A Resource for USMLE Step 1

Prepara t ion

Co m p iled by th e TTUHSC Schoo l of Med icin e

Office of S tude nt Affa irs Dr. JoAnn Larsen

Assistant Dean for Student Affairs USMLE W hats it for? I n order to beco m e a licensed ph ysicia n in th e Un it ed St a tes, ind iv idu a ls m ust pass a series of e x a m in a t ions conducted by the N a t ion a l Board of Med ica l Ex a m in ers. Th ese ex a m in a t ions are th e Un it ed Sta tes Med ica l Licensing Ex a m in a t ions, or USMLE. Curre nt ly th ere a re four separa t e e x a ms wh ich m ust be passed in order to e lig ib le for m ed ica l licensure :

Step 1 , usu a lly t a k e n aft e r th e co m p le t ion of th e second y e ar of m ed ica l schoo l ; Step 2 Clinical Knowledge (CK) , usu a lly t a k e n dur ing th e fourth y e ar ; Step 2 Clinical Skills (CS) , usu a lly t a k e n during th e fourth y e ar ; a nd Step 3 , t yp ica lly t a k e n dur ing th e first y e ar of post gradu a te tra in ing.

Step 1 assesses wh e th er you underst a nd and ca n app ly i m porta nt concepts of th e scie nces basic to th e pract ice of m ed icin e , w ith specia l e m ph asis on princip les a nd m ech a n isms underly ing h e a lth , d ise ase , a nd m odes of th erapy . S tep 1 e nsures m astery of not on ly th e scie nces th a t prov ide a founda t ion for th e safe a nd co m pete nt pract ice of m ed icin e in th e presen t , but a lso th e scient ific princip les requ ired for m a inte n a nce of co m pete nce through life long le arn ing.

Step 2 assesses wh e th er you ca n app ly m ed ica l k now ledge , sk ills, a nd underst a nd ing of clin ica l scie nce essen t ia l for th e prov ision of pa t ient care under superv ision a nd includes e m ph asis on h e a lth pro m ot ion a nd d ise ase pre v e nt ion. Step 2 ensures th a t du e a t t en t ion is de voted to princip les of clin ica l scie nces a nd basic pa t ient -cen tered sk ills th a t prov ide th e foundat ion for th e safe a nd co m pete nt pract ice of m ed icin e .

Step 2 Clinical Skills (CS) A clin ica l sk ills exa m ination was part of the origina l design of USMLE. The NBME was charged w ith including a test of clin ica l sk ills using standardized patients when such an exa m ination was shown to be va lid, re liable, and practica l. NBME research and the work of other organ izations adm in istering clin ica l sk ills exa m inations de monstrate that clin ica l sk ills exa m inations m easure sk ill sets different from those m easured by traditiona l m u ltiple-choice questions. Mastery of clin ica l and com mun ication sk ills, as we ll as cogn itive sk ills, by indiv idua ls seek ing m edica l licensure is important to the protection of the public.

I m p le m e nta t ion of th e clin ica l sk ills e x a m in a t ion bega n in Jun e 2004. Th e clin ica l sk ills e x a m in a t ion is a separa t e ly ad m in istered co m pon e nt of Step 2 and is referred to as Step 2 C lin ica l Sk ills, or Step 2 CS. Th e co m puter-b ased, m u lt ip le -cho ice co m pon ent of Step 2 is referred to as Step 2 C lin ica l Know ledge , or S tep 2 CK.

USMLE Step 2 CS is adm inistered at five regional test centers (CSEC Centers) in the United States.

Step 3 assesses wh e th er you ca n app ly m ed ica l know ledge a nd understa nd ing of b io m ed ica l a nd clin ica l scie nce esse nt ia l for th e unsuperv ised pract ice of m ed icin e , w ith e m ph asis on pa t ient m a n age m ent in a m bu la tory se t t ings. Step 3 prov ides a fin a l assessm ent of ph ysicia ns assu m ing indepe nde nt responsib ilit y for de liv ering ge n era l m ed ica l ca re .

Requ ire m e nts for lice nsure in e ach st a te a re se t by th e st a t e s m ed ica l lice nsing boards. E ach st a te board m a y de ter m in e th e m a x i m u m nu m ber of t i m es th a t a person m a y t a k e e ach Step e x a m a nd st ill re m a in e lig ib le for licensure . I n Texas, individuals are limited to three attempts at each Step exam. Bu t wh a t w e re re a lly h ere for is to t a lk about prepar ing for S tep 1 . St ep 1 is your first B I G hurd le . And m a k e no m ist a k e about it , th is is a VERY i m port a n t t est . A v ery good perfor m a nce on Step 1 ca n defin it e ly h e lp you wh e n it co m es to securing a top-ra te residency , a nd lik e w ise a poor score ca n hurt you a nd li m it your opt ions. And a fa ilure on Step 1 ca n e li m in a te the possib ilit y of so m e residencies a ltoge th er. So it is defin it e ly in your best interest to do a ll you can to m a x i m iz e your ch a nces of do ing w e ll , regard less of wh a t t ype of reside ncy you m a y choose to pursu e . How is Step 1 scored? W h e n you t a k e Step 1 , th e co m puter records your responses. Aft e r your t est e nds, your responses are tra nsm it t ed to th e NBME for scoring. Th e nu m ber of t est it e ms you a nsw er correct ly is con v erted to two equ iv a le nt scores, on e on a thre e -d ig it score sca le a nd on e on a two-d ig it score sca le . Both sca les are used for score -report ing purposes.

O n th e thre e -d ig it sca le , m ost Step 1 scores fa ll be tw e e n 140 a nd 260 . Th e m e a n score for first - t i m e e x a m in e es fro m accred it ed m ed ica l schoo l progra ms in th e Un it ed St a tes is in th e ra nge of 200 to 220 , a nd th e st a ndard de v ia t ion is approx i m ate ly 20 . Your score report w ill include th e m e a n a nd st a ndard de v ia t ion for recen t ad m in istra t ions of th e e x a m in a t ion . Th e two-d ig it score is deriv ed fro m th e thre e -d ig it score . I t is used in score report ing beca use so m e m ed ica l licensing a u thorit ies h a v e requ ire m ents th a t include la ngu age describ ing a " passing score of 75 . " Th e two-d ig it score is deriv ed in such a w a y th a t a score of 75 a lw a ys corresponds to th e m in i m u m passing score .

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B locks of it e ms are constructed to m e e t specific conten t specifica t ions. As a resu lt , th e co m b in a t ion of b locks of it e ms cre a tes a for m of th e e x a m in a t ion th a t is co m parab le in conte nt to a ll oth er for ms. The perce ntage of correct ly a nsw ered it e ms requ ired to pass v ar ies fro m for m to form . How e v er, e x a m in e es t yp ica lly m ust answ er 60 to 70 perce nt of it e ms correct ly to ach ie v e a passing score .

W hat is the minimum passing score? In Dece mber 2006, the Step 1 Com m it tee decided to ra ise the three-digit score recom m ended to pass Step 1 from 182 to 185. The new m in im u m passing score w ill be applied to Step 1 exa m inations for wh ich the first day of testing is on or after January 1, 2007.

W hat is Texas Techs policy on USMLE exams? Step 1 Exam

A ll students w ill be requ ired to t a k e th e Un it ed Sta t es Med ica l Licensing Ex a m in a t ion (USMLE) Step 1 a t th e e nd of Ye ar Two and no later th a n June 30 . E xcepted fro m th is requ ire m e nt a re students who m ust re m ed ia te a B asic Scie nce course i m m ed ia te ly fo llow ing Ye ar Two. Such students w ill co m p le te a n y re m ed ia t ion work / e x a m by Jun e 15 fo llow ing Ye ar Two and t a k e USMLE Step 1 by Ju ly 31 of Ye ar Thre e .

A l l s t u d e n ts w ho t a k e t h e U SMLE S t e p 1 no l a t e r t h a n Ju n e 3 0 fo l lo w in g

co m p l e t ion of Ye a r T w o w i l l b e e l ig ib l e to s t a r t t h e Ye a r T h r e e c l e r ksh ip ro t a t ions in Ju l y of t h a t y e a r .

Passage of USMLE Step 1 is requ ired for pro m ot ion to Ye ar Four.

For stude nts who m ust repe a t USMLE Step 1 , le a v e fro m th e th ird y e ar curricu lu m

to prepare for th e e x a m is not requ ired but is strongly recommended and encouraged. An y requ est for such le a v e m ust be approv ed by th e Associa te D e a n for Educa t ion a l Progra ms or th e Assista nt D e a n for Stude nt Affa irs.

Stude nts who re ach th e e nd of th e Ye ar Thre e curr icu lu m a nd h a v e not y e t passed

Step 1 w ill be p laced on ad m in istra t iv e le a v e of absence for up to on e y e ar, consisten t w ith Sect ion 4 .1 of th is po licy w h ich a llows no m ore th a n six (6 ) y e ars to co m p le te th e curr icu lu m for th e Doctor of Med icin e degre e , inclusiv e of a ll le a v es, repe t it ion, or deco m pression of a n acade m ic y e ar. Passage of th e e x a m dur ing th is t i m e fra m e w ill resu lt in re turn to th e curricu lu m .

I n ab ilit y to pass Step 1 w ith in th e on e - y e ar le a v e of absence w ill resu lt in

w ithdra w a l fro m th e curricu lu m as st a ted in th e S OM Stude nt Affa irs Stude nt H a ndbook under Student Le a v es of Abse nce . Appe a ls regard ing th is issu e w ill be h a nd led as ou t lin ed in Sect ions 6 , 7 , a nd 8 of th e Grad ing a nd Pro m ot ions po licy .

Step 2 Exam

For stude nts who beg in th e curricu lu m in August of 2005 or la ter , passage of S tep 2 C lin ica l Know ledge a nd Step 2 C lin ica l Sk ills w ill be requ ired for gradu a t ion. Passing scores m ust be docu m e nted no la ter th a n May 1 of th e y e ar gradu a t ing.

How do I apply for Step 1? Th e in it ia l a pp lica t ion for Step 1 is don e on th e I n t ern e t . Go to w w w.nb m e .org. C lick on NBME Licensing Exam Services, th e n National Licensing Examination Services Website. I n th e y e llow LOG I N box , p le ase note you do not h a v e a USMLE I D nu m ber y e t . I nste ad, click on First time user a nd fo llow th e instruct ions. As part of th e app lica t ion ,

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you w ill ind ica te a 90-da y e lig ib ilit y period during w h ich you p la n to t a k e th e e x a m . Pa y m ent is a lso requ ired a t th is t i m e ($480) .

Pr int out the app lica t ion for m wh ich w ill requ ire your sign a ture a nd a p icture . Bring th e for m to th e Stude nt Affa irs Office for sign a ture Dr. McMa hon, Dr. Larse n , Ta m ara La n e , a nd K are n N e lson are a u thoriz ed to sign th e for m .

Th e n t a k e th e for m to th e Reg istra rs Office (2C400 across fro m th e Sy n erg ist ic C e nter) a nd h a v e th e schoo l se a l pu t on it .

After th a t , you re re ady to m a il it in .

W here do I take the test? Tho mson Pro m etric, a part of Th e Tho mson Corpora t ion , prov ides sch edu ling a nd t est cen ters for th e co m puter-based co m pon e nts of USMLE. S tep 1 a nd Step 2 CK are g iv e n a round th e wor ld a t Pro m etr ic Test C e nters (PTCs) . Pro m etric t est ce nters a re loca ted throughout th e U.S . I n Te x as th ere a re ce nters in :

Ab ile n e A m ar illo Aust in (2 ) Be a u m ont Bedford (2 ) Corpus Christ i D a llas (2 ) E l Paso Houston (3 ) Lubbock McA llen Mid la nd S a n Anton io (2 ) Ty ler W aco W ich it a F a lls

How do I schedule my test? O nce your app lica t ion h as be en processed, you w ill rece iv e a n e m a il fro m NBME not ify ing you th a t your app lica t ion is co m p le te . About a w e e k la ter , you w ill rece iv e a second e m a il fro m th e m not ify ing you th a t your sch edu ling per m it is a v a ilab le ; th is m essage w ill include instruct ions for accessing th e e lectron ic sch edu ling per m it using th e reg istra t ion e n t it y's interact iv e w ebsit e . PRI NT OUT YOUR SCHEDULI NG PERMIT a nd k e ep it in a safe p lace . You MUST br ing it w ith you to th e t est ce nter on th e da y of your t est . You w ill not be a llow ed to t a k e th e e x a m w ithout your sch edu ling per m it . O nce you v e got t en your per m it , you m a y schedu le your t est on lin e a t w w w.pro m etr ic.co m for a n y a v a ilab le t est da te th a t is w ith in your approv ed 90-da y e lig ib ilit y period. Not a ll Pro m etric ce nters a re ope n on w e ek e nds, a nd USMLE e x a ms are not n ecessarily offe red e v ery da y th e ce nters a re ope n . Please note that May through July are one of the busiest periods for these testing centers because of the large USMLE demand during that time PLAN AHEAD!

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http://www.prometric.com/

You w ill be ab le to ch a nge your t est da te aft er you h a v e sch edu led it I F your n ew t est da te is st ill w ith in th e 90-da y e lig ib ilit y period. I f you m ust reschedu le ou tside th e approv ed e lig ib ilit y period, you w ill n e ed to re app ly a nd pa y a n add it ion a l fe e .

W hat is the format of the test? Th e Step 1 t est da y is a n 8 -hour da y . Th e 8 hours includes th e t est itse lf as w e ll as bre a k t i m e. Th e ex a m consists of approx i m ate ly 350 m ult ip le cho ice qu est ions arra nged in b locks of 50 qu est ions wh ich m e a ns you w ill h a v e about 1 .2 m inutes per quest ion. D uring e ach b lock you ca n a nsw er qu est ions in a n y order, go back and re v ie w qu est ions in th e b lock , a nd ch a nge answ ers. O nce you h a v e e x it ed a b lock or th e t i m e for th a t b lock h as e xp ired , you w ill no longer be ab le to re v ie w quest ions or ch a nge answ ers in th a t b lock .

Some blocks are harder than others. Don t p an ic if your first b lock h appe ns to be a m ore d ifficu lt on e .

The questions are random , so don t e xpect a b lock of pa tho logy qu est ions, a

group of ph ar m aco logy qu est ions, e tc.

Some questions will include pictures h istology, gross pathology, CT im ages, etc.

Approximately 75 % of the questions are SI NGLE BEST ANSWER. Th ere w ill be a n y wh ere fro m 3 to 5 a nsw er cho ices.

Other questions consist of extended matching a list of it e ms fro m w h ich

you m ust choose th e on e best a nsw er tha t corresponds w ith th e nu m bered it e ms or qu est ions loca ted be low th e list .

Can I practice taking the test? You shou ld acqu a int yourse lf w ith th e t est softw are w e ll before your t est da te (s) . Pract ice t i m e is not a v a ilab le on th e t est d a y , and t est ce nter st a ff a re not a u thoriz ed to prov ide instruct ion on use of the softw are . A br ief tu tor ia l on th e t est da y prov ides a re v ie w of th e t est softw are , includ ing n a v iga t ion too ls a nd ex a m in a t ion for m a t , prior to beg inn ing th e t est . I t does not prov ide a n opportun it y to pract ice . 1. You can practice by downloading software from the NBME website (h t tp : / / w w w.usm le .org / Orie nta t ion / 2007 / re ad m e .h t m # softw are) . Th e NBME softw are you insta ll h as ov er 100 pract ice t est it e ms a nd a softw are tu tor ia l . So m e pract ice it e ms m a y include m u lt i m ed ia files, such as v ideo or a ud io clips.

2. You can schedule a practice test at a Prometric Test Center. O nce your Step 1 app lica t ion h as be e n processed a nd you h a v e rece iv ed your Sch edu ling Per m it , you are e lig ib le to reg ister for a Practice Session for th a t ex a m in a t ion. Pract ice Sessions are a v a ilab le a t Tho mson Pro m etric, a part of Th e Tho mson Corpora t ion, t est ce n ters. The Practice Sessions use the same sample test materials that are available on the USMLE website; however, they do not include any multimedia items. NO NEW SAMPLE TEST MATERIALS ARE PRESENTED AT PRACTICE SESSI ONS. Those who are e lig ib le to reg ister for a Pract ice Session m a y t a k e on ly on e session per e x a m reg istra t ion. Ple ase note th a t Pract ice Sessions are not a v a ilab le on m a jor loca l ho lida ys and during the first two weeks of January . Note: Th e NBME softw are , know n as FRE D , w ill rep lace th e Pro m etric softw are for th e USMLE Pract ice Session beg inn ing in D ece m ber 2006 . Inst a lla t ion of FRE D for th e USMLE Pract ice Sessions w ill be ph ased in ov er se v era l w e e ks. I f you sch edu le to t a k e a CBT Pract ice Session fro m D ece m ber 2006 through Ja nu ary 2007 , you m ight t est w ith

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e ith er th e Pro m etric or FRE D t est de liv ery softw are . Unt il th is tra nsit ion is co m p le te , e x a m in e es who w ish to pract ice w ith th e actu a l FRE D softw are shou ld use the sa m p le m a ter ia ls a v a ilab le a t th e USMLE w ebsit e . Th e Pract ice Session is a m a x i m u m of 3 .5 hours a nd is d iv ided into 3 1 -hour b locks of 46-50 m u lt ip le cho ice t est it e ms e ach. W h e n you co m p le te th e session, you w ill rece iv e a pr inted perce nt correct score .

I f you reg ister for a pract ice session , a YELLO W Sch edu ling Per m it w ill be m a iled to you w ith in two w e e ks w h ich w ill a llow you to sch edu le th e Pract ice Session . Do not schedule a Practice Session using your permit for the actual Step examination. Th e $42 fe e for th e Pract ice session m ust be pa id d irect ly to Pro m etr ic by cred it ca rd a t th e t i m e you sch edu le your appo int m e nt .

W hats on the test? As we have talked about already, the NBMEs Comprehensive Basic Sciences Exa m is the closest thing to the real thing that they will let anyone see. In fact, since ALL of the items written by NBME are copyrighted, you should be a little leery of anyone other than NBME who claims to have actual USMLE questions. The NBME offers a breakdown of the content areas on the test :

System * *

40 % 50 % G e n era l princip les 50 % 60 % Ind iv idu a l orga n syste ms

h e m atopo ie t ic / ly m phore t icu lar n ervous /specia l se nses sk in /conn ect iv e t issu e m uscu losk e le ta l resp ira tory card iov ascu lar gastro intest in a l re n a l / ur in ary reproduct iv e e ndocrin e

Process

30 % 50 % Nor m a l structure a nd funct ion 30 % 50 % Abnor m a l processes 15 % 25 % Pr incip les of th erape ut ics 10 % 20 % Psychosocia l , cu ltura l , occupa t ion a l a nd e n v iron m e nta l considera t ions

* Perce ntages a re sub j ect to ch a nge a t a n y t i m e. Se e th e USMLE w ebsit e for th e m ost up- to-da te infor m at ion . * * Th e ge n era l princip les ca tegory includes t est it e ms concern ing those nor m a l a nd abnor m a l processes th a t a re not li m it ed to specific orga n syste ms. C a tegories for ind iv idu a l orga n syste ms include t est it e ms concern ing those nor m a l a nd abnor m a l processes th a t are syste m specific.

NBME also publishes a more detailed outline of the topics covered on the Step 1 exam. Use this as an outline to make sure you are covering all of these topics in

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your study plan. Youll find the complete outline of whats on the Step 1 exam at the end of this book in Appendix A. How do I prepare for Step 1? Se v era l th ings h a v e be e n prov e n to h e lp stude nts prepare to do th e ir best of S tep 1 . 1. LEARN the material you are currently studying in your classes. Approx i m ate ly 70 % of th e qu est ions on th e e x a m are lik e ly to use or co m b in e infor m at ion in w a ys th a t you h a v e not se e n before . I t is the purpose of th e t est ing age ncy to se e how adept you are a t t a k ing part ia l infor m at ion a nd, based on th a t ,figur ing out a n a nsw er you consider to be a h igh probab ilit y response . And you can t do th a t w ith MEMORI Z E D m ater ia l, bu t you ca n do it using m a ter ia l th a t you h a v e LEARNE D . 2. KNO W how to approach multiple choice questions and PRACTICE. So m e peop le se e m to inst inct iv e ly k now how to a nsw er m u lt ip le cho ice qu est ions correct ly , oth ers of us not so m uch . Th ere a re sk ills th a t you can le arn to h e lp you a nsw er th ese k inds of t est qu est ions. H ere s how K ap la n reco m m e nds approach ing v ign et t e st y led m u lt ip le cho ice qu est ions :

1. asse m b le k e y clu es into a m e nta l sn apshot of th e pa t ie nt . 2. underst a nd precise ly wh a t is be ing ask ed 3. a llow a fe w m o m ents to th in k , reca ll , a nd to a n t icipate possib le a nsw ers 4. co m pare th e g iv e n cho ices to your a nt icipa ted a nsw er 5. m ark cho ices th a t m a tch best 6. ru le out cho ices th a t don t account for a ll find ings 7. m ark th e best a nsw er

Kaplans experts say that people who are bad at multiple choice questions focus on the choices rather than the stems of the questions. Th is is a v ery in efficie nt approach a nd on e th a t t e nds to resu lt in m ore m ista k es. Those who are good at multiple choice questions focus on the stems, not the choices.

I f you a lw a ys fe e l th a t your perform a nce on m u lt ip le cho ice t ests doesn t equ a te w ith your m astery of th e m a ter ia l , you m ight th in k about h a v ing your t est t a k ing a n a ly z ed. Th e Un iv ersit y of Missour i a t K ansas C it y s Inst itu te for Profession a l Prepara t ion ( IPP) offe rs a n on lin e Step 1 diagnostic test . W h e n a n a ly z ed, th ese t ests not on ly e v a lu a te perfor m a nce in e ach of th e se v e n basic scie nces a re as, bu t a lso look a t so m e 40 oth er intra - t est v ar iab les w h ich ca n he lp you ga in insight into th e t ypes of e rrors you m a y be co m m it t ing as you go through a t est , especia lly wh e n th ese errors m a y be depressing your ov era ll perfor m a nce . V ariab les such as : th e a m ount of t i m e spe nt on d iffe re n t t ypes of quest ions ; corre la t ions be tw e en the length of a qu est ion a nd th e lik e lihood of a nsw ering it successfu lly ; perfor m a nce on qu est ions wh ich re ly on strict defin it ions or precise interpre t a t ion of t echn ica l vocabu lary ; a nd th e e x ten t to wh ich you a re ab le to n arrow down your cho ices to two good answ ers and th e e x ten t to wh ich your second cho ices a re correct , a re e x a m p les of th e intra - t est v ariab les a n a ly z ed wh e n you t a k e a " D iagnost ic " t est . I n add it ion to a su m m ary da ta sh e et show ing your perfor m a nce in th ese a re as, th e y m a y a lso prov ide a co m puter gen era ted six to e ight page report wh ich d iscusses th ese v ariab les a nd g iv es so m e concre te suggest ions for m in i m iz ing th e i m pact of th ese " e rror pa t t erns " . Th is d iagnost ic t est is a v a ilab le for a sm a ll fe e . For de t a ils a nd how to order a t est , p le ase go to h t tp : / / w w w.u m kc.edu / ipp /cbt . asp. Th e y a lso offe r a full - length Mock Board Exam. H ere is a sa m p le Step 1 D iagnost ic Test report . STEP 1 REPORT

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http://www.umkc.edu/ipp/cbt.asp

All Step 1 "Diagnostics", "Mock Boards", and "Tests" produce a summary similar to the one shown below. In addition, the "Diagnostic" also provides a computer generated six to eight page report which discusses these variables and gives some concrete suggestions for minimizing the impact of these "error patterns". Student Name PercentCorrect Overall 54 Percent Correct of 2nd Choices 37 Mean Time per Question 62 Category: % Correct Mean Time (sec) Questions Involving Statistics 61 60 Diagnosis Questions 62 53 Questions Involving Judgement 53 51 Process Questions 49 51 Questions Involving Definitions 51 51 Cause Effect Reasoning Questions 51 51 Questions with Graphics 40 61 Questions Requiring Visualization 43 54 Subject: % Correct Mean Time (sec) Anatomy 43 55 Behavioral Sciences 63 54 Biochemistry 37 45 Microbiology 52 45 Pathology 56 48 Pharmacology 45 55 Physiology 65 62 Question Type: % Correct Mean Time (sec) Multiple Choice 49 52 Extended Foils 55 51 Confidence levels: % Correct Number Mean Time (sec) 1 (low) 16 25 62 2 36 22 69 3 33 15 51 4 74 38 52 5 (high) 75 24 26 Cognitive Level: % Correct Mean Time (sec) Recall 52 45 Comprehension 42 59 Application 63 59 3. ALLO W enough time to prepare, but not too much. A lthough you w ill h a v e approx i m ate ly 10 w e e ks fro m th e t i m e schoo l e nds to th e de ad lin e for t a k ing Step 1 (Jun e 30) , four to six w e e ks shou ld be p le nty of t i m e to prepare for S tep 1 . Ma n y students in th e past who h a v e t a k e n longer th a n 6 w e e ks to prepare la ter sa id th e y fe lt th e y took too m uch t i m e, a nd actu a lly lost ground w ith th e ir study ing. An a lysis of our own stude nts ov er th e y e ars shows th a t you ge t th e m ost b ang for your buck by study ing for 6 to 9 hours per d a y for 4 to 6 w e e ks. Be low you ll se e a graph of hours / da y and w e e ks of study ing graph ed aga inst actu a l S tep 1 scores.

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30

230

3-5 hours per day / 2-4 weeks3-5 hours per day / 4-6 weeks3-5 hours per day / > 6 weeks 6-9 hours per day / 2- 4 weeks6-9 hours per day / 4-6 weeks6-9 hours per day / > 6 weeks>9 hours per day / 2-4 weeks>9 hours per day / 4-6 weeks>9 hours per day / > 6 weeks

4. MAKE a study schedule and stick to it. Th is is a crit ica l st ep in successfu l S t ep 1 prepara t ion . More de t a iled infor m at ion about study sch edu les is in th e fo llow ing sect ion . 5. STUDY smart. Spe nd ing 10 hours a da y passiv e ly re ad ing study gu ides or old notes is m uch less effect iv e th an spend ing h a lf th a t a m ount of t i m e in act iv e study . Exp la in concepts ou t loud to a study partn er , pract ice a nsw er ing qu est ions by e xp la in ing wh y th e r ight answ ers a re right a nd th e wrong a nsw ers a re wrong. I f concept m app ing works for you , do it . I f th ere a re oth er m e thods th a t work for you , use th e m . OTHER STEP 1 ADVICE Judy Schw en k er, K ap la n s Curricu lu m D irector, t a lk ed about th e w a ys in wh ich USMLE e x a ms are si m ilar to m ed ica l pract ice :

1 . you m ust find k ey inform a t ion 2 . th e infor m at ion you n e ed m a y be buried 3 . th ere a re d istract ions 4 . th ere is t i m e pressure 5 . you m ust use probab ilit ies to m a k e decisions 6 . you ll n e v er k now it a ll 7 . situ a t ions won t e x act ly fit wh a t you v e le arn ed

Sh e a lso t a lk ed about th e m ista k es m ost co m m on ly m ade wh en prepar ing for Step 1 : 1 . passiv e study ing 2 . insufficie nt pract ice w ith qu est ions 3 . m e m or iz ing, not underst a nd ing th e m a ter ia l 4 . in appropria t e t est da y stra teg ies 5 . m isre ad ing or m isinterpre t ing qu est ions

So where do I start?

8

1. Self -assessment. I th ink a ll of th e e xperts agre e tha t th e first th ing you n e ed to do

is t a k e so m e sort of d iagnost ic t est to se e wh ere your a re as of stre ngth and w e a k n ess a re . D iagnost ic t ests are a v a ilab le fro m K ap lan , NBME, and a v arie ty of oth er on lin e sources th a t a re listed la ter under O th er Resources.

2. Make a study schedule. Lots of sa m p le sch edu les a re out th ere a nd links to th e m

are included la ter in th is notebook . BUT p le ase re m e m ber th a t th ese sch edu les w ere m ade by ind iv idu a l stude nts and th e sch edu les reflect those stude nts ind iv idu a l circu msta nces. Wh e n you prepare your ow n study sch edu le , you m ust first look a t your ow n d iagnost ic t est resu lts and prepare your sch edu le w ith m ore t i m e a llot t ed to w e a k er sub jects, and less t i m e to stronger subj ects. I nd iv idu a l study pace a lso n e eds to be factored in , as so m e acco m p lish m ore per study da y th a n oth ers.

H ere s so m e adv ice fro m K ap la n s Judy Schw en k er : (1 ) Ta k e a co m pre h e nsiv e t est to beg in as a m easure of wh ere your reca ll is right now. Use th e K ap la n d iagnost ic test if you h a v e t a k e n it . (2 ) O nce you know your perce nt correct score for e ach sub j ect , use th is infor m a t ion to decide th e re la t iv e a m ount of re v ie w t i m e to pu t into e ach a re a . For e x a m p le , if Ph ysio logy is 20 % low er th a n Microb io logy , you shou ld be spend ing a t le ast 20 % MORE t i m e re v ie w ing Ph ysio logy th a n you put into Micro. (3 ) As you beg in to re v ie w a sub j ect , look over so m e qu est ions on the m a ter ia l before you st art to re v ie w. Th is w ill h e lp k e ep you focused on w h a t is i m porta n t to k now a nd show you how you w ill n e ed to use th e infor m at ion on th e t est . (4 ) As you m ov e through th e m a ter ia l, cre ate your ow n conde nsed su m m aries of th e k e y m a ter ia l so you can re v ie w th ese r ight before t est da y . 20-30 pages per sub j ect is a dece nt siz e to shoot for , beca use oth erw ise you w ill e nd up t a k ing too de t a iled notes a nd th e y won't h e lp a t th e e nd. (5 ) As you fin ish a sub j ect , use Q B a n k to cre a te a nd t a k e a t est w ith m a ybe 50 it e ms fro m e ach sub j ect th a t you h a v e co m p le ted up to th a t po int . So if you h a v e fin ish ed An a to m y and Ph ysio logy , you wou ld do a 100- it e m test under t i m ed, t est m ode assessing those 2 a re as. By th e end, you w ill be t a k ing long pract ice t ests under t est cond it ions th a t cov er a ll th e co m p le ted sub j ect a re as. Th is h e lps k e ep th e e arlier m a teria l in m e m ory , a nd g iv es you a m ore accura te p icture of your preparedn ess. I t a lso g iv es you good pract ice for th e m e nta l st a m in a a nd pacing n e eded on t est da y . (6 ) Pla n t im e dur ing th e fin a l 2 -3 w e e ks to do noth ing bu t re v ie w your own su m m ar ies a nd t a k e incre asing nu m bers of sim u la ted t est m odu les of 50 it e ms e ach under t i m ed cond it ions (on e hour per m odu le ) . Th is is th e fin a l " ge t it a ll fresh in m ind, bu ild m enta l st a m in a , a nd intensiv e t est pract ice " ph ase , w h ich shou ld le ad r ight up to 2 da ys before your actu a l t est da te . O ur exper ie nce h as show n th a t stude nts who are do ing 70 % or be t t er on our fu ll-le ngth si m u la ted e x a ms (or co m parab le pract ice t ests cre a ted w ith Q ba nk or IV Q ba nk ) by th e ir t est da tes D O PASS, so th is is a good lev e l to a i m for. You m a y a lso choose to t a k e on e of th e NBME tests to ge t a pred icted USMLE score . I f you do decide to do th is, be adv ised th a t based on fe edback I h a v e got te n on th e board , For m 1 se e ms to be th e m ost re liab le . (7 ) Don t study a ny th ing th e d a y before . Plan so m eth ing fun and m ind less, beca use study w ith in 24 hours of th e e x a m actu a lly hurts your ab ilit y to reca ll fro m e ar lier re v ie w ing.

Additional Advice from Kaplan

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Tips for the Week Before D ur ing th e last few da ys before th e e x a m you shou ld be t aper ing off your study ing, and ge t t ing into m e nta l a nd ph ysica l sh ape .

1. This is not the time for cramming in new material... bu t a t i m e to org a n ize a nd integra te wh a t you a lre ady know. Work on m a k ing wh a t you know m ore accessib le . 2. Review keywords, phrases and concepts. Look ov er your su m m ary notes on e m ore t i m e. Th is is th e t i m e to drill yourse lf on esse nt ia l infor m at ion . Th e k e y is to pract ice reca ll, not si m p ly re ad ov er the m a ter ia l aga in. W h at you n e ed to know is prob ab ly a lre ady in your h e ad. Your t ask now is to tra in yourse lf to access it wh e n you n e ed it . Do ing pract ice qu est ions is a good w a y to re inforce your reca ll sk ills. Use th e m to clarify your underst a nd ing of k e y de t a ils. 3. No one can know everything that is asked on this exam. Be hon est w ith yourse lf about wh at you do a nd do not know. Know ing th a t you do not know so m eth ing g iv es you m ore of a se nse of contro l on th e e x a m a nd m a k es you less lik e ly to pa n ic wh e n you e ncounter th e m a teria l a nd / or w aste t i m e on qu est ions you a re not lik e ly to ge t correct .

4. Get yourself onto the right time schedule. W a k e up e v ery da y a t th e sa m e t i m e you w ill n e ed to on th e da y of th e e x a m . Th is w ill g e t your circad ia n rh y th m coord in a ted w ith th e e x a m sch edu le . Do not n ap be tw e en 8 : 00 a m a nd 5 : 00 p m . O th erw ise you w ill accusto m your body to shut t ing dow n dur ing th e cr it ica l e x a m hours. I f you ge t up a t th e r ight t i m e e ach da y , you w ill a lso find it e asier to fa ll asle ep a t n ight . By ge t t ing into th e proper sle ep-w a k e cycle , you w ill find it e asier to ge t to sle ep th e n ight of th e e x a m as w e ll. 5. You should be getting a sufficient amount of sleep. For m ost peop le th a t m e a ns a t le ast 6 to 7 hours a n ight . S le ep is a n esse nt ia l t i m e for your bra in to conso lida te wh a t you h a v e le arn ed. You n e ed sle ep ; it m a k es you a m ore efficie nt le arn er wh e n you are a w a k e . 6. Take some time each day to relax. H a v e a good m e a l. Ta k e a w a lk in the fresh a ir . F ind t i m e for e x ercise . Th e ch a nge of pace w ill refresh you a nd th e physica l act iv it y w ill h e lp you re la x and sle ep a t n ight . 7. I f you haven't done so already, visit the Prometric Test Center wh ere you w ill be t a k ing th e e x a m . I t w ill be ind ica ted on your e x a m en try t ick e t . Th is w ill ensure you know how to ge t th ere a nd how m uch t i m e you shou ld a llow for th e co m m ute . You ca n se e wh ere you shou ld park , and se e wh a t th e co m puter se t -up is lik e . 8. Review the tutorial at ht tp : / / w w w.usm le .org /st ep1 / defa u lt .h t m . Beco m e fa m iliar w ith th e interface , th e loca t ion of k e y infor m a t ion on th e scre en a nd how to n a v iga te be tw e e n scre ens. I f you w a lk into th e e x a m fa m iliar w it h th e e x a m , you w ill not h a v e to use a n y of your v a lu ab le bre a k t i m e to do th is on th e t est da y .

Kaplans Tips For The Day Before The Exam 1. Take the day off from studying. Th is is your da y to re la x a nd ga th er your strength

before th e m a in e v en t . G e t ou t of bed a t th e sa m e t i m e you w ill h a v e to ge t up th e n e x t da y . I f you fe e l you m ust study , li m it yourse lf to re v ie w ing your own notes a nd flashcards.

2. Have some fun. Go for a w a lk . Liste n to your fa vor it e m usic. Go se e a good co m edy or a n act ion m ov ie th a t w ill a llow ca th art ic re le ase . Go shopp ing. Spend t i m e w ith a sign ifica nt oth er. Do w h a t e v er you lik e . You h a v e work ed h ard a nd deserv e it .

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http://www.usmle.org/step1/default.htm

3. Make sure that you have checked out the basics for the exam:

H a v e you work ed through th e USMLE tu tor ia l?

Do you know wh ere th e Pro m etric ce nter is, a nd how to ge t th ere?

Do you h a v e a lt e rn a t iv e tra nsporta t ion if , for e x a m p le , your car does not st a rt?

Do you trust your a lar m clock to w ak e you up in t i m e? I f not , m a k e

a rra nge m e nts w ith frie nds as back up. You w ant to be sure to w a k e up rested , refresh ed, and on t i m e.

La y out wh a t you'll n e ed for th e e xa m before you go to sle ep. Th is

includes photo ident ifica t ion , sch edu ling per m it a nd confir m a t ion nu m ber, as w e ll as a n y person a l it e ms lik e e y e g lasses. W h ile you're a t it , don't forge t to pack a lunch!

4. Call your friends and classmates and make some plans to celebrate . You'll n e ed to

b low off so m e ste a m a n y how, a nd t a lk ing w ith co lle agu es w ill re m ind you th a t you are not in th is by yourse lf .

5. Be sure to do some physical activity. Just taking a walk for an hour will help relax you.

6. Get a good night's sleep. To h e lp you sle ep, consider a hot ba th or w ar m m ilk . Avo id t a k ing sle ep ing m ed ica t ion as it m ay le a v e you groggy in th e m orn ing.

Kaplans Tips for test day 1. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized. You w ill be g iv e n a lock er to store your person a l it e ms a nd th e n assign ed a co m puter st a t ion. Re m e m ber th a t you h a v e a tot a l of se v e n hours to co m p le te 350 qu est ions, a nd a tot a l of on e hour to be used throughout th e da y for bre a ks a nd lunch . 2. To cope with fatigue, you will need to schedule breaks. Our recom m ended schedule for the exa m is:

Question Block Break time at end of Block B lock 1 No bre a k B lock 2 5 m inute bre a k B lock 3 5 m inute bre a k B lock 4 30 m inute lunch bre a k B lock 5 No bre a k B lock 6 10 m inute bre a k B lock 7 Don e!

Th is a llows you 10 m inutes e x tra to use as n eeded. Re m e m ber th a t you w ill n e ed to sign in a nd out whe n you t a k e bre a ks. You shou ld a lso be a w are th a t if you le a v e th e e x a m roo m during a b lock , it w ill be m ark ed as a n irregu larit y in your t est ing session . Th erefore , you n e ed to consider a ft e r e ach b lock wh e th er you w a nt to t a k e a ba throo m bre a k .

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3. Start with the beginning of the question block and work your way to the end. The idea here is to get into a rhythm that will help create what one psychologist calls a " Flow " experience. The flow experience is a state of optim al concentration and m axim al perform ance. 4. Do not skip any questions. I f you don't know it wh en you co m e to it , you are not lik e ly to know it la ter . Sk ipp ing around w astes t i m e a nd ca n end up confusing you . D e a l w ith e ach qu est ion as you co m e to it , a nsw er it as best you ca n , and m ov e on to th e n e x t qu est ion . 5. Limit your use of the marking feature to no more than two or three questions per block. Of course you should answer each question as you com e to it, but you m ay want to double-check yourself on a few questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used correctly, m arking will help you revisit questions where you have a high probability of getting the answer correct. Misused, marking causes you to not give a question your full attention the first tim e around. You simply m ay not have tim e to go back and look at questions you have m arked, especia lly if you m ark a lot of them. 6. Be cautious about changing answers. I n ge n era l , your odds of ch a ng ing a correct a nsw er to a wrong on e are so m uch h igh er th a n th e re v erse th a t it is si m p ly not worth th e risk . I f you ch a nge a n a nsw er, you are m ost lik e ly m a k ing it wrong! Your first i m pu lse is usu a lly th e correct on e . S t a y w ith it un less so m e cle ar insight occurs to you . 7. If you finish a question block with time left over, go back and "check" only those answers that you have previously marked. Checking almost always leads to changing and tends to reduce your score. If you have a spare moment, make sure that you have entered an answer for every question in the block and then, relax. Sit, take a break, and mentally prepare yourself for the next block of questions. Focus on the questions to come, not the ones that are past. 8. Monitor your time. Know how m uch you h a v e left , so you do not find yourse lf rush ed a t th e e nd. Work on your pacing fro m th e beg inn ing of th e qu est ion b lock . Ch eck your w atch e v ery 10 qu est ions to m a k e sure you are on th e correct pace to fin ish . I f you pace yourse lf throughout th e b lock , you shou ld not be squ e e z ed for t i m e a t th e e nd. 9. Relax. D uring th e bre a ks be tw e e n qu est ion b locks, try to re la x a nd not th ink back ov er th e e x a m . Th e desire to reca ll quest ions is strong, but not h e lpfu l . Those qu est ions are in th e past ; you w ill n e v er se e th e m aga in. Focus on re la x ing a nd m a k ing th e m ost of your bre a k . Re m e m ber, you w ill a lw a ys t end to re m e m ber those qu est ions you ge t wrong.

AND HERES SOME PREP ADVICE FROM SOME OF OUR STUDENTS I d reco m m e nd study ing no m ore th an about 5 w e e ks. An y m ore a nd you w ill st a rt forge t t ing th ings you le arn ed e ar lier. I cau t ion you to t a k e wh a t your classm ates sa y about th e ir e x a m w ith a gra in of sa lt , beca use e v ery e x a m is d iffe rent . A lso, buzz words a re not t yp ica lly used on Step 1 . Rath er th a n use th e words sm udge ce lls , for e x a m p le , th ey ll probab ly just show you a b lood sm e ar. H a v e a p la nn ed study sch edu le th a t you st ick to. I f you fa ll be h ind, you ll h a v e a h ard t i m e ge t t ing through e v ery th ing a nd st ill be ing ab le to rev ie w m a ter ia l. Do not use F irst A id or th e a ll- inclusiv e books as th e so le study a id. I f possib le , use th e H igh Yie ld books. Start e a r ly , st ick to a sch edu le , t ry not to beco m e ov erwh e l m ed w ith a ll a v a ilab le resources. Pick a coup le for e ach sub j ect beca use in m y e xperie nce you ca nnot absorb it a ll . Use F irst A id as a scaffo ld it re a lly is h e lpfu l for reca ll associa t ion .

12

Th e last w e e k / fe w d a ys before Step are v ery d istract ing don t g iv e yourse lf too m uch t i m e to study , 4 -6 w e e ks work ed for m e . But be prepared m enta lly for th e a n x iety th e w e e k before th e t est focus on e asier sub j ects to rev ie w.

W hat about review courses? So m e students find th e structure a nd d iscip lin e of a re v ie w course v ery h e lpfu l as part of th e ir S tep 1 prepara t ion. Unfortun a te ly so m e progra ms sch edu le th e ir courses a t t i m es of th e y e ar th a t don t co incide w ith m ost first - t im e ta k ers prepara t ion efforts. N e v erth e less, h ere is th e infor m at ion on re v ie w courses th a t a re a v a ilab le . Marshall University Joan C Edwards School of Medicine Th ird Annu a l USMLE Step 1 Re v ie w Course May 14 - June 6, 2007 Huntington, WV Course I nformation:

17 da y course

Approx i m ate ly 120 lecture hours

8 a m - 4p m , Monda y - Frida y (no class on Monda y , Ma y 28 - - Me m or ia l D a y )

O v er 20 a w ard- w inn ing facu lt y w ith e xpert ise in USMLE Re v ie w

Access to JCES OM USMLE w ebsit e , includ ing pract ice e x a ms w ith fe edb ack

Cost: $1 ,500 per person (does not include hote l acco m m oda t ions) Space is limited to 100 registrants & guaranteed only after payment is received

Kaplan V isit w w w.k ap la n .co m for m ore infor m at ion. Liv e Prep courses a re 6 -7 w e e ks in le ngth . Price is $3 ,399 does not include food or acco m m oda t ions. S tep 1 Liv e Re tre a t price is $5 ,599 includes food and acco m m oda t ions. O th er progra ms are a v a ilab le .

Location Step 1 Atlanta Area Ja n . 8 - Feb. 17 , 2007** * Chicago Mar. 12 - Apr. 29 , 2007

Jun . 11 - Sep. 30 , 2007 * * Jun . 18 - Sep. 23 , 2007 *

Chicago Area Apr. 30 - Jun . 10 , 2007* * * Aug. 27 - Oct . 6 , 2007* * *

Dallas Area Aug. 6 - Sep. 16 , 2007* * * D.C. Ja n . 22 - Mar. 11 , 2007

Aug. 13 - Sep. 30 , 2007 Houston Apr. 23 - Jun . 10 , 2007

Oct . 1 - Nov . 18 , 2007 Miami Apr. 16 - Jun . 17 , 2007

Oct . 15 - D ec. 16 , 2007

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http://www.kaplan.com/

Newark (NJMI ) Ja n . 8 - Feb. 25 , 2007 Mar. 5 - Ju l . 8 , 2007 ** Aug. 27 - D ec. 16 , 2007* * Sep. 3 - D ec. 9 , 2007 * Oct . 1 - Nov . 18 , 2007

New York Feb. 26 - Apr. 15 , 2007 Jun . 18 - Aug. 5 , 2007 Sep. 10 - Oct . 28 , 2007

Pasadena Ja n . 8 - Feb. 25 , 2007 Ma y 21 - Ju l . 1 , 2007

Philadelphia Area

Ma y 29 - Ju l . 9 , 2007 ** *

*E x tendedPrep * *KMI * * *Step 1 Prep Re tre a t E v e n ings a nd W e e k e nds W e e k e nds on ly Step 2 Prep Re tre a t Note : An y of th e abov e Liv ePrep courses ca n be purch ased as part of a D e lux ePrep Pack age . University of Missouri at Kansas City I nstitute for Professional Preparation For m ore infor m at ion v isit h t tp : / / w w w.u m kc.edu / ipp / progra ms.asp January 8 to March 16, 2007 This 10 -week, highly interactive program is for students who have a history of difficulty with standardized tests; including multiple unsuccessful attempts at Step 1 . I t focuses on clin ica l corre la t ions in B ioch e m istry , Physio logy , and Pa tho logy , Microb io logy a nd m icrob io logy re la ted b ioch e m istry . Th ese are th e fie lds th a t t yp ica lly ca use e x a m in e es th e gre a test d ifficu lt y . O th er a re as included are An a to m y , Ph arm aco logy , E m bryo logy , G e n e t ics, B iosta t ist ics a nd Beh a v iora l Science . A t yp ica l sch edu le for Monda y through Fr ida y in vo lv es a n e ight hour da y . So m e w e e k e nd sessions are a lso sch edu led. Th is sch edu le includes a v arie ty of sm a ll group interact iv e instruct ion led by tra in ed sm a ll group facilit a tors a nd for m a l lectures prese nted by e xperie nced basic scie nce lecturers. Th e instruct ion a l progra m stre ngth e ns th e basic sciences background of a ll part icip a nts. Co m puteriz ed e x a m in a t ions per m it st aff , m e e t ing ind iv idu a lly w ith students, to a n a lyz e a nd m on itor stude nts progress as th e y approach th e ir e x a m in a t ion. Th e progra m includes : ( a ) person a liz ed d iagnost ics, (b) scre e n ing t est ing, (c) m ock boards, (d ) pa tho logy case stud ies, ( e ) clin ica l a nd funda m enta l ph ar m aco logy , ( f) co m puter based t est ing a nd (g) th e h a ll m ark of our progra ms, qu est ion group. Tuition is $6,400, housing costs are additional. May 7 to June 1, 2007 First time test takers and repeaters with scores at 168 or above. Th is progra m is m ost be n eficia l for a stude nt w ant ing a focused re v ie w of th e h igh i m pact top ics in a structured , qu est ion based for m a t . Th e Su m m er Progra m offe rs a n intensiv e four w e e k re v ie w of th e G e nera l Princip les of Pa tho logy , prese nted by a n a t ion a lly respected pa tho log ist ; cr it ica l clin ica l corre la t ions e xp la in ed in B ioch e m istry , Ph ar m aco logy , a nd Ph ysio logy a nd a Beh a v iora l Sciences / E th ics re v ie w. S tude nts interact w ith on e a noth er and th e instructors as th e y sort ou t concepts th a t th e y underst a nd inco m p le te ly . Q u est ion-based tu tor ia ls h e lp part icipa nts to de v e lop th e k ind a nd qu a lit y of th ink ing requ ired

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file:///Users/Scotty/Library/Messages/Attachments/f0/00/22064A7F-DCB3-447C-8B62-181CD433903E//D/Documents%20and%20Settings/twimmer/My%20Documents/Web%20Pages/javascript:parentWin('/Kaplan/Article/Medical_Licensing/Step-1/View-Kaplan-Programs/Comprehensive-Courses/IMG_step1_extendprep.html')file:///Users/Scotty/Library/Messages/Attachments/f0/00/22064A7F-DCB3-447C-8B62-181CD433903E//D/Documents%20and%20Settings/twimmer/My%20Documents/Web%20Pages/javascript:parentWin('/Kaplan/Article/Medical_Licensing/Step-1/View-Kaplan-Programs/Comprehensive-Courses/IMG_step1_kmi.html')file:///Users/Scotty/Library/Messages/Attachments/f0/00/22064A7F-DCB3-447C-8B62-181CD433903E//D/Documents%20and%20Settings/twimmer/My%20Documents/Web%20Pages/javascript:parentWin('/Kaplan/Article/Medical_Licensing/Step-1/View-Kaplan-Programs/Standard-Courses/IMG_step1_retreat.html')file:///Users/Scotty/Library/Messages/Attachments/f0/00/22064A7F-DCB3-447C-8B62-181CD433903E//D/Documents%20and%20Settings/twimmer/My%20Documents/Web%20Pages/javascript:parentWin('/Kaplan/Article/Medical_Licensing/Step-2-CK/View-Kaplan-Programs/Standard-Courses/step-2-ck-prep-retreat.html')http://www.umkc.edu/ipp/programs.asp

for success on Step 1 . D a ily sm a ll group lecture re v ie w sessions w ill a id in orga n iz a t ion a nd re t e n t ion . E m ph asis is p laced on understand ing of th e co m m on d ise ases a nd re la ted tre a t m ent reg i m ens. I n add it ion , th e progra m w ill prov ide a d iagnost ic, se lected sub j ect e x a ms, a nd a m ock board . Tuition is $3000. August 28 to October 20, 2006 (dates not yet announced for 2007) This 8 -week, live lecture program is designed both for first time test takers who desire a review of basic science concepts and for the student who has scored at 167 or above on Step 1 and who is planning on sitting for the USMLE Step 1 in early November. S tude nts w ith a h istory of d ifficu lt y on st andard iz ed e x a ms are m ore lik e ly to be successfu l w ith our longer prepara t ion progra m beg inn ing in Ja nu ary . As w ith a ll of our courses, focus on underst a nd ing th e m ateria l cov ered , pract icing appropr ia te t est t a k ing stra t eg ies, a nd app ly ing a ll sk ills acqu ired a nd conten t re v ie w ed in a co m puter based t est ing en v iron m ent . Th is liv e lecture progra m w ill include a re v ie w of Bacterio log y , Pa tho logy , Physio log y , I m m uno logy , V iro logy , a nd B ioch e m istry . Tuition is $4,600. Housing costs are additional.

FALCON PHYSICIAN REVIEWS For m ore co m p le te infor m at ion v isit h t tp : / / w w w.fa lconre v ie ws.co m / inde x .h t m . Complete review package includes:

Books Lu xury Hote l Acco m m oda t ions D a ily Cont inenta l Bre a kfast a nd Lunch O v er 325 contact hours (Step 1 ) O v er 15 ,000 USMLE Type Ex a m Q uest ions Ground transport a t ion to a nd fro m th e a irport . Shutt le Serv ice to shopp ing, m ov ies, a nd oth er a re as of interest

Step 1 Programs include infor m at ion fro m : An a to m y , H isto logy , B ioch e m istry , Microb io logy , E m bryo logy , Ph ysio logy , N euro logy , Ph ar m aco logy , a nd Beh a v iora l Science , p lus C lin ica l V ign e t t es, C ase H istories, G lossy S lides, a nd S a m p le Tests. REVIEW COURSE DATES for 2007: Ja nu ary 8 to Febru ary 23 - Course Full Ju ly 16 to August 31 Ma y 7 to Jun e 22 August 20 to October 5 Ma y 14 to Jun e 29 (Mia m i) October 1 to Nov e m ber 16 Ma y 14 to Jun e 29 (Ph ilade lph ia , PA are a )

Northwestern Medical Review For m ore infor m at ion v isit h t tp : / / w w w.northw estern m ed ica lre v ie w.co m / inde x .php ( fro m th e w ebsit e ) : North w estern Med ica l Re v ie w offers liv e - lecture courses in prepara t ion for th e USMLE a nd C OMLEX Step /Le v e l 1 , 2 a nd 3 e x a m in a t ions. Th ese courses a re design ed to a llow curren t m ed ica l students or gradu a t ing intern a t ion a l ph ysicia ns to pass th e ir e x a m in a t ions in th e ir first a t t e m pt or to ra ise th e ir pre v ious scores to a sa t isfactory le v e l. Re v ie w p la ns ra ng ing fro m a 3 -da y qu ick re v ie w course to a 15 -da y co m pre h e nsiv e

Unless otherwise noted, all courses are held in Dallas. Cost of course: double occupancy - $4,550; single occupancy - $5, 550.

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http://www.falconreviews.com/index.htmhttp://www.falconreviews.com/miami/index.htmhttp://www.northwesternmedicalreview.com/index.php

prep ara t ion a re a v a ilab le .

Courses a re t a ught by d ist ingu ish ed a nd e xperie nced m ed ica l boards lecturers, m a n y of who m h a v e a u thored best -se lling Northw estern Re v ie w books or h a v e m astered m u lt i m ed ia TALLP m ethodo logy .

Progra ms are offered at various m edica l schools or convention sites w ith in the USA, Caribbean Islands, and se lect sites in Asia and Europe. All courses include complete sets of study m ateria ls, ev iew books, pretests, audio CDs and USMLE web-based question bank access. r

NB I 300 (STEP I ) 10 , 15 , a nd 21 - D AY USMLE REV IE W

LO CATI O N D ATE

E ast La nsing, MI Ja nu ary 12 - 21 , 2007

E ast La nsing, MI Febru ary 13 - 22 , 2007

Ph ilade lph ia , PA E x tended W e e k e nd Pla n

Feb 24 - 25 , March 3 - 4 , March 10 - 11 , April 14 - 15 , April 21 - 22 , a nd Ma y 5 - 6 , 2007 S a turda ys and Sunda y m orn ings

E ast La nsing, MI Ma y 21- 30 , 2007

E ast La nsing, MI Jun e 2 - 11 , 2007

standard TUITI ON RATES

NBI 300 (21-day ) $1780

NBI 300 (15-day ) $1380

NBI 300 (10-day ) $1080

FOR STUDENTS W ITH DOCUMENTED LEARN I NG D ISABILITIES OR ADHD Marshall University Medical H.E.L.P Program For m ore infor m at ion v isit h t tp : / / w w w. m arsh a ll. edu / m ed ica lh e lp / ( fro m th e w ebsit e ) Th e Marsh a ll Un iv ersit y Med ica l H .E .L.P. Progra m bega n in 1986 w ith a v ision of h e lp ing m ed ica l students a nd ph ysicia ns w ith le arn ing d isab ilit ies a nd / or A D H D succe ed acade m ica lly . S ince th a t t i m e, Marsh a ll Med ica l H .E .L.P. h as work ed w ith approx i m ate ly 600 stude nts fro m across th e Un it ed Sta tes a nd se v era l fore ign countries. A fiv e w e e k intensiv e course is h e ld four t i m es e ach y e ar in Ja nu ary , March , Jun e , and Septe m ber, w ith ind iv idua l on e on on e sessions a v a ilab le the rest of th e y e ar. Throughout th e intensiv e progra m top ics such as re ad ing a nd co m preh ension , re ad ing ra t e , le arn ing stra t eg ies, m e m oriz a t ion t echn iques, t est - t a k ing sk ills, e rror a n a lysis, a nd se lf - est e e m are t a rge ted for i m prov e m e nt . This 5 -week course is held four times a year: January, March, June, and September. The cost is $4,500 and does not include accommodations.

16

http://www.marshall.edu/medicalhelp/

OTHER STUDY RESOURCES Th ere a re probab ly as m a n y m ore w ebsit es a nd books a v a ilab le th a n those th a t a re listed h ere . I f you find a book or w ebsit e th a t you find h e lpfu l, p le ase se nd it on to m e so I can include it in our list of resources. Re m e m ber th a t you ca n e asily ge t ov erw h e l m ed by using too m a n y resources as you study , so p ick out th e few th a t se e m to work best w ith your sty le of study ing a nd le arn ing a nd go w ith it . Wh a t works for on e person m a y not work for a noth er, so be carefu l about using a book just beca use so m eon e e lse sa id it work ed for th e m . Try it for yourse lf if it doesn t fit you , m ov e on to so m eth ing th a t does. A nu m ber of books are a v a ilab le for ch eck -out in th e Stude nt Affa irs O ffice library . For online question banks, review books, etc. w w w.usm lesteps123 .co m

w w w.usm lerx .co m

h t tp : / / w w w.e x a m m aster2 .co m / wdse ntry / t tuhsc-1 .h t m

w w w.score 95 .co m

w w w.boardprep .n e t / stepon e .h t m l

w w w.ape x test ing.co m

BOOKS

NMS Re v ie w for S tep 1

H igh-Yie ld Pa tho logy

Step Up : A H igh-Yie ld, Syste ms-B ased Re v ie w for USMLE Step 1

USMLE Step 1 Reca ll : Buzz words for th e Boards

H igh-Yie ld Co m preh ensiv e USMLE Step 1 Re v ie w

K ap la n Q Book

F irst A id C ases for USMLE Step 1

USMLE Step 1 Secre ts

F irst A id Q&A for USMLE Step 1

Go l j a n s Rap id Re v ie w of Pa tho logy

Robb ins Re v ie w of Pa tho logy

Pr ince ton Re v ie w USMLE Re v ie w

B lu eprints Step 1 Q&A

App le ton & La nge USMLE Step 1

Pla t inu m V ign e t t es (E lse v ier)

Rap id Re v ie w Series - USMLE Step 1

Study Schedules O n e of th e b iggest p ieces of adv ice th a t stude nts a nd e xperts a lik e g iv e surrounds th e ide a of de v e lop ing a nd st ick ing to a study sch edu le . Aga in, e v erybody h as th e ir own ide a of wh a t works for the m a nd wh a t doesn t , or wh at top ics n e ed to be stud ied m ore , bu t you a lso n e ed to h a v e a sta rt ing po int . Re m e m ber you m ust cre a te your own study sch edu le based on YO UR ind iv idu a l n e eds. Bu t h ere is a w ebsit e w ith PD F files of a doz en or so sa m p le study

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http://www.usmle123.com/http://www.usmlerx.com/http://www.exammaster2.com/wdsentry/ttuhsc-1.htmhttp://www.score95.com/http://www.boardprep.net/stepone.htmlhttp://www.apextesting.com/

sch edu les so you ca n ge t a n ide a of wh ere to st art m ost of th e m are about 4 w e e ks or so. h t tp : / / w w w.bu mc.bu .edu / D ept / Conte nt . aspx?D epart m e nt I D = 42&Page I D = 7554

Youll find a sample 28-day study schedule at the back of this book in Appendix B.

APPEND IX A USMLE Detailed Outline of Topics Covered on Step 1

GENERAL PRI NCIPLES

Biochemistry and molecular biology

ge n e e xpression : D NA structure , rep lica t ion, a nd e xch a nge o D NA structure : sing le - a nd doub le -stra nded D NA, st ab iliz ing forces,

superco iling o a n a lysis of D NA : sequ encing, restrict ion a n a lysis, PCR a m p lifica t ion ,

h ybrid iz a t ion o D NA rep lica t ion , m uta t ion , repa ir , degrada t ion , a nd in act iv a t ion o ge n e structure a nd orga n iz a t ion ; chro m oso m es ; ce ntro m ere , t e lo m ere o reco m b in a t ion, insert ion sequ e nces, transposons o m ech a n isms of gen e t ic e xch ange , includ ing transfor m a t ion, tra nsduct ion ,

con juga t ion, crossov er, reco m b in a t ion, link age o p lasm ids a nd bacterioph ages

ge n e e xpression : tra nscript ion , includ ing defects o t ra nscr ipt ion of D NA into RNA, e nzy m at ic re act ions, RNA, RNA degrada t ion o regu la t ion : cis-regu la tory e le m e nts, tra nscript ion factors, e nh a ncers,

pro m oters, sile ncers, repressa nts, sp licing ge n e e xpression : tra nsla t ion , includ ing defects

o th e ge n e t ic code o structure a nd funct ion of tRNA o structure a nd funct ion of riboso m es o prote in sy nth esis o regu la t ion of tra nsla t ion

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o post - t r a ns l a t io n a l m od if ica t io ns, inc lu d in g p h osp hor y l a t ion , a d d i t io n of C H O u n i ts

o prote in degrada t ion structure a nd funct ion of prote ins

o princip les of prote in structure a nd fo ld ing o e nz y m es : k in e t ics, re act ion m ech an isms o structura l a nd regu la tory prote ins : liga nd b ind ing, se lf - asse m b ly o regu la tory propert ies

e n ergy m etabo lism , includ ing m etabo lic sequ e nces a nd regu la t ion o gen era t ion of en ergy fro m carboh ydra tes, fa t t y acids, a nd essent ia l a m ino

acids ; g lyco lysis, pe ntose phosph a te pa thw a y , t ricarbox y lic acid cycle , k e toge n esis, e lectron tra nsport and ox ida t iv e phosphory la t ion, g lycoge no lysis

o storage of energy : gluconeogenesis, glycogenesis, fatty acid and triglyceride synthesis

o th er m ody n a m ics : fre e e n ergy , ch e m ica l equ ilibr ia a nd group transfer pote n t ia l, e n erge t ics of ATP and oth er h igh- e n ergy co m pounds

m etabo lic pa th w a ys of sm a ll m o lecu les a nd associa ted d ise ases o b iosy nth esis a nd degrada t ion of a m ino acids ( eg , ho m ocyst inuria , m ap le syrup

urin e d ise ase ) o b iosy nth esis a nd degrada t ion of pur in e a nd pyri m id in e nucleot ides o b iosy nth esis a nd degrada t ion of lip ids ( eg , dyslip ide m ias, carn it in e deficiency ,

adre noge n it a l sy ndro m es) o b iosy nth esis a nd degrada t ion of porph yr ins o ga lactose m ia a nd oth er sm a ll sugar d isorders

b iosy nth esis a nd degrada t ion of oth er m acro m o lecu les a nd associa ted abnor m a lit ies, co m p le x carboh ydra tes ( eg , lysoso m a l storage d ise ase ) , g lycoprote ins, a nd proteog lyca ns ( eg, t ype I I g lycoge n storage d ise ase )

Biology of cells

structure a nd funct ion of ce ll co m pon e nts ( eg , nucleus, cy tosk e le ton , e ndop lasm ic re t icu lu m , p lasm a m e m bra n e )

sign a l t ra nsduct ion ( includ ing basic princip les, receptors a nd ch a nn e ls, second m esse ngers, sign a l t ra nsduct ion p a th w a ys)

ce ll-ce ll a nd ce ll- m a tr ix adh esion ce ll m ot ilit y intrace llu lar sort ing ( eg, t ra ffick ing, e ndocy tosis) ce llu lar hom eostasis (eg, turnover, pH m a intenance, proteasom e, ions, soluble prote ins) ce ll cycle ( eg , m itosis, m e iosis, structure of sp ind le appara tus, ce ll cycle regu la t ion) structure a nd funct ion of basic t issu e co m pon e nts ( includ ing ep ith e lia l ce lls, conn ect iv e

t issu e ce lls, m uscle ce lls, n erv e ce lls, a nd e x trace llu lar m a trix ) adapt iv e ce ll response to in jury intrace llu lar accu m u la t ions ( eg, p ig m e nts, fa ts, prote ins, carboh ydra tes, m in era ls,

inclusions, v acuo les) m ech a n isms of in jury a nd n ecrosis apoptosis

Human development and genetics

e m bryoge n esis : progra m m ed ge n e e xpression, t issu e d iffere n t ia t ion a nd m orphoge n esis, ho m eot ic ge n es, and de v e lop m e nta l regu la t ion of ge n e e xpression

congen it a l abnor m a lit ies : princip les, pa t t erns of a no m a lies, dysm orphogen esis princip les of ped igre e a n a lysis, includ ing inh er it a nce pa t t e rns, occurrence a nd

recurre nce risk de ter m in a t ion popu lation genetics : Hardy-We inberg law, founder effects, m utation-se lection equ ilibriu m

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ge n e t ic m ech a n isms : chro m oso m a l abnor m a lit ies, m e nde lia n inh er it a nce , m u lt ifactoria l d ise ases

clin ica l gen e t ics, includ ing gen e t ic t est ing, pren a ta l d iagnosis, n e wborn scre e n ing, ge n e t ic counse ling / e th ics, gen e th erapy

Biology of tissue response to disease

infla m m at ion , includ ing ce lls a nd m ed ia tors o acute infla m m at ion a nd m ed ia tor syste ms o v ascu lar response to in jury , includ ing m ed ia tors o infla m m atory ce ll recru it m ent , includ ing adh erence a nd ce ll m igra t ion , a nd

ph agocy tosis o bactericida l m ech a n isms a nd t issu e in jury o clinica l m anifestations (eg, pain, fever, leukocytosis, leukemoid reaction, and chills) o chron ic infla m m at ion

repara t iv e processes o wound h e a ling, h e m ostasis, a nd repa ir : thro m bosis, gra nu la t ion t issu e ,

a ng iogen esis, fibrosis, scar / k e lo id for m at ion o rege n era t iv e processes

n eop lasia o classifica t ion, h isto log ic d iagnosis o grad ing a nd st ag ing of n eop lasms o ce ll b io logy , b ioch e m istry , a nd m o lecu lar b io logy of n eop last ic ce lls :

tra nsfor m a t ion, oncogen es, a lt e red ce ll d iffe re n t ia t ion , a nd pro life ra t ion o h ered it a ry n eop last ic d isorders o in v asion a nd m etastasis o tu m or i m m uno logy o para n eop last ic m a n ifest a t ions of cancer o ca ncer ep ide m io logy a nd pre v e nt ion

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

progression through th e life cycle , includ ing b ir th through se n esce nce o cogn it iv e , la ngu age , m otor sk ills, a nd socia l a nd interperson a l de v e lop m ent o se xu a l de v e lop m e nt ( eg , puberty , m e nopa use ) o influ ence of de v e lop m e nta l st age on ph ysicia n -pa t ient interv ie w

psycho log ic a nd socia l factors influ e ncing pa t ie nt beh a v ior o person a lit y tra its or cop ing sty le , includ ing cop ing m ech an isms o psychody n a m ic a nd beh a v iora l factors, re la ted past e xperie nce o fa m ily and cultural factors, including socioeconom ic status, ethnicity, and gender o adapt iv e a nd m a ladapt iv e beh a v iora l responses to stress a nd illn ess ( eg , drug-

se e k ing be h a v ior, sle ep depriv a t ion) o interact ions be tw e e n the pa t ie nt a nd th e physicia n or th e he a lth care syste m

( eg , transfere nce ) o pa t ie nt adhere nce , includ ing ge n era l a nd ado lesce nt

p a t ie nt interv ie w ing, consu lt a t ion , a nd interact ions w ith the fa m ily o estab lish ing a nd m a inta in ing rapport o da ta ga th ering o approach es to pa t ie nt educa t ion o e nt icing pa t ie nts to m a k e lifesty le ch a nges o co m m un ica t ing bad n e ws o d ifficu lt interv ie ws ( eg , a nx ious or a ngry p a t ie nts) o m u lt icu ltura l e thn ic ch aracterist ics

m ed ica l e th ics, j urisprude nce , and profession a l be h a v ior

20

o consent a nd infor m ed conse nt to tre a t m e nt o ph ysicia n -pa t ient re la t ionsh ips ( eg , e th ica l conduct , confident ia lit y ) o de a th and dy ing o b ir th -re la ted issu es o issu es re la ted to pa t ient part icipa t ion in rese arch o interact ions w ith oth er h e a lth profession a ls ( eg , referra l) o se xu a lit y a nd th e profession ; oth er boundary issu es o e th ics of m a n aged care o orga n iz a t ion a nd cost of h e a lth care de liv ery

Multisystem processes

nutr it ion o ge n era t ion, e xpe nd iture , a nd storage of e n ergy a t th e who le -body le v e l o assessm e nt of nutrit ion a l st a tus across th e life spa n , includ ing ca lories, prote in,

esse nt ia l nutr ients, h ypoa li m e nta t ion o funct ions of nu tr ie nts, includ ing essen t ia l , t ra ns-fa t t y acids, cho lestero l o prote in-ca lor ie m a lnutr it ion o v it a m in deficie ncies a nd / or tox icit ies o m in era l deficiencies a nd tox icit ies o e a t ing d isorders ( eg , obesit y , a nore x ia , bu li m ia )

t e m pera ture regu la t ion adapta t ion to e n v iron m e nta l e x tre m es, includ ing occupa t ion a l e xposures

o physical and associated disorders (eg, temperature, radiation, burns, decreased atmospheric pressure, high-altitude sickness, increased water pressure)

o ch e m ica l ( eg , gases, v apors, sm ok e inh a la t ion , agricu ltura l h a z ards, vo la t ile orga n ic so lv ents, h e a v y m eta ls, princip les of po ison ing a nd th erapy )

fluid, electrolyte, and acid-base balance and disorders (eg, dehydration, acidosis, alkalosis)

Pharmacodynamic and pharmacokinetic processes

gen era l princip les o pharm acokinetics: absorption, distribution, m etabolism, excretion, dosage intervals o m ech a n isms of drug act ion, structure - act iv it y re la t ionsh ips o conce ntra t ion- and dose - effect re la t ionsh ips ( eg , e fficacy , pote ncy ) , t ypes of

agon ists a nd a ntagon ists a nd th e ir act ions o ind iv idu a l factors a lt e ring ph ar m acok in e t ics a nd ph ar m acody n a m ics ( eg, age ,

gender, d ise ase , to lera nce , co m p lia nce , body w e ight , m etabo lic proficiency , ph ar m acoge n e t ics)

o drug side effects, ov erdosage , tox ico logy o drug interact ions o regu la tory issu es ( eg, drug de v e lop m ent , approv a l , sch edu ling)

gen era l propert ies of a u t aco ids, includ ing pept ides a nd an a logs, b ioge n ic a m in es, prosta no ids a nd th e ir inh ib itors, and sm ooth m uscle / endoth e lia l a u t aco ids

ge n era l princip les of a u tono m ic ph ar m aco logy gen era l propert ies of a n t i m icrob ia ls, includ ing m ech a n isms of act ion a nd resista nce ge n era l propert ies of a n t in eop last ic age nts a nd i m m unosuppressa nts, includ ing drug

effects on rap id ly d iv id ing m a m m a lia n ce lls

Microbial biology and infection

m icrob ia l classifica t ion a nd its basis bacteria a nd bacteria l d ise ases

o structure a nd co m posit ion

21

o m etabo lism , ph ysio logy , a nd regu la t ion o ge n e t ics o n a ture and m ech a n isms of act ion of v iru le nce factors o pa thoph ysio logy of infect ion o ep ide m io log y a nd eco logy o princip les of cu lt iv a t ion , assa y , a nd labora tory d iagnosis

v iruses a nd v ira l d ise ases o ph ysica l a nd ch e m ica l propert ies o rep lica t ion o ge n e t ics o princip les of cu lt iv a t ion , assa y , a nd labora tory d iagnosis o m o lecu lar basis of pa thoge n esis o pa thoph ysio logy of infect ion o la ten t a nd persisten t infect ions o ep ide m io log y o oncoge n ic v iruses

fung i a nd fung a l infect ions o structure , ph ysio logy , cu lt iv a t ion , a nd labora tory d iagnosis o pa thoge n esis a nd ep ide m io logy

parasit es a nd parasit ic d ise ases o structure , ph ysio logy , and labora tory d iagnosis o pa thoge n esis a nd ep ide m io logy

princip les of st eriliz a t ion a nd pure cu lture t echn iqu e

I mmune responses

product ion a nd funct ion of gra nu locy tes, n a tura l k iller ce lls, a nd m acroph ages product ion a nd funct ion of T ly m phocy tes, T- ly m phocy te receptors product ion a nd funct ion of B ly m phocy tes a nd p lasm a ce lls ; i m m unog lobu lin a nd

a nt ibod ies : structure a nd b io log ic propert ies a nt ige n icit y a nd i m m unoge n icit y ; a n t ige n prese nta t ion ; ce ll act iv a t ion a nd regu la t ion ;

to lera nce a nd clon a l de le t ion i m m uno log ic m ed ia tors : ch e m istry , funct ion , m o lecu lar b io logy , classic a nd a lt e rn a t iv e

co m p le m e nt pa thw a ys, cy tok in es, ch e m ok in es im munogenetics; MHC structure and function, class I , I I molecules; erythrocyte antigens i m m un iz a t ions : v accin es, protect iv e i m m un it y a lt e ra t ions in i m m uno log ic funct ion

o T- or B - ly m phocy te deficie ncies ( eg , D iG eorge sy ndro m e) o deficie ncies of ph agocy t ic ce lls o co m b in ed i m m unodeficie ncy d ise ase o H IV infect ion / A I D S a nd oth er acqu ired d isorders of i m m un e responsiv e n ess o drug- induced a lt e ra t ions in i m m une responses, i m m unoph ar m aco logy

i m m uno log ica lly m ed ia ted d isorders o h yperse nsit iv it y ( t ypes I IV) o t ra nsp la nt a nd tra nsp la nt re j ect ion o a uto i m m un e d isorders o r isks of transp la nta t ion, tra nsfusion ( eg , graft - v ersus-host d ise ase ) o iso i m m un iz a t ion, h e m oly t ic d ise ase of th e n e wborn o i m m unopa thoge n esis

i m m uno log ic princip les underly ing d iagnost ic labora tory t ests ( eg , ELISA, co m p le m e nt fix a t ion , RIA, agg lut in a t ion)

inn a te i m m un it y

Quantitative methods

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funda m e nta l concepts of m e asure m e nt o sca les of m e asure m e nt o d istribut ion , cen tra l t endency , v ariab ilit y , probab ilit y o d ise ase pre v a le nce a nd incide nce o d ise ase outco m es ( eg , fa t a lit y ra t es) o associa t ions ( eg , corre la t ion a nd cov aria nce ) o h e a lth i m pact ( eg , risk d iffe re nces a nd ra t ios) o sensit iv it y , specificit y , pred ict iv e v a lu es

funda m e nta l concepts of study design o t ypes of e xperi m enta l stud ies ( eg , clin ica l t ria ls, co m m un it y interv ent ion tria ls) o t ypes of observ a t ion a l stud ies ( eg , cohort , case -contro l , cross-sect ion a l , case

series, co m m un it y surv e ys) o sa m p ling a nd sa m p le siz e o sub j ect se lect ion a nd e xposure a lloca t ion ( eg , ra ndo m iz a t ion , stra t ifica t ion ,

se lf -se lect ion, syste m at ic assign m e nt) o outco m e assessm e nt o intern a l a nd e x tern a l v a lid it y

funda m enta l concepts of hypoth esis t est ing a nd st a t ist ica l inference o confide nce interv a ls o sta t ist ica l sign ifica nce a nd Type I error o sta t ist ica l pow er a nd Type I I e rror

__________________________________________________________ HEMATOPO IETIC AND LYMPHORETICULAR SYSTEMS

Normal processes

e m bryon ic de v e lop m e nt , fe t a l m a tura t ion, and perin a ta l ch a nges orga n structure a nd funct ion ce ll / t issu e structure a nd funct ion

o product ion a nd funct ion of e ry throcy tes, h e m og lob in , O 2 a nd C O 2 tra nsport , t ra nsport prote ins

o product ion a nd funct ion of le ukocy tes a nd th e ly m phore t icu lar syste m o product ion a nd funct ion of p la te le ts o product ion a nd funct ion of coagu la t ion a nd fibrino ly t ic factors

repa ir , rege n era t ion, a nd ch anges associa ted w ith st age of life

Abnormal processes

infect ious, infla m m atory , a nd i m m uno log ic d isorders o infect ions of th e b lood, re t icu loendoth e lia l syste m , a nd ly m ph a t ics o a llerg ic a nd a n aph y lact ic re act ions a nd oth er i m m unopa tho log ic m ech a n isms o acqu ired d isorders of i m m un e deficie ncy o a uto i m m un it y and au to i m m un e d ise ases ( eg , Coo m bs posit iv e h e m o ly t ic

a n e m ia , cryog lobu lin e m ias, ITP) o a n e m ia of chron ic d ise ase o t ra nsfusion co m p lica t ions, tra nsp la nt re j ect ion

traum atic and m echanical injury (eg, m echanical injury to erythrocytes, splenic rupture) n eop last ic d isorders ( eg , ly m pho m a , leu k e m ia , m u lt ip le m y e lo m a) m etabo lic a nd regu la tory d isorders, includ ing acqu ired a nd congen it a l

o a n e m ias a nd cy topen ias ( eg , iron deficie ncy a n e m ia , h e m og lob inopa th ies, h ered it a ry sph erocy tosis)

o cy th e m ia o h e m orrh ag ic a nd h e m osta t ic d isorders ( eg , coagu lopa th ies, D IC )

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o b le ed ing secondary to p la te le t d isorders ( eg , von W illebra nd) v ascu lar a nd e ndoth e lia l d isorders ( eg , effects a nd co m p lica t ions of sp le n ecto m y ,

h ypersp le n ism , TTP, h e m o ly t ic-ure m ic sy ndro m e) syste m ic d isorders a ffect ing th e h e m atopoie t ic a nd ly m phore t icu lar syste m ( eg,

nu tr it ion a l deficie ncies, syste m ic lupus ery th e m atosus) id iopa th ic d isorders

Principles of therapeutics

m ech a n isms of act ion, use , and adv erse effects of drugs for tre a t m e nt of d isorders of th e h e m atopo ie t ic syste m

o b lood a nd b lood products o treatm ent of ane m ia, drugs stimulating erythrocyte production (eg, erythropoietin) o drugs st i m u la t ing leu kocy te product ion ( eg , G -CSF, GM-CSF) o a nt icoagu la nts, thro m bo ly t ic drugs o a nt ip la te le t drugs o a nt i m icrob ia ls ( eg , a nt i m a lar ia ls, a n t i-H IV) o a nt in eop last ic a nd i m m unosuppressiv e drugs o drugs used to tre a t acqu ired d isord ers of i m m un e responsiv e n ess

oth er th erape ut ic m oda lit ies ( eg , sp le n ecto m y , ch e la t ing age nts, rad ia t ion th erapy for ly m pho m as, p lasm aph eresis)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

e m ot ion a l a nd beh a v iora l factors ( eg , d ie t , depression a nd i m m un e responses, b lood dop ing a m ong a th le tes)

influ ence on person , fa m ily , a nd socie ty ( eg , ch ildhood le u k e m ia ) occupational and other environmental risk factors (eg, heavy m etals, hydrocarbons, lead) ge nder a nd e thn ic factors ( eg , h erba l t re a t m e nts w ith bone m arrow depression)

CENTRAL AND PERIPHERAL NERVOUS SYSTEMS

Normal processes

e m bryon ic de v e lop m e nt , fe t a l m a tura t ion, and per in a ta l ch a nges, includ ing n e ura l tube deriv a t iv es, cerebra l v e n tr icles, n eura l crest deriv a t iv es

orga n structure a nd funct ion o sp in a l cord , includ ing gross a n a to m y , b lood supp ly , and sp in a l re fle x es o bra in st e m , includ ing cra n ia l n erv es a nd nucle i , re t icu lar for m a t ion, gross

a n a to m y , a nd b lood supp ly o bra in, includ ing gross a n a to m y and b lood supp ly ; cogn it ion , la ngu age ,

m e m ory ; hypoth a la m ic funct ion ; li m b ic syste m a nd e m ot ion a l beh a v ior ; circad ia n rh y th ms a nd sle ep ; contro l of e y e m ov e m e nt

o se nsory syste ms, includ ing propr iocept ion, pa in, v ision, h e ar ing, ba la nce , t aste , a nd o lfact ion

o m otor syste ms, includ ing bra in a nd sp in a l cord , basa l ga ng lia a nd cerebe llu m o a utono m ic n ervous syste m o periph era l n erv e

ce ll / t issu e structure a nd funct ion

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o a xon a l t ra nsport o e xcit ab le propert ies of n e urons, a xons a nd dendrit es, includ ing ch a nn e ls o sy nth esis, storage , re le ase , re upta k e, a nd degrada t ion of n e urotra nsm it t e rs

a nd n e uro m odu la tors o pre - a nd postsy n apt ic receptor interact ions, troph ic a nd growth factors o bra in m etabo lism o g lia , m y e lin o bra in ho m eostasis : b lood-bra in barrier ; cerebrosp in a l flu id for m a t ion a nd flow ;

choro id p le xus repa ir , rege n era t ion, a nd ch anges associa ted w ith st age of life

Abnormal processes

infect ious, infla m m atory , a nd i m m uno log ic d isorders ( eg , m en ing it is, m u lt ip le sclerosis, m y asth en ia gra v is)

t ra u m at ic and m ech an ica l d isorders ( eg , subdura l a nd ep idura l h e m ato m as, cord co m pression , periph era l n erv e in jury )

n eop last ic d isorders, includ ing pri m ary a nd m etast a t ic acqu ired m etabo lic a nd regu la tory d isorders ( eg , de liriu m , Re y e sy ndro m e) v ascu lar d isorders ( eg , cerebrov ascu lar occlusion , v e nous sinus thro m bosis, a rt e r ia l

a n e urysms, h e m orrh age ) syste m ic d isorders a ffect ing th e n ervous syste m ( eg , lupus, d iabe t ic n e uropa th y ) id iopa th ic d isorders a ffect ing th e n ervous syste m congen it a l d isorders, includ ing m etabo lic ( eg , neura l tube defects, cerebra l p a lsy ,

m e nta l re t a rda t ion, Down syndro m e) dege n era t iv e d isorders ( eg , per iphera l n e uropa th y , A lzh e i m er de m e nt ia , Park inson

d ise ase , Hunt ington d ise ase , a m yotroph ic la tera l sclerosis) parox ysm a l d isorders ( eg , ep ilepsy , h e adach e , pa in sy ndro m es, a nd sle ep d isord ers

includ ing n arco lepsy , rest less legs sy ndro m e / period ic li m b m ov e m e nt , circad ia n rh y th m d isorders, paraso m n ias)

d isorders of specia l se nses ( eg , b lindn ess, de afn ess) psychopatho log ic d isorders, processes a nd th e ir e v a lu a t ion

o e arly -onse t d isorders ( eg , le arn ing d isorders) o d isorders re la ted to substa nce use o sch izophre n ia a nd oth er psychot ic d isorders o m ood d isorders o a nx ie ty d isorders o so m atofor m d isorders o person a lit y d isorders o ph ysica l a nd se xu a l abuse of ch ildre n , adu lts, a nd e lders o other disorders (eg, dissociative, impulse control, post-traum atic stress disorder)

Principles of therapeutics

m ech a n isms of act ion, use , and adv erse effects of drugs for tre a t m e nt of d isorders of th e n ervous syste m

o a n esth e t ics o h ypnot ics o psychoph arm aco log ic age nts ( eg , an x io ly t ics, a n t idepressants, a nt ipsychot ic

agents, m ood-st ab iliz ing agents) o a nt icon v u lsa nts o a n a lgesics o st i m u la nts, a m ph e ta m in es o a nt ipark inson ia n drugs o sk e le ta l m uscle re la x a n ts, botu linu m tox in

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o n e uro m uscu lar j unct ion b lock ing age nts (postsy n apt ic) o a nt ig la uco m a drugs o drugs used to decre ase intracra n ia l pressure ( eg , m a nn ito l , h igh-dose

g lucocort ico ids) o a nt i m igra in e age nts o drugs affect ing a utono m ic n ervous syste m (eg, a n t icho lin esterases)

oth er th erape ut ic m oda lit ies ( eg , rad ia t ion , CFS shunt ing, surgery )

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

e m ot ion a l a nd beh a v iora l factors ( eg , drug abuse , de m e nt ia , sle ep depriv a t ion, accide nt pre v e nt ion, pe ts)

influ e nce on person , fa m ily , a nd socie ty ( eg , de v e lop m e nta l d isab ilit ies, de m e nt ia , ge n era t ion re v ersa l , nu trit ion, se izures, sle ep d isorders)

occupa t ion a l a nd oth er e n v iron m e nta l risk factors ( eg , box ing, carbon m onox ide e xposure )

ge nder a nd e thn ic factors

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