Virtually everyone preparing for Step 1 will use
UWorld and First Aid. But are you using them correctly, or are you wasting your time? The stakes are high. The USMLE Step 1 is the most critical exam most of us will take in our medical careers. Step 1 remains the most cited factor for giving residency interviews. Programs use it
to screen applicants; they reject roughly 50% of all applications without reading them thoroughly. So every med student wonders: how do I use UWorld and First Aid to maximize my Step 1 score? What does it take to get a 240+ or 250+? Here, you will learn: Why Most Students Use First Aid + UWorld WrongMost students will use resources like First Aid and UWorld. The question is, “how?” (To read Beyond UFAP: Why a List of Resources Isn’t a Good Step 1 Strategy, click here). Many prefer to read First Aid first. Then, they use UWorld to “test themselves” on the material. In other words, they will learn the cardiology section in First Aid, then do cardiology questions from their QBank. First Aid before UWorld seems logical; many students follow it. However, I don’t like the “First Aid-First” approach for two reasons: First, without a Strong Foundation, Reading First Aid = Waste of TimeEver heard the advice, “just read First Aid”? It’s horrible advice. Why? Because unless you know the material well first, First Aid won’t teach you. (I’ll explain why later). If you know antiarrhythmics well already, First Aid will help refresh your memory. However, if your fundamentals are weak, First Aid isn’t the solution. Their explanations have improved over the years. However, the essence of First Aid is the same: condensed facts you need to know for the exam. It is not conducive for having an integrated understanding of the material. Second, passive Reading Helps Us Recognize (But Not Use) KnowledgeHave you ever read/listened to something passively, and thought, “Wow, I understand this!” Then, in a QBank question, you failed to apply it to the vignette? This disconnect between what we can recognize, and what we can use is enormous. I may see a passage on Hashimoto’s and think, “Oh, I’ve seen that before!” But when I’m forced to differentiate between Hashimoto’s and subacute granulomatous thyroiditis I fall flat. Waiting to do QBank questions only delays the identification of our knowledge gaps. Why? Learning new material from First Aid is challenging so we often resort to memorizing the words on the page. (Again, learning from First Aid is painful). But because we memorized the information, we get the question wrong. Too late, we realize we never really understood the material. The result of memorizing First Aid? Having to repeat the entire process, learning the material we never understood in the first place. The most obvious example of time-wasting? Students who read all of First Aid before they do any QBank questions. They do their “first pass,” thinking they need to see everything before they do practice problems. Only after their first practice test/QBank questions do they realize the error of their ways. (To read How Are USMLE Questions Written? 9 Open Secrets for Impressive Boards Scores, click here). Mastering the fundamentals from the beginning saves time and leads to a higher score. The “First Aid-First” approach wastes time and gives us less time to improve our scores. Instead, here are the four keys to using UWorld and First Aid to maximize your Step 1 score. 1. Understand First Aid’s Purpose/OriginSo many people follow the dogma of “just do First Aid.” However, few stop and consider its purpose. (To read The Worst Mistake Students Make with First Aid for the USMLE Step 1, click here). Here’s First Aid’s “origin story” from an attending who had attended Yale. (First Aid’s place of birth). His recollection explains both First Aid’s simplicity and how to use it. At the time the USMLEs came into prominence, Yale students were underperforming. Subpar Boards scores weren’t acceptable for such an elite institution. So what did they do? The authors of First Aid approached students who had taken the USMLE. Then the authors asked those students what questions were on it. First Aid: Answers to Remembered USMLE Questions?First Aid isn’t alone in “surveying” students about the content of their exams. (Doctors in Training comes to mind). However, what First Aid does with that information is critical. According to this attending, they write the information you would have needed to answer the question. In other words, First Aid has the raw information needed to answer the “remembered questions” from prior test-takers. First Aid’s origin explains the most common complaints by most Step 1 test-takers, including:
Use First Aid As a Target of What You Will MasterHow does First Aid’s origin story help you study for Step 1? By giving you a target of what to master. Unlike most med school exams, Step 1 emphasizes the application and integration of knowledge. As such, you must understand the mechanisms of disease. However, mastery of material takes time. Most students think they don’t have time to understand subjects. Instead, they search for sources of “high yield” facts that they cram. (To read Why I Stopped Using Zanki and Brosencephalon, click here). Don’t succumb to cramming and memorizing facts. Learn “why?” and “how?” rather than, “what?” Here are some examples:
2. UWorld = Diagnosis; First Aid = TreatmentIn medicine, our treatment is only as good as our diagnosis. Prescribing antibiotics for a misdiagnosis of pneumonia won’t help if it’s lung cancer. There’s no such thing as the right treatment for the wrong diagnosis. Studying is similar. If we misunderstand our weaknesses (misdiagnosis), our studying suffers (mistreatment). Doing UWorld First Tells Us Where to FocusA massive challenge for Step 1 studying is knowing how to apportion our time. We know we’re supposed to study. But which of the many weaknesses to address? And how much time to spend on each? So many students guess at their weakest subjects. They sit down with a vague idea like, “I guess I should study genetics today.” Instead of guessing, you should use QBanks to guide your studying. Doing questions before studying content helps you diagnose your strengths and weaknesses. Making mistakes will also focus your studying. Your treatment will match the diagnosis. My recommendation if you are studying a particular organ system/block? Do a short block of subject-specific questions, say 10-15 items. Then use First Aid and related resources to master those weaknesses. In other words, you could do 15 cardiology questions. Doing these questions first will surface many misconceptions/gaps in your knowledge. Let’s say one of those weaknesses is “heart failure.” You’d go to First Aid’s “heart failure” section, and master the related material. Getting Questions Wrong First Makes Your Studying More EfficientResearch suggests failing to answer a question helps with later recall. That mirrors my experiences. Let’s say you just got a question wrong because you misinterpreted a physical exam finding. You’ll be much more engaged when learning the material later. Your purpose will be more precise. Want an additional benefit to doing questions before learning the material? Remember that First Aid doesn’t teach well. If you get a question wrong, the First Aid explanations will make much more sense. Why? Because you will have the QBank explanation and also a clinical context to which to apply your learning. “But Won’t My UWorld Percentages Be Lower?”Doing QBank questions before you’ve studied the material will likely lead to lower percentages. But does that matter? (To read UWorld: Is Your Strategy Wrong? (I Scored 270 By Ignoring The Dogma), click here). We want to believe we can control our scores by inflating our QBank percentages. Hearsay, and “score predictors,” reinforce the link between how many questions you get right and your final score. Instead, in times like this, remember two things:
Don’t ask how to maximize your QBank percentages. Instead, maximize how much you can integrate and apply. 3. Depth > Shallow BreadthSo you’ve used UWorld to address your biggest weakness. But what are 240-seekers to do next? Once you identify a weakness, master the topic. For example, embryology was one of my most difficult subjects. For a while, I got every cleft lip/palate question wrong. So what did I do? I learned enough about cleft lips/palates, so I’d never get another related question wrong. Use an Electronic Copy of First Aid to Find All Related InformationTo find as much related information as possible, use an electronic copy of First Aid (affiliate link). With an electronic copy, you can search for terms like, “palate” and “cleft palate.” Your goal is to find anything related to that topic that would be most likely to show up on your test. Then you should learn as much as I could on those topics. (To read more on how to master subjects and never forget them, read below). Mastering material takes more time than memorizing. However, the payoff of mastery is significant:
(To read more about Anki, click here). But once finding the relevant First Aid sections, how exactly do you develop mastery? Use Other Resources to Develop MasteryMed school bombards you with unrelated facts. However, what you do with those facts is up to you. When you’re tempted to memorize, do this instead:
4. Make Connections, Then Anki CardsIt’s easy to read First Aid and assume you should memorize the facts. Burkitt’s lymphoma’s translocation? OK, I guess I’ll make an Anki card on that fact. Its response to chemotherapy? Yep, another card! Making Anki cards to cram facts is a waste of time. So how do you master the material, never forget it, and crush your USMLE? For each disease you learn, ask three simple questions:
For example,
(To answer the question, Burkitt’s is an 8,14 translocation. This translocation causes overexpression of the myc oncogene because myc’s expression is now driven by the Ig heavy chain promoter. Like all oncogenes, myc stimulates cell proliferation. Thus, myc overexpression explains why Burkitt’s lymphoma is a VERY rapidly-growing tumor. However, its rapid growth is also its Achilles’ heel. Traditional chemotherapy targets rapidly-dividing cells, so Burkitt’s is very responsive to chemo). If you struggle to make these connections yourself, check out the Yousmle Step 1 cards. In it, you’ll find pre-made cards targetting students’ most significant gaps. You can master more in less time and maximize your USMLE score. Similarly, if you watch lectures but forget them immediately, check out the Yousmle Online Course. Not only will you make connections, but with the integration/application questions you’ll never forget another lecture again. Check out the Yousmle Online Course here. Free Master Anki QuestionsWhat has worked for you or not? Share your experiences in the comments! Photo by Element5 Digital. Is there Anki for Step 3?Hoop and Ruck's Step 3 Anki Deck
All cards come in an easy-to-study Q and A format with Zanki style. It spans through an array of topics, such as: Pediatrics. Internal Medicine.
How long should 100 Anki cards take?8. How Long Should it Take to Review Anki Every Day? Short answer: Old cards: ≤ 1 hour per 100 reviews.
Where can I get a Zanki deck?To use Zanki, you'll need to download the Anki app to your computer or mobile device. Then, it's recommended you go to the “Anki Palace” where the website creator has collated a resource to find all the different types of decks available for download and how to do it. The site leads you to the Reddit for Anki.
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