As promised, I will write in detail on the USMLE Step 1. These tips that I write is for helping you all. I already passed this phase so this is based on my experiences. USMLE Step 1 is back to basics where you have to know the detail concepts of things that you may not have to remember during clerkships. I already signed up for a question bank for Step 2 CK and it seems less stressful than USMLE Step 1. However, it seems trickier than USMLE Step 1 as there are more than one good answer. For the USMLE Step 2 CK they test you on what is the “best” answer out of all the good answers. So, it seems to be more memorization based then concept based, but correct me if I’m wrong.

Image from Google Images

Anyways, going back to the main topic of this topic, doing questions after questions is a key method in covering all angles of the USMLE Step 1 test. Don’t worry about USMLE Step 2 CK for now, as you need to pass Step 1 first.

For the USMLE Step 1, I regret not doing enough questions. I did all of USMLE World questions 2.5 times and half of USMLERx questions. There are about 3000 USMLERX questions and about 2100 USMLE World questions with a total of 3600 unique questions. I wish I finished USMLERx questions as doing more question helps grasp the concepts better. However, USMLE World is the best Qbank, which I think, is a must and to fully penetrate the medical concepts, one should add a second question bank. If you have time then add a third question bank; the more questions you do the better but keep in mind USMLE World is the best and it’s a must.

A secondary question bank helps because they present with different questions, which can present the medical concept in an alternate view to better understand it.

So, at the end of the day, just keep doing questions. Do not neglect questions, especially USMLE World questions. Also, keep First Aid for the USMLE Step 1 by your side as it should be read often with questions.

This post should be familiar to you and if you are looking for a way to modify your First Aid for your studies. I know you heard this millions of time, but I’ll say this from my own experience, First Aid for the USMLE Step 1 is a must. I passed the Step 1 with a great score, above the national average, with just remembering the little gritty details from the book and from the notes I wrote down.

Learning from the book is a waste of time. You should not be reading cover-to-cover and trying to learn from it. The First Aid for the USMLE Step 1 is not a learning tool instead, it is a outline for what will most likely be on the test. The First Aid should be used in conjunction with USMLE World question bank. Of course you should memorize the First Aid book cover to cover but only if you learned the materials beforehand. When you understand the medical concept then memorizing it is so much easier. I strongly recommend you go over First Aid book with Doctors in Training after you do one round of USMLE World question bank.

Make sure you get the latest version of the book.  Get the First Aid for the USMLE Step 1 2013 version if you are just starting out.  It's not out yet but you can pre-order it when it comes out in January 2013.

Honestly, I was lost when I was reading the book, but Doctors in Training (DIT) program helped a lot get a good grasp of the materials covered. I will write detailed reviews of DIT and USMLE World question bank in a later post.

I probably read in detail each and every page of First Aid more than ten times. I wrote a lot from USMLE World and other sources. If you look at the pictures you can see that I had I hole punched and ring-binded so it would be easier for me to flip through it. Also, if I needed extra space to write in some information, I can just add ruled paper or if I need to draw a diagram I can add printing paper. Basically, I did what I needed to do in order to fully study comfortably.

Overall the First Aid for the USMLE Step 1 is a great book and you should buy the latest version. Also after your purchase, you should go to the First Aid team’s website and go over it’s errata and correct the errors on the book; it’s a hassle I know, but it’s worth your time.

Do your best to understand and memorize all the concepts in the First Aid book, because it has everything you need to get a great score on the USMLE Step 1.

The subject of Anatomy, to me, seems very boring, dry, and sometimes hard because of the boring nature of the subject. Unfortunately, the question banks don’t really give enough images to fully grasp the anatomical figures in the questions. You probably heard that Anatomy subject is low-yield, but don’t count on it. The Anatomy subject should be given a good amount of attention, especially CT scans. Neuroanatomy is very high-yield and you should be familiar with the overall picture of the brain. Questions can give you a scenario of a dysfunction of a patient, and they may ask you which part of the brain contains the nucleus that is damaged that caused the dysfunction.

The best way for me to grasp Anatomy is to look at the body in all angles. For example, I had a hard time to distinguish the cricothyroid muscle from the other surrounding muscles because the images online doesn’t show an isolated picture of the target muscle. I’m a visual person so, picturing the anatomical structure helps in me answering questions. For example, horseshoe kidney is fused at the inferior poles in Turner Syndrome patients, and it cannot ascend because the inferior mesenteric artery stops it. I had to imagine that in order to grasp the concept.

I found 3D Human Anatomy Atlas 2 by Visible Body; it is a software for both PC and Mac. It's also an app which is also available for iPhone and iPad users on the Apple App Store and Android users on Google Play store.. The App is incredible and it’s one of the top-rated medical app on the Apple App Store. If you don’t have a tablet, you can still get the computer-based software; however, navigating via a tablet makes things more efficient. The software allows you to rotate the anatomical figures in 360 degrees position so you can see the anatomical figure in all angles. Also if you have an organ or tissue that is blocking the view of your target anatomical structures then you can either fade is or hide it from view. The app also allows you to take screen capture and share it with others. I used the software to draw out the figure for a previous post, Adrenal Glands – First Aid for the USMLE Step 1. If you have the iPad with retina display, the app takes advantage of the sharp display and shows it with incredible precision. The app costs about $40 for the iPad; I’m not sure about the prices for other platforms. When I bought a MacBook Pro with a student discount, I was given a $100 Apple gift card, which I used to buy the app.

Anyways, studying anatomy just from pictures is hard, and I prefer to study smart not hard so, I invested the money in getting what I need to study better. I recommend 3D Human Anatomy Atlas 2 by Visible Body for everybody, especially for people who are visually oriented learners. This study tool worked for me, but I can't guarantee that it'll work for you, but try it and see.

Most of us students are not morning people, and I can tell you from experience, that studying at night works best for me. However, studying in the morning is the best because you’ll have full of energy. Some of you probably feel tired in the morning, well that could be for two reasons which clearly would lead to tiredness right after awakening. First, if you didn’t get at least 7-8 hours of “consecutive” sleep then you will not feel well. When I say consecutive, I mean sleeping continuously sleeping without waking up in the middle of the night. Second reasons deals with over sleeping; if you over sleep then you will feel tired. Oversleeping can lead to tiredness because you glycogen stores will be depleted. Remember if you sleep for 10 hours or so, which means you haven’t eaten anything within that time frame so your body has little to no energy.

How to Charge Up for Studying
1. Jogging or other Cardio Workout
Jog in the Morning for 20 minutes; or walk and jog together in 30 minutes. Jogging in the morning is better than taking in all that caffeine which will irritate your stomach and make you urinate more often than normal. Jogging will also help you in vasodilating your cerebral arteries so more oxygen will enter your brain. More oxygen will allow for more metabolism of neurons.

2. Take a Good Shower
This should be obvious for everyone, but to some people it’s not. One of my friends in another state is studying and he told me he didn’t take a shower for over 2 days. As disgusting as it sounds, it’s reality, and common among some medical students. You have to take a shower in the morning to clear off the accumulated oil and to wake your self up. In the obvious sense, you should take a shower after jogging.

3. Multivitamins
Take a multivitamin pill everyday; this is something some people take for granted. Multivitamins are highly important because it has all the co-factors that are required in producing the neurotransmitters and other biochemistry functions, which are important in helping in focusing and enhancing memory and other body chemical reactions.

4. Omega-3 Fatty Acids from Fish Oil
Take 1000 mg of Fish Oil daily, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in combination.  Omega-3 Fatty acid is very helpful in myelination of neurons for faster brain processing and photographic memory. As you will study that increasing in myelination will lead to increase in space constant. Space constant measures how far along an axon an electrical impulse will travel. So in simple terms, increasing your space constant will allow you to think faster.
Warning: Do not over consume Fish oil.  Fish oils are natural blood thinners, so don’t take it with aspirin or other NSAIDs.  Also, buy the quality fish oil so it will be cleared off mercury.  Cheap fishoils are no good as they have little omega-3 fatty acids with no significance.  I tried a lot of those capsule fish oil and they stink and they were a waste.  So I tried a pure form with lemon flavor; I usually ordered the Carlson The Very Finest Fish Oil; and it works!  However, if you are near a Vitamin Shoppe store you can get their store brand for $7 less.

5. Ripe Bananas 
You would be surprised how well ripe bananas can help; it has a good concentration of tyramine. When you study the autonomic pharmacology section you will learn about tyramine and how in helps in neurostimulation. Ripe bananas will definately wake you up.   
USMLE Step 1 Fact: Tyramine is high in wine and in cheese, patients who take selegiline, a selective monoamino oxidase inhibitor type B, will have an emergency hypertension reaction.

What I mentioned will work for everyone if done consistently. Don’t expect it to help you right away, give it couple of days to see a significant difference. I have tried so many methods of studying in the morning and the best method for me is what I mentioned; try it and see if it works for you.

These days are long and I’m still studying for the USMLE Step 1. I had distractions in my studies and that hindered me to fully focus. Another thing was the money problem. SJSM has an unusual billing policy so I had to work on getting money for living in Chicago. SJSM wants to continuously have me paying even when I’m not taking any classes so I don’t get any chance to save up. This is one of the reasons my studies are difficult and SJSM doesn’t understand that. I guess that’s one of the prices I have to pay for going to a Caribbean school; it’s all about money.

One of the most significant things I learned in studying well is to study somewhere else other than you own home. The USMLE Step 1 is an important test and you cannot risk studying at home because your family will bother you. Your family will never understand the important of this test nor will they understand that you shouldn’t be bothered. If you’re going out to watch videos go to a coffee shop or something. If you’re going to do Qbank questions then go to the library. When you feel bored go to the gym and burn off that anxiety, built up from all the studying.

You should realize that no matter how you study you should make each minute worth it. That means that it’s better to have a quality study than a quantity study. What I am trying to say is it’s better to have 7 hours of quality study than to have 16 hours of off and on study.

I’m in my fourth semester here in Saint James School of Medicine and so I tried many things in my previous semesters to increase my efficiency in studying; some worked and some failed.  The methods that worked for me, I use it on a consistent basis and it helped me get through.  If your current study methods didn’t work for you then try what I did and perhaps it will help you.

Don’t Re-Write All the Notes
This is a common mistake most medical students make, and I made it too in my first semester. The notes are right in front of you, why would you want to re-write them. If you were to re-write the notes then only re-write the little important ones. The medical lectures the teachers give out are so big and you don’t have time to re-write and understand the concepts. In medical school every minute is precious and you don’t have time to write a novel so don’t attempt to write one. Therefore, don’t re-write the notes unless they are key concepts that will help you understand the material.

Read Out Loud
This helped me so much; I am a visual and an audio learner, and most people are. Read the notes out loud and don’t be lazy about it. If you read out loud you won’t loose attention of what you’re reading. If you read silently then it’s guaranteed that you will loose focus on what you’re reading. Medical terminology and concepts are not easy to comprehend easily, such as examples are pathways of the intrinsic clotting factors. It takes a while to differentiate and understand intrinsic and extrinsic pathways. Read out loud with someone and trust me it helps; and it didn’t just help me, it helped other students as well, especially in Histology.

Repetition is the Key
Remember the saying “practice makes perfect” well it’s true. If you read a medical term over and over again then the information will be stapled to your head. The same principal applies when reading the notes over and over again. This is what I did, I read one slide once, then went to the next one and read that, then I went back to the first slide and read it again. After reading slide one and slide two again, I read slide three, after reading slide three I went back to slide one, and I continued this process which allowed me to memorize the information easily. Also while doing this I read out loud so that helped my memorization even more.

These study methods takes a good amount of energy and so you will be tired after the first lecture, but you will get more out of it than re-writing the notes or reading them silently. Just note, try the study methods and be consistent about it, don’t be lazy about studying, if you are lazy then ask yourself what are you doing in medical school. Good luck studying.

This is a long post and I wrote it when the electricity went out at 1 AM last night. Thank GOD, my laptop had enough juice to keep my busy.  It was pitch black outside when the electricity went out and at 1 AM it’s not a good idea to go out alone in Bonaire.

Pharmacology, in MD3, is the hardest class in Saint James School of Medicine. It’s not hard in terms of understanding concepts but it’s hard due to the amount of information a student has to comprehend and memorize. Students have to study for Pharm and on top of that they have to study for Pathology I class and Microbiology. Each of those three classes requires a good amount of dedication but Pharm requires the most amount of dedication.

Dr. B teaches Pharmacology at 8 AM so, upcoming MD3 students, you better be awake for this class. Dr. B also teaches Embryology class for MD1 students, as mentioned in an earlier post. Pharmacology takes Physiology, Microbiology, and some Pathology concepts and incorporates that with the use of drugs. If you thought Histology was hard in your MD1 class, wait till you take this class, it will boggle your mind.

The block tests for Pharmacology are all clinical based. Dr. B wastes no time in giving out straight forward questions; he gives you clinical scenarios and asks you which drugs are best for the patient to take. Block one test is the easiest test, you will learn the foundation of Pharmacology and which receptors trigger which reaction in the human body. Block one test is easy once you understand the concepts backwards and forwards. Block one exam has to deal with more Physiology so you can figure out the answers on the test if you know the basics. Block 2-4 tests have to do with memorizing drugs, their classifications, their modes of action, their adverse effects, and their uses for whichever diseases.

Dr. B does confuse the class from time to time when he breaks down what we need to study for SJSM’s block tests and what we need to study for USMLE Step 1 exam. Honestly, I could care less about USMLE Step 1 at that time; I’m more concerned about passing Pharmacology than studying for USMLE Step 1. After teaching us a concept he mentions the chances of it being on Step 1 exam in percentage wise; and this confuses us even more with all the volume of information we already have in our hands. However, Dr. B is extremely knowledgeable in his field and he teaches very well. From block 2-4 his teaching is a bit off due to the subject but he will take the time to help you if you don’t understand. If not all I still remember a good amount of Pharmacology taught to me.

When he comes into class he will waste no time waiting for everyone to quiet down. Dr. B will start lecturing over the noisy class. Usually the people in the front rows quiet down and the people in the back are the ones who take time being quiet. He will keep an eye on who on attends class and who conducts well on his tests.

Attendance is a big factor in Dr. B’s class. If you come to class everyday and pay attention or study once you get home then you will pass. If you miss his classes then you may as well pray that you get high scores in his tests. Pharmacology is a difficult subject and most people in the class gets around 70s or above and that’s considered good because it’s a two semester class packed in one. Pharmacology concepts are condensed to be taught in the 16 months curriculum of Basic Sciences. In the last block test I wasn’t that worried about Pharmacology because my good attendance helped me out. I passed all of my previous tests so I wanted to concentrate on other subjects which I was weak on. There are other people who’s grades were very low but since they attended his class, it showed their effort, Dr. B showed them mercy and they passed. If a student has poor attendance and did porly on tests then he/she will have no help if his/her final score is not a passing mark.

Study Tips
Pharmacology is mostly about memorization and, just like histology, repetition is the key. You should get stacks of notebook paper and write and re-write the drugs over and over again until they are stuck to your head. Studying the same material everyday will store the information in your long-term memory. Dr. B’s slides are a bit all over the place because there is so much information on there but he will not test you on all that information and nor will they show up on USMLE Step 1. One way to study well in his class is using Kaplan Pharmacology book as a guide. You should highlight, on the book, what is on Dr. B’s slides so you can easily study for his tests without trouble. Dr. B will also point out the “drugs of choice” for certain diseases; make sure you learn that hardcore because those are easy questions. Most of his questions ask you what is the best choice so more than one drug can be the answer, but when it comes to the drug of choice (“DOC”), then only one drug is the correct answer.

New students are already flocking Bonaire with their excitment of studying medicine with dedication. If you’re an MD1 in two to three weeks onward you’re going to ask yourself what did you get yourself into. The amount of studying you have to do is ridiculously crazy. The amount of information you have to retain is so massive. You will have to study like you never studied before in your life. I’m an MD4 now and it’s been over a year since I studied in SJSM and in the following post I will tell you how to conduct your studying habits so you can do well in these medical school exams.

Medical Ethics
Medical ethics is the easiest class in MD1 and it seems like a joke to most people and to me it was. However, you still need to look over the material at least 2 times to do well. In order to do well in that class, pay attention to Dr. D or whoever is teaching. I don’t want to write out any full names of any teachers online, but if you have the Serbian teacher Dr. D, a very smart man by the way, then you should read on. Pay attention to what Dr. D is teaching. Make sure you write down the case studies he presens and discusses in class. He will test you based on those case studies and know the components of what is what. If there are any definitions, understand them, apply them in case studies, and then memorize them hard-core. Read his slides at least twice and you should be fine for his tests, it’s not hard as the other classes.

Gross Anatomy
Anatomy class is demanding, but it’s not impossible to get an A. If you’re good at memorization by picturing things then this class should be a breeze. Anatomy is mostly about memorizing the different bones and muscles of the human body. Also, you have to know the nerves and which muscles they work with. Anatomy tests are based on the lecture in class which is a major part and the practical test which is the minor part. The Board Review Series Anatomy book is the guide for this class. In the back of each chapter do those practice questions; if you can answer all those practice questions then you should not be making anything less than an A. In Anatomy lab, pay attention to what the instructor tells you to study. And keep your ears open to which muscles the instructor mentions and study that hardcore, and also study what the “clinical significance” is of whatever he mentions.

Embryology
Dr. B, the Pharmacology teacher who teaches in MD3, also teaches embryology. In his class don’t even look at the text book. Study from his PowerPoint slides, it has everything you need to get an A in his tests. His tests are straight forward, however all of his questions are clinical based because all the USMLE Step 1 questions are clinical based. The Fall 2010 class is the largest batch of students in SJSM history so he may or may not give a review before the test depending on time, but if he does give a review PAY ATTENTION to him. In his review he will tell which slides to ignore and which slides to study. I can’t stress enough when I tell you DON’T study from the text book; STUDY HIS SLIDES.

Histology
Histology class is the most demanding and the hardest class of MD1. The dean of Basic Sciences, Dr. K, teaches this class and he expects a lot from his students. When I was an MD1 he told me and my class “you’re all MDs, you have to struggle”. Therefore, you can get an idea of what you’re about to go through. For me I spent 80% of my study time for Histology and I did well in my first test because I put so much effort into it. Just like Embryology slides, you need to study from Histology slides. The test comes directly from the slides. Histology class has so much volume of information that you may or may not be able to study everything. The key to studying Histology is repetition. If you read a slide don’t spend 30 minutes on it trying to memorize it, move on to the next slide after reading and understanding it once. Go through an entire set of slides once and then do it over again. The more repetitions you do the more the information will stick to your head, and that’s the key in studying histology; repetition is the key.

Just keep in mind what I wrote above. Don’t deviate from it because I went through MD1 last year and the teachers have no changed so most things have stayed the same. I wrote this post to help the new MD1s and it is your choice to follow it. Good luck and I hope you will enjoy this semester with us as you study and begin your medical career.