Key Virtual Education Tools in a Modern Learning Era: Surveying the Forces of UFAPS

Austin Kim


December 21, 2021

The modern era's titleholder for the gold standard of STEP 1 preparation, UFAPS (UWorld, First Aid, Anki, Pathoma, and Sketchy), seems to be the go-to quip for preclinical students looking to succeed on their first board exam.

While many of the old guard may tout that nothing beats seeing, palpating, and diagnosing live patients, few would argue that there is much educational value in a similar approach for the content of STEP 1: an 8-hour standardized exam rooted in the flashcard-fought flowchart fundamentals of biochemistry, genetics, histology, and other rote mechanisms that students are taught to never parrot to their patients in the name of proper bedside manner.

As a battle-hardened UFAPS soldier myself, I can only testify to its efficacy, and the equivalent ire it draws out of salaried professors asking how dare only a small percentage of the class decide to show up to in-person lectures. How dare we borrow six-digit loans to stay home, catch up on sleep, and take care of ourselves! Surely our tuition must mean something to us!

A bold question, and one that duly deserves an investigation into the dramatis personae of the usurpers of today's preclinical education.

Definitive Question Bank

At stage left stands our staunch vanguard UWorld. Founded by Dr Chandra Pemmasani in 2003, UWorld is the most imposing of our players and exists to hold the line as the definitive question bank to test one's mettle upon.

Though many may try, flying the banners of AMBOSS and Kaplan, nothing quite stands up to UFAPS' mighty repository of board-style questions and detailed explanations, leading students to spend hundreds of dollars to sip at its immaculate fountains for just a few months.

So immense is the measure of its reach that UWorld has now expanded to the likes of the MCAT and even SAT, looking to embrace students in its gargantuan anti-screenshotting hug from their most formative ages.

Perched nearby is his wizened advisor, First Aid. The McGraw Hill–published book dating back to the early '90s was once a forerunner in frequently tested facts and creative mnemonics (with varying degrees of success).

In modern times, First Aid is content to stand in the shadows, but it's always ready to lend a reliable hand as a supplementary text when one must actually read up on a topic.

In a world where thousands of pages of Gray's and Robbins are just too dense for the average millenni-zoomer brain to procure a reasonably straightforward explanation, the maxim is to use First Aid and UWorld hand-in-hand, get "injured" on a tough question, and find "first aid" in the comfort of salient points written in bite-sized chunks.

The Daily Grind

Behind sprawl the soldiers — our main fighting force, composed of the legion known as Anki. Thousands upon thousands of cards created by medical students across the world with too much time on their hands, Anki is a 15-year-old flashcard program operating on the principle of spaced repetition: Its war room algorithm strategically schedules cards based on their perceived difficulty by the user.

Universally, it is a board-studier's daily ritual to review 200 old cards and cram in 200 new ones over a morning cup of coffee — and an evening cup of coffee. Moreover, the strength of Anki lies in the ability to upload and share card decks across the internet, multiplying across Reddits and Discords in a collaborative effort that spawns platoons infinitely strong.

The illustrious named decks of Zanki, AnKing, and Pepper could practically prepare students all on their own, as long as the space bars on their keyboards could withstand such a brutal assault.

Voices of Reason

Finally, supporting our forces are the soothing voices of Drs Husain Sattar and Andrew Berg, founders and primary narrators of Pathoma and Sketchy, respectively. Dr Sattar's friendly face inspires many, as he took it upon himself to author his own textbook and lecture series on everything the average student needs to know about pathology for STEP 1.

Spanning all mechanisms of disease and everything from cell death to rashes, Dr Sattar's calm instruction and simple diagrams break down even the most complex of histological slides. So successful is he that many have gilded him with the ever-reverent title of "Dad."

In tandem stands the colorful videos of Sketchy, determined to approach microbiology and pharmacology with visual mnemonics in the most meme-worthy (SSRIs), cringe-worthy (toxoplasmosis), and so-horrible-you-can't-stop-watching (macrolides) ways possible.

True Sketchy scholars need no further explanation for the above examples. The spells they cast invoke equal parts brilliance and ire at their cartoon aids, yet few medical students are truly immune to their catchy beat. The recent tradition of the annual Sketchy Halloween party, where students come dressed up as their favorite bacterium or beta-blocker, truly demonstrates the power of their siren song.

Capturing TikTok Attention Spans

With such a powerful army sitting on their laptops at the beck and call of their fingertips, it is no wonder that preclinical students feel no need to attend their lectures anymore. Professors may scoff at us, cursing UFAPS as harbingers of the end, where even medical education has fallen prey to the TikTok attention spans of the modern student . But I will attest from personal experience there was nothing I learned for STEP 1 that was taught better in a classroom over a 2-hour lecture than online in a 15-minute video (8.5 minutes if watched at 1.75× speed, as is etiquette).

And so, with the beast of an exam slain, I graduated from my preclinical years having gone to the lecture halls an astonishingly meager amount, ready to actually use my stethoscope on something other than an electronic training dummy and stuff countless items into the pockets of my short white coat like countless others before me.

Old Friends in Your Pocket

It was here that I realized that the shift to grinding out, independent-style learning is exactly what our schools expect of us in our third and fourth years, where classroom instructions are done away with and replaced by real patient exposures.

The diligent preclinical class attenders have now found themselves ambushed in foreign territory. There are no textbooks, no daily lectures, and no one to hold your hand as your intern tells you to "go see this one" at 5:30 in the morning when you barely understand what rounds are.

But it's okay. The mercenaries of UFAPS prepared you for this suddenly autonomous chapter in your education. You can look it up on that phone choking in your chart-filled pocket.

Use the elevator ride to quiz yourself on the myriad ways your attending will grill you on your patient's post-op fever. One cannot possibly see everything there is on the family medicine shelf exam by working at the local clinic for 6 weeks.

And so where do we, newly knighted upperclassmen on the front lines of patient care, turn to for our bodies of knowledge? We enlist the question banks of UWorld, the decks of Anki — old friends in whom we once again find solace — to cram in concepts between patients, over lunch, and while waiting for the bus home.

Only time will tell if these habits will continue to guide my career through residency and beyond. I shudder to think of what my future learning will look like if this routine we all swear by is quickly shut down by the additional responsibilities of actually being a doctor.

In that vein, I wonder, would I be so beholden to swear by these regimens if I were not a single bachelor in a cramped apartment with no notes, no charts, and nothing better to do in my free time than play League of Legends?

There is also a conversation that must be had about paying $60,000 a year just to learn everything online for 3% of the price. But one thing is for certain: For many, floundering in this preclinical twilight, the forces of UFAPS are here for you.

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About Austin Kim
Austin is a fourth-year medical student at Tulane University and is currently applying for residency in physical medicine and rehabilitation. With a theater degree from Emory University, he found himself drawn to PM&R for its unique appreciation of the human body and the import of function — an ethos he pursued extensively as a student of dramaturgy. His career interests naturally include sports and performing arts medicine. In his free time, Austin enjoys board games, watching VTubers, and playing a certain critically acclaimed MMORPG.


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