USMLE Step 1

Your first two years of med school...judged by one test

My newest project is Pharm450.com, the easiest way to learn pharmacology for USMLE Step 1. Pharm450 packs an entire course on medical pharmacology into a set of entertaining videos that leverage your visual, spatial, and emotional memory so you learn faster and retain more.

I’ve written elsewhere about studying and test strategy, but this post contains some specifics for Step 1 including how to plan your schedule, what resources to use, where to focus, and the days leading up to Test Day.

It’s important, but not everything. You’ve heard so much about this test from older students. While the anxiety is building, it’s important to keep some perspective. Your STEP1 score is not a make-or-break score. Do your best and move on to the next set of hurdles. Your residency application is a combination of board scores, letters, grades, and research. You probably only need two of those to be great to get an interview, and after that it’s absolutely more about personality than raw numbers. Ultimately keep in mind that this test doesn’t define who you are. It’s ridiculous how much pressure is placed on this one test value and faculty I talk with say it’s only one piece of a small puzzle.

It’s a marathon. If you know what you want to do, it’s the things you do week after week after week that get you there. Research, relationships, work ethic on sub-internships, etc that get you in. Step1 is just one number they might use to screen. They don’t compare people like “student A is 225 versus Student B who is 235”….no. The competitive programs compare based on letters and research and relationships.

Now on to what you probably came for…

Do questions. That’s the biggest thing you can do now that will effect your grade. Stop just straight reading First Aid. Switch from this inefficient undirected review to only spot review based on the questions you encounter. By now you should have a pretty good idea of what you’re weak in. Spend time there so you stop bleeding points.

Question banks: Rx … UW. UWorld is by far the best. Rx is lower quality, but is an excellent stepping stone earlier in your study. I started off my early studying with Rx, and once complete moved on to UWorld. I found Kaplan too detailed and a little out of touch with UW. Absolutely finish UWorld and the two self assessments. Mark good questions and come back for a fast second pass on those marked ones. I think UWorld and Rx are the best bang for your buck; Kaplan is just nice additional coverage. You would be fine not even using Kaplan. More on my resources page on UWorld and question banks.

Spreadsheet your schedule. Track daily progress, see when you are falling behind your goals, make notes, keep motivated. You can see my spreadsheet here.

Use Kaplan for extra questions in your weak areas. Even then, probably best to repeat UW questions in those areas. But if you find you’ve memorized the UW answers for those, then try Kaplan.

Accuracy before speed. Keep the question banks in un-timed tutor mode. Only switch to timed blocks and practice tests in the last 10-14 days leading up until Test Day. While in un-timed tutor mode go slowly and really think through questions and work on your technique and thoroughly flesh out a process that works for you.

Practice tests in the home stretch. Save these for the end. Taking one early to “see where you stand” is absolutely a waste. You should already know your weak areas from your grades thus far. If you do poorly, you’ll freak out. If you do well, you’ll have a false sense of security. I did five NBMEs; the higher numbers mean it’s more recent. Pay to get the correct/incorrect. They don’t offer explanations, but you can search online forums for help. Save the two UW SAs until the last 2-3 days before Test Day.

Why did I get that wrong? For every question, really try to parse that out. Did you misread? Did you over think? Were you able to see what the test writers were going for? Did you narrow it down and guess wrong? Were you jumping at a distractor? Did you narrow it down and give up and just guess? Did you simply not have the requisite knowledge to answer? Did you rule out the correct answer and, if so, why? Or was the correct answer still among the ones you did not cross out?

If you lack base knowledge… then it’s rote study time that’s needed. Practice questions themselves can beat the information into you. But if you’re consistently missing because of inadequate content, then best to pause and really dig into that area…instead of continuing to bleed points.

If you’re second guessing yourself… then maybe you’re over-thinking it. Try asking yourself a different question: what is the tester trying to get after? What are they trying to test me on? It might make the question unfold simpler than it seems. Maybe you’re overthinking to make it more complicated.

Triage your block time. For the questions about study bias and such, probably simply doing lots of questions would be good. You’ll get familiar with the tested aspects. For example, time on calculation questions was an issue for me, so I liked to leave these questions till the end of the block when I didn’t feel as much pressure to move along and didn’t fall into the trap of blowing a lot of time. Just straight skipped them when I hit them. Don’t even guess. Come back when you have time. As you get really good in the last week or so, you’ll start having more time at the end to review and do those. Leave them to the end when you have less feeling of pressure like you need to move on.

Only use Pathoma where you need review. Don’t simply plod through it. Goljan however is really good to listen. I hit the treadmill an hour each day for focused listening to one Goljan session each day. I swear, nearly every day I got a question correct only because I had just heard that man talk about it. For more tips on how to use this, see my resources page.

Anatomy is always in context. You only need First Aid and UWorld. BRS is too dense at this point. I recall that most questions centered around the following:

• Innervation of the lower extremity (tibial, common peroneal/fibular, anterior compartment, typically a tackle or injury just below the knee).
• Brachial plexus. Know this cold. Draw that diagram repeatedly at moderate detail. Know a few muscle innervations off that, winged scapula, thoracodorsal.
• Collateral blood supply of the stomach. In an emergency, if you had to cut an artery, which would be okay? Would the spleen still get blood supply?
• Portal hypertension anastomoses. There are only three so make a simple table and memorize. Most often it was the esophageal varices.
• Rotator cuff muscles. SItS and their movement. Innervations not very important.

Online videos are a great way to learn. More tips on my resources page.

Eat well and exercise daily. Take care of yourself. De-stress by exercising. Spend time preparing nutritious foods (leafy greens, veggies, low carbs, lots of water, low sugar).

In your last week, focus on timing and routine. Get closer to simulating the full test experience. Start doing questions at the same time your exam will begin on test day. Practice the marathon portion. Aim for 150-200 questions per day so you start to understand your personal psychology when fatigued. Get some experience working through that.

Practice tests under real conditions. Start at 8am. Consider doing 8-10 warm up questions before. Take the appropriate breaks. Get to know yourself and how you’re going to work through fatigue when it hits you. Better to learn how to handle yourself now than wrestle with this on test day.

Do nothing the day before Test Day. Something I wished I had allowed more time for: rest before the exam. Maybe do ten questions the day before the exam just to keep some focus, but you really need to restore your energy before walking in there. You want to be busting with energy to tackle The Test, not worn out from a forced march. Watch a movie. Exercise so you’re tired and sleep well. Go to bed ridiculously early.

Always keep in mind that this one test does not define you and that, if you have dreams, you can always find a way to achieve them.