Step 1: Studying pharmacology

I was probably most at a loss as to how to study for pharmacology than for any other subject. Even while going through the curriculum during the first two years, I had difficulty with the rote memorization that pharmacology demands. Because of this, I tried a lot of different approaches in order to figure out how to best study pharmacology for the USMLE Step 1.

It wasn't until the middle of Year 2 Semester 1 that I figured out the best way for me to learn pharmacology was a combination of making tables and flashcards. I have a table for antibiotics, antivirals, antifungals, antiarrhythmics, antineoplastics, diabetes medications, etc... The tables were (of course) made in Excel and provided the overall organizational at-a-glance picture of the pharmacology for a given field or disease. I really wish that I had started making these tables during CVPR. The act of making them was a means to learning, but then I also had this great resource for quick reference or for re-learning the material while studying for boards.

I caught on a little earlier to making and using flashcards for learning pharmacology. Like making tables of drugs, the act of making flashcards also helped me learn the material; then, I also had the flashcards as a resource for memorization. I made my flashcards in a program called Anki, which uses an algorithm that purports to maximize learning by spacing out the intervals at which cards repeat based on how difficult you rate it. Cards "mature" as you see them more often. A card that you repeatedly rate as "Easy" or "Very easy" may be presented next in a few months or longer. In that way, "mature" cards don't take away from learning other cards that are more difficult.

I started making Anki decks for pharmacology during CVPR and liked it enough to continue during Neuro and DEMS. By the time my dedicated study period rolled around, I already had a lot of great resources for studying pharmacology - all of which I had created myself. I consolidated all of my pharmacology tables into one Excel document with many tabs. I also consolidated all of my pharmacology-related Anki decks into a single deck with each card categorized with labels. That way I could easily quiz myself on, for example, only anti-epileptic drugs.

With these two consolidated resources in place, I then built upon them during my dedicated study period. I did this mainly through practice questions. Whenever I came across a pharmacology question, there was almost always at least one drug in that question that I didn't know. The obscure drugs were usually one of the answer choices. But I would look up the drug and make a flashcard for it.

I made two types of cards. The first type of card was standardized to look something like this:

Drug X:
1. Mechanism of action
2. Clinical uses
3. Toxicities

The reason for this standardization was to avoid memorizing a particular card and to instead encourage actually learning the material. It would have been too easy for me to start remembering the idiosyncrasies of various cards if they weren't standardized.

The second type of pharmacology card I made was directed questions about very important facts. For example:

What drug has been shown to reduce mortality in patients with congestive heart failure?

The answer, of course, is spironolactone. I made a card like this anytime an important fact like that came up in my studies, most often from practice questions. A lot of these cards were idiosyncratic toxicities of particular drugs.

I bought a set of PharmCards and used them regularly over Summer break, but they didn't really work as well for me because they were too difficult to organize. I ended up giving them away to a friend of mine after they say unused for an entire semester.

I also bought Katzung & Trevor's Pharmacology Examination and Board Review and studied lightly from it over Year 2 Winter break. I became frustrated with it because it seemed that the questions at the end of each chapter did not really draw directly from the material presented in that chapter. I also wasn't a fan of the organization of the text. During the dedicated study period, I did return to this book for helping me to answer some specific pharmacology questions. I also used it to help me study anti-epilepsy and anti-neoplastic drugs, both categories that take a little extra effort to nail down.

Overall, I think that the pharmacology tables and the Anki flashcards together helped to drastically improve my performance on pharmacology questions. I make this claim by comparing my percent-correct performance in pharmacology questions on practice sets early in the dedicated study period compared to late in the dedicated study period.


Click here for the pharmacology Anki deck that I created.