My Step 1 Experience: What I Did Wrong & What I’d Do Differently

Am I doing this right?

This was a question that I often asked myself while studying for Step 1. With so many different resources, study tools, and stories of success, it can be difficult and confusing to create your own plan. I ultimately reached my goal of scoring over a 250 on Step 1, but there were many doubts along the way.

(Click here to read my how I prepared for USMLE Step 1).

It took endless hours of planning, executing the plan, and spending many days & nights alone hovering over my computer focused on my goal. That said, there are many things I wish I could go back and tell my younger self. Ultimately, that’s what all advice on this website is – a collection of knowledge and experience that I would have liked to know a year ago.

In my preparation, I did many things right, but I also did many things wrong. In this post, I’ll reflect on these aspects of my study strategy, and ultimately the year leading up to the big test.

Remember to shape your own plan as you go and modify accordingly. Don’t get resource overload. If you started using one Anki deck and like it, stick with it. Don’t stress about the newer, bigger edition that inevitably comes out while you’re studying. And don’t think you need to use every resource that others use.

Moving on, here’s what I felt I did wrong and what I’d do differently:

 

Wrong: Cramming all class lectures the day or two before exams.

Why: I completely pretended like class lectures didn’t exist until a day or two before the final exam. Consequently, I came very close to failing a block in the spring semester. I’m talking like 3% away from failure. Failing a block would have negated the Step 1 score that I’d worked so hard to achieve. Don’t do that. Not a good look.

What I’d do differently: I’d still focus mainly on boards, but I’d also make it a point to at least skim through the week’s powerpoint slides every other day or so. A small bit of effort each week will save you a world of stress the night before an exam.

Wrong: Thinking that certain topics from lecture were not important because they were not in board review resources.

Why: Bridging off the previous point, during the block I almost failed, we had two lectures devoted to a “Step 2 level” topic. This topic wasn’t in First Aid or any other board prep resource. So, I said screw it. This topic showed up not once, but twice on my Step 1 exam. Maybe the lecturer actually wrote for the USMLE. Who knows. Either way, jokes on me. Ha.

What I’d do differently: There are many topics and facts during preclinical lectures that truly are unimportant minutiae that you will never see on your exam, but if a certain topic is stressed by a professor, learn it at a surface level at the very least.

Wrong: Ignoring anatomy

Why: My exam was heavy on anatomy (like 4-5 questions per block), and I’d say a good 1/3 of it was not in any board review resources. Your test may not have much anatomy, but still – if I had this much anatomy, others did too. And it’s worth thinking about. These anatomy questions weren’t extremely difficult. Delving just a little deeper into anatomy would’ve surely awarded me a few extra points on my exam.

What I’d do differently: I used the Gray’s Anatomy review book questions during M1 a bit and wish I’d used it for Step 1. You can devote 2 days to powering through it during dedicated or simply do a few questions each day over the course of a month. A few of those anatomy questions I mentioned that were not in FA or UWorld were in the Gray’s Anatomy review book (you can buy it here). Furthermore, I’d make sure you get familiar with normal anatomy on imaging (X-ray, MRI, CT). Again, the anatomy questions weren’t hard. Mostly innervation and blood supply. HEENT nerves, arteries and veins are pretty high yield. Pelvic anatomy. Stuff like that.

Wrong: Spending too much time on the internet

Why: During the weeks leading up to my exam, I’d relentlessly scour Reddit for reports and experiences of students who recently took Step 1. So many of these posts were hysteric and histrionic (“The new exam is nothing like we’ve ever seen before! Nothing is high yield! You’re all doomed!”). Like any neurotic med student, this stuff freaked me out. For example, I read a couple posts claiming that Step 1 was super heavy on parasites, many of which went beyond the First Aid/Sketchy scope. I stayed up til like five a.m. on night in a panic reading up on a bunch of wild, rare parasites. It should come as no surprise that I literally had one parasite question on my exam, and it was super easy. I also spent one afternoon learning about another 20+ bacteria that weren’t in FA/Sketchy. Total waste of time and mental energy.

What I’d do differently: During dedicated, do not go on Reddit, SDN or any other outlet to read stories from people who have recently taken the exam. Do not read anyone’s “Step 1 experience and post-exam thoughts”. People exaggerate. People take different tests. There will stuff that isn’t in Step 1 resources, there aint a damn thing you can do about it. Studying is only half the battle. Going into the exam cool, calm, collected and confident is the other half.

Wrong: Not starting Sketchy earlier

Why: Sketchy is the quickest and most efficient way to nail down the high yield pathogens that will appear on Step 1. I absolutely detested Sketchy Pharm, but Sketchy micro is still amazing. My problem was that I always thought “Oh I’ll watch XYZ videos in Sketchy next week/month/whatever”. I never ended up finishing it.

What I’d do differently: I think Sketchy is a great way to kick off your board prep in the fall of second year. Just watch a few videos per night. Easy way to knock out an important Step 1 subject early on.

WrongFinishing UWorld too early & attempting a second pass

Why: This is a big topic of debate and I’ll try to explain my reasoning the best I can succinctly, but know that there is no right answer. It is well known that UWorld is the best question bank and perhaps the most important study resource for Step 1. You can certainly start UWorld earlier and do it twice to ensure that you didn’t forget old information, questions, explanations, etc. But I feel that you can use UWorld more efficiently if you start a little bit later, because the later you start, the more you know. The more you know, the better you’ll do. The better you do, the less time you’ll devote to combing through explanations. I finished before dedicated and planned to do a second pass, but my second pass was ultimately fruitless and a waste of time, so I quit.

What I’d do differently: Start UWorld just a littleeee bit later (few weeks-month later) so I could still finish it a few weeks before my test, while hitting my incorrects during the mid-late stages of dedicated.

Wrong: Ignoring First Aid

Why: No matter what anybody says, First Aid is the gold standard for Step 1 prep. Yes, you can absolutely watch Boards and Beyond and Pathoma videos, do Q-banks, and rip through ten million Anki cards to learn the same information that is in First Aid, but actually sitting down and reading a chapter or two of First Aid is wildly beneficial. It’s not easy to articulate why, but I’ll do my best – it allows you to see “everything” on a given subject quickly, compartmentalize information, and give refresh those facts floating around in the heavy brain of yours. Doing Anki cards is like looking up into the sky and seeing thousands of stars randomly scattered throughout. Reading First Aid creates constellations. It’s efficient.

What I’d do differently: I chose to follow along with Boards and Beyond by making my Anki deck, because no such thing existed at the time and I didn’t like the style of other decks. This obviously worked well, but if such an Anki deck existed already (which they do), I’d spend the months leading up to dedicated watching Boards and Beyond videos and following along in First Aid with a pen in hand, annotating quips from Dr. Ryan, drawing little pictures, underlining important things, etc. I did this during dedicated and it made a lot of subjects really “click” for me. It also allowed me to pick up on bits of information I missed during my first pass through B&B. This was probably the most efficacious thing I did during dedicated.

Wrong: Watching Pathoma during dedicated 

Why: Leading up to dedicated, I’d spent many months thoroughly learning Pathology in Boards and Beyond, drilling concepts/facts with Anki cards, while also completing both USMLE Rx and UWorld before dedicated to solidify all of this. While Dr. Sattar is a master teacher, Pathoma is actually pretty superficial. After spending many, many hours watching Pathoma during dedicated, I realized I was learning nothing new and it was a waste of time. Special note: Chapters 1-3 of Pathoma are absolutely essential and I think everyone should watch them again in the week leading up to the exam.

What I’d do differently: If Dr. Ryan’s new Pathology section is up to par with Dr. Sattar’s first three chapters, you can skip Pathoma. It’s unnecessary. There, I said it. Now, Pathoma is still a fantastic resource, but going from months of B&B -> Pathoma felt a little… “dumbed down”. I think Pathoma would be best utilized as a first-pass resource to kick off your board prep and get you acquainted with the high yield pathology quickly (B&B is much longer). In hindsight, I would spend 2-3 weeks flying through Pathoma in November to get a good background on the high yield pathology principles before delving into B&B.

Wrong: Taking too long of a dedicated study period

Why: During the winter in the early days of my Step 1 prep, I spent an hour on the phone getting advice from a third year friend of mine. He stressed to me one very important thing – you will reach a peak, that is when you need to take the exam, and after that peak… your scores will start dropping. Being the stubborn (read: stupid) person I am, I internally scoffed at his words and ignored this little gem of wisdom. I thought more time = more knowledge = better scores. Wrong. And only after taking the exam can one truly realize this. You have more time in second year to study for Step 1 than you think. I studied relentlessly in the months leading up to dedicated, and by the time dedicated came, I was bored. There wasn’t really anything new to learn. I was on maintenance mode for the majority of dedicated. My practice test scores went like this: 248; 257; 252; 260; 253; 249; 248. Why? I had too much time to forget things. Too many videos. Too many questions. Sure, I learned a lot more during dedicated, but my mental sharpness and test taking ability started to fade by the end. I had more knowledge, but I was making more stupid mistakes than ever. One step forward, two steps back.

What I’d do differently: Move the damn thing up two weeks.

Wrong: Letting Step 1 consume my life

Why: I wrote a lot more on this hereI didn’t go out or do much of anything fun during second year. I told myself that I needed to relentlessly study and avoid “fun” things because I needed to be ~committed~ to succeeding on Step 1. Other than to get food, I often wouldn’t leave my apartment for days in a row. I ignored friends. I forgot my hobbies. I built a wall around myself. I chose monasticism. This made me miserable. And the worst part – it was entirely unnecessary. I believe I would have snagged those few extra points and cracked 260+ on the exam if I had taken care of myself more in the time leading up to the exam.

What I’d do differently: Stick to a workout routine. Meal prep and avoid the 10 p.m. trips to get unhealthy take out food. Disconnect from the internet and social medias. Take at least one night off per week. Hang out with friends. Randomly go to the bars once in a while instead of studying. Go outside. Go for a walk around the beautiful campus with some good tunes vibrating through the mind. Be kind to myself. Laugh at minor failures. Smile more. Realize that everything is going to be alright.


 

And for one last final note (because this needs to be stressed over and over again): You will reach a point of saturation in your knowledge and studying. What you know is about 60-70% of the exam. Your ability to apply it and think through difficult questions is the other 30-40%.

You will see stuff that is nowhere in any board review resource, Anki deck, or question bank. You will also see things that you’ve learned presented in unfamiliar ways, questions that are worded vaguely, and questions that simply make you say “WTF” in your head while you’re sitting in your exam cubicle. But that’s okay. Everyone’s in the same position. Have some zen. Be calm. You need to be sharp and you need to be a good guesser. To be sharp and a good guesser, you need rest, energy and confidence. This is more important than you may realize.

Take care of yourself. Work harder than you’ve ever worked in your life. Be kind to yourself. Realize that you’ve come this far, you are brilliant, and you can beat the exam. Then do it.

After all… I’m pretty dumb, so if I can do it, you can too.

For updates on the latest posts, follow me on Twitter: @JordanSoze

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