Step 1 Studying

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This is one of my most requested topics through instagram DMs. I’m writing this down as a stream-of-consciousness once so that I can send this link to anyone who asks for it… but I don’t want to talk about it a lot more than that! Everyone’s step 1 experience is tortuous in its own special way, and although I’m very hopeful that mine was one of the worst so that I can console myself into believing that not every single doctor out there is as traumatized by this exam as I was, I’m fairly certain this is wishful thinking.

One disclaimer is that I knew I wanted to do something primary-care related, and since the average step 1 score for ob/gyn (which I was thinking about at the time) was somewhere around 226 vs. neurosurgery at 244, there was a lot more cushion and a lot less pressure on me to go nuts aiming for a 280. If I’d changed my mind later to doing something more competitive, there were certainly other aspects of my application that in combination with the score I did end up receiving would have likely made me successful candidate in any specialty, but my approach was definitely an “I don’t want any roadblocks to residency but more than enough seems superfluous” one and that might not be the very comfortable for someone who knows ahead of time they need a high score.

Another disclaimer is that this is not a post about how to approach the exam as an IMG. I get that question from a lot of instagrammers as well and honestly, I don’t have expertise in that area and would feel bad trying to give advice about it!

So, now that I’ve written disclaimers that are probably a lot longer than the actual content of how I studied, here it is:

  1. Do well in medical school. This doesn’t necessarily mean make 100s on every exam, but it means studying like someone’s life depends on it, because at some point someone’s life will probably depend on how hard you studied in medical school. This also has the benefit of making step 1 studying a review rather than a crash course in all of medicine, which would be physically impossible to do.
  2. Pathoma. Either get this or Goljan’s and stick with it. You can use it during the preclinical years, but definitely pay more attention to your lecturers in real life since just knowing the pathology is not the only key to success as a physician.
  3. First Aid. Obviously. I would advise against buying this as a first year and maybe not even until the second semester of MS2 if you’re at a school that still has 4 preclinical semesters. Over-annotating will be wholly counterproductive and you’ll seriously get lost in the woods if your whole book is covered in something you just knew would be helpful when you started reviewing. It won’t be. My favorite tip for this book was to get it unbound and 3-hole-punched so you could put it into separate binders. One small section at a time somehow feels one million times less intimidating than the entire thousand-page volume. Also see bonus #11 for disposal techniques.
  4. UWorld. UWorld UWorld UWorld. If you know everything in all of the answer explanations, you probably will score beyond your wildest dreams.
  5. Strategize timing. I know most people probably can’t do this one, but for me it worked really, really well. I had built up some elective time during MS1/MS2 (thank you Spanish and alternative medicine) that meant I had a LOT of free time in MS4, so I moved my first MS3 rotation into MS4 and took an extra 6 weeks of at the end of MS2. I finished a couple of projects I’d been working on, went on vacation with my family, did MS3 orientation with the rest of my class, and then started studying. I only studied for about 3 weeks in total before taking another 3 weeks off. It was a little weird seeing the rest of my classmates get started on the wards, but in hindsight is now absolutely a decision I’d make over and over again to protect my mental health.
  6. Find a a good study spot. I went home to my parents’ house and let my mom drive me to my undergrad library every morning when she went her work nearby. This meant I couldn’t call it quits early if I was getting bored of studying since I had no way to get home. I had the perfect study carroll and the librarians all started bringing me coffee and giving words of encouragement because they’d literally never seen anyone study so hard. #UNCWproblems
  7. Flashcard study walks! I know all of the pharmacology that I know only because I took pre-made flashcards of drugs on short walks 2-3 times per day. Thankfully the campus where I was studying was really safe/car-free so it worked out pretty well that I could walk and read at the same time. After a certain point my body just needed to stand up, but I am the type of person who needs studying momentum and even a 15 minute break can derail my train of thought, so this was a good happy medium. It felt like a “break” to me but I would advise using this technique with caution if you are of the mindset that a real break entails actually stopping studying.
  8. Take evenings off. If you have already studied 9 hours in the library all day, how productive is your brain actually going to be at home? Just enjoy time with family or friends and try not to think about anything important.
  9. Let loved ones know you’re not feeling like yourself. This was key – despite the relatively low-stakes nature of my exam prep and the overall way I approached the test, I was beside myself with fear 99.9% of my waking hours, and that manifested itself as me not being totally emotionally stable. Now, looking back, I know my strategy paid off and I shouldn’t have been as anxious as I was, but one of the best things I did for myself was to surround myself with support and to let them know that this was at least somewhat par for the course, since at the time I would have probably crumbled if it wasn’t for my parents. There was one night the week of my exam where I freaked out to the point of a panic attack, sobbing and practically screaming that I “knew nothing,” so my mom literally turned every single page of First Aid saying “do you know something about what’s on this page?” and when I answered yes, she wrote something down and at the end did some really phony math that demonstrated I knew 98% of everything in First Aid. Obviously I didn’t, but I needed that morale boost and I think everyone could use that kind of cheerleader who doesn’t judge you or ask questions but just helps during the hell that is step 1.
  10. Don’t study the day before the test! I think this is pretty obvious, but relax and just try to remember how to breathe. My mom came to the rescue again with this one… she found a friend with a yacht and got me invited to spend the afternoon and evening on the water so that I literally could not get access to my books no matter how hard I tried.
  11. Bonus: shoot First Aid. My dad took me to a shooting range after the test was over and I unloaded 15 rounds into the front cover. This was incredibly cathartic and though I usually do not condone gun use now as a pediatrician, I would make a special exception for anyone wanting to exact revenge on an inanimate object such as First Aid, as long as it’s done with adequate eye and ear protection and safe shooting technique and environment.

I guess step number 12 would be to almost immediately start studying for step 2, which I found much more pleasant and actually applicable to real life as a physician. I can do a separate post about it later, but for now check out OnlineMedEd which is what I used and loved. It helped boost not just my numerical score (average step 2 CK is much higher at baseline) but my actual percentile. It also helped me look good on the wards!

That’s pretty much it. Writing this all down actually brought back a strange amount of emotion… so glad I don’t ever really have to think about this again!

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