Step 1 is the first test out of three in the United States Medical Licensing Examination (USMLE). It is one-day of examination with seven 60-minute blocks that are composed of up to 40 questions, taking 8-hours total. At a cursory review, it is just like any standardized examination, but mention it to any medical student and they will shudder.
Unofficially, people have claimed USMLE Step 1 is the most difficult and important of the 3-part USMLE series. And, speaking from personal experience, Step 1 was one of the hardest things I had to do. But, now that I have successfully gone through the process and had some time to reflect, I want to offer what I wish I would have known before taking Step 1.
It is not about how hard you study; it is how smart you study.
In the beginning, my approach to Step 1 was pure repetition. If I got through UWorld, Sketchy, First Aid, Firecracker and Goljan audio as many times possible, I thought I would get a stellar score and succeed. I was hoping to passively absorb the information. However, with this approach, my NBME tests kept projecting a score much lower than my goal. I was confused at first. I got a first and almost second pass through all of these resources. How could I be doing so poorly?!
I reevaluated my studying approach and realized that brute memorization was good for my short-term memory; however, it is impossible to stuff the amount of information that is testable for USMLE Step 1 into your short-term memory. So, what is the solution? You have to study smarter. Studying how a system works and why a system works will bode much better on the test than pure memorization. Even though Step 1 will ask several memorization-based questions, I was surprised by the number of critical thinking questions there were. USMLE Step 1 is really a test to get you to start thinking like a doctor and you cannot learn that passively.
Caring too much about what other people are doing can make Step 1 way more stressful than it has to be.
Everyone advised me to not listen to other people, but some things are easier said than done. In the beginning, I opted for more solo studying; but after a couple of months, I found that isolating and started a group chat with my friends where we would discuss questions we missed. I really do think group studying is valuable.
However, I wish I did not worry so much about what other people did or were doing. For example, several of my friends and blogs mentioned Anki decks and how they were amazing. I wasted unnecessary time trying to work with Anki and incorporating it into my study time with little success. Also, when people would share their study schedules and habits on social media, it always brought me anxiety. As a result, I am going to pass on the same advice that I did not listen to.
Everyone has their own individual way of studying, so do not feel pressured to do anything just because your friends are.
The knowledge you gain from USMLE Step 1 is actually helpful in the clinic.
Although some medical schools have started making changes that involve taking USMLE Step 1 after clinical rotations, my medical school still followed a more traditional format where we took Step 1 before our clinical rotations. Without the experience of our clinical rotations, it was difficult for me to contextualize all the studying I was doing every day. Sometimes I wondered if I actually had to learn certain facts to treat patients.
However, I wish I had known how important the knowledge you learn for Step 1 is during clinical rotations and shelf exams. I started my pediatrics rotation right after finishing Step 1 and I was surprised by how many times facts from Step 1 came up. I wish I had known this before because knowing your studying is valuable for much more than a test can be really motivating.
In the end, USMLE Step 1 is just a test.
There is a lot of pressure surrounding Step 1 and it can be overwhelming. However, it is just a test and what truly matters is passing. Remember that USMLE Step 1 is only one part of your application and residency interviews are holistic evaluations. This test should not define you. Working hard and trying your best is what really matters. At our medical school, we had deans and professors who were amazing physicians and they reiterated that Step 1 is just a comma in your journey, not a period. There is so much more for your medical training after Step 1. I wish I kept this perspective especially in times that were extremely stressful.
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