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  #1  
Old 11-27-2012
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Czech Republic Mark's Step 1 experience

Hi guys,

I am student at Masaryk university (Czech rep., Europe) and made the Step 1 this Friday in Munchen. I found most IMG who study for USMLE are from Caribean or India, so I put down some notes on differences in european medical background, compared it to things required in USMLE and made suggestions for european IMG on a separate page. You can find details, explaining why I did it mostly subject based, on my background there.

Preparation time: 1,5 year. Since this time I used Goljan's RR path, audio and Webpath along my classes, make annotations to FA.
1 year prior, I studied psychology from BRS phys along the class, then Pharmacology (KLN, Lipincots ilustrated) along the class.
8months prior: started revieweving biochem + genetics (KLN) about 4hrs a day, took about 3 months. Did almo UW Qbank and Kaplan Qbank along with it. Spend a long time on explanations, that's why the preparation looks so long.
5 months prior: reviewed microbio: MMMRS + LIR Q&A. The type of viruses (nucleated, ss, DNA/RNA) and diseases with spots started to make sense. Took about 2 months.
3 months prior: simulated exam 1: 70%.
Then reviewed anatomy: LIR Q&A, Kaplan Qbank
Physiology: BRS Phys + Qbank + Qbook (Phys chapter)
Wanted to do LIR Q&A Pathology, but there was no time. Did only UW pathology Q, and poped into RR pathology and FA.
1 months prior: did UW Qs (finished the 1800)
1 week prior: Simulated exam 2: 83%, free 150q: around 90%
NBME:
7: 175/200
12: 173/200
13: 189/200
While doing NMBE, I realized the questions I have wrong are not in FA and other people had also difficulty answering them. This + NBME results (timed, offlne) boosted by convidence and I got that feeling that the guys at NBME knows which Qs are not in FA (because students answer them wrong) and put these questions more often. This idea led me to do NBME and review them (ever last day before exam), rather than memorizing FA.

Kaplan Qbank: finished 52%, did subject-wise, timed: 70% correct.


My advices:
1. You don't need more than one book for one subject. The best is the one you used for class exams (if it cover everything from Step 1), or Step 1 review. If you studied LIR: Biochem: you may need just a few single gene disorders (clinical presentations) , you don't need to go through the whole book.
2. The key are Questions. In fact, with solid school background, UW Qbank + NBME + FA should be OK. DO AS MUCH QUESTIONS AS POSSIBLE. 50q per day with reading all explanations is good speed (try to get this speed even if you have only 1/2 of a day for prep). When you reach stable above 80% or 90% per block and are confident, you may switch to another source of Qs, and if you're again sharp, swith to another subject. If the question explanation does not make sense, use FA or RR. You do not have to go further (but wikipedia would be the last choice, if you are brave).
3. When doing subject-based preparation, you may use Qbooks (my favourite was Lipincots Iluustrated Q&A review). Some Qs are low yield and tough, but it prepares you for the exam, you will not be surprised by anything.
4. As soon as you finished with subject-based, Switch to random, timed mode as soon as possible. I used Qbooks (went cheep): NMS and FA Qs is OK, and NBME (these are the most like the exam). Keep checking the FA. If there is some obscure pathology, search RR.


What sources I used and found it good:
Overall:
- Kaplan Qbank: twice tougher than the exam, but teches well. (bought it for year, managed to do only 52%)
- UW Qbank: a must. (did offlne)
- FA: for checking the high-yield facts. I haven't read it front-back even once, because I almays had the feeling I have to look into more complex book (I prefer to read it once and understand well). This made me really slow. I managed to read through each system chapter after i did some questions on that topic.

Anatomy: did profound basic study in class. Lippincott's Illustrated Q&A (LIQA) Anatomy helped me to transfer this knowledge into ability to answer Qs. (Didn't need KLN). Wanted to do LIQA neuroscience but had no time (it probably wasnt needed, just know the difference btween PICA and AICA occlusion, had that q on exam).

Physiology Did Ganong in class (overkill). Reviewed BRS in Step prep. Great book. Kaplan Qbank Qs were again usefull.

Biochemistry: I was a bit scared by this subject, especially after I found like 5 more lysosomal storage disorgers in LIQA: Biochemistry. You don't need to know them all: Gaucher, Nieman Pick, Tay-Sachs is a must, but if you cannot distinuish Fabry and Krabbe by clinical presentation, it's not going to kill you, just try to associate the acumulated substrate. Kaplan Qs were tough and low yield. Just make sure you understand everything in FA (study KLN if needed), understand all Qs in UW, and you will pass fine.
So do: UW, kaplan Qbook. LIQA: Biochemistry or every single Q in Kaplan Qbank is not compulsory. (although the more the better).

Behavioral: BRS BS (twice, first read didnt get it, second after 1 year OK) + Qs

Microbio: MMRS is a gret book (had the old version, was enough). LIQA: Microbio/Immuno was helpfull, as well as UW (a must) and again the more Qs the better. Fa is also a good content outline. I used also Fa Cases because I didn't feel too strong, the cases are fine, you may do them even before Qs.

Immuno: Did KLN in one week, I think it was usefull. Again, do as much Qs as possible. I had only 60-75% in UW, so LIQA: Microbio/Immuno helped me.

Pathology Goljan audio is fabulous (it's slower than reading, but it really makes sense, even though its few years old). I did along with Webpath (both images and Qs are perfect) for class (together with RR Goljan). RR Path s great book, because it covers almost all pathology you may be asked (even the not frequently tested items). I suggest after studying proper book once, do Qs and search back in RR if necessary to explain the answers., and anotate in FA.
Wanted to do Red robins or LIQA: Rubin's Path but had no time.

Pharm The KLN + video are the best. After this high-yield course (do it preferentialy paralelly with class), you are ready to do any Qs (UW or Kaplan) and you may need just to open FA or KLN to make sure.
BTW: Do you know mechanism of action of baclofen?

So basically read carefully one book in each subject, then jump on the questions, don't be bogged down that it takes you 4 hours to review them and go through the explanations (particullary UW are high yield) and FA. It is going to get better as you start to repeatedly encounter the same topic.

I heard that some people did 200q per day. For the 2 months before exam, I did 50q/D (about 4 hours), and got towards 100q. In the week before exam, I did NBME Qs in the speed 150q/D (with searching explanations for wrong answers).

How much time should spend doing Qs and reviewing them?
- In the last 2 months, 20% answering questions, 70% reviewing is OK. Avoid reading low yield dense books instead.

Where to learn the clinical presentations?
- 1. figure out on your own with pathophys&anatomy, 2. Class 2. RR path has the classic ones, 3. I got Schwartz textbook of physical diagnoses (read it along my class study) and it helped.

Is there a good atlas of CT / MRI images?
- I had radiology class in the 2nd part of 4th year, and bought Learning radiology by Herring. I gues it's more for step 2, but there are plenty of images testable on Step 1. You may consider briefly looking at the images.

Which books I didnt use:
- step 1 pathophysiology review: Cases and concepts: It's fine for the class, and first read studying, but to me the cases has low pace and I used it before sleep. Qbank pathophys Qs are better.

So my magic formula for Step 1 is this:
1. review book per subject, read once very carefully and patiently. Basicaly KLN fit's this well. But they are long, you may consider doing these adjustments:
  • KLN Behavioral -> BRS Behavioral (shorter)
  • KLN Anatomy -> Class material + LIQA: anatomy and embryo (or any other source of testable material, not only the carpaltunnel and radial sulcus giveaway)
  • KLN Biochem is OK, videos useful
  • KLN Phys -> BRS Phys (shorter, faster to read, bullet point, with Qs)
  • KLN Microbio -> MMRS, anyway, hammer a lot of Qs. There is lot of memorization, but the exam Qs are not very difficult
  • KLN Immuno is OK
  • KLN Path -> RR Path (not really shorter, but more associations, across-subject topics, and Step 1 tricks)
  • KLN Pharm is perfect, watch the great videos preferably
This generaly agrees with the poll results here.
Read FA after the book.

2. Qs. Does not have to be all online, but make sure you have plenty of them. The more the better. UW is a must but don't stop here. Return to your books (if needed) and to FA (frequently) to cover similar pathologies to the one asked about in the Q stem. Do them timed.
3. Repeat point 2. as much as you can (always new questions, only UW might be worth looking at briefly once again). Gradually, switch to random Qs, NBME Qs are good for this purpose.
4. Train the 8hour marathon (I did 2 simulated tests in Qbank, but if you have watches you can simulate on any material: FA Qs, NMS Qbook, Kaplan Qbook, NBME the world is so colourfull! ) Actually I believe putting 7 NBME blocks from recent forms into 8hrs would make similar soup to the one I ate on the test date.
5. Day before relax, you are going to make it. Not like me, who was feeling like got cold during the 5hrs bus journey, and was sweating from virus or anxiety (who knows?). Do some sport for 1-2hrs to relieve your anxiety few days before the test.

Good luck to all of you guys! And thanks a lot four your help. If you would have any q on me or resource I used, feel free to ask.

Turning to CK in the near future.

Marek


PS:
High yield concepts + bits and pieces:
- diffuse glomerulonephtitis sounds like nephritic, but is nephrotic sy (correctly diffuse glomerulonephropathy)
- young guy with subarachnoid hemorhage suggest what? (A: E-D sy, Marfan, or AV malformation)
- cystic fibrosis is high yield. Read everything about it in RR path (or other reliable source).
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  #2  
Old 12-12-2012
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Default Result's here

257/88


I expected above 240, but this is perfect. Let's enjoy today!

Thanks for you guys and everyone who helped me with this!
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  #3  
Old 12-12-2012
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Quote:
Originally Posted by smartmark View Post
257/88


I expected above 240, but this is perfect. Let's enjoy today!

Thanks for you guys and everyone who helped me with this!


woooahh.. that is a massive score , congratulations
good luck!!
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  #4  
Old 12-12-2012
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Congrats dude! Awesome score! Young guy with SAH suggests what? I wld think it's MArfan's--can u explain what pls? Thanks!
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  #5  
Old 12-13-2012
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Quote:
Originally Posted by Nino View Post
Congrats dude! Awesome score! Young guy with SAH suggests what? I wld think it's MArfan's--can u explain what pls? Thanks!
I don't remember which one was there on the exam, but all these things should come into mind (they will give you more signs to differentiate between them).
BTW: APCKD could be another one, but in an older guy.
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Old 12-19-2012
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Thumbs Up congratz

first of all congratzzz man it is such a nice score !!!!!!
2ndly i want to ask i have kaplan q bank of 2007-08 .. is it enough to do that only or should i buy the new edition ??
what was the percentage of correct answers when u did kaplan q bank???
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Old 12-20-2012
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Quote:
Originally Posted by samba View Post
first of all congratzzz man it is such a nice score !!!!!!
2ndly i want to ask i have kaplan q bank of 2007-08 .. is it enough to do that only or should i buy the new edition ??
what was the percentage of correct answers when u did kaplan q bank???
Thx

Most of the questions were edited in 2010, some 2011, very few 2012. (They say it at the bottom of the question).. So 2008 is old, but one or two year is fine.

As said in the post, scored 70% correct, but I did it subject-wise, not random. Timed.

Last edited by smartmark; 12-20-2012 at 05:24 AM.
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  #8  
Old 12-20-2012
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Smile

thnx for sharing this info. wish u a gud luck for the coming stepzzz
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Old 12-20-2012
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Congratulations! Nice score.

I want to ask the level of LIQA review books as compared to Kaplan Qbank. Do you think they resemble actual exam? Do you recommend to read these books, as I have these books available.

Waiting for your advice. I have read some Qs and they look pretty good, a lot of figures there.
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  #10  
Old 12-20-2012
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Quote:
Originally Posted by mutant View Post
I want to ask the level of LIQA review books as compared to Kaplan Qbank. Do you think they resemble actual exam? Do you recommend to read these books, as I have these books available.
The LIQA Qs are detailed as kaplan Qbank, but in a different way: Kaplan Qbank asks you on sth you cannot know and makes you to make educated guess. LIQA Qs asks details from the subject, but those which you studied, I think it's like a test at the end of a seminar on a subject...
=> LIQA Qs are much lower yield, they are not necessary if you are confident you rememver the textbook (like MMRS, Kaplan biochem). But they are useful if you want to master a subject you are not strong at yet (and if you have the time).

Ex:
I was scoring around 60% on UW microbio (some multisystem presentations were difficult for me). So I read MMRS. It took me about 2 weeks. Then I wasn't sure I remember it well. I didn't want to read MMRS again, cause it would be boring. So I did LIQA microbio (reviewed with FA). Sometimes they are picky at detailes in LIQA, but overall the question presentation very much resemble NBME/USMLE. After LIQA microbio, I was confindent I am prepared for anything on the test day (this was confirmed by approaching 80% at microbio/multisystem Qs in Kaplan qbank). Maybe it's overkill for Step 1, but extracting info from FA into ansering a Q with clinical vignette is not easy.

I did LIQA biochem, cause I read IMGs do worse in biochemistry than AMS, and I ran out of Kaplan an UW biochem Qs. Some Qs were too much detailed (don't worry if you dont remember every detail), but I scored biochem well on Step 1.
I did LIQA anat, cause reading Kaplan or High yield anat was boring to me (it didnt make me to imagine it well) and I read few experiences about detailed anatomy Qs. Well, LIQA anat is similar to Kaplan Qbank to me. Most of anatomy Qs on Step 1 are easy as those in UW, but again, it makes you strong and confindent.
I didn't have time for LIQA patho, which is very highly rated in FA. You may check it.
Didnt do the neuroscience book, but didn't need it much on the exam. (just be sure to google some pictures of brain cross-sections of the strokes listed in FA, lateral medullary sy is not trivial).
I choosed LIQA cause they were pretty recent (2011).

You get better on aswering questions by doing and reviewing Qs. It doesn't matter whether it's UW Qbank, Kaplan Qbank, LIQA or Qbook, just do questions which are more than just recalling a single piece of knowledge from FA = which makes you integrate many things from FA.
(all of the listed are Qs of high quality to me.)
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  #11  
Old 12-20-2012
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Thank you for your detailed reply. It was really helpful.
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