USMLE STUDENT ADVICE
Student #1:
I found Kaplan Q-bank to be essential because it was the best example of what
the exam style and question difficulty would be like. First Aid was also
Essential. Step-up was good as a refresher. The Board Simulator Series
question books were good to use as a review, but I think I spent more time on
them than I should have. I would definitely suggest preparing a schedule ahead
of time. Otherwise you might find yourself spinning your wheels. Take breaks
when you need to and consider a change of scenery from Champaign. Good luck
and remember...If it is necessary than it must be possible.
Student #2:
Personally, I study well by reviewing notes and practicing questions over and
over. First Aid was an absolute must (I also used Step Up as a supplement).
I would study First Aid, but I would also find some good resource on the
subject I was studying to be able to look up more details on the subject. I
would write lots of notes in First Aid, so by the last week before the exam, I
was only using one book.
QBank was also crucial for me. I thought QBank had much more detailed
questions than the ones on Step I. So, if you are doing well on QBank, you'll
do fine on Step I, in my opinion. But I would strongly suggest using QBank
wisely. Don't just do the questions and see if you got it right. Most of the
learning from QBank and questions is really going through the explanations. I
would go through the explanations and write the additional information in
First Aid. again, I just consolidated all the info into one book.
I also found that having a study buddy helped quite a bit. If anything, it
motivates you to get to the library, forum, or wherever you study. (I'd avoid
just studying at home all the time, too many distractions). Eric and I would
designate mornings to pounding through some awful subject like leukemias and
lymphomas. It kept us moving forward and we learned a lot from each other.
Also, give yourself some time off. You need a break and your brain will
appreciate it. Try to keep the stress level in check.
When M2 is over and you're getting geared up to study for StepI, ask M3and M4s
how they studied, you'll get a lot of different responses and you'll find what
works for you earlier in the game as opposed to a few weeks before the exam.
My advice is that you give yourself six FREE weeks (don't try to do a lot of
other things at the same time) to study for the exam, MAX. Other
upperclassmen have reiterated the same feeling. Otherwise, you'll suffer
serious burnout. Good luck!
Student #3:
My step 1 advice:
1. Get a study buddy or two even if you plan to study quietly most of the time. It's amazing how much more productive you can be just because another person is sitting with you. Better yet, if you get stuck, you have someone to answer your question right away.
2. That said study on your own terms. If you study best at home with lots of sunlight in your pj's and your best friend studies in the basement of anyplace beside her home, remember it's every person for him/herself right now -- don't be offended if your system doesn't work for someone else -- you can still be friends when it's all over.
3. KNOW First Aid. Lots of us used First Aid and Step-Up throughout M2 so that you have read them by the time the year is over. First Aid has more material, but Step-Up is better organized. Many of us started with First Aid, and then added the missing info into Step Up while going through Step Up...this allowed for some active learning in the whole thing. If you want to supplement your understanding with BRS, that's great, but you'll never have time to work your way through all the BRS books. When it comes to test day you need to really know what you know -- it's best to have a solid understanding of common concepts rather than lots of obscure facts floating in your head. If you have weaker subjects, you may want to read through those High Yield titles. Sometimes sitting down and reading a High Yield book straight through is a great way to solidify the concepts that haven't quite been pieced together. It's also a good "break" from questions that have you depressed.
4. Make a rough outline of what you want to study in the 4-6 weeks you spend studying. My study buddies and I took off the first week of the "summer" after school started. Then we spent 2 weeks on the "understanding" subjects via a systems based review -- this included physio, pathophys, pharm, path, biochem. Then we went back through the systems based review concentrating on the "memorization" subjects -- path, embryo, anatomy. We organized our systems in such a way that we had a day off at least every two weeks, if not every week. This left a bit more than a week to spend purely on questions. We also worked on questions (Kaplan Q bank, Pre-Test) during our review, but on a much smaller scale.
5. Questions: Kaplan Q-bank will prepare you for the format of the q's, but keep in mind that most people agreed these are the average are harder than the real test. Don't get discouraged! Pre-Test is good, too. Again, remember that if you've completed M2, been studying for weeks, and come across questions that you have never heard before, it's probably NOT high yield. There are two Kaplan questions banks now: q-bank and IV-bank -- the last being the "Integrated Vignettes bank" which is really lots of the same questions over again. It's not all that necessary to buy both. Consider sharing a long-term subscription (6 mo) to the q-bank with a couple people. This way you can do questions during the spring semester. Keep in mind that you can only be logged in on one computer at a time, so once you get to the real studying, you'll likely want to get more than one subscription.
6. M2: Learn your path and pharm. You won't remember pharm when it comes time for Step 1, but you’ll be much better off reviewing. Don't get bogged down w/ everything about every drug for Step 1. Stick to what's in First Aid, and you should be good. Once spring semester hits, you'll find yourself with less studying for class, so make sure to take the opportunity to start reviewing. At a bare minimum, read First Aid and/or Step Up as you go along in pathophys (somehow the name of that class escapes me).
7. By the time you're close to the test you really will be able to identify what information is important and what's not. Really know what you know. Draw a line and decide when it's time to stop learning new things and concentrate on mastering what you already know.
8. It sounds like a sucky month or two of hard-core studying. It is. You will survive. Study your butt off so that when your score comes you can say that you really couldn't have studied any more -- that's the easiest way to accept your score and move on, no matter what it is.
9. Continue to work-out, see your significant other, eat and sleep. Hold yourself to your schedule, but allow yourself down-time as well. It might be better to front load your first two weeks so that come closer to the test you're not burned out.
10. What to punt: I couldn't believe it when I heard people say it last year, but if you know everything in First Aid, you will do great. Augment your understanding of key physio and pathophys. Anatomy is far from high yield.
11. Scheduling: Any less than 4 weeks after spring semester is over is probably pushing it. Make sure to allow enough time off before starting M3, especially if you're starting with a real rotation like medicine.
Test day:
1. Take a break after every section. Even if it's just 2 minutes at your desk to close your eyes and think about something else. I made the mistake of going straight through from block 3 to block 4, and got 5 questions into block 4 and starting thinking I didn't give a damn any more. But then I had 45 more questions to answer before I could take a break!
2. On the same note, the test is looooong, even if you've taken a couple of days to sit and do several hundred q's in the same manner. Pace yourself. Take breaks to get water, stretch, etc. Bring candy to stash in your locker at the testing center (nothing, and really, nothing can be taken in the room with you).
3. Chicago is a fine place to take the test. There's plenty of fast food right on that block -- including healthy options, so there's really no need to pack a lunch or worry about food. Bring an extra shirt or sweatshirt as the temp varies in the testing center.
4. Arrive early. Once you have arrived, you are checked in that order and allowed to start. Your ticket says be there 30 min early, but an hour won't hurt, you'll almost certainly get to start early and that means going home early too!
5. When it's all over, take a vacation, but beware: you will be way more exhausted than you think. Plan something lazy with good food and drink.
6. It's hell, but once it's over you'll almost forget it happened -- I promise. Before you know it, you'll be an M3 and one day get a nice page saying you passed Step 1. That's when you really start sleeping again (until you start medicine, that is)!
Student #4:
Anyway, my advice to the kiddies coming to m2 is this:
1) Buy BRS Path. Take it to class and take notes in it. Never lose this
book. Read it every night before bed.
2) Don't try to study too much during the course of the year. You'll just
freak yourself out because you won't be able to. No matter, there's plenty of
time after spring semester gets out.
3) For studying, I used Step Up and First Aid and found them to be very good
Complements of each other.
4) Q bank. Get Q bank. Try and go through it at least twice. Don't cry with
the anatomy questions, it'll be ok.
5) Read the section of High Yield Behavioral Science where they talk about how
to answer the "what would you do/say?" questions. It's got better advice than
Kaplan.
6) The way I studied was by body system. For the first two weeks I did
physio, path, and histo of each system. Then I went back and did the
memorizing stuff like anatomy, micro, embryo. I did a little pharm every day.
I left a few days to tie up loose end like biochem, genetics, immuno and the
like. Then I spent a week doing questions on Q bank.
7) Study with a buddy. Change up where you study every so often.
8) Don't expect to have a life. Don't expect to remain emotionally stable.
Have someone else cook for you and do your laundry.
9) Be sure to leave yourself at least 10 days between boards and clerkships.
Try to go to a beach where they serve umbrella drinks to relax.
Student #5:
Start with First-Aid. Then do the Kaplan Q-bank, and finish with First-Aid
again.
I was surprised about how time pressured the test was.
Student #6:
I found Qbank to be more difficult than the actual exam. The
Robbins question book was excellent too. ICM is actually a good
framework for boards review, and HxPxDx gets you thinking about things in
the context of how a patient presents. A fair number of the tests that we
learned in HxPxDx turned up on step 1 as part of the vignettes. I'd
mainly suggest that people go the class during ICM because the lectures
are all on heavily tested diseases and which abnormal lab values point to
a particular diagnosis. Spend the time preparing for classes
by reviewing basic sciences that relate the the lectures, especially path
and physio. There's a 28 day plan out there somewhere that organizes a
study plan, using the highly rated board review books too; and I found
that useful. In the month before the exam, take as many questions as you
can. Good luck.
Student #7:
General Rules
1. Stick to your plan. You may freak out a week before the test because
you bombed a couple of practice tests or wonder if your plan is all that
great. All of your classmates will have different methods and opinions
about prepping. Sticking to your plan will end up being at least as
important as what details the plan entails.
2. Prepare to feel like you failed. First-aid uses the phrase 'comfortably
pass' but there is no such thing. I scored a 195 which is probably in the
intended range of the comfortable passers but I was never comfortable.
Specific Ideas:
1. Get First-aid during spring break of M-2. Pick out the 2 or 3 sections
you're weakest on and get through them once before finals. Anatomy, biochem and
phys are good choices.
2. Take 5 weeks if you can stomach it. Conventional wisdom is that 3 or 4
weeks is enough time to prep. If you've been a borderline student, I
really encourage giving yourself 5 full weeks. I broke it down as follows:
Weeks 1-3:
Complete First-aid and BRS path. These are the only books
I used. Divide up these 21 days based on the % of the test from each
subject. I think First-aid has this info. 5 days on path, 3 on biochem
etc. Put Micro and Pharm near the end because of the excessive
memorization.
50 practice questions each day; stick to subjects you're working on
Call the Sylvan testing center to confirm your date. Ask for directions in
person. Their website directions were wrong when I took the test and all
the test-takers ended up in a residential cul de sac in North Chicago
suburbia.
Week 4:
Switch to 200 questions each day in 50 question blocks
This week will also be filled with the First-aid and
brs-path info that you're still missing. From here on out, most info that you know
should be put aside for good. Focus on the lists & facts that you have yet
to nail down.
Week 5:
200 questions a day. Do not skimp on this.
The list of pictures and high yield facts at the end of First-aid path are
good for this week. They will be a welcome change to flashcards & notes.
Student #8:
I think the best thing was the Kaplan Qbank. The computer format is just like
the exam and the questions are comparable. If anything the questions have a
little more detail than the actual exam but they really prepare you for what
they will ask. Also, "First Aid for the Boards" is invaluable and should be
used as a template or outline with other materials for details. The
information in it is high-yield and for a few subjects all you really need to
know (Behavioral Science, Biochem.) Otherwise, try to maintain your sanity as
best as possible. Don't get stressed if you fall off your schedule but do
what you can to cover everything, don't get hung up on one subject forever.
Study for the test not as a review of M1 and M2 or as prep for M3, the test is
just a hurdle so focus on that when studying forget the big picture.
I hope this helps.
Student #9:
I would say a couple of things...I think I would have been ALOT less stressed
if I had really started studying around Jan/Feb, versus Mar/Apr. Also, I
believe that First Aid for the Boards is almost mandatory--that was one of the
best resources I used. I would say that if they can't find the motivation to
study early on, start by picking up a practice question book (ie, NMS or
Kaplain)--testing my knowledge (or the lack thereof, really:)) seriously
kicked me into a higher gear, since I started to get a realistic sense of how
much I really needed to review before June.
Tell them to know their micro and pharm quite well...those were probably the
most difficult questions for me...
Student #10:
When I began to prep for Step 1, I had 5 weeks until the exam. I studied
pretty hard for it. I waited until May to start studying specifically for
the Step 1 (ie, not during XMAS, etc).
The first thing I did was review Path by using the CD/ROM which accompanies
Big Robbins (available in Med Library and can be burned). It allows you to
see a lot of images and get through a broad range topics very efficiently.
I did the entire Robbins question book at the same time (this is a very good
source for path shelf exam too). Together this took about 10 days.
The Schneider and Szantos Path book should be mastered since it is very high
yield.
Then I reviewed Physio, Micro and Anatomy using Costanzo BRS, Ridiculously
Simple Micro, and First Aid, respectively for each topic. I pretty much
didn't mess with Biochem since it seemed too detailed for a limited ammount
of study time. Pretest path, pathophys, and clincial vingettes are very
good.
It seems to me that First Aid is most useful for anatomy (know the brachial
plexus and corresponding lesions) and pharm. I found it to be overrated. I
also used Step-Up and thought it was pretty weak in general. The gold
standard board review tapes were a waste of time. I tried to use the
Underground Clinical Vingettes but never got into them and they are very $$$
for what you get. The Board Simulator Series are hard and not that useful.
I used Kaplan Q bank which is amazingly efficient (costs $99 for 4 weeks).
The single best source I found for me. I think that doing practice questions
is the only way to go given a short ammount of time to study. I did around
4000 different questions total (q bank plus pretest and robbins).
The exam is mostly path and pathophys. Most questions are integrative (e.g.
Histo and Micro combined) so doing questions gets you prepped for that type
of format.
My exam had what seemed to be a disproportionately large ammount of
endocrinology, several epi questions (eg, PPV, NPV, power, Spec, Sens), lots
of "what would you do if..." type weird questions, and thankfully very
little biochem. Anatomy was mostly a labelled diagram or X-ray/MRI image.
Pharm was not too bad and the First Aid chapter should be enough.
Hope this helps.
Student #11:
We liked the Kaplan online question bank--doing them earlier in the year with friends is good to ensure you have an understanding of the test format and the style of topics you need to study. I also liked taking notes within the First Aid book and had it open when I was studying each particular subject.
Student #12:
Here's my advice: Get review books for M2 classes at the beginning of
the semester and use them to study for the class, then you'll be more
prepared to use them for Step 1. Starting around winter break, get First
Aid for Step 1 and any other M1 review books that you think you need.
Start slowly going over them and assessing your weak areas, so you can
concentrate on them. After final exams in May, take a little break, then
sign up for the Kaplan question bank online and study the review books
and do as many questions as you can. The questions will give you the
best idea of what to expect on the actual test. While you study, sleep
well, eat well, and take some breaks. After the test, go away on
vacation!
Student #13:
As far as books go, the three I found most useful were First-Aid, Step-up and BRS path. First-Aid and Step-up complemented each other well.
Brs Path helps pick up some of the detail without bogging you down too much.
As far as sceduling study time, make up a schedule that allows you to cover
all major subjects and still leaves at least 1 1/2 weeks to review at the end.
Also, recommend that they find a study buddy- it helps pass the time and keeps
you from going off the deep end. Finally, don't forget your famous words of
wisdom that inspired all of us "knock the socks off it!"
Student #14:
I think some of my own personal advice for step 1 is:
1. Pick a date you know you can stick to for taking the exam. Changing
dates, postponing the exam is a poor choice, it will drag out, motivation
lowers, procrastination becomes easier. Choose a date that works well in
your summer schedule, one that isn't too rushed by a wedding one needs to
attend or too far off that one studies endlessly. A fair amount of study
time is 6-7 weeks; longer than that, diminishing return on the effort
spent (but some people feel they need to study longer). I spent 5 weeks,
wished I'd spent 6 weeks, but any longer than that and I would've gone
bonkers. You can only study day in/day out for 14 hours a day for so
long, you have to be realistic and know your limitations and realize that
you can't give up your entire summer for this exam. There is a life
outside of medical school, and that is a VERY IMPORTANT point that many
students forget.
2. I recommend medschool.com as a website for preparation. They have a
schedule you can choose (2,4, or 6 week plan) and it guides you day by day
on what to do to study correctly, even tells you books to read, pages you
need to cover, exact assignments. For those of us with motivational
problems and lack of confidence, it's nice to have direct instructions as
to what to study. Some people prefer to go as they see fit, I just need
more structure. Know your personality before you begin the process and
then decide what works for you. People who prefer a looser style do not
enjoy medschool.com because it is too strict. I loved the structure and
the guidance, helped me feel confident.
3. Do lots of problems but do not let the scores you receive get you
down. Most books are way harder than the actual test or more obscure. A
very good book is NMS USMLE Step 1. The NMS questions are thorough and
more fair. Try to do almost the whole book by the exam date. Board
Simulator Series is very very tough, scoring 40-50% on those tests is
good. Some people may find it defeating to consistently score so low; it
did little for my pre-boards confidence so I switched to NMS and was
getting 65-80% and feeling better. Another essential is First Aid for the
Boards Step 1--get the latest edition for the year you're taking the exam.
The book is updated yearly, changes a lot per year. Spend the final week
of studying memorizing First Aid as best as you can, and doing lots of
problems. Spend less time on Epi, Behavioral--those are easier on the
exam but they definitely need to be learned. Easy to score well on those
sections if you do review them well, short term is best, the last week
before the test and of course the night before. Also, spend lots of pharm
time on drug SIDE EFFECTS, that's a chunk of the pharm questions. Big
ticket, big picture side effects and drug interactions. The bulk of the
test is pathology, know it cold. BRS path is a great book for that.
Review a path atlas as well, know pictures as they show up on the test
often and can help give you that last clue to find the correct answer on
the test. Micro made ridiculously simple is another good book.
4. Schedule the test with a friend also taking step 1. It was nice to
have a friend go with me to Springfield the night before, stay in the same
hotel room, keep me calm, drive with me on test morning, take the test
with me, etc. I think it's nicer than going thru it alone. If not, take
a spouse, partner, friend, helps chill the nerves. Go up the night
before, get to know the town, drive to the test site the day before, go
inside, see the testing room, find the restroom, make sure you know
directions from the hotel to the test site. Leave for the exam very
early, get there on time. Any added stress is just not needed on the day
of the exam! Pack your own lunch and lots of little snacks, some
caffeine, some sugar, some salt, what have you. I found my stomach was so
nervous, I couldn't swallow an entire sandwich, so it was good I had
packed granola bars and M&M's and comfort foods like Sprite and gummy
bears. Peanut butter and jelly is a good soft food for lunch, easy on the
gut! Try to sleep the night before, the test is long and rigorous, you
need to be awake to work fast and review your answers well.
5. Just recognize and admit now that the time you spend studying for Step
1 is just going to suck the big one, you'll have no life, it'll be
miserable, just know that and come to grips with it now and you will be a
lot better off knowing you're prepared to give up a lot for a few weeks
and then it's over. Fighting it all the way until test day is a waste of
better-used energy and mental capacity. And definitely take a night off
each week to relax, see a movie, go to Jupiter's, have a drink, eat pizza,
whatever floats your social boat. Don't make it a torture test. Study
late each night, then on Friday, go out for a drink. Sleep in on
Saturday, and start back up again. Little rewards are essential. Or
study til 11pm, go out dancing, do that a few nights a week, you won't
feel so tortured. Treat yourself right, go shopping, do something to be
happy. It is not an easy time, seek help and reassurance and support from
friends and family. Talk to friends about your stress and anxiety, share
it with Ron Brewer, but definitely do not keep it pent up inside. It will
tear you down, and most of us all can admit that Step 1 was a frightening
experience full of fitfull nights of sleep, stomach aches, headaches,
jumpy nerves, and so forth. I have never felt worse. So I made sure to
work out 5x/week and go out socially 1-2 nights/week. That helped a lot,
and I talked to friends, shared my pain, let them hold me up.
That is my novel. I hope it helps. We are human, not superhuman, this is
only 1 stupid test in a long-line of medical career testing, it's not
worth losing your mind, but it is incredibly easy to do so under the
stressful conditions.
Student #15:
Don't bother with the kaplan q-bank -- their focus is way too narrow, and after about 500 questions (there's around 2000 in the database), there seems to be a lot of repetition.
Student #16:
Practice questions are the area of biggest gain, especially those that are on the computer. Kaplan was good, but not quite broad enough and there began to be redundancy between questions.
Stick to general review books such as First Aid and Step-Up: A High-Yield Review for the USMLE Step 1 except in your weakest areas.
Believe in yourself! After M-1 and M-2, you have a great base to pass and do well on the boards
Student #17:
1) Get hold of First Aid as soon as possible -- Use it as a study guide
during M2 year and add notes to it to personalize it. Single most useful
tool for Step 1
2) Find sample questions (Kaplan questions are probably the best, Boards
Simulator Series has very difficult questions, but excellent explanations,
but can be discouraging)
3) Its always good to be able to review pertinent M1 material as it ties
along to topics being studied during M2.
Student #18:
I think that learning the pathology, pharm, and FCP and CLS courses as
thoroughly as possible while taking them are going to set the best
foundation for studying.
Student #19:
1. Dominant portion of time should be devoted to Pathophysiology,
Pathology, Pharmacology & Clinical vignettes.
2. Use Williams & Wilkins __Board Simulator Series: A Body Systems
Review for USMLE Step 1__
3. Skim First Aid for the USMLE Step I prior to doing intense prep. to
gain an overview of your weaknesses & then review difficult material from
this book the last week before the exam.
4. Use lots of practice questions on a regular basis, not just at the
very end.
5. Use appropriate stress management: eat right, sleep normally,
exercise.
6. Call the testing center and check that they have set their monitors to
at least 70 Hz. Taking the computer-based exam on monitors set at 60 Hz
will be an unnecessary strain.
Student #20:
I did pretty well on Step 1, and it was purely a matter of organization
and effort. Here's my list of suggestions:
1) Obviously, memorize everything in "First Aid for Step 1"
2) Take the weekend off after finishing M-2, then DO NOT take another day
off until the test. Period. Study 8-10 hours a day.
3) Time must be divided between reviewing subjects and taking practice
tests. Worst mistake you can make: Not working enough practice problems.
4) Figure out weak and strong areas: Work on fixing the weak spots,
especially if they are important.
5) Study Path like there's no tomorrow. BRS review is good.
6) Siegel's notes are particularly useful for pharm!
7) Clinical Microbiology Made Ridiculously Simple is fun. Silly, but very
useful.
8) Use a lot of different study books. I used BRS for lots of the
subjects-- NMS is TOO DETAILED, you'll never get through them. I've
heard that the Board Simulator Series is okay but don't know first hand.
Look in the CHUB bookshelves, there's a bunch of nice review books there.
Look these over and see which one's you're comfortable with before
investing.
9) SCHEDULING--- Can't emphasize this enough. This is the most important
point by far. MAKE A CALENDAR!!!!! I did this and alotted time based
on what I needed to concentrate on, allowing almost all of the last 2 1/2
weeks to work practice problems. That's right, about 3 weeks to review 2
years of med school! That means some subjects get 2-3 days of review, and
that's it. Some subjects that were strict memorization and insane anyway
(anatomy, pharm) I used only the First AID stuff for. Others I went
through entire review books. For Biochem, which I wasn't confident in, I
read the entire Lippincott book from cover to cover! High Yield
Neuroanatomy! Read it! Also use High Yield for Embryo, and for Anatomy
if you care enough about anatomy to review it (my bias peeps through).
10) Once again, your score will almost exactly correlate to the number of
practice problems you work. Think MINIMUM of 2000 practice problems.
3-4000 is much better.
11) Don't go crazy. I took the test back when it was a two day, 16-hour
behemoth. Gunners at the top of my class were CRYING b/c they were so
stressed out in anticipation. If you feel this way, it's NORMAL, and
doesn't mean you are "blowing it." Don't let the emotions derail you.
Have your cry and get back to work.
One or two more points You don't have to have been a super gunner in M1
to get a
good Step 1 score. I was very much middle of the curve in M-1. I studied
like a FIEND in M-2, especially for pathology. The M-2 material
reinforces the M-1 stuff in a meaningful way, a clinically relevant way
that is consistent with the type of questions on Step 1. So for the short
term, the best thing the M-2's can do for Step 1 is to study pathology
like their life depends on it. Knowledge of pathology is very helpful!
Also, the ICM semester (Spring of M-2) is surprisingly helpful for Step 1.
Some students skip the SPring and take Step 1, then take the ICM semester
later. I do not recommend this, as the ICM material helps prepare the
students for the clinically based scenarios that appear on Step 1!
Finally, I don't recommend that students delay taking Step 1, this is a
bad idea. The temptation is to think that if you have more time (say, a
summer...), you'll do a better job preparing. WRONG. You need to upload
the material fast and hard, and then dump it out again on the test. If
you take a long time studying, you'll forget too much of the earlier stuff
you learned. Correct me if I am wrong (you know better than I do), but
doesn't history show that students who take the early test do better than
those who take it later?
