It’s over. I killed the beast. Tackled the giant. Conquered Goliath.
Last Friday I took USMLE Step 1; arguably the most daunting test in a doctor’s career. I dedicated 7 1/2 weeks, 6 days a week, 12 hrs a day to study for this test. Unlike other accounts I’ve read, my test day felt great. I went into the test knowing that I couldn’t have tried any harder, so come what may. There were certainly questions that stumped me, but I felt that my test was easier than uworld, and about equivalent to the NBME’s. The evening after my test my smile grew wider and wider as I realized it was over. It has felt unnatural to wake up the last couple of days and not immediately walk into my office to start going through uworld questions by 7 am. I’m remembering that I have family, friends, and hobbies. Life is immeasurably better, and I swear spring waited until now to bloom just for me.
I want to share with you 11 things I learned while studying for Step 1.
1. You can never learn First Aid enough. If you think you have mastered every minutiae in that 600+ page review book, think again. Review review review. Every detail in that book is fair game, and you will be expected to know the difference between very similar diseases based on tiny incidental findings.
2. Questions questions questions. I am extremely grateful that I completed the USMLErx qmax qbank before I started uworld. I started USMLErx during my last block of M2, and I finished it the first week of my dedicated study period. I treated this question bank as my first pass of First Aid, and it allowed me to hit uworld running. Between question banks and practice tests, I did over 6,000 questions. Very worth it.
3. Make sure you are learning the concepts behind the questions you miss. Evaluate every missed question. Was it a simple mental error? Was the material completely new? Was it a concept you keep forgetting, regardless of the number of times you learn it? Once you’ve identified the problem, record the lesson you learned in a manner that is easy to retrieve. For example, for each question I missed I did three things: I wrote the lesson I learned in a notebook, I annotated it into First Aid, and I made an anki digital flashcard. You have to find a way to do this fast while still being thorough. It takes a lot of time initially, but practice makes perfect. This meant that I was constantly reviewing the concepts I had learned as I read First Aid, reviewed my daily flashcards, and read through my notebook.
4. Carefully select the location you study in and be consistent. I chose to study at home. This made sense to me for a couple of reasons. We don’t have any children yet, and my wife is very busy at nursing school, so I knew that my home would be quiet. I also have the benefit of having a home office. I made sure to do all of my studying in the office, so that I wasn’t sick of the rest of the house on the rare occasion I left my study cave. I made sure my office was stocked with water, whiteboard, food, tissue, light, etc. I only intended to leave my study space to use the bathroom and to find more food. Wherever you decide to study, make sure it is a place you can consistently use. I would only suggest studying at home if you are guaranteed solitude, and have a room that you will only use for studying, thus protecting the rest of the house from your Dr. Jekyll and Hyde moments.
5. Plan consistent breaks and use them wisely. Studying for this test is a mental marathon. Don’t try to sprint your way through it. I scheduled a basketball break from 12 – 12:30 pm, lunch from 12:30 – 1 pm, and a 15 minute guitar break every two hours
6. If you’re tired, switch to a different study source. There will be times your productivity slumps and you simply cannot read another page of First Aid or correct any more uworld questions. Instead of taking an unscheduled break, try switching up your source. I found that if I grew tired of reading, it was time to watch pathoma or sketchy micro videos.
7. Don’t take your loved ones for granted. Realize that you are not the only one who is sacrificing for your test. Your wife, roommates, friends, parents, or anyone else you normally associate with is going to have to put up with you. On your days off, try your hardest to be a normal human. Laugh if you will, but this is harder than it sounds. There were times during my study period when I took my wife out to dinner, and the only thing I could talk about for conversation was the contraindications for monoamine oxidase inhibitors. Thankfully Mrs. DebtAnatomy is very supportive and understanding. However, show gratitude to those around you for their support, and make sure you dedicate your post-step 1 time to making up for lost time.
8. Take lots of food with you on test day. You’ll be shocked at how hungry Step 1 will make you. Treat yourself to your favorite snacks that day, and make sure you have twice the amount of food that you would normally eat. Better full than hungry 🙂
9. Take a weekly practice test, and don’t let them get you down (for too long). My sights were probably a little too high for my first couple of Saturday practice tests, and they put me in a sour mood the rest of the weekend. It stunk, but I learned to use that feeling to my advantage. When Monday came around, I was ready to throw myself into studying; determined to score higher on my next test. With patience and a ton of hard work, my scores rose into my target range.
10. No Regrets. You will not learn everything you want to. You will not have First Aid completely memorized (even if you think you do). But make sure that when you walk into your test you can be certain that you tried your hardest, you left it all on the field, and no amount of do-overs would change the outcome. This is the only reason that I am sitting here comfortably before I even know my score. Whatever number those three little digits show in three weeks, I’ll have the luxury of knowing that I did my best.
11. Take EVERYBODY’S advice (including mine) with a grain of salt, and do what works for you. You succeeded in undergraduate school, you rocked the MCAT, and you got into medical school. You know your study preferences better than anyone on student doctor network. Find what works for you, stick your fingers in your ears, and ignore what your classmates are doing.
To everyone reading this who has yet to take Step 1, I wish you a warm good luck.
3rd year anybody?
EDIT: I have since received my score. As most of my class knows who I am, I do not wish to post my score, because I do not want to be accused of bragging, etc. However, I also realize that as a reader you might pay closer attention to my Step 1 advice knowing that I scored well. So here is a compromise: Whenever I listened to advice, I paid extra attention to guidance from people who scored >250. Using this bar of measurement, my pre-step 1 self would’ve paid extra attention to my post step 1 self. If that’s not clear enough for you, then I suggest you study extra hard! 🙂