Studying for Step 1

I don’t think I have ever studied this hard for an exam before. I thought that as soon as the eighth hour of the USMLE Step 1 exam[1] was done last Saturday and I clicked “Submit”, I would immediately feel a huge weight fall off my shoulders. Each of my muscles would gradually release their tension. I would lightly drift to my car and home. The rest of the night would be spent dancing in pure bliss.

Instead, I dreamed of exam questions that night.

Perhaps it will take a couple of days for my body to finally transition back from a high stress mode. Or maybe I will have to wait for several weeks until I get my score to relax completely. Nevertheless, while I may not know yet how I did, I did learn some crucial things in the process.

Find your motivation. It is hard to expend so much time and energy on an exam that tests such a broad range of topics and often includes much extraneous and rare information that you do not expect to be relevant in your future clinical work. In my case, I made it a point to leave some free time between my exam and my next year school to travel. I recognize that I will have fewer opportunities to travel in the future and it will be nice to be distracted and not worry about my score while I wait for it arrive. Yet, most importantly, focusing on my trip during the six-week study period allowed me to be regularly reminded of the bright light at the end of a seemingly endless dark tunnel.

You are not a machine. Make sure to give yourself at least an hour of free time each day, ideally including some sort of physical activity as a means of destressing and getting a break from sitting in the library all day. There will be a point during your study period at which you will start to feel seriously burnt out. Try to keep things interesting by studying with friends or going to cafes instead of the library. The last stretch is always the most difficult but you can get through it. Especially if you have your motivation and realize that replacing your designated free time with more studying may actually start to hurt, rather than help, your score. During the first half of my study period I was really tempted to push my exam date later. Yet four weeks later, I was struggling to stay attentive and accepted that I was trying my best but simply would not be able to continue such intensive studying for more than two of the remaining weeks.

Be flexible. Everyone has a different approach to studying for this exam and tests in general. I wish I had done more research beforehand about different study plans. Then again, it is really hard to predict how time-intensive or effective different study resources will be for you. Rather than rigidly adhere to a preconceived study plan, accept when a resource is not working for you and spend more energy on a resource that is yielding results. Near the end, I realized I was not going to finish my question set or even take the two self-assessments I had paid for. So I shifted focus to topics that need to be crammed near the end anyway, like microbiology and pharmacology and swear I saw some questions in the actual exam that seemed almost identical to the questions I practiced with.

Stay in perspective. Yes, the Step 1 exam is indeed a significant determinant of what residency program you will get into. But remember, you have already made it so far. You have jumped through many hoops to get into medical school and to be on the privileged journey of helping heal people and communities. Do not turn your entire pre-clinical training into Step 1 preparation. Make time for other activities or research that you are interested in rather than focus all your energy on studying topics that may not even be relevant in your future clinical year. Overall, recognize that this is one of many exams you will be taking as a physician in training so keep time to just stay human and enjoy time with friends and family along the way.

[1] The United States Medical Licensing Examination (USMLE) is a multi-part professional exam sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners(NBME).