Step 1/COMLEX I Exam Survival Guide

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Congratulations! Welcome to one of the most exciting times of your medical school career: preparing for your first big exams. Although it may not seem like it now, you are about to learn a lot – about both medicine and yourself – and you will be able to look back on this time period in amazement at what you were able to accomplish.

I have drafted a list of some general advice for students preparing to study for Step 1. But as you prep, remember some key points. First, every student has his/her own way of learning that works best for them. Seek advice from multiple upperclassmen and integrate that advice into a plan that works best for you. Second, every school has its own unique way of approaching boards in terms of the amount of time you’ll have off and popular resources at that institution, so each approach will be different.

Resources
These resources helped as I studied for Step 1 – but this is by no means a comprehensive list.

When it comes to study aids, keep your list as small as possible while covering all of your bases. Obviously, the backbone of all Step 1 studying is First Aid for the USMLE. I bought the most updated version in December of the year before I took Step 1, had it spiral-bound at Office Max, and used that as my primary resource when studying. I annotated First Aid only so that I would be able to see all my annotations every time I read that one text. I used a four-colored pen: blue for pathoma annotations, green for sketchy micro, red for Q bank answers, and black for DIT information. Most of the information in these various resources is already in First Aid, so you do not want to be wasting time writing out extra information.

UWorld is a go-to question bank for your board preparation. I wanted to save that until I had already done some preparation so I could make the most of the higher order questions UWorld offers. USMLERx was a great first question bank to use because it focused primarily on fact recall and soaking up as much information from First Aid as possible – which I liked during my first pass.

Scheduling
Be as organized as possible to make the most of your studying. I utilized the online program Cram Fighter to make a daily schedule for me. The website combines all of your resources and creates a schedule in an order you choose. For me, I personally liked it as it gave me very specific tasks each day that I could check off as I went through my studying, which made each day seem less daunting and more manageable. At our school, we also started studying while in school, so it made balancing classwork duties with board prep duties very doable.

In terms of overall scheduling, I separated my studying into specific blocks based on my resources. This is another area that will be very different from school to school, depending on how much time off you get. For example, at our school, most of the board preparation is spread out over 5 months, with only a few weeks at the very end of very dedicated, complete time off.

My schedule had 4 “blocks,” or periods in which I prepared. The first 2 blocks consisted of 2 complete passes (one pass each block) through First Aid, Pathoma Videos, and Sketchy Micro bugs. I utilized USMLE-Rx during the first block and switched to UWorld after I had completed the first pass and gained a comfort level with the material. Both of these blocks occurred while still in school. The first one was over a slightly longer period, allowing for difficulty with the first pass through materials. The third block was where I completed the Part 2 section of my Doctors In Training prep course.

When it comes to board prep courses, there are again many different options and many people do not utilize one at all. At my school, DIT was very common and used by the majority of people. I felt I would like the structure, and it would help identify weak areas for me. I liked it, but I also felt the other resources had been utilized well and could have done without.

The final “block” was in the last week before my test, when I did a complete final pass through First Aid. This is where all the magic happens. By annotating every single thing over those 5 months into that one book, this final pass allowed me to once again see all I had studied previously. Each day, I made little scratch sheets of either information I often forgot or very specific facts to review at the end of the day. The final pass can be scary because it seems there is a lot you still do not know, but it is impossible to know everything, and you have to remind yourself that.

Practice, Practice, Practice
In my opinion, the single best way to prepare for boards is utilizing question banks. They will help you become comfortable with higher level thinking and knowledge application like you’ll need on the actual test day. In addition, practice exams like NBME are a great way to assess yourself. I even had some NBME questions show up on my actual exam. Some of the NBMEs will undershoot your score, while the later ones are the most accurate – so save those for closer to the test. The UWorld practice exams are good too, but they often will overshoot your test score. I did the majority of these within the last 6 weeks before my tests.

For Osteopathic Students
As an osteopathic student, I took both the USMLE and COMLEX exams. First and foremost, TAKE BOTH EXAMS. All it will do is open doors. You are trying to make sure your application is viewed similarly to your allopathic counterparts. I took my USMLE on a Thursday, took Friday completely off to recoup, and then studied Saturday through Monday for my COMLEX the following Tuesday. I did not do any COMLEX-specific QBanks during my prep; instead I answered questions from Savarese “The Green Book” between my tests in addition to reading that cover to cover.

The tests are very different, so be forewarned. USMLE is much more higher level thinking with complex questions, but fewer total questions during a shorter test. Although tougher, this style of exam can allow you to work through some questions that you may not immediately know for certain. COMLEX is a much longer, more exhausting test with more questions. The questions are much more fact recall (either you know the answer or you don’t). Also, in my opinion, I felt they highlighted much more obscure medicine, such as obscure parasites or OMM techniques not covered in Savarese. Everyone will have a test they prefer, but, I promise that studying for one will prepare you well for the other. I focused primarily on Step 1 as my primary target, and I did not feel disadvantaged when it came to COMLEX.

Final Advice
I know there is a lot of information, but hopefully it will help some of you get a general sense of what is to come this spring. Talk to multiple upperclassmen you trust to see what advice is going to work best for you individually based on your study techniques and school schedule. Another piece of advice I would have is to find a study buddy! It can be great to have someone to keep you on track and review questions. My study buddy and I tested on the same day and took practice exams around the same time, so we could keep each other honest and compare how effectively we were studying. Also, it helped that we both wanted to do well but were going into different specialties.

In addition, I advise everyone to have an outlet during this stressful period. Whether it’s working out or listening to music, find something to decompress during this time period. Every person around you will be studying something different and in a different way. You should zone in on your goals and what is working best for you. Finally, although this may sound corny, I always tell students to wake up every day and remind yourself how awesome medicine is and how cool the information you are learning is. It is much easier to remember the material if you are actively engaged and interested in it while you are studying it.

Best of luck when studying this spring! Clerkship life is awesome, and you are almost there!

Michael Messina, MSIII

Michael Messina, MSIII

Mike Messina is the 2017-2018 Great Lakes Representative to the EMRA Medical Student Council. He attends Ohio University Heritage College of Osteopathic Medicine Dublin.
Michael Messina, MSIII

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