If You Could Prepare for Step I Again, What Would You Do Differently?

Northwestern University Feinberg School of Medicine students who scored more than one standard deviation above the national mean on the United States Medical Licensing Examination Step 1 were asked what they would do differently if they had the opportunity to take Step 1 again. Here are some helpful responses:

  • I would attempt to identify my weak spots early and drill them down. For me there were always certain subjects (like Nephritic & Nephrotic syndromes, biochemical pathways…) that I just struggled with. If you see yourself continually getting questions wrong, or not knowing why they’re right, take extra time to utilize a different resource for those subjects.
  • Start UWorld a little before dedicated so as to not have to study as many hours each day as I did. I started in dedicated, but I would have started to chip away starting in March
  • Read FA regularly as you go through the Feinberg curriculum. This way, I would have read FA twice before dedicated
  • I went to a research conference during dedicated to present my research. I would not recommend this. In general, wind down on all existing responsibilities BEFORE February of pre-dedicated studying. Do not multitask during dedicated (e.g. research, side projects, etc.)
  • I would consider doing a QBank before I started UWorld (e.g. Kaplan), depending on how stressed I was/how much time I had. This would not have worked for me because I was simultaneously completing my research at the same time as pre-dedicated studying.
  • Be careful about studying with significant others. This worked for me, but I would caution that is stressful and potentially too much for a relationship to handle (please keep this answer especially anonymous!)
  • Many people will talk about pushing back the exam quite a bit. Try to just gauge your own progress and not listen to others and what they are doing. It’s repeated advice but once you are in it you will need to hear it over and over: do what’s best for you.
  • I think it would have been nice to do another question bank, at least partially. I had run out of UWorld questions by the last few weeks of study time, and I wished that I had done some kaplan earlier so that I still had UWorld left (or I had just picked up kaplan for a few weeks, but that’s expensive).
  • I would stop Kaplan and begin Uworld earlier. I think Uworld is a wonderful learning tool and superior to Kaplan. However, don’t start Uworld so earlier that you reset and start over. I think that some of the value of the QBanks are lost when you do them more than once!
  • Start a Question bank (either USMLERx or Kaplan) at the beginning of M2 year and do corresponding questions)
  • If I could do it all over again, I would make sure that I always had reviewed the material in first aid for a unit while we were studying that in class. There are lots of topics that we never learn in class but that we have to know for boards (i.e., RTAs, amyloidosis). It’s way easier to learn something like RTA when you’re learning Everything else about renal than if you learn it a year later during dedicated study period. So my advice is to make sure that by the end of each school unit, you’ve read through all of first aid for that unit and have a decent understanding of the material within it.
  • About half way through M2 year, I began keeping my First Aid book open during lecture and annotating it with additional information or explanations that I thought would be useful. If I could go back in time, I would get a copy of First Aid and start annotating it on the first day of lecture as a M1 student. Subjects like biochemistry are covered early in M1 year so I essentially had to relearn it doing my dedicated period. It never hurts to start studying early or at least start thinking about Step 1.
  • Trust the system. Throughout much of my designated study time, I was quite stressed out and was constantly worrying that I was not studying correctly and was not as prepared as classmates. Three things I wish I would have known then is that 1.) medical students have a remarkable ability to project confidence when they in fact are as worried as you are, 2.) there is a reason why Feinberg medical students do so well on Step I compared to peer institutions; the first two years are remarkably effective at preparing students to do well, and 3.) there is not only one correct way to study. Every student learns in different ways; what is most critical is to via trial and error to identify what resources work best for you and to stick with it.
  • I wish that I hadn’t taken more than one NBME. I did not do as well as I wanted to on any of them and found it really discouraging, and I didn’t find them at all reflective of my final score or the U World scores that I was getting. For me, the NBME practice tests added unnecessary stress and discouragement that I wish I had avoided.
  • I wish I had known earlier that many people out-score their NMBE practice exams on the real test by 10-20 points. When people started doing NBMEs a few weeks before the test it was a HUGE source of anxiety in our class because everyone thought that they weren’t prepared enough. Trust the process- what you’ve done will be enough.
  • I wish I was able to do more Boards specific Anki cards, especially ones that had pictures on them. It’s hard because there are so many flashcards and the decks are hard to get through. Some people said they used the big pre-made Anki First Aid deck and picked out cards on the topics they didn’t know as they went through UWorld questions/videos. It would have been nice to have a nice deck of targeted flashcards to go through towards the end of study time.
  • Stop waffling about what resources I should be using and just stick to the basics. I wasted hours on a bunch of different things I thought might help that didn’t and be realistic with myself about my endurance and study schedule (scheduled like 11 hours/day and ended up doing 8 most of the time)
  • Step 1 is largely based on integrative knowledge with an emphasis on clinical application. About half way through second year, I began to focus less on the minute details presented in lectures and instead spent more time focusing on integration and application. My favorite thing to do for any given disease was to find a well written review article in NEJM or JAMA that succinctly covered pathophysiology, epidemiology, diagnosis, and management. This is the type of knowledge that will “stick” and is really what will be tested on Step 1. Furthermore, it is what will be important in the long run and will be of great aid on your clinical rotations as an M3. If I could do it over, I would have studied with this way all year. I am in no means advocating foregoing Robbins. It is an invaluable text for second year.
  • I would have changed the order I used my review books in- I used First Aid first and then USMLE Secrets. I think that the Secrets book would have been better first because it’s less comprehensive. I also would have gone back over the subjects I felt like I knew well closer to the exam. I ended up spending more time on the things I didn’t know well, and therefore did better in those areas than on ones I knew well.
  • I would take it sooner. There is a sense of “think how much more I could learn in that extra week” but when it all comes down to it, I don’t actually think that is the case. There is a finite amount of material to learn and after that it’s just spinning your wheels and trying not to forget faster than you learn. I had three and a half weeks and two and a half to three weeks would have been adequate.
  • I would have paid more attention to anatomy, public health and behavioral sciences. There were a number of questions on brachial plexus lesions, obesity, diabetes, and bioethics that were new to the boards this year and were “gimmes” if I had reviewed them. BRS Behavioral Science is a must. I’m not sure what to use for anatomy, but I would emphasize clinical correlations and imaging. If you know the BRS anatomy Q’s then you should be good. Remember that pathology is of the utmost importance but it’s probably only 65 percent of the test
  • I would relax more before I started studying. A lot of people started talking about studying really early in the year and it made me feel anxious. If I could have had the confidence to know that 4 weeks is completely sufficient study time, that would have helped. Also, starting at Spring Break I read the First Aid chapter for every unit that we covered. I would have started reading First Aid at Christmas along with lectures—not studying (just reading to know what topics are covered).
  • I would definitely make more of a concerted effort to have a study group and/or schedule time to see friends at MUCH more frequent intervals. Everybody will tell you not to pay attention to how everyone else is studying, which is excellent advice but also serves to drive people away from their classmates during study time. I took this too much to heart in the first couple weeks and avoided Galter to study by myself. It was awful. If you have a significant other or are going home to your family to study, that’s great; but I didn’t have either of those resources and the isolation of Step I prep was what nearly drove me over the edge. You need to eat, you need to sleep, you need to work out if that’s your thing; but don’t forget human contact as well.
  • I would take Step1 on a Friday instead of a Monday
  • If I could do it all again, I would take the test earlier! Feinberg prepares us really well during our first two years and I started to slowly review after coming back from Winter Break. So by the time our “dedicated study time” came around, I was ready to get to it. I know it doesn’t sound like a long time to consolidate everything you learned those first two years, but trust me, 4 weeks is more than enough!! I took it in four and if could do it again, I’d do take it after three weeks.
  • Make a STRICT study schedule that is MANAGEABLE. Make a study schedule that gives you time to go though both First Aid and UWorld one time minimum (though more times would have been nice…). However many break days you think you will need per week, plan for an EXTRA half or whole day for “unorganized study time” that is not accounted for in your schedule. I had one day a week for “free study time” in my study schedule and it allowed me to catch up on days that I fell behind on and solidify my knowledge on areas I still felt I needed to work on.

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