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First Aid is often hailed as the Step 1 "Bible" by everyone and anyone who has had to study for those dreaded medical examination boards. In fact, the most common piece of advice I personally heard as a wide-eyed junior medical student was to have First Aid in one hand and then UWorld in the other.

But there's often still very little detailed advice out there on how to use First Aid productively and efficiently.

What to do then? Should I try to read it? Impossible, First Aid is too dense. Should I try to re-copy it or make flashcards for every section in First Aid? Inefficient and therefore useless. Do I leave it under my pillow at night and try osmosis? Ha! I wish.

After trying a couple of strategies, I finally came upon a few things that worked for me. Using the three pointers below, I was able to stay productive — and (more importantly) sane — throughout my Step 1 study period, and ultimately score a 260.

did you know that 24 hours could earn you 30 more points on USMLE Step 1?

1. Build Your Tolerance to First Aid ASAP (i.e. Start Early)

As soon as you start medical school, get an older (within the past 2-3 years) edition of First Aid. It'll be cheap and incredibly worth it. 

First Aid is incredibly dense and chock-full of high-yield information. It's impossible to digest completely in a few weeks, or even a few months' time. You won't understand how important each word contained within First Aid is unless you also recall hearing it in class or doing a question regarding that particular piece of information.

Having it there with you for all your classes and questions will make it that much less of a stranger when you finally buckle down and study full-time for Step 1. (It'll seem more like a old buddy who's there to send you friendly reminders than a stranger constantly harassing you about everything you still need to know). Also, First Aid has a unique style of writing; it takes some time to get used to, so start early.

*Oftentimes, people will say that there is no point in starting studying early because you'll have to re-learn everything for the test. That's simply not true. If you are very familiar with the Step 1 Bible (ahem — First Aid) by the time you start studying full-time, just knowing where the topics are in relation to each other in the book will be a huge blessing and time-saver. And there's no need to get a new edition of First Aid during first year because:

2. Annotate Your Old Edition of First Aid with UWorld (starting Second Year of Medical School)

So you've been flipping through that old First Aid as you go through each of your classes. Well done! The question now is how to annotate. 

Sure, you can take notes in First Aid from each class, but then you risk cluttering your First Aid with information that is low-yield. Keep it readable (i.e. take notes from your classes in a separate notebook, on the PowerPoint presentations, etc.) until you're ready to start doing questions.

During second year, either a 6-month or full-year subscription to UWorld's Qbank works. Once you've got that, then annotate all the high-yield questions into your old edition of First Aid. (You may also want to avoid making these mistakes with UWorld.)

How do you know what's high-yield? Easy: In your Qbank, look at the percentage of students who got that question right. If it's higher than 50%, then you MUST know that material. If it's lower than 30%, then it's probably too low-yield to worry about. But if it's in that grey zone between 30-50%, then it depends on what kind of score you are aiming for. If your goal is to pass, there's no need. But if you want to aim for the stars, then you certainly have to annotate these as well.

Note: Annotation does a few things for you. First, it makes sure you truly understand the question and the reason each of the answer choices are provided (and why they're wrong). Second, it motivates you to rephrase the concept using your own words. This way, you not only remember it better, but you will also be capable of explaining it to someone else. And thirdly, annotating First Aid forces you to relate to how First Aid presents that material and how the wording is different/similar to UWorld, which further contributes to your understanding and memory of that concept. (Spaced repetition can also make a huge difference in your understanding as well.)

Once you've done a decent amount of annotation, your old First Aid might become battered and chaotic, and rather impossible to read. That's perfectly fine, because second semester of second year is when you shell out the cash and get the newest edition of First Aid, which you should be:

3. Mapping, Not Reading

First Aid is not linear like a storybook, there's no introduction or denouement, and the information cannot be followed in a sequential manner. Your coursework is meant to provide the linear structure, but if anything, you need to look at First Aid like a map; every concept needs to be seen in relationship to multiple other topics. 

Take the complications of diabetes for example: What is the pathophysiology behind these complications? How can it be related to a form of incontinence? How can that form of incontinence be similar to an indication for the use of metoclopramide? And how can metoclopramide have side effects similar to those of antipsychotics?

Was that a far jump? Certainly. But you can expect Step 1 to do the same. This last step is difficult to do, it is not for beginners, but if you've followed the first two steps of this blog diligently, then by last few months before your Step 1, you should be fully capable of doing this using your new uncluttered edition of First Aid.

Let's look at cataracts as another example: Why do adults get them? Why do infants get them? What is the biochemical explanation for infantile cataracts? How is that syndrome parallel to another enzyme deficiency? What is the TORCH explanation for infantile cataracts? What are the other symptoms of that congenital disease? And what are the symptoms of the other TORCH diseases?

Final Note:

If you're wondering if the annotations in the your old First Aid are wasted, my answer is most certainly NOT. The whole point of annotation is a mental exercise. If you were paying attention as you annotated, then you most likely noticed that First Aid already had that piece of information in it even as you were annotating it. You saw those words, but you probably just didn't pick up on the significance of it, or the scenario that this information could be presented in, until you were annotating it.

But now, with your fresh copy of First Aid, those words should look more like your roadmap than anything else. And if you did it right, it's not only a roadmap for scoring high on Step 1, but for having a successful, knowledgeable medical career into the future far beyond Step 1. 

Lastly, on a separate but related note, if you haven't experimented with thought mapping or thought webs, I'd definitely recommend doing so early and often. 


turn your 230 into a 260 on the USMLE in 24 hours
Jennifer Li

Jennifer Li

Jennifer Li is a graduate of the University of Pennsylvania College of Arts & Sciences and currently a medical student at Icahn School of Medicine at Mount Sinai. She has received a competitive grant from the New York Society of Vascular Surgery and is currently pursuing a scholarly year in vascular research before entering her 4th year of medical school. Jennifer has an extraordinary testing record. She has been a long-time tutor and teacher in numerous subjects of medicine, including anatomy and physiology, and is extremely dedicated to the success of her students.
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