USMLE Step 1 2006 Computer-based Content and Sample Test Questions GUIDE TO E FFICIENT EXAM PREPARATION

By Live Dr - Sun Nov 30, 3:50 am


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-



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.”


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


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.


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,


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.


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.














Register for USMLE Step 1

Schedule test date and


Typical period

to take exam

Expect scores 3–6 weeks

after exam

“Crammable” subjects should

be covered later and less

crammable subjects earlier.



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


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.


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.



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.



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.



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.


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


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



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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