First Aid for the USMLE Step 1 2024: A Student-to-Student Guide (2024)

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FIRST AID
USMLE
STEP
2024
FOR
THE®
®
A STUDENT- TO - STUDENT GUIDE
THE most recommended content resource for USMLE prep
Over 1,300 must- know concepts with many new high - yield facts
Enhanced tables and mnemonics for rapid learning and high retention
Exceptional illustrations and images help you visualize key concepts
Tao Le Vikas Bhushan Connie Qiu Anup Chalise Panagiotis Kaparaliotis
Boards& Beyond
IS NOW PART OF THE McGRAW HILL FAMILY
L E A R N M O R E
Mc
Gra w
Hill

FOR
THE®
New York / Chicago / San Francisco / Athens / London / Madrid / Mexico City
Milan / New Delhi / Singapore / Sydney / Toronto
USMLE
STEP 1
2024
FIRST AID
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
VIKAS BHUSHAN, MD
Founder, First Aid for the USMLE Step 1
Boracay, Philippines
CONNIE QIU, MD, PhD
Resident, Department of Dermatology
Johns Hopkins Hospital
PANAGIOTIS KAPARALIOTIS, MD
University of Athens Medical School, Greece
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
ANUP CHALISE, MBBS, MS, MRCSEd
Registrar, General and Colorectal Surgery
North Middlesex University Hospital, London
CAROLINE COLEMAN, MD
Assistant Professor, Department of Medicine
Emory University School of Medicine
SEAN EVANS, MD
Resident, Department of Medicine
Emory University School of Medicine

First Aid for the® USMLE Step 1 2024: A Student-to-Student Guide
Copyright © 2024 by Tao Le and Vikas Bhushan. All rights reserved. Printed in the United States of America. Except as
permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distrib-
uted in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of
the publisher.
Previous editions copyright © 1991 through 2023 by Tao Le and Vikas Bhushan. First edition copyright © 1990, 1989
by Vikas Bhushan, Jeffrey Hansen, and Edward Hon.
Photo and line art credits for this book begin on page 755 and are considered an extension of this copyright page.
Portions of this book identified with the symbol are copyright © USMLE-Rx.com (MedIQ Learning, LLC).
Portions of this book identified with the symbol are copyright © Dr. Richard Usatine.
Portions of this book identified with the symbol are under license from other third parties. Please refer to page 755
for a complete list of those image source attribution notices.
First Aid for the® is a registered trademark of McGraw Hill.
1 2 3 4 5 6 7 8 9 LMN 27 26 25 24 23 22
ISBN 978-1-266-07720-3
MHID 1-266-07720-0
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required. The authors and the publisher of this work have checked
with sources believed to be reliable in their efforts to provide information that is complete and generally in
accord with the standards accepted at the time of publication. However, in view of the possibility of human
error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the
information contained herein with other sources. For example and in particular, readers are advised to check
the product information sheet included in the package of each drug they plan to administer to be certain
that the information contained in this work is accurate and that changes have not been made in the recom-
mended dose or in the contraindications for administration. This recommendation is of particular importance
in connection with new or infrequently used drugs.
This book was set in Electra LT Std by GW Inc.
The editors were Bob Boehringer and Christina M. Thomas.
Project management was provided by GW Inc.
The production supervisor was Jeffrey Herzich.
LSC Communications was printer and binder.
This book is printed on acid-free paper.
Copyright © 2024. Exclusive rights by McGraw Hill for manufacture and export. This book cannot be reexported from
the country to which it is consigned by McGraw Hill. The International Edition is not available in North America.
McGraw Hill books are available at special quantity discounts to use as premiums and sales promotions,
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www.mhprofessional.com.

v
Contents
Contributing Authors vii
Associate Authors viii
Faculty Advisors ix
Preface xi
Special Acknowledgments xii
General Acknowledgments xiii
How to Contribute xv
How to Use This Book xvii
Selected USMLE Laboratory Values xviii
First Aid Checklist for the USMLE Step 1 xx
` S E C T I O N I G U I D E TO E F F I C I E N T E X A M P R E PA R AT I O N 1
Introduction 2
USMLE Step 1—The Basics 2
Learning Strategies 10
Timeline for Study 14
Study Materials 17
Test-Taking Strategies 20
Clinical Vignette Strategies 21
If You Think You Failed 22
Testing Agencies 23
References 23
` S E C T I O N I S U P P L E M E N T S P E C I A L S I T UAT I O N S 25
` S E C T I O N I I H I G H - Y I E L D G E N E R A L P R I N C I P L E S 27
How to Use the Database 28
Biochemistry 31
Immunology 93
Microbiology 121
Pathology 201
Pharmacology 227
Public Health Sciences 255

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vi
` S E C T I O N I I I H I G H - Y I E L D O R G A N S YS T E M S 279
Approaching the Organ Systems 280
Cardiovascular 283
Endocrine 329
Gastrointestinal 363
Hematology and Oncology 409
Musculoskeletal, Skin, and Connective Tissue 449
Neurology and Special Senses 499
Psychiatry 569
Renal 595
Reproductive 629
Respiratory 677
Rapid Review 707
` S E C T I O N I V TO P - R AT E D R E V I E W R E S O U R C E S 739
How to Use the Database 740
Question Banks 742
Web and Mobile Apps 742
Comprehensive 743
Anatomy, Embryology, and Neuroscience 743
Behavioral Science 744
Biochemistry 744
Cell Biology and Histology 744
Microbiology and Immunology 744
Pathology 745
Pharmacology 745
Physiology 746
`
Abbreviations and Symbols 747
Image Acknowledgments 755
Index 773
About the Editors 828

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vii
Contributing Authors
CHRISTIAN FAABORG-ANDERSEN, MD
Resident, Department of Medicine
Massachusetts General Hospital
MORGAN BUCHANAN, MPH
Emory University School of Medicine
Class of 2025
ANTHONY G. CHESEBRO
Renaissance School of Medicine, Stony Brook University
MD/PhD candidate
EMILY HAND
St. George’s University School of Medicine, Grenada
Class of 2024
KATHERINE LEBLANC, MSc
University of Washington School of Medicine
MD/PhD Candidate
ANNA LIGOCKI, MD, MS
Resident, Department of Medicine
Ascension Saint Agnes Hospital
FAATEH AHMAD RAUF, MBBS
Resident, Department of Medicine
ISMMS NYC Health+Hospitals/Queens
CAROLINA CABAN RIVERA
Lewis Katz School of Medicine at Temple University
Class of 2025
JAIMIE LYNN ROGNER, MD, MPH
Resident, Departments of Medicine and Pediatrics
University of Rochester Medical Center
GEORGIOS M. STERGIOPOULOS, MD
Research Fellow, Department of Molecular Medicine
Mayo Clinic, Minnesota
Image and IllustratIon team
YOOREE GRACE CHUNG
Emory University School of Medicine
MD/PhD Candidate
TANYA KONDOLAY, MPH
Aureus University School of Medicine
MD Candidate
NOAH NEWMAN, MD
Resident, Department of Internal Medicine
Emory University School of Medicine

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viii
Associate Authors
MAKENNA ASH
Emory University School of Medicine
Class of 2025
MARGARET GINOZA, MD, MPH
Resident, Internal Medicine–Pediatrics
Baylor College of Medicine
TALEAH KHAN, MBBS
CMH Lahore Medical College and Institute of Dentistry, Pakistan
PRABHAT POUDEL, MBBS
Nepal Medical College Teaching Hospital, Nepal
DANUSHA SANCHEZ, MD
Resident, Department of Emergency Medicine
Poznań University of Medical Sciences, Poland
ADITYA SINGH, MBBS
All India Institute of Medical Sciences, Raipur, India
ANNABEL LU
Emory University School of Medicine
Class of 2024
Image and IllustratIon team
AUBREY REED
Emory University School of Medicine
MD/PhD Candidate

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ix
Faculty Advisors
RITU AMATYA
FHI 360, Nepal
MARK A.W. ANDREWS, PhD
Professor and Founding Chairman, Department of Physiology
Duquesne University College of Osteopathic Medicine
MARIA ANTONELLI, MD
Assistant Professor, Division of Rheumatology
Case Western Reserve University at MetroHealth Medical Center, Cleveland
SAMAN BENTOTA, MD
Physician and Microbiologist
Sri Lanka
JOE B. BLUMER, PhD
Associate Professor, Department of Pharmacology
Medical University of South Carolina College of Medicine
BRADLEY J. BRUGGEMAN, MD
Assistant Professor, Obstetrics and Gynecology
University of Florida College of Medicine
CHRISTOPHER M. BURNS, PhD
Professor of Basic Medical Sciences
University of Arizona College of Medicine, Phoenix
BROOKS D. CASH, MD
Chief, Gastroenterology, Hepatology, and Nutrition
University of Texas Health Science Center at Houston
DIMITRI CASSIMATIS, MD
Associate Professor, Department of Medicine
Emory University School of Medicine
CATHERINE CHILES, MD
Associate Clinical Professor of Psychiatry
Yale School of Medicine
BRADLEY COLE, MD
Assistant Professor of Neurology
Loma Linda University School of Medicine
CAROLINE COLEMAN, MD
Assistant Professor, Department of Medicine
Emory University School of Medicine
MARTHA FANER, PhD
Associate Professor of Biochemistry and Molecular Biology
Michigan State University College of Osteopathic Medicine
CONRAD FISCHER, MD
Associate Professor, Medicine, Physiology, and Pharmacology
Touro College of Medicine
AYAKO WENDY FUJITA, MD
Fellow, Division of Infectious Diseases
Emory University School of Medicine
RAYUDU GOPALAKRISHNA, PhD
Professor, Department of Integrative Anatomical Sciences
Keck School of Medicine of University of Southern California
MEREDITH K. GREER, MD
Assistant Professor, Division of Pulmonary, Allergy, Critical Care, and Sleep
Medicine
Emory University School of Medicine
AMBER J. HECK, PhD
Associate Professor, Department of Microbiology, Immunology, and
Genetics
University of North Texas Health Science Center, Fort Worth
VASUDEVA G. KAMATH, MSc, PhD
Assistant Professor of Biochemistry
The University of Arizona College of Medicine, Phoenix
CLARK KEBODEAUX, PharmD
Clinical Associate Professor, Pharmacy Practice and Science
University of Kentucky College of Pharmacy
MATTHEW KRAYBILL, PhD
Clinical Neuropsychologist
Cottage Health, Santa Barbara, California
GERALD LEE, MD
Associate Professor, Departments of Pediatrics and Medicine
Emory University School of Medicine
KACHIU C. LEE, MD, MPH
Assistant Professor (Adjunct), Department of Dermatology
Lewis Katz School of Medicine at Temple University

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x
JAMES LYONS, MD
Associate Dean, Professor of Pathology and Family Medicine
Alabama College of Osteopathic Medicine
NILADRI KUMAR MAHATO, MBBS, MS, PhD
Assistant Professor of Anatomy
Marian University College of Osteopathic Medicine, Indianapolis
CARL MARFURT, PhD
Professor Emeritus, Department of Anatomy, Cell Biology and Physiology
Indiana University School of Medicine–Northwest, Gary
PETER MARKS, MD, PhD
Center for Biologics Evaluation and Research
US Food and Drug Administration
DOUGLAS A. MATA, MD, MPH
Director of Molecular Pathology
Foundation Medicine, Cambridge, Massachusetts
SOROUSH RAIS-BAHRAMI, MD, MBA
Professor of Urology and Radiology
University of Alabama at Birmingham Heersink School of Medicine
RICHARD P. RAMONELL, MD
Assistant Professor of Medicine, Division of Pulmonary, Allergy, Critical
Care, and Sleep Medicine
University of Pittsburgh School of Medicine
KEISHA RAY, PhD
Associate Professor, McGovern Center for Humanities and Ethics
University of Texas Health Science Center at Houston
SASAN SAKIANI, MD
Assistant Professor of Medicine, Department of Medicine
University of Maryland School of Medicine
SARAH SCHIMANSKY, MB BCh BAO
Resident, Department of Ophthalmology
Bristol Eye Hospital
NATHAN WM. SKELLEY, MD
Associate Professor, Medical Director of Orthopaedic Surgery
Sanford Health–University of South Dakota School of Medicine
TONY SLIEMAN, PhD, MSc
Associate Professor, Department of Basic Sciences
New York Institute of Technology College of Osteopathic Medicine at
Arkansas State University
MATTHEW SOCHAT, MD
Physician, Hematology/Oncology
Southeastern Medical Oncology Center
HOWARD M. STEINMAN, PhD
Assistant Dean, Biomedical Science Education
Albert Einstein College of Medicine
JACQUELINE TRUONG, DPM, MPH
Associate Professor, College of Podiatric Medicine
Western University of Health Sciences
RICHARD P. USATINE, MD
Professor, Dermatology and Cutaneous Surgery
University of Texas Health Science Center San Antonio
SYLVIA WASSERTHEIL-SMOLLER, PhD
Professor Emerita, Department of Epidemiology and Population Health
Albert Einstein College of Medicine
ADAM WEINSTEIN, MD
Associate Professor of Medical Sciences and Pediatrics
Frank H. Netter MD School of Medicine at Quinnipiac University
ABHISHEK YADAV, MBBS, MSc
Associate Professor, Department of Medicine
Rutgers New Jersey Medical School
KRISTAL YOUNG, MD
Clinical Instructor, Department of Cardiology
Huntington Hospital, Pasadena, California

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xi
Preface
With the 34th edition of First Aid for the USMLE Step 1 we continue our commitment to providing students with
the most useful and up-to-date preparation guide for this exam. This edition represents an outstanding revision in
many ways, including:
22 entirely new or heavily revised high-yield topics reflecting evolving trends in the USMLE Step 1.
Extensive text revisions, new mnemonics, clarifications, and corrections curated by a team of 16 medical student
and resident physician authors who excelled on their Step 1 examinations, and verified by a team of expert
faculty advisors and nationally recognized USMLE instructors.
Updated with 81 new and revised diagrams and illustrations as part of our ongoing collaboration with
USMLE-Rx and ScholarRx (MedIQ Learning, LLC).
Updated with 21 new and revised photos to help visualize various disorders, descriptive findings, and basic
science concepts. Additionally, revised imaging photos have been labeled and optimized to show both normal
anatomy and pathologic findings.
Updated exam preparation advice, tailored for the current pass/fail scoring system and Step 1 blueprint changes.
New advice on how to utilize emerging AI tools to increase studying efficiency.
Updated photos of patients and pathologies to include a variety of skin colors to better depict real-world
presentations.
Improved organization and integration of text, illustrations, clinical images, and tables throughout for focused
review of high-yield topics.
Revised ratings of current, high-yield review resources, with clear explanations of their relevance to USMLE
review. Replaced outdated resources with new ones recommended by Step takers.
Real-time Step 1 updates and corrections can be found exclusively on our blog, www.firstaidteam.com.
We invite students and faculty to share their thoughts and ideas to help us continually improve First Aid for the
USMLE Step 1 through our blog and collaborative editorial platform. (See How to Contribute, p. xv.)
Louisville Tao Le
Boracay Vikas Bhushan
Baltimore Connie Qiu
London Anup Chalise
Athens Panagiotis Kaparaliotis
Atlanta Caroline Coleman
Atlanta Sean Evans
San Francisco Kimberly Kallianos

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xii
Special Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thousands of thoughtful
comments, corrections, and advice of the many medical students, international medical graduates, and faculty who
have supported the authors in our continuing development of First Aid for the USMLE Step 1.
We provide special acknowledgment and thanks to the following individuals who made exemplary contributions to
this edition through our voting, proofreading, and crowdsourcing platform: Yazmin Allegretti, Athanasios Angistriotis,
and Nikitha Crasta.
For support and encouragement throughout the process, we are grateful to Thao Pham, Jinky Flang, and Jonathan
Kirsch, Esq. Thanks to Louise Petersen for organizing and supporting the project. Thanks to our publisher, McGraw
Hill, for the valuable assistance of its staff, including Bob Boehringer, Jeffrey Herzich, Christina Thomas, Kristian
Sanford, and Don Goyette.
We are also very grateful to Dr. Fred Howell and Dr. Robert Cannon of Textensor Ltd for providing us extensive
customization and support for their powerful Annotate.co collaborative editing platform (www.annotate.co), which
allows us to efficiently manage thousands of contributions. Thanks to Dr. Richard Usatine and Dr. Kristine Krafts
for their outstanding image contributions. Thanks also to Jean-Christophe Fournet (www.humpath.com), Dr. Ed
Uthman, and Dr. Frank Gaillard (www.radiopaedia.org) for generously allowing us to access some of their striking
photographs.
For exceptional editorial leadership, enormous thanks to Megan Chandler. Special thanks to our indexer, Dr.
Anne Fifer. We are also grateful to our art manager, Susan Mazik, and illustrators, Stephanie Jones and Rachael
Joy, for their creative work on the new and updated illustrations. Lastly, tremendous thanks to our compositor,
GW Inc., especially Anne Banning, Gary Clark, Cindy Geiss, Denise Smith, Debra Clark, and Gabby Sullivan.
Louisville Tao Le
Boracay Vikas Bhushan
Baltimore Connie Qiu
London Anup Chalise
Athens Panagiotis Kaparaliotis
Atlanta Caroline Coleman
Atlanta Sean Evans
San Francisco Kimberly Kallianos

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xiii
Each year we are fortunate to receive the input of thousands of medical students and graduates who provide new
material, clarifications, and potential corrections through our website and our collaborative editing platform.
This has been a tremendous help in clarifying difficult concepts, correcting errata from the previous edition, and
minimizing new errata during the revision of the current edition. This reflects our long-standing vision of a true,
student-to-student publication. We have done our best to thank each person individually below, but we recognize
that errors and omissions are likely. Therefore, we will post an updated list of acknowledgments at our website,
www.firstaidteam.com/bonus/. We will gladly make corrections if they are brought to our attention.
For submitting contributions and corrections, many thanks to Ehsen Abdul-Kabir, Suleiman Jamal Abou Ramadan,
Ghaith Abu-Hassan, Raghed Abu Jabeh, Ruby Abu Nassar, Suhaib Abusara, Rochana Acharya, Biplov Adhikari,
Sumera Afzal-Tohid, Marium Aisha, Wahid Aloweiwi, Sajjad Altmimi, Mohammad Arabi, Laila Ashkar, Nabil Askar,
Emily Babcock, Abdulrahman Bani-Yassin, Angelina Bania, Gabriella Barr, Shreya Bavishi, Heather Beyea, Karun
Bhattarai, Pratik Bhattarai, Suzit Bhusal, Iuliia Bochinina, Stephanie Brown, Nicholas Buehler, Jack Carey, Paola
Del Cueto, Amy Cunningham, Suyash Dawadi, Molly Dexter, Jeevan Divakaran, Manasa Dutta, Prabin Duwadee,
Gian Ferrando, Talia Fradkin, Louna Ftouni, Aaron Goldman-Henley, Priyanka Goswami, Jackson Green, Ishan
Gupta, Fariah Asha Haque Haque, Mariam Hassan, Shelly Colleen Heredia, Hung Ho, Rachel Holmes, Kaitlyn
Hoyt, Samkit Jain, Subhah Jalil, Abdelrhman Muwafaq Janem, Julia Katcher, Avneet Kaur, Nadim Khutaba,
Sourabh Kumar, Nery y Mara Lamothe, Guilherme Leite, Anna Marmalidou, Tanya Mateo, Juliana Maya, Nathan
McDermott, Jose Antonio Meade, Shivani Mehta, Muhammed Mikaeel, Dylan Mittauer, Andrew Mohama,
Gamble Morrison, Andrew Moya, Alexandra Jan Mrani, Waneeza Mughees, Ziad Nabil, Ezra Nadler, Shamsun
Nahar, Sajjad Nazar Majeed, Antony Nemr, Hyder Nizamani, Sophie O’Hare, Charis Osiadi, Fahreddin Palaz,
Sharon Pan, Archana Pandey, Abigail Poe, Emily Pompeo, Zoe Pujadas, Yochitha Pulipati, Nicholas Purvis, Denise
Qyqja, Parul Rai, Yoshita Rao, Liran Raz, Eva Rest, Carol Sánchez Jiménez, Ridha Saad, Luke Schroeder, Sirous
Seifirad, Muhammad Shahzaib, Amir Hossein Shams, Naimatullah Sharifi, Ajay Ajit Pal Singh, Ramzi Skaik, Swati
Srivastava, Zargham Abbas Syed, Miranda Teixeira, Grayson Tishko, Hirak Trivedi, Ana Tsiklauri, Luis Vilatuna,
Amanjot Virk, Stefani Wren, Richard Wu, and Hsinyu Yin.
General Acknowledgments

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xv
This edition of First Aid for the USMLE Step 1 incorporates thousands of contributions and improvements suggested
by student and faculty advisors. We invite you to participate in this process. Please send us your suggestions for:
Study and test-taking strategies for the USMLE Step 1
New facts, mnemonics, diagrams, and clinical images
High-yield topics that may appear on future Step 1 exams
Personal ratings and comments on review books, question banks, apps, videos, and courses
Pathology and radiology images (high resolution) relevant to the facts in the book
For each new entry incorporated into the next edition, you will receive up to a $20 Amazon.com gift card as well as
personal acknowledgment in the next edition. Significant contributions will be compensated at the discretion of the
authors. Also, let us know about material in this edition that you feel is low yield and should be deleted.
All submissions including potential errata should ideally be supported with hyperlinks to a dynamically updated Web
resource such as UpToDate, AccessMedicine, and ClinicalKey.
We welcome potential errata on grammar and style if the change improves readability. Please note that First Aid style
is somewhat unique; for example, we have fully adopted the AMA Manual of Style recommendations on eponyms
(“We recommend that the possessive form be omitted in eponymous terms”) and on abbreviations (no periods with
eg, ie, etc). We also avoid periods in tables unless required for full sentences. Kindly refrain from submitting “style
errata” unless you find specific inconsistencies with the AMA Manual of Style.
The preferred way to submit new entries, clarifications, mnemonics, or potential corrections with a valid,
authoritative reference is via our website: www.firstaidteam.com.
This website will be continuously updated with validated errata, new high-yield content, and a new online platform
to contribute suggestions, mnemonics, diagrams, clinical images, and potential errata.
Alternatively, you can email us at: firstaid@scholarrx.com.
Contributions submitted by May 15, 2024, receive priority consideration for the 2025 edition of First Aid for the
USMLE Step 1. We thank you for taking the time to share your experience and apologize in advance that we cannot
individually respond to all contributors as we receive thousands of contributions each year.
How to Contribute

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xvi
` NOTE TO CONTRIBUTORS
All contributions become property of the authors and are subject to editing and reviewing. Please verify all data and
spellings carefully. Contributions should be supported by at least two high-quality references.
Check our website first to avoid duplicate submissions. In the event that similar or duplicate entries are received,
only the first complete entry received with valid, authoritative references will be credited. Please follow the style,
punctuation, and format of this edition as much as possible.
` JOIN THE FIRST AID TEAM
The First Aid/ScholarRx team is pleased to offer paid editorial and coaching positions. We are looking for passionate,
experienced, and dedicated medical students and recent graduates. Participants will have an opportunity to work
on a wide variety of projects, including the popular First Aid series and the growing line of USMLE-Rx/ScholarRx
products, including Rx Bricks. Please use our webform at https://www.usmle-rx.com/join-the-first-aid-team/ to apply,
and include a CV and writing examples.
For 2024, we are actively seeking passionate medical students and graduates with a specific interest in improving our
medical illustrations, expanding our database of photographs (including clinical images depicting diverse skin types),
and developing the software that supports our crowdsourcing platform. We welcome people with prior experience
and talent in these areas. Relevant skills include clinical imaging, digital photography, digital asset management,
information design, medical illustration, graphic design, tutoring, and software development.

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