I passed my Step 1 exam nearly a year ago, which feels surreal to say. As an extremely anxious test-taker, Step 1 did not feel like an not exam. It was THE exam. It was a monstrous, career-defining, monumental milestone that endlessly intimidated me. I desperately searched the internet (Reddit, Twitter, random forums) for any advice, trying to calm my nerves and combat anxiety with information. I found myself emailing or direct messaging complete strangers that had passed Step 1 in the hopes that their story, their studying methods or their mere acknowledgement could validate my ability to do well on this exam. I read threads written by examinees who did not pass the exam, tried to learn from their mistakes, analyze what they changed and silently cheered when I would reach the end of their posts to see that they succeeded after the first attempt.
But I quickly reached a point where I was researching the mental, social and emotional aspects of the exam as much as, if not more, than I was studying academic material. And it was brutally exhausting. There was so much conflicting information from anonymous sources, without hardly any way to verify what was accurate. Understandably, there are variations in everyones’ studying/testing experiences. No matter how similar, no two medical students are the same. There is no specific program, guideline, or set of rules that will guarantee an automatic pass on the exam, no matter how much money you spend or how much you memorize. The more I allowed myself to understand that and truly believe it, the more forgiving I became towards myself. Most importantly, it enabled me to redirect the energy previously allocated to anxious thoughts to studying academic content more efficiently.
Therefore, I am sharing the lessons I’ve learned from my experience. I hope that these lessons find whomever needs them and I hope they provide the validation, reassurance and support every medical student deserves during their Step 1 dedicated studying period. One way or another, you will conquer this exam.
1. IT REALLY IS AN EXAM
-It really is an exam. If you’re taking Step 1, you have inevitably taken other exams before. While Step 1 may hold a lot more importance and weight to it, it is still just an exam. This means you can prepare for it, you can study for it and if you do all of that, there is a good chance you will pass it. It is not an impossible, ultra-complex, unfair collection of questions with ambiguous answer choices. Passing is difficult, but not unimaginable.
-The material and content tested on Step 1 has been shared widely in various ways. Books such as First Aid for the USMLE Step 1 have served as a textbook or holy grail for many students. This is not a trick. No one would be able to pass this exam without being prepared for it. Study resources (Uworld, First Aid, Anki, Pathoma, Sketchy) are not a shot in the dark. They have been designed in adherence with material tested on the exam. Do not discount what these resources teach you. There is no top secret book of the “real” things the exam tests. The content from your first two years of medical school is exactly what is presented throughout these resources. How you choose to utilize this information is how it will serve you best. What works for one person does not have to work for another. Focus on what techniques cement concepts into your mind. Study tools are meant to be personalized. And remember less is more, choose 3-4 resources that serve you best and ignore the rest.
2. CURATE YOUR SUPPORT SYSTEM
-For this exam, you need someone objective. Someone who is able to understand the significance of the exam while maintaining perspective that it is still only an exam. This will allow you to trust that they recognize the importance of what you are going through, but also give them the ability to talk you down when your anxiety is running high.
-Do not share insecurities about your test-taking abilities, test-taking experiences, etc, with large groups of people. Keep it limited to a select 2-3 individuals. Having too many chefs in the kitchen becomes counterproductive and creates confusion instead.
-Choose your people based off their ability to support you, not their personal credentials. In other words, you may have a classmate who passed Step 1 with a great score on their first attempt and therefore feel like they’re uniquely qualified to help you do the same. More likely than not, their support will be instructing you to do exactly what they did. There is a distinct difference between a support system and academic guidance.
-Your support system should provide accountability for basic things that get lost in the stress of studying. Are you eating well? Are you exercising? Are you sleeping? Are you taking breaks and enjoying something unrelated to medicine? Can you de-stress or vent without feeling judged? While these factors may not seem like priorities, studying for such a long, grueling exam will take a toll on you and having a proper support system is crucial.
3. GET THE MOST FROM PRACTICE QUESTIONS VIA UWORLD + AMBOSS + NBMEs
-Uworld is the gold standard for a reason: it works. The material is accurate and questions/explanations are detailed to the level required by the exam. Complete all of Uworld once (~3000 questions), go through every single question you have gotten wrong, reset the bank and do all ~3000 questions again.
-AMBOSS has a question bank as well as self-assessments for Step 1. The best thing you can do for yourself is expose yourself to as many practice questions as possible. The test-writers will ensure the questions vary in style and word choices as that is part of what makes the test so difficult. The team at AMBOSS understands this and have created various difficulty levels to their questions for this exact reason.
-NBMEs are notoriously tricky, confusing and frustrating. Take them anyways. Do not focus on the score you get, focus on what concepts are being tested. When you see the same concept appear frequently across multiple question banks, recognize this is a high yield concept. You need to know it well.
-It is crucial to have a strong foundation of knowledge for this exam. But reading textbooks or notes are not the only methods to process the information needed. Learning through answering questions is underrated, yet extremely effective. It is also one of the most involved ways of active learning, which makes it that much more challenging. I personally struggled with this the most. It was very frustrating to face questions on concepts I felt I hadn’t studied enough to answer and then to get that question wrong, which affirmed my belief that I just needed to study it more. But there were also questions where I recognized the concept, got the question wrong and realized I misunderstood or incorrectly recalled a fact or detail about that concept. This created opportunity for me to specifically target knowledge gaps I had pertaining to each concept rather than waste my time reviewing broad/generalized topics.
4. THE STRUGGLE WITH SELF-DISCIPLINE
-Preparing for and taking this exam is unlike any other experience. At most, until this point, you will have taken final exams at the end of semesters which test on 4-5 months of material. Step 1 encompasses 2 years worth of material. Everything you have you learned through your first two years of medical school is integrated into clinical scenarios and presented as a question.
-Many people hear of a “dedicated” study period for Step 1 where students spend 8+ weeks exclusively studying 9-10 hours/day. This requires sheer discipline. The biggest struggle I faced through this was remaining motivated. Preparing and taking Step 1 is an uphill climb that only grows more difficult the higher you climb.
-Being self-disciplined does not translate to following a strict schedule. Instead, it means being honest with yourself. No two study days may look the same but that doesn’t mean a routine isn’t beneficial. The core of your routine has to focus on productivity. If you are able to and benefit from changing where you study, what meals you’re having, what time you’re sleeping and waking up, then do so. But within a limit. Going to sleep or waking up an hour earlier/later than the day prior won’t majorly affect your schedule, but getting through 20 vs. 40 Uworld questions in the entire day will.
-There are certain elements of your studying that you cannot afford to budge on, like the number of practice questions you complete per day. Not only is this because of the number of questions you have a relatively limited time to get through, but also because consistently doing questions will build your endurance to answer question after question, which is what Step 1 is.
-Create a list of negotiable and non-negotiable things you want to get through studying. You don’t need to watch every video, read every page or listen to every podcast. You may, however, need to watch a video on renal physiology if it’s particularly difficult for you to understand. Or, to study lung pathology, you may benefit from creating a chart that compares the various diseases. There is such a range of content on the exam that a “one size fits all” approach to studying is unlikely to work. Remember that this is not your absolute first time encountering this material, you have studied and performed through several semesters of medical school to get here. You have your own strengths and weaknesses when it comes to the different subjects and your study plan should be personalized to reflect as such.
-An indefinite amount of study time will not benefit you. This exam is intimidating and you have to balance being adequately prepared vs. rushing into it, as well as underestimating or not believing in yourself, and delaying the exam to the point you can’t perform optimally. Many people say that Step 1 is about long-term memorization. This is true for fundamental concepts that build upon each other. However, there are dozens of elements tested on Step 1 that are just memorization and one can only remember them for so long. Furthermore, burn-out is a commonly overlooked problem. Your mind and body can only train to an extent before you run out of fuel and need to recharge. Get comfortable with knowing you will never know 100% of what is on the exam, nor will you ever be 100% ready to take it. But you will take it anyways and you will pass, regardless. What is going to serve you the most is your preparation. Your preparation is your investment into this exam, you need to trust it and yourself.
5. EXAM DAY MENTALITY
-Step 1 consists of 280 multiple-choice style questions. 80 or so questions are considered “experimental” and do not contribute to the test-taker’s score. However, the test-taker does not know which questions are experimental and therefore must do their best answering each question to maximize their score/chance of passing the exam. Do not get caught up in trying to “game the system.” There are no shortcuts. It does not matter whether certain questions count or not, you have to give your best to every question, regardless.
-Stop thinking that they test-writers are trying to trick you. Allow yourself to believe that the test-writers have written fair and quality questions meant to assess your medical knowledge. This sounds straight-forward and simple but makes a difference. Many students, including myself, overthink questions and psych themselves out of the right answer, despite having the knowledge to answer the question correctly.
-There is no benefit to any form of cynicism on test day. You need positivity to uplift your mood and maintain the energy needed for such a long, tedious exam. Your mind will not perform its best if it remains shackled by doubt or fear. I know it’s impossible for the fear not to be there, but at this point it is exam day. Forgive yourself in advance, give yourself a blessing that no matter what happens with the exam, you will be okay because you know you tried your best. You don’t need anyone else to relieve yourself of that extra pressure, you can do that for yourself to better optimize your performance.
-Take a mock exam at the same prometric center you are scheduled to take Step 1. Your mind and body will be significantly more relaxed being in a familiar environment. If you’re unable to take a mock exam at the center, at least drive there once before if you are able to. Small things like knowing where to park, ensuring you can physically find the center, verifying the center’s rules and regulations are all ways to feel better prepared, and therefore calmer the day of the exam.