Background 94% of program directors cited the USMLE Step 1 score as the most important factor in determining an applicant’s competitiveness for residency. Thus, medical students are motivated to attain the highest possible score. With the recent announcement of Step 1 switching to a pass/fail standard, it is important to analyze factors which predict meeting this goal. Objective To investigate the factors which can influence or predict performance on USMLE Step 1. Methods We conducted a systematic literature search on PubMed, Web of Science, Scopus and ERIC in 2019. The key words were “USMLE”, “Step-1”, “score”, “success” and “predictors.” The search included articles published between 2005 and 2019.  Studies that did not focus on Step 1 outcome or allopathic medical students in the United States were excluded. Results 275 articles were found, 29 of which met our inclusion criteria. Analysis from these articles demonstrated that predictors of USMLE Step 1 score can be divided into unmodifiable and modifiable factors. Unmodifiable factors include gender, MCAT score, pre-clinical grades and NBME/CBSE scores. Modifiable factors include taking USMLE Step 1 within two months of completing pre-clinical courses, motivation from anxiety, multiple-choice questions completed, unique Anki cards seen and complete passes of First Aid for the USMLE Step 1. Conclusion Our review suggests that although students can focus on modifiable factors to increase their score, the energy expenditure required to increase Step 1 score by one point is unrealistic. This may have impacted the NBME’s decision to change Step 1 to a pass/fail exam.

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BACKGROUND The BRAF-V600E gene is a protein kinase involved in regulation of the mitogen activated protein kinase pathway (MAPK/MEK) and downstream extracellular receptor kinase (ERK). The BRAF-V600E mutation has a significant role in the progression of pediatric brain tumors. 85% of pediatric CNS tumors express the BRAF mutation. Thus, BRAF targeted therapy in pediatric CNS malignancies has potential to become the standard of care for tumors expressing this mutation. OBJECTIVE Current pediatric CNS brain tumor treatment focuses on chemotherapy and radiation, causing significant toxic side effects for patients. The significance of this case series lies in relaying our experience using targeted therapy in BRAF-V600E positive CNS pediatric brain tumors. METHODS We followed the disease course, progression, and treatment of three pediatric patients with three different CNS tumors. Each of these individuals was treated with surgical resection, chemotherapy, and/or radiation as per standard protocol. When that modality failed to reduce tumor progression, we found that each of their different tumors was BRAF-V600E positive and they were all started on targeted therapy. DISCUSSION Vemurafenib, Dabrafenib, and Trametinib are BRAF-V600E/MEK inhibitors that were initially used to treat melanomas. However, more research has shown that various pediatric CNS tumors are BRAF-V600 positive. Therapy with these BRAF inhibitors has been shown to slow tumor progression, but toxicity can be severe. This case series shows one patient with successful tumor regression, one patient with prolonged disease stabilization, and one patient with initial response but subsequent progression and ultimate death. It has been shown that using BRAF inhibitors in lower grade CNS tumors are more effective than higher grade CNS tumors. CONCLUSION The success of Vemurafenib and Dabrafenib/Trametinib in causing pediatric CNS tumor regression is promising, but further studies are needed to solidify their role in pediatric CNS cancers.