Saturday, July 18, 2015

Step 1 Aftermath

First off, to the kind soul who tried to leave a lengthy, encouraging comment recently on the “How to Study in Medical School” post and perhaps was wondering why it didn’t show up: I think I accidently deleted it. Sorry. I did see it and appreciated your words, though.

This has nothing to do with this post
As the title suggests, Step 1 is over (!!!) and I’ve started third year. I had planned to write up a “How to Study for Step 1” type post, but I think a post like that would be misleading. There isn’t one best way to study for Step 1, just like there really isn’t one best way to study for medical school. That said, I feel like a “How to Study in Medical School” post (like this one) is a bit more helpful because it’s such a different beast than anything you’ve done before. Step 1 is too, to some degree, but by the end of two years in medical school you should have a fairly good handle on what works for you and what resources you like. 

So there isn’t one prescription for an awesome Step 1 score. That said, as I was planning my study schedule out, I found it helpful to read about what other people did, found helpful, or had success with. Also, even though there isn’t necessarily one way of doing things, there are definitely some common resources and themes that lend to success on what might be one of the most important tests you ever take. With that in mind, I’ll try to give at least of a rough sketch of what I did below.

Laying a Foundation

The first thing I’ll say is that probably one of the most helpful things you can do to get a solid score on Step 1 is lay a good foundation for yourself in the first two years of medical school. Don’t get too caught up in what’s “high yield” or whatever. You just don’t know what matters and what doesn’t, especially in first year and into the beginning of your second year. There were things that showed up during my dedicated study period that I remember seeing in first year and never really thought I’d ever see again. So just do your best to do well in classes. I know some people go to schools where they feel like professors mostly just drone on about their research, but by and large medical education across the U.S. is fairly standardized, at least more or less in terms of essential content.

The Resources

Outside of class material, there are some tools available during your first two years that might prove helpful. I’ve written extensively about using Anki to make flashcards. Some people who like the idea of flashcards but don’t want to make them have liked Firecracker. First Aid is helpful to at least look at along with your classes, just to see what might be particularly important and get familiar with how it’s laid out, but more so in second year. Pathoma for pathology and Sketchy Micro (I guess now it’s called Sketchy Medical) for microbiology (and maybe soon for pharm? That would be sweet) are absolute gold. Some people (I’m one of them) enjoyed listening to Goljan audio during second year and/or during their dedicated Step 1 study period while working out or driving. Some people like doing question banks during second year. I just didn’t have the time.

Experiment with what’s out there. There is a lot. By the middle of your second year or so, start nailing down what resources you are likely to use for your dedicated period. Don’t try and do too much. I feel that it’s better to have a handful of resources down pat than to stretch yourself too thin.

Personally, I ended up using First Aid, Pathoma, Sketchy Medical, and UWorld during my dedicated study period. I had used all of these except for UWorld throughout second year. During the year, I tried to make Anki cards with most of First Aid content and Pathoma along with some class stuff, and had watched most of the Pathoma videos at least twice by the time the dedicated study period began. I decided not to keep using Anki through my Step 1 period. It had served its purpose, and I felt like I wouldn’t have enough time (and that turned out to be true). I also used a website called Cramfighter to plug in my resources and spit out a study schedule for each day – it was pretty awesome, and I highly recommend it.

A Day in the Life

My dedicated study period was five weeks. I felt like four was a bit too short, but six weeks was long and I wanted to maximize my vacation time afterwards. Five weeks ended up being perfect for me. Before second year ended, my school provided everyone with an NBME practice exam (Form 12), and I scored 215.

Our last final was on a Thursday, we had a long weekend, and then I got to it on the next Monday. For the first four weeks, my goal was to get through everything once. My day started typically around 6 am. I’d exercise while listening to Goljan audio, shower, eat breakfast, and get started with UWorld questions around 8 am. This would take the bulk of the day. I’d do two blocks of 46 questions (until they changed the max to 44 to match the new change in Step 1) on random timed. One note about that: some people like doing questions by subject or in tutor mode. It doesn’t matter. Pick what you like and what you think will serve you best. I liked random timed because 1) that’s how the test is and 2) by this point you should have at least seen everything in the first two years, so it’s not like you’ll being seeing stuff that you’ve never seen before (for the most part). Also, it let me see things several times over throughout the study period – that repetition is important for me.

I’d do the two blocks, which would usually take about an hour and half or so. The next 4-5 hours would be spent reviewing all of the questions, reading all of the explanations (read at least the educational objective for each question, even the ones you got right. For most questions, I’d also read at least the expanded explanation. If you’re feeling frisky, read the explanations for each of the answer choices). For questions I missed or concepts I wanted to see again, I’d keep a running list for each test in OneNote where I would put explanations, pictures, graphs, etc. This was probably one of the more important things I did. I’ll talk a little more about it later. I kept First Aid nearby while reviewing, and made myself physically turn to the page that dealt with whatever question I was on, regardless of whether I got it right or wrong (if you have an electronic copy, word searching for the page you need makes this a lot faster). Repetition is the mother of learning.

After I finally finished UWorld stuff for the day (usually between 1:30-3 pm), I would read First Aid. It was usually about 30 pages a day, and I took my time getting through it. First Aid is not a thorough text. It’s more of an outline. If you didn’t lay a decent foundation during the first two years, it will seem like gibberish. If you did, though, you’ll be able to read through it and be reminded of things you learned before. This is when I also watched Pathoma videos.

Around 6 pm, I’d call it quits for a couple of hours and hang out with my wife and son, eat dinner, put my son down, etc. Some nights I’d take a bit more time off, but most every night I had some stuff to finish up. I usually watched at least a half hour of Sketchy Medical videos (probably the easiest, most efficient learning you will do) and attempted to get through some Lange pharm cards (I ended up abandoning this halfway through the deck).

To take a quick rabbit trail: for those that have significant others, the dedicated study period can be a difficult time. There’s really no way around it. You have a very finite amount of time to prepare for what is probably the most important test you will take, and endless amounts of information to memorize. This is probably the most time you will ever spend studying in your life. Still, though, it’s important to pay attention to those around you and their needs. Communication, as always, is key. Way ahead of the start time of your dedicated period, be sure that you are talking with your significant other about what’s coming up and what it might look like. Err on the side of overestimating the time Step 1 will require from you here, at least to some degree, so that if you end up having more time, it will be a pleasant surprise for both of you since you were both prepared for the worst. Make sure that you take at least a couple hours each day to spend with your significant other, and at least one day off each week. And it’s OK to count down the days. It’s always important that you and your SO aren’t resentful for any reason towards each other, and that’s especially true during this time. Talk with each other, and understand that even though you are exhausted at the end of each day, this is difficult for them too and the world doesn’t revolve around you. This period will end, Step 1 will be over someday soon, and normality will resume.

Back to an outline of a typical day. The last thing I would usually do each day is review my running list of wrong questions, both for that day and all of the previous tests that week. Once a week, I would go back to the previous week and review all of those (so on week 3 I would review all of the missed stuff from week 2). This was probably the most helpful thing that I did in terms of making my weak areas my strengths. I usually finished my day by 11 pm or so.

So that went on for four weeks, six days a week. I took Sundays off and just hung out with my family. By the Monday of the fifth week, I had made it through Pathoma, UWorld, and First Aid once.

Tuesday of the fifth week, I took another school-provided practice test (NBME 17) and scored 245. I took two practice tests in total. I know some people have this idea that they need to take every test possible on the off chance a question shows up on the actual test, but my feeling is that the tests are best used for assessment purposes to see how things are going. You really aren’t learning much by taking them, and in the dedicated period your time is best spend learning from your chosen resources. But do what works for you. The only thing that might be worthwhile is taking two tests back to back a week out just to get an idea of how exhausting the real thing is.

Wednesday through Saturday of that last week was spent making a mad dash through First Aid and Pathoma. I had already finished my “take my sweet time to learn stuff” pass through the material – this was just to see everything again closer to the test. Each day, I also went through a week’s worth of missed questions on my running list. I took Sunday off, and the test was the next day.

Game Day

The morning of the test, I made sure that I was up early enough to eat breakfast (while reading through the rapid review section of First Aid) and get to the testing center in plenty of time. I sat in the parking lot for about a half hour finishing up the rapid review section (I definitely remember seeing stuff on the test that made me glad I reviewed some of those last-minute details) before it was time to go in.

The test itself is a marathon. I took at least a short break between each block to collect my thoughts (or at least zone out for a bit), although the breaks got longer as the day progressed. I did bring some earplugs, which was helpful. And keep in mind that you have to go through the whole fingerprint/search/sign in or out process each time you enter or exit the test room, which takes at least a couple of minutes. I thought the test itself was harder than the practice exams, but sort of easier than UWorld – at least in the sense that there were more first and second order questions and less third and fourth order ones.

I walked out fairly certain that I at least passed, but otherwise had no idea how things went. It was hard, and I felt like it was harder as it went along (although it’s probably just because I was pretty fatigued in the last few blocks). As the days went on, I became less sure that I passed, but for the most part didn’t think about it at all for the next few weeks (which is partly why this post is a bit later than I had intended).

The Aftermath

My final score ended up being between 250 and 255. That’s a little vague, I know. I’m sort of trying to preserve the few shreds of anonymity that I have left, but I also know that’s frustrating to read through an entire Step 1 experience just to get to the end and have no idea how it turned out for the person. Also, since I’ve talked so much about studying in medical school, it would be sort of anticlimactic if I didn’t at least give an idea of how things turned out.

So that’s my Step 1 experience. This post has turned out to be a bit longer than I anticipated. Feel free to email me or leave comments below with any questions. Good luck. 


  1. Did you count/guesstimate how many mistakes you made after coming out of the exam?

    1. No - I've never really been one of those students who remembers a bunch of questions afterwards. I was ready to be done and pretty much just didn't think about it for several weeks afterwards, aside from remembering a random question or two that I probably missed.

  2. What were your parameters on cram fighter? How did you match all your resources so you were studying the same thing in FA and Pathoma?

    1. I didn't worry too much about matching things up perfectly. FA is a much broader resource than Pathoma, while Pathoma specifically focuses on, well, pathology.

      Also, I personally like seeing things at different times in different resources. So you might cover, say, Wilson's disease in Pathoma extensively and then cover it briefly again when you read the short blurb in FA. It serves to jog your memory and reinforce the topics you are learning.

  3. Thanks for the post, it's helpful to know what other people have done. How did you get around the screen capture block in Uworld to keep the question log?

    1. It was annoying, to say the least. I don't really have an exciting solution - I just retyped anything I felt was important (the bullet points in the question log weren't terribly long, usually) or if there was an image I really wanted google searching for "xzy pathway uworld" would sometimes bring up something similar.


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