as someone who did well on Step 1, i will take the perhaps less popular opinion that the USMLE is basically a preclinical achievement test with a little bit of reading comprehension thrown in. i'm sure there is a positive correlation between step 1 performance and IQ but to call the Step 1 an "intelligence test" is ludicrous. If you can wade through the distractors and find the "secret trigger," a term I am now coining for the fact that usmle is still LITTERED with triggers, but they've simply become "trigger phrases" -- i.e. "systolic murmur best heard at left lower sternal border that increases in intensity on Valsalva" = hypertrophic cardiomyopathy. You can have a very poor understanding of the actual physics rationale for this murmur, of the systolic anterior motion against the anterior mitral leaflet due to venturi forces and the preload-dependent nature of the murmur, but if you remember the "trigger phrase," you're set. There's a LOT of that on the USMLE, where they've simply repackaged a tidy concept into a slightly more wordy but equally trigger-happy prompt. the questions i didn't get right on the test, I knew almost immediately why I missed the question, and it was simply a knowledge misfire -- you either know the black box side effect of Aldesleukin, or you don't.
