Step 1: An Exam to Forget

Step 1. If you are in medical school or know anyone in medical school then you have definitely heard of it. This is the major exam that is taken (typically) between year 2 and year 3. The score technically ranges from 1 to 300, but most people score between 140 and 260. The passing score is 194 and the mean is 229 with a standard deviation of around 20 (at least, it was the last time I checked, this typically changes slightly every year). You need to pass this exam to continue in medical school and once you pass you can never take it again, which means if you get a 195 that is your score for life.*

These scores are so important because they will play a strong part in what residency you can get into. Each residency typically has a standard average Step 1 score it considers, so if you don’t do amazingly in this exam it has the chance to block you from getting into certain residencies. Hopefully, this will not be the case for much longer as we know that Step 1 score does not correlate in any way with how good a doctor you will be.

Step 1 + Step 2 CK Percentiles: What's a Good Score for Each Specialty?

This post is not going to be a description of how I studied and how I think others should study. Frankly, I think those posts are not particularly helpful and within the first month of second year I was already completely fed up of people telling me how I “needed to” study in order to do well in Step 1. I will tell you that I am content with my score and if you have specific questions about my study methods feel free to reach out to me directly. I am going to go over some of the overarching lessons I learned or things that drove me crazy in the hopes that it helps someone else.

1. “Start studying for Step 1 immediately”
As soon as I started year 2, I had people telling me I needed to ignore classes and focus on annotating First Aid (the Step 1 studying bible). I had people telling me that if I hadn’t been doing this since first year I was in trouble. Every variation of “YOU’RE BEHIND!!!” that you can think of. For some people all of these things worked great and I am not saying they’re not good ideas but they are not necessary. I did not start annotating First Aid until November of my second year and I know some people didn’t until dedicated. Using First Aid is not the only way to study because, surprise, you’re in medical school. Everything you are learning at school is going to help you for Step 1.

2. Make a Schedule
This one freaked me out. My school required us to make a schedule for dedicated (the study period between when school ends and you take the exam, typically 4-8 weeks). Everything Step 1 advice blog I read said that you had to make a schedule and stick to it to do well. But I suck at schedules. I get things done, I write to do lists but schedules like the one you see below with “9am-10am: study X” don’t work for me. I thought that if I didn’t stick to the schedule I couldn’t do well. I did make my schedule so I could give my school the proof of my productivity that they required, but I did not use it as a schedule. For each day I assigned a topic (e.g. cardiology) and that was my topic for the day. I aimed to go through certain number of resources for each topic and do at least a certain amount of random questions each day but as far as the schedule I had below I did not stick to the hourly rules.

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This was my schedule as I submitted it to the school. It was not a precise schedule that I kept to, more of a guide of what I wanted to accomplish. I never once got up at 7am until exam day and I don’t think I ever started studying before 9am.

3. Exercise/Don’t Exercise
I am not a very fit person and I do not enjoy going to the gym. I think I have been to the gym 5 times since moving to Detroit. I received drastically varied messages about exercise re: studying for Step1. Some people told me I had to incorporate exercise into my studying routine others told me it was too late for me because it was not already a regular thing I was doing and I shouldn’t start anything new. Since I knew year 2 would be a stressful year I had begun incorporating 15-20mins of yoga into my morning so this is what I continued during dedicated. I also tried to do some yoga/stretches at the end of the day to better transition from studying to sleeping. My schedule says I went for an hour-long walk every day between 5 and 6pm. Hopefully you realize by now that that is not what really happened. I didn’t go for an hour-long walk every day before dedicated and I wasn’t suddenly going to develop that habit overnight; however, I did make a point to go outside and walk everyday at some point, usually when I felt that I couldn’t focus. I think the main message of the exercise comments is that you need to make sure you don’t spend every hour of the day sitting and studying.

4. Other People
This one is hard. Everyone around you is freaking out. Comparing how many flashcards they’ve done, how they’ve done on practice tests, the number of study resources they have used. This list goes on. I found that spending time with or talking to most of my peers studying for Step 1 was not great for my mental health. This does not mean avoid people altogether. If possible, find friends in the years above who can be a little more supportive and talk you down when you get overwhelmed without making you feel like you haven’t studied enough. I was lucky enough to have a supportive partner who is not in medical school, which meant that I could avoid medical students without completely isolating myself. These supportive friends don’t have to be people you see/know in person either. I received plenty of non-stressful support from the MedTwitter community; so don’t worry if you live alone and only know people in your medical school class, there are other ways to spend time with people.

5. Food
Eating well is important at any time, but especially during periods of intense studying and stress. For many people stress decreases their appetite but that should not mean you stop eating. Make sure to include meal and snack breaks in your schedule and really do follow them. If you are financially able to, dedicated is the time that I recommend splurging a little. If you live alone, get groceries delivered so you don’t have to stress about making time to get food. If you like cooking, that’s a great break but if you don’t like to cook then it’s okay to order out a little more than normal. Listen to your body and take care of yourself! If you are the sort of person who sometimes slips into unhealthy eating habits or may struggle to eat for a while, find friends or a roommate you can talk to in advance, tell them what problems may arise, and ask them to be a little pushy with you about eating if necessary.

Much of this advice holds true for many big exams but Step 1 is probably the most intense exam I’ve taken in a long time. I know that now the MCAT is about as long as Step 1 (I took the old MCAT with scores in double digits) so perhaps some of this advice will be helpful to those of you studying for the MCAT as well. Please don’t take any of my advice as a requirement. We all work differently and the most important thing for you to take away from this post is that there is no one right way to do this. Listen to your brain and your body and do what works for you. If you have any other thoughts about lessons you learned while studying for Step, please share them!

* Although this was the case when I took Step 1 in 2018, we now know that the USMLE is going to change Step 1 to a pass/fail exam starting no earlier than January 2022. This fact does not really change my advice but I hope might make things a little less stressful for students taking the exam.

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