First Aid: purchased. UWorld subscription: activated. But do I need anything else?

It’s common to feel overwhelmed by the myriad resources for Step 1 prep. Many students often wonder about the best resource that helps combine physiology and pathology for the USMLE Step 1. In my own prep, I felt that even though First Aid was incredibly necessary for exam preparation, there had to be something that was more comprehensive than the series of facts printed in Le and Bhushan’s invaluable pages.

And then I found it: Edward Goljan’s Rapid Review: Pathology.

Now in its 4th edition, Goljan’s book (often referred to simply as “Goljan”) is a 700+ page text written entirely in outline format that covers the essential knowledge that any Step 1 master and 3rd year medical student should be expected to know. Here are a few reasons why this excellent but daunting text may be the best or worst resource you can add to your Step 1 repertoire:

The pictures are extraordinary

With more and more pictorial- and imaging-based questions appearing on the USMLE, it makes sense to have a resource at your disposal to introduce you to the visuals of every testable pathology. From peripheral blood smears, to the gross clinical manifestations of systemic lupus erythematosus, this book provides a comprehensive view into the world of high-yield patient presentation without having to seek out Dr. House’s clinic of obscurity. I particularly enjoyed the pictures in the microbiology sections — the culture microscopy and gram stain images make recognizing every bug a non-issue.

The explanations are as cut-and-dry as they are thorough

Let’s face it. You had physiology in your first year, and you’ve forgotten how a good working knowledge of fluid and electrolytes can explain why your congestive heart failure patient is hyponatremic. Fear not! You’ll find yourself instantly reminded by reviewing a great diagram or subheading that will bring the basic science to the forefront of your mind. Goljan’s text combines very clear and quick statements with global understanding. It may take more time than you’d like to get through an entire system’s chapter in extreme detail, but you can be sure you’ll learn a few great mechanisms along the way.

It’s not only pathophysiology

Goljan has the ability to seamlessly work every [pertinent] basic science concept into the conceptualization of disease pathology. You’ll quickly be reminded of the importance of anatomy, histology and biochemistry, and how it pertains to the most relevant concepts tested on Step 1. That said, this text is in no way an anatomy or biochemistry review book, but rest assured: Dr. Goljan wrote a biochemistry review book in his rapid review series as well, and it’s less than 200 pages!

Concept cross-linking

The most beneficial attribute of Goljan’s book is its ability to cross-link concepts across sections. Read something important about calcium’s involvement in a series of different diseases? Don’t worry — you’ll cover it all again in a section on calcium physiology and pathology. I’ve always believed that repetition builds retention, so seeing a piece of information more than once is bound to help it stick in your mind.

For all the benefits the book offers, it probably deserves a spot on your bookshelf this testing season. However, you may want to keep the following in mind as you read:

Goljan is more than 700 pages

If you’re a slow reader, or have less than 6 weeks to prepare for Step 1, you’ll be lucky to read the book with any understanding as you cram UWorld and First Aid into your calendar. Questions and test-taking practice are absolutely vital to Step 1 success, so if you find yourself reading for 12 hours a day and never getting to that UWorld block, you’re likely doing something wrong. If stressed for time, either only use Goljan for a strict reference, or eliminate the book entirely from your resource library.

There’s no way all of this is on Step 1

If you’re reading the text now and you’re finding yourself bogged down by extra material or simply material you haven’t covered in your basic science years, it’s probably superfluous and low yield for a question on the exam. While Goljan is a great resource for mechanism explanation, some concepts are not worth creating a question over for a basic science test. Learning to treat or manage disease or order diagnostic tests will rarely (if ever) be asked on the Step 1 exam. That said however, Goljan’s book may prove to be a wonderful supplement for your third year clerkships. Take some sections with a grain of salt and focus on what is stressed in UWorld or First Aid instead.

If you have the time to read Goljan, or integrate it as a secondary resource into your library, I would highly recommend it. It’s a great unifier of concepts; reminder of basic science information, and phenomenal atlas of pathology. Even as a resident in radiology, I still find myself flipping through its pages and learning something new. Remember though: as great as it is, it has competitors and equivalents. Your success on Step 1 depends on your work ethic and endurance. Remember that in choosing resources, simplicity is the ultimate sophistication. Prioritize UWorld, and do NOT overburden yourself with a massive pile of resources! Good luck, and enjoy the ride!