A survey of the top study resources for the first two years of med school.
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There are hundreds of resources available to help you study with new onespopping up every year, so it’s important to narrow in on the best. Here is ashort list of the best resources I used during the didactic portion of medschool. I cover various approaches to learning: review texts, memory palaces,video lectures, spaced repetition software, physical note cards, and more.
Every student uses
There is no resource that will cover 100% of the NBME STEP1 exam, so you’llpull from various sources. Don’t fall into the trap of thinking your gradeswill improve if you have more resources; you’ll get spread thin. Better tofocus on knowing a few good resources thoroughly, and then picking pieces fromother resources as needed. That said, here are three resources every medicalstudent uses for the boards.
First Aid for STEP1
- Content review for entire exam
- Everyone taking STEP1 purchases a copy of this.
- Everything you need to know to pass. Not a good primary learning tool, butan excellent outline review.
- Often referred to simply as First Aid or FA
- New editions come out every January. This is the book you will likely spendthe most time with in the months leading up to STEP1.
- Consolidate resources: annotate other resources (Pathoma, Firecracker, etc)into this so you’re not spread among five review books.
- Don’t write every random fact or you’ll clutter out the important things.This book is already distilled down to high concentration; only add a factif it really helps clarify or was a key to some practice question.
- You’ll definitely want a hard copy to annotate, but also a digital copy fortext search
- You’re going to spend a lot of time with this book and carry it everywhereyou go. Consider cutting off the binding so you can put it into a 3-ringbinder for protection and to easily lay flat. Staples/OfficeMax will punchholes for $3, but be sure to ask them to slice very close to the binding,otherwise you lose some of the inner marginal text.
- For each module in school, pull out only the relevant section and use aslim folder.
- Since I had a PDF of the original, anything that wasn’t actual studymaterial was thrown away: all pages from front cover until BehavioralScience, all pages after Rapid Review. This cut out over a hundred pages.
Pathoma
- Concise video lectures covering all relevant pathology along with a slimreview text
- About 1.5 - 2.5 hours of video per organ system
- Highly, highly recommend (you’ll also see it highly recommended in First Aidresource recommendations appendix)
- Purchase the longest possible subscription (eg. 21 months) because you’llkeep coming back to these videos during your modules and especially in therun up to STEP1.
- Record audio so you can listen while you commute or exercise
- Combine with Goljan’s lectures to get multiple views of keytopics. Sometimes one explains it better than the other. Goljan givesgreat cross-cutting explanations, particularly with respect to nutrition andbiochemistry, topics Pathoma does not cover.
- During each block, watch each video three times. Watch at 1x to learn,and then a week later at 1.3x or 1.7x to review, and finally once morebefore the exam. Whenever I get tired of doing questions, popping up aPathoma video is an easy step down that still keeps me productive.
- In your 1x pass, underline in your book the things Sattar emphasizes in hisslides. If he draws a diagram, draw it in your book’s margin. Forsubsequent passes at 1.3x and 1.7x, just sit back and absorb the slides.
- Read more on other pathology resources.
USMLE World
- The official practice question bank of USMLE
- 2618 questions total
- bank of 2250 questions
- two self assessment exams (184 questions each for a total of 368 questions)
- Explanations are of the highest quality
- various purchase options
- Purchase about 30-90 days out from your STEP1 date
- Organize your classmates to get a group discount
- When you hit dedicated STEP1 study time, you must do every question in thisqbank at least once. Many students go through twice.
- For your modules, you’ll want to purchase theUSMLE-Rx or Kaplan qbanks
- Tips:
- Under “Utilities → Preferences”, set your defaults to “Tutor”, “Unused”,and pick a font.
- It’s a buggy Java app, so be sure to close and restart every day. If youleave it open for days in a row it’ll start bogging down.
Most students use
The three resources above will provide the most comprehensive coverage in thefewest number of resources. You should be spending the vast majority of yourdedicated STEP1 study time focused on those three. Everything else here is tolearn throughout your regular curriculum or hit your hot spots during yourdedicated period.
Beyond those, nearly all students pull from a few additional resourcesthroughout their coursework. The following is a survey of resources. Choicesdepend on your weaknesses and learning style.
Firecracker
- Flashcard software prepoplated with STEP1 material (a combination of FirstAid, Goljan, etc.)
- Spaced repetition algorithm to optimize when to reviewwhat information. Simply reviewing your books and notes from the first pageonward is terribly inefficient; spaced repetition algorithms optimize yourreview schedule.
- As you cover material (daily) you add it to the question pool (flag it).
- The “practice simulations” are very low quality; stick to Rx/Kaplan/UWorld
- Learn the keyboard shortcuts (when you’re doing a quiz, there’s a littlelaptop icon on the bottom right)
- Anki is a similar and better tool for its design and feedback metrics, butFirecracker is better overall for medical students because it isprepopulated saving you hundreds of hours of reinventing the wheel by makingyour own cards or hassling with those from others.
- A big downside to Firecracker is the lack of figures and images:everything is text-based. This makes it especially hard when it comes tobiochemical pathways or anything in First Aid with a diagram. Think of allthe figures First Aid has; Firecracker has none of those. Any figures theyhave are picked off random websites, likely to avoid copyright fees.
- While comprehensive, another downside of Firecracker is moderate quality,relative to some of the more highly edited resources like First Aid, UWorld,Kaplan, Rx, Goljan, etc. Firecracker is written by senior students andresidents, and as such it uses inconsistent formatting and very oftenincludes extraneous detail. I was often frustrated by what seemed like itsfocus on pedantic details. The spaced repetition algorithm is absolutelythe best strategy; however, the content of Firecracker needs improvement.That said, Firecracker appears to be evolving and improving faster than anyother resources in this list. They listen to customer feedback and dailymake edits and improvements.
- I probably spent half of my pre-boards time in medical school learning withFirecracker, although for various reasons, I would not spend that much timeif I had to do it again. Read more onhow I use Firecracker.
- Ken Noguchi writes about his use of Firecracker.The Firecracker blog has a lot of (biased?)casestudiesfromcustomers.
Lippincott’s Microcards
- Flashcards that show a vignette, key symptoms, diagnosis, treatment, andhigh yield facts.
- Covers about 140 bacteria, viruses, fungi, protozoa, and helminths.Everything is relevant for STEP1.
- Underline and annotate to emphasize key facts. As with adding to any reviewresource, be careful not to add too much. It’s okay to add a small tablecontrasting against other bugs, but be careful to not add low-yield randomfacts that will clutter the card.
- Combine these with Picmonic
Picmonic
- ~800 static memory scenes with audio tutorials
- $250 for 12 months, or $25/month
- I use this only for spot memorization (eg. pharm, vasculitides, micro,viral) rather than conceptual material (eg. pathophysiology)
- Whenever I hit something I have trouble recalling, I skim the picture inPicmonic or queue it up in a review play list.
- I only use the Learn feature (not Explore or Quiz)
Videos
- YouTube is a treasure trove of focused topical videos.
- Each module, create a playlist and add videos as you come across them.Here are ones I collected.
- Browse and subscribe to various channels and playlists out there:
- These were especially useful for anatomy:
- Handwritten Tutorials(YouTube) - Excellent, simplevideos of key topics in anatomy, biochem, immunology, neuroscience, pharm,and physiology.
- Khan Academy has been building up a great collection of videos in biology,cells, cellular respiration, immunology, human biology,physiology, and more.
- Teddy Has An Operation forthose interested in going into surgical specialties
Question Banks
USMLE World is the best choice for STEP1 dedicated study, but youwant to save it until that time. Throughout the year and even at the start ofyour dedicated study period, you’ll want to work through either of thefollowing standard question banks.
Until you get close to STEP1, do questions in Un-timed Tutor Mode. Thisallows you to take your time, look up things if you choose, and get immediatefeedback. When you get a few weeks out from STEP1, then you want to do timedtests to work in endurance and pacing. Several times I accidentally createdblocks that were timed; Rx lets you delete them from the web interface, butyou have to email Kaplan to delete these tests.
USMLE-Rx Qmax
- 2524 total questions
- Written by the authors of First Aid, answer explanations show pages fromFirst Aid so consider this a companion qbank
- 12mo subscription is $149 with $50 discountafter freeAMSA membership(regularly $199)
Kaplan
- 2006 total questions
- $210 with AMA membership ($20) for a total of $230
- regularly $300 without AMA membership)
- answer explanations contain links to video and other media, as well as scansfrom pages in medEssentials for USMLE Step 1
- terrible customer support
Comparing Kaplan and USMLE-Rx
- Kaplan has the best explanations. Rx is more straight forward for learningFirst Aid.
- Kaplan’s explanations tend to teach broad lessons about the questiontopic, including details and links tomedEssentials for USMLE STEP1, occasional videos, andbetter explanations of why answers were wrong relative to the correctanswer. Best of all, Kaplan often takes the opportunity to review alarger portion of the relevant pathophysiology. Rx tends to just statefacts relevant to the immediate question. Don’t skip the Kaplan “ReKaps &Refs”; they’re golden.
- Kaplan is harder than Rx. Kaplan often seems pedantic, usesdescriptive terms not in First Aid, and uses images of histology/culturethat look very different from First Aid, but if you get good at Kaplan,you’ll probably know the material nuances better than with Rx. I found myKaplan scores slightly lower than my Rx scores, but I always felt like Iknew the material better after Kaplan. Avoid favoring Rx over Kaplansimply because your scores are better with Rx. Read another student’sreview on Kaplan.
- Kaplan regularly uses second-order questions, and some are eventhird-order. Rarely will you find a straight recall question in Kaplan(first-order). In contrast, Rx is full of first- and second-orderquestions, but no third-order. In this way, one Kaplan question covers2-3 layers of information while an Rx question only covers 1-2. UWorldhas zero first-order questions, so its complexity is more like that ofKaplan.
- Rx ties directly into FA (the explanations literally show you the relevantFA pages). Use it as a way to learn FA, but it’s lacking those broadlessons that Kaplan explanations often emphasize.
- Both provide about the same level of post-test analysis.
- Rx has a better user interface.
- Rx is a clear winner here: smooth web interface (HTML), but poor iOS app.
- Kaplan has a terrible interface (Flash) and even worse iOS app. If I hada nickle for every time Kaplan froze or logged me out, I’d have bought alot of coffees.
Ultimately, I ended up using both qbanks a lot because I found it great to seeinformation from multiple perspectives. I used Rx mostly during the schoolyear to learn FA, and I used Kaplan mostly during the dedicated STEP1 studyperiod before switching to UWorld. Whenever pressed for time, I used theKaplan bank to cover more material per question.
First Aid Q&A for USMLE Step 1
- 1000 questions organized into basic principles and organ systems, plus afull length exam.
- Consider buying a paper-based question bank because sometimes it’s nice tostudy without your computer or outside on a sunny day.
- I’ve found maybe 10% of these questions duplicated in USMLE-Rx Qmax
- I sometimes use these as throwaway pretest questions early onin a module to “prime” my brain for key concepts to be on the lookout for.
- Much like USMLE-Rx, but great for when you want to put your computer asideand knock out extra questions.
Anatomy
- Netter is the gold standard and has all the classic diagrams you’ll see inlectures, eg. cervical plexus. Atlas of Anatomy 2e is also great, butprobably best to stick with Netter.
- To learn anatomy, skip anatomy lectures. They go too fast to actuallylearn. Instead drill with Netter Flashcards and online videosso you can pause and memorize as needed. For each exam, put all therelevant cards on the ring and flip through those as you can.
- The educational value of stabbing yourself. I found that using my ownbody to learn made the experience more vivid. If I stabbed myself in theback below the floating rib, what would I hit? Trace the pathway ofnerves/arteries/veins on your own body. Watch as you flex specificmuscles. All the while imagine what’s going on under the hood. (Don’tactually stab yourself, but just use your imagination.)
- U Michiganhas detailed explanations of various dissections along with relevant quizzes.
- Buy the recommended Clemente dissector and Netter atlas, same editionrecommended. This way you match the lecture slide references.
- As a table, buy two dissectors and two atlases to leave in the lab.
- Personally buy Netter for home study (keep it for life).
- Consider getting a second copy of the dissector for personal prep (not agooey lab copy)
- Only buy two (2) dissecting kits for your entire table and share. Make sureyou have two of everything: scalpel, small & large scissors, small & largehemostats, small & large toothed & non-toothed tweezers (pickups).
- Consider buying your ownfresh lab coatinstead of using the stained used ones. Write your name prominently on thecollar or front. Personalize as inspired.
Buythick multi-colored friendship bracelet stringto tag arteries, veins, nerves, muscle, etc. Regular sewing thread is toothin and you’ll want multiple colors. Keep it in a ziplock bag.
Studying
Here are a few blog posts from others that influenced my thinking aboutstudying and productivity in med school.
Find more tips and tricks in “Med School Strategy”
Pathoma Youtube
Step 1
- Effect of Popular Study Resources on USMLE Step 1 Performance - tl;dr: question banks are the most effective and efficient study method
- How To Study Effectively -comprehensive guide from UC San Diego on an organized and active approach tostudying in med school
- Erik Reinertsen describes his approach in the weeks leading up
- Ken Noguchi on STEP1 -covering his experience with Firecracker, Pathoma, and UWorld
- What do your class top 10% do differently? (r/medicalschool)
General study methods
- Scott Young:How to ace your finals,Learn Faster and Better
- What Do Top Students Do Differently (from me)
Beyond Medical school
- White Coat Investor -about managing student debt, investing, insurance, budgeting (not about studying)
Anki
- Excellent software and performance feedback graphs, but you have to spendtime populating. Firecracker is prepopulated.
- Good for hot spot memorization of tables/charts (eg. drugs, cytokines,vitamins) but not recommended for general use since pre-populated resourcesexist
- Excellent advice on how to make the best cards:Anki: 10,000 cards laterand20 Rules of Formulating Knowledge.
- Some prepopulated decksalreadyexist for the“Rapid Review” tables in FirstAid.Pharmacologyis one great use for this.
- Better graphs than Firecracker to chart progress
- Downside: Lacks good methods for sharing/updating decks with classmates
- Everyone I know who used this eventually abandoned because of time involvedin creating and curating decks
Goljan STEP1 audio
- A series of lectures as part of a boards review course he conducted
- These lectures were delivered with the first edition ofRapid Review Pathology text, but you can still follow along in the latestedition. The slides and a scan of the original textbook can be foundonline.
- Full of board pearls since he helps edit the USMLE questions. While most ofthe pathognomonic stuff is outdated and boards questions rarely use suchclassic tip-offs, the concepts are still valid and tested in similar ways.
- It’s thorough but not well organized, but makes for good backgroundlistening while running errands, doing chores, or exercising.
- Comparing against Pathoma:
- Pathoma is more updated, organized, and focused.
- Goljan covers biochemistry, fluids, nutrition, and other important STEP1concepts not included in Pathoma.
- Goljan often makes cross cutting connections between topics which providesmore context than Pathoma.
- While studying for STEP1, I regularly would get a question only because Ihad heard it in a Goljan lecture while working out earlier that same day.
- I highly recommend watching Pathoma at your desk at high speed andlistening to Goljan while you’re working out.
First Aid Basic Sciences
- A companion to First Aid for STEP1, but this is a learning tool.
- Covers all basic science in First Aid, but is due for an update compared to FA.
- You could probably get by purchasing this instead of the random specializedand overly-detailed books that professors recommend. The exception isLilly’s Pathophysiology of Heart Disease, an absolutely fantastictext for your cardiology module.
Pathoma Mp3 Download
Other pathology resources
- BRS Pathology
- Concise and well-organized review
- Simpler than Pathoma
- Each chapter has about 20 solid questions
- Goljan’s Rapid Review Pathology
- The same topic sequence as Pathoma but much more detail, especially whenit comes to microbiology, but not as much as Robbins & Cotran (aka “TheBible of Pathology”, get this if you’re interested in Pathology as aresidency).
- Further on in the curriculum, I realized I wanted more details and aalternative view on pathology so I started skimming chapters from this butPathoma is sufficient for a good foundation.
- The first edition of this text is what his audio lectures arebased on
If you had to rank order the complexity of these resources: BRS < Pathoma <Goljan’s < Robbins & Cotran. Pathoma is more than enough for STEP1.
How I use Firecracker
When you fall behind
Sometimes I fall behind and the question load can be overwhelming. Here aresome strategies:
- Put in the time. There’s no substitute to just putting in the time.Glancing at the info and rating it a 1 is better than ignoring it forever.Try to just remember one bit of info and then move on.
- Do Fewer questions. Narrow the scope of a quiz. Otherwise, you mightfeel like you’re getting punched from every direction as random topics hityou.
- Above the calendar, click “More Options” > “Do Fewer Questions”.
- Spread out questions. Spread over the coming days/weeks.
- You can only spread Review and Catchup questions (not Study).
- Above the calendar, click “More Options” > “Spread Out Questions”.
- Switch to Normal Mode. Focus on a smaller set of the highest yieldmaterial.
- Normal mode contains about half the number of questions.
- You still get the benefit of reviewing topics according to how strong youare, and you can always take a moment to review the full topic and all itssub-topic details that you might have been tested on in Legendary Mode.
- To switch learning modes, click the doctor icon in the top-right >“Account & Settings” > “Settings” > “Normal Mode” (default is “Legendary”)
- Your flagged topics, notes, and history will all remain.
- In the months leading up to STEP1, I switched to Normal mode so Icould hit the high points but start spending more time with qbanks andother resources.
- Check STEP1 only. No need to include STEP2 (3rd year) questions.There’s a lot of overlapping coverage and you’ll be fine with just STEP1.This is also under “Account & Settings”.
- Uncheck topics covered better elsewhere. Pathoma is better at pathologythan Firecracker, so I ended up un-checking many of these topicspost-module. Physiology was also another item I unchecked. Firecracker wasbest at brute memorization of micro and pharm.
Long term value proposition
The real value of Firecracker comes after months of use. It surprised me howmuch I retained from past modules because Firecracker forced me to touch onthings now and then. I’d say that half its value can be realized for learningin your present module, but half its value is longitudinal over all yourblocks. Put in the time to review old material.
Put in the time
There are no short cuts to simply putting in the time to actually learn.Merely owning Firecracker or any resource won’t make you a better student.The hard reality is that you have to put in the time.
With Firecracker, there’s a lot of upfront work of slogging through questionsbefore you start to reach steady state maintenance mode. As long as you’reflagging new topics a few times a week (as you’re going through new material),it’ll be a battle to keep that number down.
Pathoma Free Trial
You need to spend time on weekends and vacations chipping away at questions,or they pile up.
Recording audio from video
As I watched Pathoma and Picmonic, I recorded the audioto mp3 so that I could listen to it while commuting, exercising, or doingchores. While lacking the visual experience it’s a way to eek out a littleextra learning as you exercise your visual recall. The audio will make littlesense unless you’ve spent time watching the videos to pick up the mentalimagery.
- Install Audacity to record and export audio
- Install Soundflowerto channel audio from your browser to Audacity
For listening on the go, I recommend Jarv NMotion Sport Wireless Bluetoothheadset. They’re inexpensive and it’s super convenient to not have cordsgetting tangled while you’re on the go. For listening at your computer, Irecommend Audéo earbuds - expensive, but excellent quality and snug fit.
Convert your mp3s into a podcastto use the podcast apps which often have the feature to rewind 15 seconds soyou can hear a key fact repeated. This is especially true for iOS where thedefault Music app is not designed to listen to tedious hour long lectures. Ifyou use Dropbox to host all the files, be sure to change thedownload link ending to ?dl=1.Validate your feed to troubleshoot.
Record settings
- Audacity
- Set the microphone to Soundflower (2ch), Mono
- Enable ‘Sound activated recording’ so you won’t have to start/stop/trim;it’ll just start when the video starts, and stop when the video stops.
- Audacity: Preferences > Recording > enable ‘Sound activated recording’
MP3 export settings
- How I name MP3s from each service (ID3 info): Artist / Album / Track
- Pathoma / chapter / topic
- Picmonic / organ system play list / vignette
- Encoding settings
- Install either LAME or FFmpeg
- 22 KHz sampling, (fast) variable 65-105 kbps, mono
Sometimes when I pull my headphones out, this setup gets in aweird state where I have no sound. When this happens, ensure theSoundflower icon in menu bar is set for 2ch output to be “Built-in Output”.Usually this fixes the situation.
Thanks to classmates Evan McClure and Giacomo Waller for tips on recording MP3s