Preparing for STEP ONEPresented by Gale Naquin, PH.D

Nov. 30, 2021

1

It's just another hurdle to becoming aDoctor

2

First and Foremost:

3

Believe in Yourself!

You have been studying for this test for the past two years! It's time to shine.

Step 1 is a one-day examination

. It is divided into seven 60-minute blocks and administered in one 8-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 40. The total number of items on the overall examination form will not exceed 280.

Applying for the Test and Scheduling Your Test Date Application follow the instructions on the NBME website.

• January 26, 2022 is the effective date of the change from a numeric score to Pass/Fail. All Step 1 exams taken on or before January 25, 2022 will receive a numeric score and pass/fail outcome. All Step 1 exams taken on or after January 26, 2022 will receive a pass/fail outcome only.

4

Test Break Time

Your test session is scheduled for a fixed amount of time, and the computer keeps track of the time allocated for each block and for breaks. At the start of the testing session, you have a total of 45 minutes of break time for authorized breaks and for computer transitions between blocks. Authorized breaks include any time you spend between test blocks, whether you remain at your seat or leave the testing room. If you complete the tutorial or other testing blocks early, the remaining time will be added to your total break time.

5

Competency Range, %*

Medical Knowledge: Applying

Foundational Science

Concepts

60–70

Patient Care: Diagnosis 20–25

History/Physical

Examination

Diagnosis

Communication and

Interpersonal Skills6–9

Practice–based Learning &

Improvement4–6

6

Table 2: Step 1 Physician Tasks/Competencies Specifications*

System Range, %

General Principles** 12–16

Blood & Lymphoreticular/Immune Systems 7–11

Behavioral Health & Nervous Systems/Special

Senses9–13

Musculoskeletal, Skin & Subcutaneous Tissue 6–10

Cardiovascular System 5–9

Respiratory & Renal/Urinary Systems 9–13

Gastrointestinal System 5–9

Reproductive & Endocrine Systems 9–13

Multisystem Processes & Disorders 6–10

Biostatistics & Epidemiology/Population Health 4–6

Social Sciences: Communication and Interpersonal

Skills6–9

7

Discipline Range, %

Pathology 44–52

Physiology 25–35

Pharmacology 15–22

Biochemistry & Nutrition 14–24

Microbiology 10–15

Immunology 6–11

Gross Anatomy & Embryology 11–15

Histology & Cell Biology 8–13

Behavioral Sciences 8–13

Genetics 5–98

Table 3: Step 1 Discipline Specifications*

Examinees with Disabilities Requesting Test Accommodations

The USMLE program provides reasonable accommodations for examinees with disabilities under the Americans with Disabilities Act (ADA). If you are an individual with such a disability and require test accommodations, visit the USMLE website before you apply for each Step for information regarding test accommodations, including procedures and documentation requirements. Requesting Additional Break Time Examinees with physical or health conditions who require additional break time should complete the request form and submit it with a letter from a qualified health care professional documenting the medical need. Examples include lactation (to express breast milk) and diabetes (to monitor/treat blood glucose). Requests for additional break time should be made prior to or upon registration for a Step examination

9

NBME Passing Score ???

USMLE Score Interpretation GuidelinesNew Guidelines Dec. 9, 2021• The test currently requires knowledge of 60% to achieve the

minimum passing score of 194.

• The exam is graded from a 1-300, with a minimum passing score being 194. Most scores fall between a wide range of 140-260. Students usually get their grade three to four weeks after the exam.

• Should you fail the exam, you can take it again (up to 4 times), but do be aware that your failing grades could follow you through your career.

• If you take the exam and aren’t happy with your grade, it’s not possible to take it again to raise your score.

Research: Students who scored higher on Step 1

• Studied 8-11 hours per day in the intensive study period

• Studied less than 40 days in their intensive preparation .

• Completed more than 2000 board style practice questions : 70% accuracy or greater

• The number of Anki (individually generated) flashcards seen• An additional 1700 Anki flashcards was associated with an additional point on

Step 1 when controlling for other factors

• Honors in first 2 years

• MCAT score particularly Biological and Physical Sciences

• Attending lectures in the 2nd year of medical school

Articles:

• Preparing to take the USMLE Step 1: a survey on medical students’ self-reported study habits

• Student-directed retrieval practice is a predictor of medical licensing examination performance

Step One Exam Overview

• One day Examination: Administered in one 8 Hour testing session Includes breaks

• Divided into Seven 60 -Min Blocks

• Will not exceed 280 multiple choice questions

• 40 or less questions per block: # of questions vary per block

• 1.5 minutes to answer each question

• Random questions; Only One Best Answer

• Guess

• ONCE EXITED A BLOCK OR TIME EXPIRES, CAN NO LONGER REVIEW OR CHANGE QUESTIONS

• Results back within4- 8 weeks

General Planning

• How long will your study period be? How many hours per day and days per week should you studyWhat will your days look like?What combination of strategies and content should there be?

Mixing of easier/harder by days or week?

What resources to use?

How many practice exams to take? Which ones?

Account for setbacks. Self care: Boundaries, food , exercise, sleep, fun

Rank strengths/weakness by subject to help determine how many passes to take.

Set a Goal

• Begin with the end in mind.” Before you begin preparing for the USMLE Step 1, you should consider where you are with your knowledge base and your score, as well as what your goal target score is.

• To determine where you are starting from, you should take a practice test. https://www.nbme.org/examinees/self-assessments NBME

The Comprehensive Basic Science Self-Assessment Practice Tests

• Multiple-choice questions on content typically covered during basic science medical education courses.

• Evaluate your readiness to take the USMLE Step 1

• Target your studies using diagnostic feedback highlighting areas of strength and weakness

• View answer explanations to reinforce your knowledge and maximize study time

• Use your self-assessment score to estimate your approximate score on the USMLE score scale

• There are multiple forms available for the Comprehensive Basic Science Self-Assessment, each containing 200 multiple-choice questions.

• Form numbers 25, 26, 27, 28, 29 and 30, are available for purchase on MyNBMEExaminee Portal.

16

Balance

You need to relax

Take personal time every day

Work out

Catch up with friends

Socialize

Go to dinner

Vent

Start a blog

Yoga/ meditation

Don't make any drastic life changes

Don't move

Relax

Success on STEP One requires active review of past material using specific resources

Primary

• U-World Learning Tool

• First Aid Learning Resource

• Flash Cards: Make your own U World, Anki, ETC

• U-World Assessment Evaluation

• NBME Practice tests: Assessment

Secondary

• Pathology : Rapid Review or Pathoma

• Physiology: BRS

• Micro Biology Sketchy Micro

• Pharmacology Anki, Osmosis

Planner

Date Topic Assignments Source Hours

HOW TO MAKE YOUR STEP 1 STUDY Plan: 6 weeks dedicated study

• WRITE THE EXAM DATE ON THE CALENDAR

• FIGURE OUT HOW MANY DAYS YOU HAVE UNTIL THE EXAM. minimum of 4 weeks of intense study.

• After five weeks of 8-12 hours of daily review, you start to plateau. You want enough to time to just reach your plateau without backsliding.

• BLOCK OFF SPECIAL DAYS: Completely block off the day before your exam. Blocking off one other full day 5-7 days prior to your exam. You will be reaching your burn-out threshold and will need a mental health day.

When creating a Study Plan Consider:

• Divide your day into 3 study sessions, Morning, Mid-day, Evening.

• Break up your activities into achievable pieces. To-Do lists, schedules, task lists

• Decide which resources you’re going to use: Recommended UWORLD, First Aid ,Pathoma., Sketchy ,AMBOSS

• Prepare to take 3 NBME practice 3 over the course of your study.

ASSIGN YOUR PRACTICE TESTS TO SPECIFIC DAYS

• You should plan for 3 practice tests.

• Take the first test at the beginning of your dedicated study period to get a baseline .

• Take your second after about 14-16 days of studying or midpoint between baseline and the STEP ONE Exam, and take your last test 5- 9 days before the real exam. Don’t plan anything else on those days, as it will take 6-7 hours at a minimum to take the exam and review the wrong answers.

• It doesn’t really matter what tests you take, but we recommend taking the most recent ones (NBME ) just before the real deal.

• FORMS, 25,26,27,28,29 30

It is better to study smarter than to study harder• 1) Goal : complete at least one round of all U World Practice

Questions and reset to do incorrects before you take Step 1 with 70% Accuracy or better.

• Focus solely on questions for the last two weeks before you take Step 1.

• Keep in mind that your average score on the practice tests will likely not improve as you progress through a single question bank since you will be constantly exposed to new material. The important thing to do is to learn from the questions you get wrong as well as the ones you get right.

How to Use the QuestioN Bank

• Start with 2 Systems and 2 Subjects: One weak, one strong

• Use timed mode:

• Begin with 2 SETs of 40 questions daily.

• Once the weak subject is at 55% accurate add another subject. Do this until all subjects are in the question set.

• Next add another system. Continue to add systems when the last one is at 55% or better.

• Once all systems are in the question bank begin doing 120 questions and then about 5 days later add 160 if possible.

• Make flashcards to shore up KNOWLEDGE , things that must be remembered .Use flashcards daily : 3 , 20 minute “sprints” : Aim 20 cards in a minute

Strategies for Approaching Questions

• reading the actual question before you go through the whole vignette.

• read the entire vignette before you answer the question

• Once you’ve read the vignette and are sure you understand the question, try to answer

Think like a Physician not as a Student

• What’s normal

• Where did it go wrong?

• How did it change?

• Review

strategic approach to reading, analyzing and answering questions.

• Use the EASE approach (Examine, Associate, Summarize, Ensure) to reduce reading errors and "knee jerk" reactions.

• Argue why right answer is the best and why the other distractors are wrong.

Analysis of Test Errors and Strategies

Question

#

System/

Subject

Knowledge or

understanding

error

Analysis or

Application

error

Approach

to

Questions

(Reading,

Analyzing,

Answering

Test-

taking

Strategy

Error/

careless/

Test or

Performance

Anxiety

Physical/

Mental

Health

Confidence

(Create a scale,

1 = Know it, 2 =

Neutral, 3 = Didn’t

know it)

Notes /

Action Steps

Content Review

• Seek to understand the big picture first, and then drill down on the details. Once you understand details, return to the big picture or clinical relevance.

• Revisit primary text(s) or use an alternative primary resource.

• Consider varying approach from disease-based reading to symptom-based reading.

Content Review

• Create study notes or flashcards that include graphic organizers (tables, flow charts, pathways). Use these study tools to compare and contrast information.

• When studying, ask yourself, Why? or How is this clinically significant? Link concepts to a patient case.

• Draw out the framework (history/presentation, MOA, course/complications, diagnosis/treatment)

• Self-assess using flashcards, quiz questions, qbanks to identify strengths or weaknesses. Prioritize study of weaker and/or heavier emphasized topics.

Reminders from 11/19/2021

• Comprehensive Basic Science Self-Assessment (CBSSA): February 22, 2022 Practice test that reflects content typically covered during basic science coursework and designed for students planning to take Step 1 REQUIRED but DOES NOT CONTRIBUTE to a course grade. Although the start time is flexible, the exam must be taken on February 22nd. Paid for by the SOM; you will receive a pre-paid voucher with redemption instructions prior to the test date. Does not require preparation and should be taken without additional studying to gauge current knowledge. Administered remotely and not proctored. After completion, you will be able to view answer explanations to reinforce knowledge. You will also receive a Step 1 score equivalent and diagnostic feedback to inform your Step 1 study efforts – sample report found here: https://indd.adobe.com/view/07e40879-b686-4770-8800-64f9e96dd58e This self-assessment contains 200 questions divided into 4 sections. It must be taken in the standard-paced format to mimic the live testing environment. Results will be shared with Student Affairs and the SOM Learning Specialist to evaluate readiness for Step 1.