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First off, I want to thank SDN and its collective wisdom, some really great stuff on these boards. I just got my score back today, and I've been putting together this guide for a while now to give back to the community. (Its LONG!)
So, how did a guy like me who slacked off in basic sciences (I only marginally passed immunology) do well on the boards? Play the game – Know what they're asking and you're already two steps ahead. Here's a good breakdown of how the test goes:
Out of each block of 50 questions, approximately:
Also this test is very integrative. You'll have path, phys, and immune all in one question. They'll combine all types of things, have you make these crazy connections – but with a strong foundation you can do it. The goal of your studying is to maximize those first two groups of questions – by building a strong foundation of BOTH concepts and details.
Strategy:
I had about 6.5 weeks to study – I would say 7 but it took me almost 4 days just to get organized – like figuring out which are the best books, putting together a schedule, etc.
Also, GOLJAN GOLJAN GOLJAN GOLJAN GOLJAN. The man is amazing, he puts stuff together like you can't imagine. Pepper your studying with his audio lectures – i.e. listen to him whenever possible. The last couple of weeks, I would listen to him while driving, randomly throughout the day, and even in the shower/while getting ready (I know its nuts, but I got an extra lecture in everyday this way!)
Daily Schedule I would study about 10-14 hours a day, depending on when I wake up, and how I was feeling that day. Early on I would spend most of the time with books, then more time with FA as the date got closer. I would try to do 100 q's a day, but it would usually be 50.
First, start off with a pass of first aid – go through it and realize what topics you know well, and what topics you will need to focus on. Also familiarize yourself with the layout, it can be confusing at times and knowing where everything is will definitely save you some time. Then, go through the various study books you have – Read important details, really go through for UNDERSTANDING, and annotate details as much as possible into FA.
Here are my thoughts about each subject and the best book to use (based on my pouring over previous experiences and from personal experience):
The last couple of weeks then, really go through FA and your notes, atleast once in depth, twice if you can, and once more in your weakest areas. Throw in some goljan as you can, and also keep doing questions (more on that to come). Keep thinking outside the box, tie together concepts, try to anticipate how they may ask the questions, and make sure you are picking up on the finer details. This is your time to re-enforce concepts, and really memorize the little details you picked up the first few weeks.
The final week, really kick it up a notch, even if you can't feel like it. That last week, my stomach would churn even holding first aid, but I knew I had to. Do some questions if you want to, but time is of the essence. Think through everything, UNDERSTAND concepts, whats in FA and your notes – learn all the details like about the viruses, the cancer drugs, the different CAH deficiencies – etc. Live and breathe FA
The last day – go for memorizing whatever details you have left, like anatomy, pharm side effects, etc. – pick up what you can, but don't overdue it. Set a schedule, and a time to be done. After you are done, THAT'S IT. PUT THE FIRST AID DOWN! You know what you know – and trust me by now, you are prepared.
I knew I would have a tough time sleeping the night before, so I didn't take any caffeine or sugar after noon the day before. After I stopped studying, I just relaxed – watched Borat, got my mind off things, and went to sleep, knowing that freaking aye man, I put my life on hold for 2 months, I was listening to Goljan in the SHOWER! I've done everything I can, so now I just gotta take it, and in a few hours it will be over.
The test: I arrived early, with a bag full of junk I never ended up using (except lunch). I spent each block going through the questions, and would mark the tougher ones. At the end of each block, I would go through all the marked ones, and really think through them, until I had gone through all of them. Then I would go through the whole block again, just to make sure I didn't misread or miss something, and I would have about a minute left after that. Whatever you do, TAKE A BREAK between each block – even 2 minutes. Just zone out, wonder which test the 60yr old guy next to you is taking, but just let your brain relax. The prometric staff were professional and everything went smoothly. Seats were comfortable – they just need to get freaking LCD screens
I thought the first couple of blocks went well, then it was downhill from there. I started feeling feverish, my heart was racing, I had a bad headache, I really thought I was getting sick. Also my eyes were getting strained from the computer screen. So I would walk outside during each break just to get some fresh air. The test is a mind game – and honestly it got the better of me – I was getting very anxious, I had to calm myself down a few times. I'm telling you this now – so you can prepare for it if it happens to you.
Timing By now you should've been taking questions in timed blocks of 50, so you know if speed will be an issue. If you are slow, try to look for the simpler questions, realize this is one of the ones you know, and move on, save your time for 2-3 step questions. If you know you rush, fight the urge! You've spent two months studying, whats a few minutes? Look over each question carefully, I almost missed (atleast) two questions just because I missed one (yes ONE) word in the stem!
After the test – damn man, you're freaking done. You did it. Now go back home, go see your family or your friends, go see the sun, go do anything. Just live life. And wait patiently for your scores (argh).
So, as far as #'s go:
First starting – about 50% on UWorld, 60% on Qbank (I stopped using Qbank about half way through)
NBME – Form 2, taken two weeks before the exam – 228
I was getting 75% on UWorld the week before the exam (finished about 60%)
Final score – 254/99
Thanks again to all the collective advice on SDN – and I hope this experience helps you out. Best of luck, and I know you will kick some ass.
Any questions feel free to ask away!
So, how did a guy like me who slacked off in basic sciences (I only marginally passed immunology) do well on the boards? Play the game – Know what they're asking and you're already two steps ahead. Here's a good breakdown of how the test goes:
Out of each block of 50 questions, approximately:
- 25-30 q's would be ones you know, from studying your ass off
- 10-15 q's would be ones you *should* know, i.e. you studied but forgot, or there are little details that are tripping you up, etc.
- 5-10 are the "out of the box" q's – experimental, stuff you've never seen before, minutia from your syllabi or even college courses.
Also this test is very integrative. You'll have path, phys, and immune all in one question. They'll combine all types of things, have you make these crazy connections – but with a strong foundation you can do it. The goal of your studying is to maximize those first two groups of questions – by building a strong foundation of BOTH concepts and details.
Strategy:
I had about 6.5 weeks to study – I would say 7 but it took me almost 4 days just to get organized – like figuring out which are the best books, putting together a schedule, etc.
Also, GOLJAN GOLJAN GOLJAN GOLJAN GOLJAN. The man is amazing, he puts stuff together like you can't imagine. Pepper your studying with his audio lectures – i.e. listen to him whenever possible. The last couple of weeks, I would listen to him while driving, randomly throughout the day, and even in the shower/while getting ready (I know its nuts, but I got an extra lecture in everyday this way!)
Daily Schedule I would study about 10-14 hours a day, depending on when I wake up, and how I was feeling that day. Early on I would spend most of the time with books, then more time with FA as the date got closer. I would try to do 100 q's a day, but it would usually be 50.
First, start off with a pass of first aid – go through it and realize what topics you know well, and what topics you will need to focus on. Also familiarize yourself with the layout, it can be confusing at times and knowing where everything is will definitely save you some time. Then, go through the various study books you have – Read important details, really go through for UNDERSTANDING, and annotate details as much as possible into FA.
Here are my thoughts about each subject and the best book to use (based on my pouring over previous experiences and from personal experience):
- Comprehensive – First aid is still the best. At first I hated the book, and then I realized just how much information is in there. It really is an acquired taste – just get used to it at first, and make sure you annotate into it. It does have holes, and you need to fill them up.
- Question banks – So I have to say trying both Qbank and USMLEWorld, that UW freaking rocks. The question style, subject matter, etc are all so similar to the step. Qbank is a great tool for testing facts – but their questions focus too much on minutia. UW Ties those facts in with concepts – its great how they do it, and that's exactly what you'll have to do on the test. Plus UW costs less (after all those books trust me it adds up). If you only have time for one – do UW. Your brain will hurt, but that's what the test is like. It really helps maximize those "should know" questions I talked about earlier, and helps tie together concepts. But make sure you read the answer choices and explanations, especially the "educational concept" at the bottom. If you have a time for a 2nd, I would then suggest USMLE-Rx – only because going through the answers is like another read of FA. Qbank? Sorry, but its yesterday's news.
- Biochem: RR Biochem – Goljan – I always had a tough time with biochem, and this book was a good balance (in between HY biochem and Lippincott's). The biochem q's on the test weren't too difficult, you either knew it or you didn't. A lot of the tougher questions came from molec/cell biology (see below)
- Anatomy: HY Gross, HY Neuro (I got HY embryo and histo but didn't use them) – Had quite a bit of neuro and extremity anatomy (upper and lower) – and an xray of a fractured foot which kinda threw me off. Otherwise not too difficult – the consensus here is really knowing upper/lower extremity and neuroanatomy well. Know the embryo from FA, and tie in Histo to disease, bc that's how it'll be tested.
- Cell/Molec bio: HY Cell/Molec bio – good book to familiarize yourself with concepts like hox genes (I had 2 q's about them), Zn finger proteins, heat shock proteins, and cell signaling/receptor/2nd messenger stuff. Also great for knowing different molecular tests, DNA/RNA synthesis, etc. A lot of the "out of the box" questions come from molec bio, worded strangely and can piss you off, but you have decode what they're asking and this book will help understand whats going on.
- Behavioral science – I used BRS Behavioral, and it was a good book. I had a good mix of behavioral on my test, this section makes up a relatively large chunk, and like everyone says it can make or break you – so study it well. I also had a lot of patient response questions, which are generally difficult to study for, and there are always two answer choices that look good – really try to figure out the best on though.
- ID/Micro – Micro Ridiculously simple – still the best book for micro – great stuff, annotate into FA – haven't had a chance to look at the newest version. Micro is pretty well represented in the test, and they test details; also know your Abx well. Delve deep into the differences between each bug, the various ways they can present – compare and contrast different infections; and focus mostly on bacteria – then on viruses, then on antimicrobials – then fungi – and least important are parasites.
- Immuno – I used HY Immuno – good read (90 pages of like huge text); but here is a key point. Immunologic processes play a huge role in the mechanism of diseases, and you know this test is about mechanisms! So know your immunopath well – i.e. ARDS in pancreatitis, why?! Why do you get the consolidation in pneumonia (related to diapedesis). So much of immune related to pathophys – so learn it in immune well, learn it in FA well, learn the immunopath during pathology well.
- Physiology – BRS Phys is great – especially since this section can be tough. A lot of charts, graphs, arrows, messy stuff. I had a good mix of cardio/resp/renal/GI phys. But really really understand what physiological changes take place during exercises/sympathetic stimulation/high altitude, and those sorts of things. Really be able to tie in with path, bc pathophys is "big-time boards"
- Pathology – RR Path by Goljan – I think its better than BRS, because its more integrative. I would say Path is getting "diluted" on the boards, because they are now mixing in path questions with biochem, or path with phys, path with immuno, etc. And goljan does a fantastic job of bringing these points together. Really focus on the first few chapters, really understand the different types of necrosis, know your immunopath, dig deep into mechanisms of diseases. Pictures - I looked at Goljan's mostly, and supplemented a few with WebPath, for most you can tell what you're looking at from the question (1 of them from the answers )
- Pharm – USMLE Roadmap – Pharm - The pharm on the test is straight forward, and usually ties in with other questions. FA is great alone, especially if you already have a strong background in pharm. I had a tough time with Pharm, bc our school doesn't teach it well; so I really focused on this section near the end.
The last couple of weeks then, really go through FA and your notes, atleast once in depth, twice if you can, and once more in your weakest areas. Throw in some goljan as you can, and also keep doing questions (more on that to come). Keep thinking outside the box, tie together concepts, try to anticipate how they may ask the questions, and make sure you are picking up on the finer details. This is your time to re-enforce concepts, and really memorize the little details you picked up the first few weeks.
The final week, really kick it up a notch, even if you can't feel like it. That last week, my stomach would churn even holding first aid, but I knew I had to. Do some questions if you want to, but time is of the essence. Think through everything, UNDERSTAND concepts, whats in FA and your notes – learn all the details like about the viruses, the cancer drugs, the different CAH deficiencies – etc. Live and breathe FA
The last day – go for memorizing whatever details you have left, like anatomy, pharm side effects, etc. – pick up what you can, but don't overdue it. Set a schedule, and a time to be done. After you are done, THAT'S IT. PUT THE FIRST AID DOWN! You know what you know – and trust me by now, you are prepared.
I knew I would have a tough time sleeping the night before, so I didn't take any caffeine or sugar after noon the day before. After I stopped studying, I just relaxed – watched Borat, got my mind off things, and went to sleep, knowing that freaking aye man, I put my life on hold for 2 months, I was listening to Goljan in the SHOWER! I've done everything I can, so now I just gotta take it, and in a few hours it will be over.
The test: I arrived early, with a bag full of junk I never ended up using (except lunch). I spent each block going through the questions, and would mark the tougher ones. At the end of each block, I would go through all the marked ones, and really think through them, until I had gone through all of them. Then I would go through the whole block again, just to make sure I didn't misread or miss something, and I would have about a minute left after that. Whatever you do, TAKE A BREAK between each block – even 2 minutes. Just zone out, wonder which test the 60yr old guy next to you is taking, but just let your brain relax. The prometric staff were professional and everything went smoothly. Seats were comfortable – they just need to get freaking LCD screens
I thought the first couple of blocks went well, then it was downhill from there. I started feeling feverish, my heart was racing, I had a bad headache, I really thought I was getting sick. Also my eyes were getting strained from the computer screen. So I would walk outside during each break just to get some fresh air. The test is a mind game – and honestly it got the better of me – I was getting very anxious, I had to calm myself down a few times. I'm telling you this now – so you can prepare for it if it happens to you.
Timing By now you should've been taking questions in timed blocks of 50, so you know if speed will be an issue. If you are slow, try to look for the simpler questions, realize this is one of the ones you know, and move on, save your time for 2-3 step questions. If you know you rush, fight the urge! You've spent two months studying, whats a few minutes? Look over each question carefully, I almost missed (atleast) two questions just because I missed one (yes ONE) word in the stem!
After the test – damn man, you're freaking done. You did it. Now go back home, go see your family or your friends, go see the sun, go do anything. Just live life. And wait patiently for your scores (argh).
So, as far as #'s go:
First starting – about 50% on UWorld, 60% on Qbank (I stopped using Qbank about half way through)
NBME – Form 2, taken two weeks before the exam – 228
I was getting 75% on UWorld the week before the exam (finished about 60%)
Final score – 254/99
Thanks again to all the collective advice on SDN – and I hope this experience helps you out. Best of luck, and I know you will kick some ass.
Any questions feel free to ask away!
jk
