I depended a lot on forums for people's views and comments on preparation and this is my two bits. Its going to be a bit all over the place, so bear with me. Also, dont read any further if you are not interested in taking the MLE because its basically really boring.
Preparation time: My opinion is you could do one of two things - spend six months preparing or spend one month. I think anything in between is a bit useless and low value. I made the mistake of working in fits and starts - in the end I spent about 4 weeks studying at about 4 hours a day average which is not enough.
Pre-study preparation: I advise spending about 2 days reading all the forums available to get an idea about what is available and come up with a plan of what you want to achieve and how to go about it.
Text Resources: I would use First Aid (FA) for study outline. Most of the areas they touch on is covered by the exam, but their content is nowhere close to sufficient. Here is my list for the subjects:
Microbiology - Kaplan notes are quite extensive. I found FA very good for a quick revision. Correlate it with every system you read. Correlate it clinically as well - causes of UTI,Pneumonia,Wound infections etc. Also, know everything about HIV/AIDS, especially opportunistic infections.
Immunology - I think you need to have a very fundamental understanding of the subject. I did not really study it at all - hoped that teaching and doing a PhD might help. It did not!!
General Pathology - Robbin's Pathology is what I skimmed through, but would recommend as standard book. Emphasis on oncogenesis seems extraordinarily high. If you ask me its slightly absurd testing me on the transcription factor responsible for aniridia, but thats what the Board wants. Understand how oncogenes,tumor-suppressor genes work. Also, I looked at all the pictures in Robbins. Cancer in every system is frequently asked so you have to know everything about everything.
Pharmacology - crucial you understand basis of neurotransmission, G protein etc. Kaplan notes in Pharmac and Biochem cover this ground well. Also, I did not read Kaplan for system pharmac but used Lippincott's review of Pharmacology + kaplan + FA for new drugs.
I usually studied Pharmac with Physiology although I found that I spent too much time on Physiology and not enough on Pharmac. I think you should study them separately.
Physiology - you have to read a good text book. Kaplan is very good for Endocrine,reproductive sciences but for the other systems I referred to bits of Ganong and some other textbooks.
It is absolutely vital that you understand the physiology of every system as most questions on pathophysiology cannot be prepared. Usually the question will ask you about parameters you have not really thought about. For example, in a question about secondary parathyroidism I was asked about Vit.D functions which was difficult as I had not thought about it.
Anatomy - mainly clinically relevant anatomy is asked. I spent a day on Anatomy and used Snell to study. Neuroanatomy is good in Kaplan Anatomy.
Embryology - again there are a few must know facts. Use FA for that. Clinically relevant embryology and defects I used USMLE Review Embryology.
Statistics,Behavioural sciences,Psychiatry - I think FA is more than enough but you must know everything in FA. For Stats do a lot of questions to understand the concepts.
Biochemistry & molecular biology - This is the hardest part of the part 1 exam. They really ask you some difficult questions. There were a few questions I could answer based on working in a lab for four years but there is no doubt that I would not know any of the answers otherwise.
I enjoyed reading the Kaplan notes which I think are detailed enough for a first read and then back it up with lots of questions.
Question Banks: As with most such exams, the best preparation is questions galore. The way to start is to do about 200 questions like an exam. Then spend a day analysing your results. Break it down into questions you guessed,did not know and were absolutely sure about. Then sub stratify them subjectwise. Now that you know what you think you are good at or poor at, make a study plan. Its critical to study smartly. For example, there is really no point studying a pyschiatry text book when only about five questions are asked and you can answer them anyway. I spent an inordinate amount of time on Microbiology but thats because I realised a large number of questions are asked in various forms.
Which qbank is the best?
After spending some time reading about other people's experiences and also my own experience of three qbanks, my answer to this question is - "It depends". ( I am a good scientist and as all scientists will tell you, the answer to every question is "it depends")
On what? I think two things:
1. How much time you have - If you are spending six months or more to prepare, an unlimited budget then do every question bank you can lay your hands on. If not,then I would argue for a more circumspect strategy.
2. How much money you are willing to spend -
I did questions from - Kaplan QBank, USMLE Rx (this is the web version of First Aid),Kaplan Q Book, First Aid q book and Appleton Lange Question book.
Of these -
USMLE Rx is very good for factual learning and reasonably cheap $59 for 1 month. It is not remotely similar to the actual exam. I used it to memorise facts and do questions topic wise and make sure I cover most topics. They do not have a very big collection of epidemiology,biostats and behavioural sciences questions but otherwise they are ok. I mainly used it as a guide to topics in every system I must not forget to study.
The Kaplan Q book is ok and again use it after you finish studying a particular topic. The First Aid Q book is terrible because all the questions are based on facts given in the First Aid text book and therefore not very detailed or extensive.
I used the Appleton Lange book once to do a seven hour exam. The questions are ok and again a rough guide to the actual exam and also because it has about 13 blocks is useful in terms of quantity of questions.
Kaplan Qbank which is really expensive(costs $199 for one month) for only 2000 odd questions is supposed to be the closest in content and difficulty to the real exam. I found the exam much more difficult however the Qbank did cover about 90% of the topics asked in the exam. My advise with the Qbank is not to rely on it entirely and remember that you will almost never have a question repeated from Qbank in the exam. I had someone tell me that no question was repeated and so the Qbank was not great - well dont expect questions to be exactly the same.
I found the Qbank useful even if I was unable to complete all the questions so would recommend it to everyone, but use it sensibly. I only took complete 50 question blocks similar to the exam with all topics included and found it was useful.
NBME - The 4 block 200 question Forms(as they are called) are closest to the real exam in terms of difficulty. I recommend doing all of them if you have enough money. It costs $45/form.
The other big problem is that you cannot reveiw your exam and dont know what the correct answers are or where you went wrong. So, use it to scare yourself into working harder. I only did Form 4 two days before the exam and it terrified me into studying Biochemistry for the next six hours.
Lastly, USMLE ECFMG CD - the one that they send to you. Kaplan has the explanations for the CD questions. I found that the CD is pretty close to the real exam and although I never went through the explanations, I would recommend doing the CD at least one week before your exam.
Doing a complete exam - 7 blocks in a timed way is absolutely vital. It allows you to get used to sitting down and concentrating for 7 hours, learn about timing your breaks and also about your score over 350 questions rather than 50 questions. It gives you a much better idea about your strengths and weaknesses. I did the 7 block exam twice and did pretty badly both times. However, it allowed me to test my endurance limits and whether taking three blocks at a time is feasible and also sort out my food,coffee and toilet breaks.
Internet resources: I did not use that much of the internet resources that are quoted in First Aid but I did use a few. here are my USMLE bookmarks!
The Biology project - useful for quick basic mol bio concepts.
http://library.med.utah.edu/WebPath/webpath.html - Internet Pathology slide website. I did not find this as useful as it is made out to be but its good to have a quick look at it , perhaps one day or maybe when you are having dinner or something.
The really useful part on this website are the review exams. I found the neuroanatomy ones very useful for revision.
Lippincott USMLE test - I dont know about this. I did not take the exam so cannot comment.
Parasitology quiz - ok. dont waste time if you dont have it.
The Princeton review - Again similar to Kaplan but I didn't have the money to do both.
USMLE Web - I found some of the free questions, forums etc. useful. Again, you cannot spend too much time on this stuff if like me you only study for four weeks.
NBME - Good. Must do the tests on this website. Scares you into studying harder.
At the end of all this, my gut feeling is that your basics will get you through. I feel as if all I actually studied in my first and second year in college and all the hard work I put in paid off because there were lots of topics I did not study this time and just hoped that whatever I had learnt over 10 years ago will help me out. It sometimes did, so I expect if you slogged instead of pissing around this exam might help show that up.
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