August 23

What’s your USMLE Step 1 Mentality?

Study Schedule, USMLE, USMLE Step 1

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How to get your mindset right for Step 1 success

USMLE Step 1 looms large in the mind of every med student. There’s a ton of pressure on you as you approach exam day. This is for good reason; your Step 1 score really matters. A good score on Step 1 makes a huge difference in giving you options for your residency, in terms of both specialty and location. (Here are the Match data from the NRMP if you’d like to dive deeper on this; you can also learn more about Step 1 percentiles.)

So we’ve established the clear importance of Step 1. Let’s put this exam into perspective, and think about the first three years of medical school and having the right mentality when it comes to this exam.

First Year (MS1) – Fundamentals

During your first year of med school, you’ll probably see a few people in your class immediately beginning to work with Step 1 resources like First Aid. However, the truth is that at this stage, it’s probably best to direct your attention to really learning the fundamentals in the courses that you’re taking.

Remember that you’re playing a long game. If you build a very strong foundation in anatomy, physiology, microbiology, and biochemistry, then you’ll make your life much easier during your MS2 year and beyond. Don’t feel like you have to do this by attending all of the lectures offered at your school. If a particular lecturer’s style just doesn’t work for you, then just read the chapter and take your own notes instead. Do whatever helps you learn best. Keep your focus on building that strong foundation in these subjects.

Although you’re focusing on your coursework at this stage, there’s an important flip side to be aware of. Don’t cram for your block exams! Cramming gives you short term gain but long term pain. You may do fine on the block exam after cramming, but you won’t be building that retention that you need to do well in your MS2 year and on Step 1.  Instead, focus on learning the material as efficiently as you can through active recall, to help it stick. This is the time to establish effective study habits, which will continue to serve you well over the years to come.

Tools like Anki (the flashcard app) can be useful, though you shouldn’t let them become a crutch. Nothing really replaces a good old-fashioned study session: actively reading something, conceptualizing it, practicing recall, and then trying to teach it back to yourself or to a friend.

Second Year (MS2) – Integration

Once you start second year, you’re going to feel the intensity pick up. Make sure that you keep yourself grounded. A little bit of stress is okay, but if it starts to spiral out of control, then it can be debilitating. Find ways to manage your stress levels; this will continue to be important throughout medical school and beyond.

During your MS2 year, you’ll want to focus on integrating your knowledge as much as possible. Try to connect systems together, and compare/contrast diseases processes. Bring back information that you learned during MS1 and connect it into what you’re learning now. Physiology, Path, and Pharm all naturally connect together, so look for those connections. The more you do this, the stronger you’ll feel going into your dedicated Step 1 study period.

What about Step 1 preparation? As you start your MS2 year, it’s a good idea to start doing some questions from a Qbank (such as UWorld). Don’t focus on quantity, but rather on quality. In other words, don’t just try to get through all of the questions as quickly as you can. Instead, go slow in the beginning, and reason through why you got a question wrong. It may be because you haven’t studied that material, so go and address that. It may also be because you did study something, but you misunderstood a concept. As you approach your block exams, do Step 1 questions in that topic to confirm that you know the most testable material very well.

Dedicated Period

At the end of MS2 and before you begin MS3, you should have a block of time dedicated to your Step 1 study. At this point, your focus should be brushing up on your weaknesses and improving your ability to integrate everything. You’ll definitely have forgotten some of the material that you learned during MS1 and even early in MS2. That’s normal! If you learned them well the first time around, you’ll be surprised at how much material comes back and how quickly, as you review and do questions.

If you feel particularly rusty on a few subjects, or didn’t understand them the first time through, then make sure you start working on those early on in your study process. Don’t try to do a deep dive during dedicated! Try to get the most important concepts down through the explanations in UWorld, Pathoma, and First Aid. If you need extra help (for example, if you have particular weaknesses, or you’ve fallen behind), you might want to reach out to a tutor. Make sure you do this early, so that time is on your side; also, make sure that the tutor you choose has ample experience in helping students with Step 1.

Whatever you do, don’t try to cram your way through First Aid and UWorld! There’s just too much material to cram. You want to focus on concepts and patterns over just pure fact cramming. This will serve you well on the exam, especially when you get to the challenging questions; having a strong grasp of the concepts is what will serve you best. It will also continue to serve you well into your clinical years.

(We’ll be doing another post on how to approach your dedicated studying soon, so watch for that.)

MS3 – Clinical

Congrats on being done with Step 1! That’s a major hurdle that you’ve cleared.

As you go into your clinical years, just remember that your Step 1 score is not the be-all and end-all of your medical career. It’s definitely important for having flexibility in choosing your residency, but once you start your residency, being diligent during your training and learning from feedback from your attendings and colleagues is going to have a lot more impact on your career down the line. Your patients are not going to care about your Step 1 score; they will care about how you treat them and help them with their health issues.

If you feel like you underperformed on Step 1, think about how you can correct course for your Shelf Exams and Step 2 CK. You probably have an intuition about what you could have done differently. Talk this out with some of your close friends and come up with a plan so that you meet your goals the next time around.

Are you ready for Step 1?

If you’ve already taken Step 1 and have some pearls of wisdom to share, feel free to comment below. We’d love to hear from you, and other students could benefit from your knowledge!

If you feel like you could use the guidance of a tutor, the experts at Medlearnity are here to help. With scores of 250+ on their USMLE exams and extensive experience in helping students prepare for Step 1, our tutors are well-positioned to help you score as highly as you possibly can on Step 1. We’ve helped all kinds of students, from those who had fallen behind and were worried about failing, to those who wanted a spectacular Step 1 score in order to get into a highly competitive residency program. To learn more about what it would be like to work with a tutor, you can schedule a free one-hour trial session.


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