Every spring second-year medical students across the country prepare for the first of three exams collectively known as “the boards,” with a great deal riding on the outcome. At most medical schools, students must pass Step 1, the first of the three tests that comprise the United States Medical Licensing Exam, before they can proceed to their clinical training in the third and fourth years. And board scores are a yardstick by which applications to residencies are measured. “If you do poorly on this exam, it can make it difficult to get into the residency program you want,” said Antony Chu, one of several Yale medical students who played a role in publishing this year’s edition of the leading guidebook to the exam. “Basically, it can have a major impact on your career.”

Chu, a senior student co-editor of the book, spent hundreds of hours last year shaping and writing First Aid for the USMLE Step 1. Published in January by Appleton and Lange, it is a student-written guide that helps medical students focus their preparation for the boards. Divided into three parts, it offers a description of the exam, “high-yield” facts that apply to a variety of exam topics and a guide to resources for study. “Essentially every medical student in the country who is taking the exam will have this book,” said Chu.

The 1999 edition counted on the work not only of Chu, but several other writers, editors and reviewers affiliated with Yale. Medical student co-editor Esther Choo revised sections of the book and contributors included M. Vaughn Emerson, Ronald Yap and Amy Nuernberg. William Stewart, Ph.D., associate professor of surgery, was one of several faculty reviewers. Tao T. Le, M.D., a third-year resident in internal medicine at Yale, was one of the book’s three primary authors.

Because the exam this year is being offered via computer at educational testing centers instead of lecture halls, the book has changed some of its advice, said Le. “The exam is no longer a pencil and paper exam,” Le said. “The guide is now computer-oriented; students need to know what buttons to push, how to navigate in Windows.”

When the guide emerged in 1990 as a 100-page book that sold for $12, it was written and self-published by students at the University of California at San Francisco. In 1992, Appleton and Lange picked it up, expecting to sell 12,000 copies over three years. It sold 9,000 in its first year alone, said Jessica Hirshon, an associate editor at Appleton and Lange, adding that the book now sells about 30,000 copies a year.

For the Step 1 guide, Chu and Choo supervised the work of seven student contributors and seven other students who reviewed material. The students’ incentive, Chu said, was not money. “They got a small stipend, but in terms of the hours they put in, it’s nothing,” he said. “The spirit of this book is a reflection of the Yale System. It’s about students helping each other grow.”