Step 1 Study Period: My Approach

If you are not studying for step 1, I’d just skip this post altogether. This is for the Googlers out there who magically find their way to my blog. I don’t feel comfortable publicly posting my score, but I will tell you it was good by any specialty’s standard.

Before I started studying, USUHS had us do an NBME pretest that I beyond failed and had zero correlation to my score. Quite demoralizing to hear people say “oh you typically improve 10-30 points from your first NBME test” when that would range from “still failing” to “oh good I hit 200.” I think 228-230 is average for the exam, so I was originally shooting for above 230 (which is probably a typical goal). I don’t suggest doing a diagnostic test prior to studying because it will likely only freak you out. If you’ve been actively studying for step 1 prior to your dedicated study period, a diagnostic might be a good idea to see where you are at.

As an FYI, USUHS does Step 1 after a year of core hospital rotations. Although it makes us further from the basic science stuff (killer when it came to relearning microbiology and neuroscience in particular), it made the clinical vignettes much simpler to understand. Pharmacology, a sore subject in pre-clerkship, became pretty straightforward after working in the hospital. I personally found it to be an advantage.

For studying, I cut out ALL social engagements. They tend to stress me out when I need to focus, and I am a happy camper doing solo activities. I would typically wake up around 9am. Sometimes I worked out in the morning and had a late start to studying (as late as noonish). I went systematically through organ systems and covered an organ system a day. I would read a chapter in First Aid, do the corresponding questions in UWorld (tutor mode), and watch the Pathoma lecture while taking notes in my book. Most organ systems could be done in a day. Cardiology and Heme/Onc needed ~2-3 days and Neurology needed ~3-4 (for me). I personally bought a fresh copy of First Aid 2017. My First Aid 2014 had notes all over it that I found either too detailed for step 1 or too basic for the level of comprehension I had reached. I tagged pages that I wanted to make sure to review again. I did one full round of UWorld and completed a chunk of the questions I got incorrect (it’s easier seeing them a second time but super frustrating to get them wrong again!).

I cooked and cleaned pretty frequently. Andrew and I would have dinner when he’d come home from work, and we’d usually watch a TV show or movie before I would get some last bit of studying done before bed. I slept a TON… like 9-12 hours a night. I can function really well if I sleep a lot, though it was probably secondary to pathologic sleep deprivation I had throughout the previous year of rotations. My study period was 5 weeks long with really 4 weeks of truly focused study time. The first week I maintained some social semblance and realized it was impossible for me to be productive. I only had a few days in the first week where I did practice problems casually and perused First Aid a little.

I did the two UWorld assessments one and two weeks before my test day and thought they were really helpful (though I panicked because people kept telling me that I would likely do 10-15 points worse on my real exam based on the uworld scaling compared to NBME). I got the same score on both assessments and ended up with 13 points higher on my real step 1 score. I personally didn’t want to pay extra for the official NBME practice exams online, especially without getting answer keys, but I have heard from many that they found it useful to get comparative test scores. Keep in mind though, I tend to test well – I am pretty calm during exams. On test day itself, I took a minute break between sections just to close my eyes and breath. I forced myself to take 25 minutes for lunch. The exam day felt shorter than I anticipated because I thought it would last forever. The nice thing is most test locations let you start early.

My grand advice is:
– Make a study plan. I felt like 5 weeks was perfect timing to include my first week of figuring the system out.
– Figure out your resources (mine were UWorld, First Aid, and Pathoma). Don’t use too many.
– Don’t be too hard on yourself if you are behind schedule. It’s inevitable. Plan your schedule like you have one less week than you really do.
– Give yourself frequent breaks!
– Don’t let yourself burn out. Schedule entire days off!

Studying for Step 1 is uber stressful but it can also be really nice to make your own schedule for once, wear pajamas all day, and be your own boss. Enjoy the perks!