Flashcards for the boards

How two frustrated students decided to make studying for the Step 1 exam easier.

The project began after a bridge game in mid-January 2003, when two medical students were commiserating about preparing for the board exam. Bridge partners Suzanne J. Baron and Christoph I. Lee were frustrated by studying for Step 1 of the United States Medical Licensing Examination—no single source seemed to provide the information they needed about pathology.

To assemble the basic facts about more than 300 diseases covered in the pathology section of the exam, the two second-year students leafed through a half-dozen review books and textbooks. Somebody ought to make the job easier, they reasoned. And so, although they don’t bet on their bridge games, Baron and Lee decided to gamble: they would develop a study aid, a set of flashcards, and they would sell it to a publisher.

Their efforts paid off. McGraw-Hill liked the idea, and three months after Lange FlashCards: Pathology came on the market last summer, more than 3,000 sets had sold. McGraw-Hill may translate the cards into Chinese, Greek, Italian, Spanish and Turkish for students in international medical schools who will take the Step 1 before applying for residencies in the United States.

Ironically, preparing the manuscript meant even more of the hard work that Baron and Lee had complained about. “I have a stack of review books this high in my apartment,” says Baron with a laugh, holding her hand waist high.

The flashcards cover disorders in 13 systems in the human body, from the heart to the immune system. To put the facts in context, Lee and Baron wrote a clinical vignette for the front of each card, and facts about the disease on the back. As Lee and Baron worked, they realized that students would find the cards useful not only in preparing for the boards, but also for studying pathology when it was taught in class. Two of their professors, John H. Sinard, M.D., Ph.D., HS ’93, FW ’94, associate professor of pathology and ophthalmology, and Deborah Dillon, M.D. ’92, associate research scientist in pathology (now at Harvard), checked their manuscript for accuracy.

To find time for the project, Lee and Baron asked Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, for permission to postpone their clinical clerkships, which their classmates began in June 2003. Angoff agreed that the project was consistent with the philosophy of the Yale System. “Students are encouraged to find the things they’re passionate about and explore them in depth,” she said. “I love the fact that they saw a need and they were going to be the ones to fill it.” (This was not the first effort by Yale students or residents to prepare a study guide. Tao Le, M.D., HS ’03, co-wrote First Aid for the USMLE Step 1 while a Yale resident, with the help of students Antony Chu, M.D. ’02, and Esther Choo, M.D. ’01, who worked on the 1999 edition of the study guide.)

“We owe a lot to the Yale System,” says Lee. Still, when they saw their friends begin work in the hospital, Baron recalls, “we felt a little left behind.”

They have something to show for their time: a stack of 286 four-by-six flashcards, which retail for $29.99. (The authors receive royalties of 10 percent.) As they apply for residencies in internal medicine (Baron) and diagnostic radiology (Lee), they’re also working on flashcards for pharmacology and for biochemistry and genetics.

Recently, Baron spotted the cards on a shelf at the Barnes & Noble bookstore near her home in suburban Boston. “I said, ‘That’s me!’ That was a huge thrill.”

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Library keeps a watchful eye on what works on the Web

In days of yore—before the year 2000, that is—libraries generally set up websites for their patrons “and assumed everyone could use them without a problem,” recalls Richard Zwies, M.L.I.S., Web services librarian at the Cushing/Whitney Medical Library.

Those days are over. A new research genre, based on usability studies, reflects libraries’ growing interest in streamlining their websites. Usability studies test how easily users can navigate a site, whether their aim is to scan the contents of the latest issue of a journal, track down an article or find out if a book is on the shelf. If a study shows that users are confused, librarians can change labels or reconfigure links.

The new approach has caught on fast. When the Association of Research Libraries offered an interactive Web-based class on usability studies last fall, 72 of its 123 member libraries, including Yale, signed up for the 90-minute session.

“The virtual front door of the library is becoming more important than our actual, physical front door,” says Zwies. In the 2003-2004 academic year, researchers, physicians, students and other users knocked on that front door—the Cushing/Whitney home page—more than 4.4 million times. In comparison, people walked into the library 329,000 times that year. Zwies says people use the Web for research because it’s accessible from almost anywhere, day and night.

Zwies just completed a small usability study of the medical library home page. He timed five volunteer testers as they tracked down several types of information. Zwies also counted the number of visitors to the “front door” for a week: users clicked on it 30,000 times. The most popular link? Webmail. Zwies actually finds that encouraging, as it suggests that many people at Yale set their browsers to the library home page. The second most popular link was to electronic journals.

The study showed that the site is generally easy to navigate, so Zwies plans only small changes. Even for this minor redesign, which eliminated redundant links, he sketched a new “wire frame,” Web parlance for the site’s “bone structure.” He then passed that on to Web designer Patrick J. Lynch, director of the MedMedia Group at ITS-Med, saying, “... it’s like a rough skeleton and Pat puts flesh on it.” (The home page already has some flesh on it, by the way: a woodcut of a cadaver, taken from the 16th-century anatomist Andreas Vesalius’ De Humani Corporis Fabrica. Visit De Humani Corporis Fabrica.)

Usability testing will be a perennial task, says Zwies. “As Web technologies arise that might be useful to our patrons’ research, we will want to test them on human beings. We will be testing and tweaking, testing and tweaking.”

Bookshelf focuses on books and authors at the School of Medicine.
Send suggestions to Cathy Shufro at

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