plan your personal
affairs to minimize crisis situations near the date of the test. Allot an adequate
number of breaks in your study schedule to avoid burnout. Maintain a
healthy lifestyle with proper diet, exercise, and sleep.
Year(s) Prior
The USMLE asserts that the best preparation for the USMLE Step 1 resides
in “broadly based learning that establishes a strong general foundation of understanding
of concepts and principles in basic sciences.” 6 We agree. Although
you may be tempted to rely solely on cramming in the weeks and
months before the test, you should not have to do so. The knowledge you
gained during your first two years of medical school and even during your undergraduate
years should provide the groundwork on which to base your test
preparation. Student scores on NBME subject tests (commonly known as
“shelf exams”) have been shown to be highly correlated with subsequent Step
1 scores.7 Moreover, undergraduate science GPAs as well as MCAT scores are
strong predictors of performance on the Step 1 exam.8 The preponderance of
your boards preparation should thus involve resurrecting dormant information
that you have stored away during the basic science years.
We also recommend that you buy highly rated review books early in your first
year of medical school and use them as you study throughout the two years.
When Step 1 comes along, the books will be familiar and personalized to the
way in which you learn. It is risky and intimidating to use unfamiliar review
books in the final two or three weeks.
Months Prior
Review test dates and the application procedure. In 2006, the testing for the
USMLE Step 1 continues on a year-round basis (see Table 2). If you have
any disabilities or “special circumstances,” contact the NBME as early as
possible to discuss test accommodations (see p. 54, First Aid for the Student
with a Disability).
Before you begin to study earnestly, simulate the USMLE Step 1 under “real”
conditions to pinpoint strengths and weaknesses in your knowledge and testtaking
skills. Be sure that you are well informed about the examination and that
you have planned your strategy for studying. Consider what study methods you
will use, the study materials you will need, and how you will obtain your materials.
Plan ahead. Get advice from third- and fourth-year medical students who
have recently taken the USMLE Step 1. There might be strengths and weaknesses
in your school’s curriculum that you should take into account in decid-
Avoid burnout. Maintain
proper diet, exercise, and
sleep habits.
Buy review books early (first
year) and use while studying
for courses.
Simulate the USMLE Step 1
under “real” conditions before
beginning your studies.
GUIDE TO E FFICIENT EXAM PREPARATION 16
ing where to focus your efforts. You might also choose to share books, notes,
and study hints with classmates. That is how this book began.
Three Weeks Prior
Two to four weeks before the examination is a good time to resimulate the
USMLE Step 1. You may want to do this earlier depending on the progress of
your review, but do not do it later, when there will be little time to remedy defects
in your knowledge or test-taking skills. Make use of remaining goodquality
sample USMLE test questions, and try to simulate the computerized
test conditions so that you get a fair assessment of your test performance. Recognize,
too, that time pressure is increasing as more and more questions are
framed as clinical vignettes. Most sample exam questions are shorter than the
real thing. Focus on reviewing the high-yield facts, your own notes, picture
books, and very short review books.
One Week Prior
Make sure you have your CIN (found on your scheduling permit) and other
items necessary for the day of the examination, including a driver’s license or
other photo identification with your signature (make sure the name on your
ID exactly matches that on your scheduling permit), an analog watch, and
possibly earplugs. Confirm the Prometric testing center location and test
time. Work out how you will get to the testing center and what parking and
traffic problems you might encounter. Visit the testing site (if possible) to get
a better idea of the testing conditions. Determine what you will do for lunch.
Make sure you have everything you need to ensure that you will be comfortable
and alert at the test site.
One Day Prior
Try your best to relax and rest the night before the test. Double-check your admissions
and test-taking materials as well as the comfort measures discussed
earlier so that you do not have to deal with such details on the morning of the
TA B L E 2 . 2006 USMLE Exams.
NO. OF QUESTIONS/ TEST SCHEDULE PASSING
STEP FOCUS NO. OF BLOCKS LENGTH OF CBT EXAM SCORE
Step 1 Basic mechanisms
and principles 350/7 One day (eight hours) 182
Step 2 Clinical diagnosis
and disease pathogenesis 400/8 One day (nine hours) 174
Step 3 Clinical management 500/10 Two days (16 hours) 182
In the final two weeks, focus
on review and endurance.
Avoid unfamiliar material.
Stay confident!
Confirm your testing date at
least one week in advance.
GUIDE TO E FFIC IENT EXAM PREPARATION
17
exam. Do not study any new material. If you feel compelled to study, then
quickly review short-term-memory material (e.g., Rapid Review) before going
to sleep. However, do not quiz yourself, as you may risk becoming flustered
and confused. Remember that regardless of how hard you studied, you cannot
know everything. There will be things on the exam that you have never even
seen before, so do not panic. Do not underestimate your abilities.
Many students report difficulty sleeping the night prior to the exam. This is
often exacerbated by going to bed much earlier than usual. Do whatever it
takes to ensure a good night’s sleep (e.g., massage, exercise, warm milk). Do
not change your daily routine prior to the exam. Exam day is not the day for a
caffeine-withdrawal headache.
Morning of the Exam
Wake up at your regular time and eat a normal breakfast. Make sure you
have your scheduling permit admission ticket, test-taking materials, and comfort
measures as discussed earlier. Wear loose, comfortable clothing. Plan for
a variable temperature in the testing center. Arrive at the test site 30 minutes
before the time designated on the admission ticket; however, do not come
too early, as this may increase your anxiety. When you arrive at the test site,
the proctor should give you a blue, laminated USMLE information sheet to
read that will explain important things such as the use of break time. Seating
may be assigned, but ask to be reseated if necessary; you need to be seated in
an area that will allow you to remain comfortable and to concentrate. Get to
know your testing station, especially if you have never been in a Prometric
testing center before. Listen to your proctors regarding any changes in instructions
or testing procedures that may apply to your test site.
Remember that it is natural (and even beneficial) to be a little nervous. Focus
on being mentally clear and alert. Avoid panic. Avoid panic. Avoid panic.
When you are asked to begin the exam, take a deep breath, focus on the
screen, and then begin. Keep an eye on the timer. Take advantage of breaks
between blocks to stretch and relax for a moment.
After the Test
Have fun and relax regardless of how you may feel. Taking the test is an
achievement in itself. Remember, you are much more likely to have passed
than not. Enjoy the free time you have before your clerkships. Expect to experience
some “reentry” phenomena as you try to regain a real life. Once you
have recovered sufficiently from the test (or from partying), we invite you to
send us your feedback, corrections, and suggestions for entries, facts,
mnemonics, strategies, book ratings, and the like (see p. xvii, How to Contribute).
Sharing your experience benefits fellow medical students and IMGs.
No notes, books, calculators,
pagers, recording devices, or
digital watches are allowed in
the testing area.
Arrive at the testing center
30 minutes before your
scheduled exam time. If you
arrive more than half an hour
late, you will not be allowed
to take the test.
Some students recommend
reviewing certain “theme”
topics that tend to recur
throughout the exam.
GUIDE TO E FFICIENT EXAM PREPARATION 18
I F YOU THINK YOU FAI LED
After the test, many examinees feel that they have failed, and most are at the
very least unsure of their pass/fail status. There are several sensible steps you
can take to plan for the future in the event that you do not achieve a passing
score. First, save and organize all your study materials, including review
books, practice tests, and notes. Familiarize yourself with the reapplication
procedures for Step 1, including application deadlines and upcoming test
dates. The CBT format allows an examinee who has failed the exam to retake
it no earlier than the first day of the month after 60 days have elapsed since
the last test date. Examinees will, however, be allowed to take the exam no
more than three times within a 12-month period should they repeatedly fail.
The performance profiles on the back of the USMLE Step 1 score report provide
valuable feedback concerning your relative strengths and weaknesses (see
Figure 2B). Study the performance profiles closely. Set up a study timeline to
strengthen gaps in your knowledge as well as to maintain and improve what
you already know. Do not neglect high-yield subjects. It is normal to feel
somewhat anxious about retaking the test. If anxiety becomes a problem, however,
seek appropriate counseling.
Fifty-two percent of the NBME-registered first-time takers who failed the June
1998 Step 1 repeated the exam in October 1998. The overall pass rate for that
group in October was 60%. Eighty-five percent of those scoring near the old
pass/fail mark of 176 (173–176) in June 1998 passed in October. However,
1999 pass rates varied widely depending on initial score (see Table 3, which
reflects the most current data available at the time of publishing).
Although the NBME allows an unlimited number of attempts to pass Step 1,
both the NBME and the FSMB recommend that licensing authorities allow a
minimum of three and a maximum of six attempts for each Step examination.9
Again, review your school’s policy regarding retakes.
I F YOU FAI LED
Even if you came out of the exam room feeling that you failed, seeing that
failing grade can be traumatic, and it is natural to feel upset. Different people
react in different ways: For some it is a stimulus to buckle down and study
harder; for others it may “take the wind out of their sails” for a few days; and
for still others it may lead to a reassessment of individual goals and abilities. In
some instances, however, failure may trigger weeks or months of sadness, feelings
of hopelessness, social withdrawal, and inability to concentrate—in other
words, true clinical depression. If you think you are depressed, please seek
help.
If you pass Step 1, you are not
allowed to retake the exam in
an attempt to raise your score.
TA B L E 3 . Pass Rates
for USMLE Step 1
Repeaters 1999.9
INITIAL %
SCORE PASS
176–178 83
173–175 74
170–172 71
165–169 64
160–164 54
150–159 31
< 150 0
Overall 67
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