After completing two years of basic science courses in medical school, every medical student has to pass the USMLE Step 1 Medical Boards, before beginning clinical training in hospitals. Your score is something that will be placed on every residency application, and is arguably the most important factors in obtaining a residency in America. As a Caribbean student, the stakes are even higher. You want to do as well as you can on the boards, because it is harder for us to obtain residencies in America. From the beginning of term 1, St. George’s University has stressed the importance of this test. In fact, during term one, we were given a mandatory lecture about scores and residency outcomes. I remember looking at step 1 programs back in September of my first term, because I was so scared after hearing that talk. I had some friends above me who had done the Kansas prep course, and they all spoke very highly of it, so I knew it was something I was interested in doing. Needless to say I made it through terms 1-5, and the Monday after leaving the island I headed to Kansas to prepare for the boards.

The institute of medical boards has been around since the 80s and is located in Kansas City. Their Step 1 Review Course lasts for 6 weeks and is Monday – Friday with some Saturdays. The cost is around $3900, but they did give discounts to SGU students, and if you came with a Uworld subscription that cost was also deducted from your bill. This cost does not include housing or food, but they do have discounted rates at nearby hotels/Air BnBs. Students are given an orientation the first Monday, where the program’s methods are explained, along with a 6 week itinerary of what to expect. Bonus – they also fed us lunch this day, which was nice since we had just completed term 5 on that Friday and many of us weren’t quite situated. First, I will explain the different components of the program, and then I will describe what the schedule is like.

First, you will be assigned to a group and you will spend every day with this group of humans. If you and friends (study buddies) are considering a step 1 prep course, you can request to be in the same group, which is what my friends and I did. A group consists of 12-ish humans all studying for step 1. Your group would be do all of the following together: UWorld Question groups, micro drills, pharm drills, and path group together. You learn from each other, while also giving and receiving different ways to remember all the information you need to know. The group would then be assigned to two facilitators. One facilitator would do questions and drills in the morning, while the other did pathology/physio in the afternoon. The facilitators would switch each week, so we would have questions first 3/6 mornings, and path/physio first 3/6 weeks.

That brings us to Question Group. The program teaches how to approach USMLE style written questions. This was one of my favorite takeaways from the program, and it helped me think about questions in a more analytical way. With the method they teach, you start off doing questions out loud and together, but as the program progresses you do more questions on your own and less out loud discussion. During discussion, you get to hear how others think/approach a question, and you also explain your thought processes (For example, I didn’t choose A cause blah blah, I didn’t choose B cause blah blah, but I did like C cause blah blah). The program gets you through the entire Uworld question bank in 6 weeks. Some of that is through question group, but each night you are also give a homework block of 40 questions. Also, you take practice tests on Saturday. Our first practice test was 6-8 blocks of Uworld, but for our second and third we would do one NBME followed by blocks of Uworld, but I’ll talk more about that later. I can’t talk about question group at KS without talking about the SMARTBOOK.

The most valuable takeaway from KS, was the importance of a smartbook. The idea of a smartbook has been around for a while. I have seen it any many blogs for step one studying. Let me try to explain what it is. So, as you are doing all these practice questions (UWorld), you are supposed to be learning from each question. If you get a question wrong, you need to figure out why you got that question wrong… for example, did you miss the question cause you didn’t know the histology for a condition, did you miss the question cause you didn’t know the treatment of the condition, or did you miss the question because you didn’t recognize the condition. Once you figure out why you missed the question, you need to learn said fact. This is where the smartbook comes in. In a composition notebook, you write down a question in the left column/side of the page, and on the right column/side put the answer. The trick to an effective smartbook, is to be as specific as possible. Below I will list good and bad examples.

Bad: Question: Emphysema Answer: protease and anti-proteases imbalance

Better: Question: What is the pathogenesis of emphysema; Answer: Destroyed alveolar septa and distended air spaces due to an imbalance between proteases and anti-proteases. Inflammatory cells make the proteases that overpower the Alpha 1 – antitrypsin

Bad: Question: Emphysema patient Answer: Barrel chest

Better: What is the presentation of Emphysema? Answer: Barrel Chest (increased AP diameter), Skinny, Pink with purse lipped breathing, Hunched Over, and wheezing.

As you fill your smartbook, the more specific and to the point your questions are, the better retention and clarity you will have. It was also encouraged that we review our smartbooks with a pal, which was beneficial to both persons involved. It was extra exposure to information we all had to know. Each time I reviewed a question I would mark it in my smartbook to make sure I paid attention to the middle and back half of the smartbook. I thought of my smartbook, MANY times during my step exam. I also use a smartbook for each clinical rotation, because I found this to be very effective for my retention. Posted below are pics of my smartbook from Step 1 and clinicals.

Pharm drills — Each night, the program assigns a question block, required first aid pages for path/physio, required pharm pages, and required micro pages. You had from 4ish – bedtime to get that done, and then you were in “class” from 8-4. For pharm, it was usually 2-4 pages that we would be required to read. Then the next day, we would go around in a circle and be drilled on the pharm. Which diabetic drugs causes pancreatitis? Tell me the mechanism of action of sulfonylureas. The goal was to recall rapidly. Sometimes, they would even turn this into games/challenges, which was also nice.

Micro drills — This was very similar to pharm. We would have required pages to read and know, and then the next day we would be drilled on those pages. If there was additional time, we could switch to pharm or even go back to older micro we had covered. Again, the goal was to recall rapidly.

Pathology/physiology Review Group — During this portion of the program, each person would be assigned 2 or so topics in a certain system, like cardiology. Each night they would create their own review of the topic and post on a google drive, and the facilitator would look it over. The next morning the whole group would go the marker boards and be responsible for all topics (not just the one they covered). There would be a timer, and in 3 minutes you would write down/organize whatever topic was at your board, for example if you were at myocardial infarct — you would list pathology, presentation, EKG changes, histology changes, treatment, diagnosis, etc, and after 3 minutes you switch to the next board and try to fill in as much as you can in the next 3 minutes, and so on until each member of the group had rotated through. This put you on the spot, but was also very challenging and fun. Our path/physio facilitator was a BOSS, so I found this part of the program to be very helpful, and I learned a lot.

Practice Exams — I am so grateful for this part of the program. You don’t realize how hard it is to take an 8 hour test, til you sit for 8 hours in a cold or hot hotel room trying to stay focused, and only have water and food on breaks. This was super beneficial to me, personally, because my first practice test taught me a lot about what I needed to do on test day. With my first test, I didn’t take a break til block three, and I took a super quick 10 min break and inhaled some pistachios. The next block I was miserable, and needed to burp, but couldn’t. I did the worse on that block. So, the next weekend during the practice exam, I took more breaks, spread out my food, and ate slowly, and my score improved. I also only ate egg whites, a few pieces of dark chocolate and bites of avocados. Fat and protein were better for me, cause carbs make me tired, and dark choco has caffeine in it, so I would nibble on that the last few blocks. I also packed plenty of water, and a small cold brew coffee in case I got tired.

There was also a few other parts of the program I need to include. Your facilitators would meet up with you one on one and observe you doing questions. While you explain your thought process, they give you feedback and help you understand how to do questions more efficiently. They would also initially meet up with you, and go over your step score goals, strengths and weaknesses, diet and exercise, etc. If you feel you need private tutoring there is also an option to pay them for that service. The course also provided a 3-4 hour session over biostats. And after your mock exams you would meet up with a facilitator and get feedback on your performance and ways to improve.

IOMB Course PROS — Smartbook, Repetition, help with test taking strategies, feedback on performance, Set schedule, multiple practice tests to help with routine and the big day, a lot of support from facilitators, isolation from friends and family (if you aren’t from Kansas City)

IOMB Course Cons — You are at the mercy of the facilitators and students of your group — if you get a great facilitator, great, if not…. SOL — My first week at the program, they actually hired a differ facilitator for us, cause our first one was not very good. But I was glad they corrected the situation, still time lost. If you are with a really encouraging/positive group of students, great, if not… SOL. Some humans aren’t as affected by other humans energy and attitude, but I like being around people who were positive and hard working.

Advice — #1 group studying vs individual studying — What works for you? Only you can know this. I like to mainly individual study, but I do enjoy some group studying. If you are someone that doesn’t like group studying, this program may not be your best bet #2 set schedule vs flexibility. Some people studying for step want to set aside a few days to work on certain weakness, however, because you are in group from 8a-4p and have homework each night, this made it very difficult to work on “weak areas” If you are a person who likes to do things at their own pace, this program may not be the best idea.

Things I would have done differently. 1. I wish I would have taken more time off after term 5 before starting my dedicated studying. After term 5, I felt tired.. both from the semester, but also from the crazy 2 day journey it takes to get from Grenada to KS. I think it would have been beneficial to take a few days off to rest and relax before starting this vigorous course. 2. I would have never done USMLE RX, but instead focused my time on Amboss or Uworld. I believe Amboss and Uworld are both better question banks for step, than USMLE RX. 3. I wish I would have spent some of term 5 going over my weaker areas before the course began, so that I felt more prepared.

Final thoughts. This blog in no way reflects the views of IOMB. These are my views alone. Studying for USMLE step 1 is a challenging and daunting process, but I wish you all the best of luck in your preparation. I am happy to answer any questions that you might have. GRIT DON’T QUIT.