Step 1

How do Step scores factor into my residency applications?

 * Residency programs get a few thousand applications for a few positions. Because they cannot review every application in detail, they look for a simple metric to sort the applicants and create a “short list.”
 * The Step 1 score is consistently one of the most important criteria used by program directors in evaluating applicants (according to NRMP Program Director Survey results which can be viewed at the NRMP Data and Reports webpage).
 * A good Step 1 score will guarantee that programs spend time looking at your application.
 * A poor Step 1 score will close doors to you.

What is a good score?

 * Charting Outcomes in the Match (also available at the NRMP Data nd Reports webpage ) is compiled annually, and identifies the average scores of students who matched successfully into each specialty.
 * These scores are the median: applicants match with scores above and below this score.
 * As a rough, ‘ballpark,’ the national average step 1 score is about 220, and the SD is 20. If you want to match to a more competitive specialty, you should aim for about 1 SD above the median. If you want to match to a top program, you should add about 1 SD
 * If you want to do Rad Onc at Stanford, a ballpark goal is 260
 * For Psychiatry at [low ranking school], a ballpark goal is passing level (low 180s)
 * Again, people match to every program with scores above and below the median.

How should I prepare?

 * Remember that no one experienced more than one way of preparing, so no one really knows which is the ‘best approach.’ Also, you are the expert in what works best for you.
 * Structure your study during M2 in order to identify your personal best studying strategy, to get used to the format of the USMLE, to know what material is high yield and to know your strengths and weaknesses as you start the summer.
 * Start doing practice questions early - this is the best preparation for Step 1, and it is also the best way to prepare for M2 exams in path and pathophys.
 * USMLE World is widely considered the best question bank available
 * Kaplan Q-bank is also very good, and is a little bit easier to coordinate with M2
 * Q banks are expensive. If you really want that high score, it’s a good investment.
 * Read First Aid once during M2. You can do this with a few hours each weekend.
 * A new edition is released every Jan, but the content changes very little.
 * You will study more effectively in the summer if you already know the book.
 * During the summer, use your question bank to guide your studying. You can’t review everything, so you’ll want to spend the most time on weak and high yield areas.
 * Remember that some subjects are tested more heavily than others. For example, you will get a better overall score by improving Path performance from 60% to 70% than by improving Anatomy performance from 50% to 80%.

Which subjects are most important?
According to UWorld:
 * Path: 25%; pathophys, pharm, micro: 10-15% each; physiology, anatomy: ~ 10% each; immuno, behavioral (including stats), biochem (including genetics), molecular / cell bio / histology: < 5%. (Note that in reality, a lot of questions from other subjects are also covered in path textbooks, so path may cover as much as 50% of the test).
 * By system: “General:” 25%; cardiovasc, neuro: >10%; GI: ~10%; other systems: ~5%.

What are the best resources for each subject?

 * Goljan Rapid Review of Pathology is the only book besides First Aid that is consistently recommended by most students. This is an outline format, and includes a lot of pathophysiology, microbiology and even some high yield pharm and biochem. It’s very dense - you should read the book during M2 (it is sufficient as the textbook for the path class along with Nandkumar’s notes) or you’ll have a hard time taking it on in the summer. BRS pathology is also very high yield and much less dense - it’s a good summer review resource if you studied Goljan well during the M2 year.


 * Many students recommend Clinical Micro made Ridiculously Simple as a high yield, pneumonic-packed and clinically relevant review of a difficult subject. Many students feel First Aid is adequate for micro, and others prefer MicroCards (Lippincott flash cards).


 * Flashcards are often recommended for Pharm. Lippincott PharmCards are thorough enough to be used for pharm during M2. This way you already know the cards for summer. Lange Pharmacology Flash Cards are less dense and include everything you need to know for Step 1 - these may be a better option if you didn’t use Pharmcards during M2.


 * For other subjects, First Aid plus UWorld is generally adequate. Use review books in other areas for your weak points if First Aid and your question bank alone are not improving your scores. The last chapter of First Aid includes a brief ranking of popular review books in each subject.


 * Most students recommend not using too many books, but a few students do actually do a comprehensive review of a review book in every subject area. Students have done well this way; other students report getting more out of reading First Aid again than reading something else. The most popular combination is probably First Aid and UWorld along with either Goljan or BRS path. This is a very individual decision, and probably mostly a matter of style.

What if I need a more structured program?

 * Pre-made comprehensive study schedules are available on-line (google it) and on the First Aid blog.
 * Kaplan, PASS and others offer review courses. These can be very expensive, but are comprehensive and very high yield. They are also very time consuming, so be prepared to turn your life over to them for the period of the review course.
 * Doctors in Training  is a less expensive alternative to the above which is administered on-line (no need to travel) which uses First Aid as its text book. Some students speak highly, stating it keeps them on a schedule and provides helpful structure and connections missing from First Aid. Others say they felt like they were paying for someone to read First Aid to them, and that the videos and quizzes were overly time consuming.

How long should I study and how will I know when I’m ready?

 * Most take about 6 weeks, and feel this was adequate. Students who take more time do not necessarily do better, but only you will know if you need more or less time than ‘average.’
 * Make sure you’re doing Q bank blocks in timed mode, simulating test conditions. Q bank questions are hard, and scores run lower than on the real test. You can find multiple score prediction calculators on-line to estimate your score from Q bank performance. The Q-banks also come with 3-4 hour self-assessment tests, which predict your score.
 * NBME offers on-line practice tests. These correlate reasonably well with your step 1 score, and can be used to assess your readiness. They do not provide explanations to questions, so they are not recommended for studying. Taking 2 of these 4 hour practice tests back to back is a good simulation of test day - this is a good way to prepare yourself against test fatigue.
 * Once you set your target score and decide how much time you’re going to put in, commit. This is the most important test you will ever take. Protect your study time, and don’t let graduate school, unplanned vacations or other demands encroach on your preparation.