For many medical students, and especially those nearing the end of their second year, one concern seems to prevail above most others: preparing for USMLE Step 1. This is the first big standardized exam in a series of licensing exams that must be taken to become a physician. The test tends to get a lot of buzz throughout the first two years of medical school. Almost all programs discuss it in at least some depth multiple times in the first two years of training, and worry about the exam begins to fester. Even as early as the first year of medical school, students may consult resources like Pathoma or Boards and Beyond to help cover classroom material while also emphasizing important points for Step 1. To put it mildly, this test will seem like a huge deal in your preclinical medical school years. While I do not have all of the answers to this test or how you can ace it (although I certainly wish I did!), I thought I would try to provide a few overall tips. You’ll notice that these tips tend to focus on your overall approach and routine rather than on specific classroom material, and this is intentional. I find that everyone will study a little bit differently and discern value in different resources. Consequently, the following is advice that I hope will help everyone, regardless of the specific progress/nature of your studying. Your health is just as important as your studying. Training your brain to know the material is one thing. Helping your brain be well-rested when you take the test so that you can think as clearly as possible and use the intelligence / quick-wit that have helped you make it through medical school thus far… that’s a completely separate thing. While we tend to focus on the material, the reality is that these two things are equally important. It is easy to underestimate the need for the latter, since there is always more information to learn. Unfortunately, however, you’ll soon realize that if you don’t take time to give your brain a break and take care of yourself, test information will simply enter in one ear and exit the other. Make the information you learn count by keeping your mind and body in the best condition possible. The specifics of this will vary for many students – some of my friends actually took one morning per week to get a massage. Others made sure they watched a movie every now and then, or scheduled nap breaks on longer days of studying. The exact nature of the health and mental break will vary, but the goal should remain constant. For many, this idea can seem difficult with limited time at hand. However, I often try to advise younger students of its importance. As a future physician, one of the skills you will need is the ability to balance your own health and demands against those of your job. An inability to strike this balance will ultimately only hurt patients. So treat this as a skill that you can master in medical school, too! Studying is great, but please do take the time to care for yourself so that you can continue down this long journey and enjoy what you do. Reminders and perspective are crucial. While you study for Step 1, it is very easy to become isolated. Sometimes, it can almost feel as if you are living in an entirely separate world from the people around you. The material ahead may seem endless, and many students can become hyper-fixated on cramming in more and more information. This often leads to feelings of frustration and sadness. During this time, it is important to do whatever you can to remind yourself of the things that bring you joy. Study with motivators around you – maybe pictures that make you happy, your acceptance letter to medical school, a letter of recommendation from a professor, or notes from friends/family and people who believe in you. Remind yourself of your value outside of academia. Talk to a supportive friend who is not in medical school to remember just how much exists outside of studying. If needed, ask them to be your personal cheerleader in times when you feel down. Do anything you need to do to remind yourself that you are smart, you are capable, and you matter in this world. Step 1 studying can feel all-consuming, and it is easy to allow this test to define your entire worth if you are not careful. Making sure you talk to people who believe in you and will remind you of why they love you – far beyond you simply being in medical school – is a game-changer. When possible, try to fully separate your “study” and “break” times. Tip #1 mentions how important it is to prioritize your health and to take some time away from studying. However, I wanted to emphasize how crucial it is to maximize this time rather than to take it without thinking. In other words: make your breaks very intentional so that they are truly a break. You may hear students say that they are studying 10 or 12 hours per day. Yet it is important to note that none of these students are studying completely non-stop… the human brain is simply not designed to be in intense focus for that long. As you study, it is important to take small breaks so that your brain can consolidate information and recover for a moment. For some people, this may mean a five-minute break per every hour of material; for others, it may be a longer study period with a longer break period, etc. Find whatever works best for you, and know that it may be different than what works for someone else. As long as you are being as productive as possible, you are doing the right thing. When you take these breaks, it is crucial to really separate yourself from the material. Take that break fully, even if it’s only a few minutes! Do not look up anything medical. Do not think about the test. If you have a difficult time with this at first, set timers that help you very distinctly draw a line between studying and not studying – and really do your best to ensure that there is no overlap between the two. You will process and remember information better this way – but even more importantly, you will feel slightly more rested, less overwhelmed, and ideally, healthier overall. It is easy to feel like you are taking a break simply because you have stopped flipping through flashcards, but if you are still thinking or worrying about the test during your break times, you are selling yourself short and losing the purpose of the break! Know that you are not alone. If you struggle during Step prep, it is unfortunately easy to feel as though you are the only one struggling. As with many other times during the medical school journey (during applications, during our first two years, etc), we tend to assume everyone else is easily cruising by. We see success rather than the invisible hardships that may be taking place, and we internalize that into feeling like we are not as smart or as capable. This is especially true during dedicated study time. One of the most unexpectedly jarring parts of the Step 1 study process for me was just how different it was from medical school in the sense that, for the first time, we really were all sent on our own. We no longer all shared in the same classes or the same schedule. We no longer collected in the same spaces – and sometimes, if we studied from home or somewhere fairly secluded, we may go a fairly significant period of time without seeing a friendly face. In reality, many of your peers also feel as though they are alone, isolated, or struggling. Try to stay connected where possible. For some students, this may involve studying with friends. For others, however, studying with peers may only add stress. This will be entirely up to you. Either way, however, it may be a good idea to at least schedule a ‘check in’ with a small group of friends – maybe once per week or once every now and then, you all just text each other to see if everyone is hanging in there or to offer a word of encouragement. Or perhaps you come back to articles like these, reminding yourself of how to maintain perspective as best as you can. Again, anything you can do to remind yourself that you are not alone in going through this medical student rite-of-passage is helpful. So many past students like myself stand in solidarity with you; we have been there and it is hard, but you can do it! And know, too, that if you are struggling, your school should be there to help. They have seen hundreds if not thousands of students take this exam over the years, and they often have resources to make sure you make it to the other side. At the very least, they can help you find the support that you need to make it through the final stretches of your studying. Know that no test defines your potential or what kind of doctor you can become. At the end of the day, Step 1 is important – but it is only one score, and it is only one part of your application. Most importantly, there is so much out there that Step 1 cannot measure: your compassion, your perseverance, your ability to empathize with patients, and your critical thinking abilities when working with a medical team. Ultimately and perhaps unfortunately, Step 1 is not actually a measure of how excellent of a physician you can become. Some residency programs are beginning to realize the nuances and caveats of the exam and its predictive value. For example, Northwestern University has posted the following statement on their residency application website, “In support of a holistic review of applications, residency programs at the McGaw Medical Center do not use USMLE scores as a screening tool.” Some discussion has occurred at the national level regarding whether or not Step 1 should be a pass/fail test, again conceding that even residency programs can get a bit too fixated on an exact number and may miss some excellent physicians who simply don’t excel in standardized testing. This leads to what I consider the most important point of this piece: always remember that you are more than any test score. You bring far more to the table than a one-size-fits-all test can measure. It may feel like everything rides on this exam, and it is easy to feel like this test defines your entire future. In reality, Step 1 only provides a small snapshot of a certain subset of skills – it’s an important part of the picture, but not the whole thing. You are always more than a number. Source
