I’m halfway through my third year of med school. I’ve already completed family medicine, general surgery, pediatrics and internal medicine rotations (along with the shelf exams for each). Somehow, I’ve reached a realization that I never saw coming: I miss studying for Step 1. Yep, I said it.

While I have enjoyed third year (for the most part), I really dislike studying for shelf exams. Aside from UWorld, everyone recommends different resources. Online Med Ed is nice, but it makes me miss Boards and Beyond. You have to muster the energy to study after coming home from a long day at the hospital or clinic. And suddenly, residency applications and the match, which once seemed so distant, are now closing in faster than Troy Polamalu chasing down a ball carrier in his prime. The beast of Step 1 has been conquered, but a million other anxieties rear their ugly heads: away rotations, evaluations, letters of recommendation, and so on. In short, you no longer have one “big thing” to focus on, but rather a myriad of small things that you need to attend to.

I miss having that one big thing to focus on. I miss the process. I miss having complete control over my day-to-day routine. So, since I’ve been reminiscing on that journey, I’ve decided to finally publish this post (which I wrote like 5 months ago). Here you’ll find a collection of Step 1 advice that didn’t seem important enough for an entire post. I’ve sorted the advice through the following phases: first year, second year (pre-dedicated), dedicated, test day, and post-test.

 

First Year

Rx or Kaplan 1st year. I think doing three question banks second year is a bit rushed (I had planned on this but it didn’t work out). Qbanks are the single best way to reinforce material and prepare you for exams. You’ll be in good shape second year if you used one throughout M1. Plus you’ll crush your tests.

Learn anatomy well. Of the myriad of information that may show up on your Step 1 exam that isn’t in UWorld or First Aid, anatomy is the “highest yield” and easiest to retain. Don’t worry about insertions or specific muscles, but instead make sure to memorize innervation, blood supply, and any clinical correlates in your anatomy class.

Supplement class lectures with board review resources. Notice I said supplement, not replace. You’re still a first year. You’re still figuring things out. Don’t get too cocky or worried about boards yet. Just follow along with Boards and Beyond, First Aid, Pathoma, etc and you’ll be way ahead of the game.

Go out after exams. Life is short. The journey is the destination (or something like that). Celebrate the little victories.  As year two comes, everyone disappears to hibernate and study, so you won’t get the opportunity.

Develop a healthy routine. This is probably the most important thing you can do for yourself during your first year. Figure out how to do well on class exams. Then get a routine.

• Learn how to cook and meal prep. You’re not gonna want to spend an hour cooking-eating-cleaning every night when you have to study for Step 1. Nobody got time for that. Getting greasy, salty take-out every night will sap your energy more than a poor night of sleep. Plus cooking is cheaper.
• Get a workout routine. You can powerlift. You can run. You can do crossfit. You can ride your bike. Doesn’t matter. Just make sure you plan set times to workout four-ish times per week. So, like… Monday, Tuesday, Thursday and Saturday you’ll workout at 7 a.m.. something like that. No excuses. Schedule and routine will make you more compliant with your plan. Once things heat up, it’s harder to get into the routine, but not as hard to stick with a preexisting plan that has worked for you.

 

Second Year

Anki phone app: Instead of spending hours repetitively pressing the space bar hundreds of times, bang out 20 cards during your little five minute breaks throughout your day. Waiting in line at Chipotle. On the toilet. Waiting for class to start. Saves time and makes Anki feel like less of a chore.

Anki at the gym: I can’t listen to podcasts/lectures at the gym, so Anki was always the perfect thing to do between sets. Again, saves you time and makes your hour at the gym even more efficient.

Goljan on car rides/commutes: Papa Goljan is a hero. Are his audio lectures completely necessary? No. Do they contain info not in Pathoma/B&B? Not really. But Goljan has a way of tying topics together and explaining them that simply makes sense and sticks in that overcrowded brain of yours. I absolutely got a question right on Step 1 because of one of his wacky stories about a certain pathology presentation. He’s entertaining too.

Writing in Pathoma margins: I mean, they’re like, the perfect size. Plus, the beauty of Pathoma is Dr. Sattar’s simple, yet illuminating illustrations. These aren’t in the text, so it’s good practice to draw them into your textbook. It’s like an extra pass of the material.

Annotate (or simply follow) First Aid while watching B&B: Like anyone, I love Anki. But I’m also a huge fan of the physical text of First Aid. It’s absolutely beautiful and perfectly organized. Following along in First Aid and annotating little gems and bits of information (or simply underlining key stuff) from Dr. Ryan is a great way to add an extra layer of retention to your learning.

Notepad: Buy one of those yellow legal notebooks (I actually don’t know what the hell they’re called) and use it as scratch paper for everything you do. Q-bank questions. Little tidbits from videos. It’s nice to have some scratch paper in front of you at all times.

Keep it close to the vest: Don’t talk about your plan with classmates unless asked. Don’t share your UWorld average, practice test scores, or anything of that nature. If you’re doing “better” than someone else, you’ve made them feel bad. If they’re doing better than you, you’ll feel bad.

Whiteboard: Get a whiteboard, hang it above your desk/study spot. Write out biochemical pathways, make charts, and draw. Each day, I’d pick one UWorld question I didn’t understand and put it up on my whiteboard. I’d look at it several times throughout the day. Really helps stuff stick.

Start UWorld whenever you feel like it: I get this question all the time. There is no right answer. Whatever you choose, map out how long it’ll take you and make a schedule that allows you enough time to finish with at least a few weeks to go before your exam (allowing you time to do a quick second pass or incorrects/marked questions).

Master sheet with equations: Get a physical piece of paper and write out all equations you’ll need to know for Step 1. Make it organized and legible. Refer to it constantly.

“Me Time”: When you’re within a few months of your test, you shouldn’t be going out, getting drunk and setting yourself back a day with a cloudy hangover. But you should prioritize stress relief. So if you’re staying in to study all weekend, set an alarm for Saturday at 8 p.m. (or whatever fits your circadian rhythm) to watch a movie or dig into your favorite show on Netflix. You need time every week to not think about medicine. Even if it is completely mindless. Actually, the more mindless the better.

Laugh at a bad UWorld score: It’s a 40 questions practice test. Yes, we’re talking about practice. Don’t let a bad day/block put you in a bad mood. Say “damn”, learn from your mistakes, laugh about it, and move on.

Google images of diseases: There are lots of pictures on the exam. Nearly every derm question will have an associated picture. Know what stuff looks like. Aside from maybe Peyronie’s disease; just use your friggin imagination.

 

Dedicated

Have an “anthem”: Dedicated is a lonely, stressful time riddled with self-doubt. Imagine yourself as Rocky Balboa training in the Siberian tundra to defeat Ivan Drago. But this is your movie. You’ve made it to med school, slaved away for years, struggled along the way, but you’ve learned so much. It’s the hero’s journey. Every hero needs a theme song. Pick a song that gets you pumped up and makes you feel like you can conquer anything. Listen to it every day and remind yourself that you’re almost there. And to keep going. This was mine:

 

Dont obsess over practice test score predictions: Again, we’re talking about practice. I scored almost 10 points higher than my UWSA2, which was taken a week before the test. You may crush your UWSAs and score far below them. You may score 15 points higher than your last NBME. Trust the average but don’t think you’re destined to get a certain score based on one test or how a certain test related to other peoples’ scores. And don’t even worry about how your UWorld percentage correlates to a score; it’s a fools errand.

Don’t read write-ups on others’ Step 1 experiences within a month of your test: During the month leading up to my exam, I read countless reports of others’ Step 1 experiences, which were usually hysteric and not at all indicative of what I experienced on test day.

Don’t stress about learning stuff that isn’t in Step 1 resources: A big fat waste of time. Bridging off my previous point, I read a few “Step 1 Experience” posts during dedicated that claimed the test had tons of wacky parasites. In my anxious and neurotic state, I spent hours researching extremely rare parasites one evening. Of course, I had one parasite question on my test and it was incredibly easy.

Personal Anki deck: Even if you use a pre-made decks, make a a separate Anki deck for random little facts that you keep forgetting, Uworld tidbits & incorrects, NBME incorrects, etc.

Listen to murmur heart sounds: I could describe the location and character of all murmurs easily, but the actual sounds threw me off when I saw that clock ticking on test day. Don’t know why, but it made me anxious.

Go over normal anatomy on high yield imaging: CXR, abdominal CT, etc.

Don’t ignore First Aid micro: Even if you do Sketchy & a Sketchy anki deck, please read the end of the microbiology chapter in First Aid. All of those “special situations” are extremely high yield.

Don’t move the exam back if you’re hitting your mark on practice tests: The more you learn, the more you’ll realize you don’t know. You can’t know everything. I would have scored better if I had taken the exam a week earlier.

Don’t be afraid to move the exam up: If you’re where you want to be on practice tests and you start to feel burn-out seeping in, you’re done. You’ve made it. Slay that dragon. Take the test. Being fresh is more important than another pass of the material.

 

Test Day

Believe in yourself: You wake up after a night of tossing & turning. It’s test day. No more UWorld. No more First Aid. No more Anki. It’s over. It’s the Super Bowl. The title fight. The final boss. There’s no room for self-doubt anymore. You’ve put in more work than any of your non-medical friends and family will ever realize. You’re a beast. You’re brilliant. Nothing can shake you. This is the time to be arrogant. Embrace the inner Kanye. You’re going to crush the test. Believe this and wish it into existence.

Write down equations during the tutorial: I’m telling you, when it’s real-deal exam day, you see 10 minutes left on the timer and you reach a stats/phys/pharm question that requires a formula, it’s much more reassuring to simply glance down at it in front of you and run the numbers. Eliminate room for mental error/brain fart on easy questions.

EAT: I brought two protein bars and an apple, ended up only eating half of a protein bar. Exam day adrenaline. Wish I would’ve calmed down and eaten in hindsight because my energy was tanking by the last two blocks.

Playlist: The real secret to success on Step 1 is the proper mindset, which obviously starts with some good tunes. If you’re feeling worn out after a few blocks and need a burst of motivation or energy, listen to your favorite pump-up song. If you’re jittery and not thinking clearly, listen to something soothing and happy. High yield.

Go outside: After my fourth (I think) block I was feeling a bit flustered and starting to doubt myself. Sitting in a cubicle, staring at a computer for 4-5 straight hours felt claustrophobic and mentally taxing. I was anxious and jittery from a bad block. I took a break, walked into the sunshine and sat on the curb. I felt the warmth of the sun on my face, heard some birds chirping, and listened to “Push the Sky Away” by Nick Cave & The Bad Seeds and “Since I Left You” by The Avalanches. This gave me a peculiar sense of serenity and confidence. I came back inside, sat down, and made that next block my bitch.

 

Post-Exam

It’s OVER. You can’t change anything. Don’t go neurotically looking up answers to questions. That’s like looking at pictures of your ex for hours on end. It’ll only drive you nuts. You will undoubtedly second guess yourself. But you have to do your best to block it out. Pretty much everyone feels like crap after the test. It’s natural. You have slaved away behind your computer screen for months – go have some fun.

Go to the bar and have some brews with your buddies. Sleep in the next day. In fact, don’t set any wake-up alarms until third year starts. Mindlessly binge watch a show on Netflix all week. Go to a baseball game. Cozy up with your significant other if you have one. Plan some date nights. Grill some steaks. Dig into a (non-medical) novel. Go to a museum. Travel. Enjoy the outdoors. Go on a hike. Visit a national park. Visit a friend in a different city for a weekend. Spend as much time as possible hanging with friends and family. Don’t talk about medicine. Do whatever makes you happy. Celebrate. It’s a glorious time to be alive. And you are one step closer to being a doctor.

Once third year starts, you have a whole new set of worries to replace Step 1. Take the time in between to love yourself.

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