My Best USMLE Step 1 Score Wasn’t Built in a Day (or a Month) — Part 1

  • /Reviewed by: Amy Rontal, MD
  • USMLEscorenotbuiltinadayAs a second-year medical student, I wondered how long I should spend preparing for Step 1. Was I better off with a truncated 5-week plan to make sure I didn’t forget anything? Or would something like 8 weeks afford me more time to really know the material? How would I know what plan would work best for my individual circumstances and learning style?

    In retrospect, I realized that there was a much more important consideration than deciding if a study plan will run for 30 days or 56 days. The first thing that I am going to ask you to do is this:

    Realize that you are not preparing for Step 1 for merely 2 months, but rather, you are preparing for Step 1 for 2 full years.

    The devoted prep time that you put together before the test is certainly important. But what I want you to know is that you can make that study block so much more effective by building the strongest foundation possible during your first two years of medical school.

    “So,” you ask, “How do I do great in class and guide my learning so that I can rock Step 1?”

    In this first installment, we’ll talk about the first few ways to get the most bang for your buck.

    1. Do what it takes to do excellently in class

    If you only put in enough effort to skirt through classwork, you are doing yourself a total disservice. The material that you learn throughout your basic science classes is incredibly applicable to Step 1. If you are able to put in some extra labor the first time through, it will pay dividends to you when you are ready to buckle down for your devoted study time.

    Medical school is a constant cycle of learning, temporarily forgetting, and then re-learning/remembering that which you once knew. No one is asking you to remember every TCA cycle intermediate from 14 months ago. But if you remember the big picture behind the cycle, and the substrates and enzymes at least sound familiar, you’ll be glad that you are not starting from scratch.

    2. Get acquainted with First Aid early, but don’t go nuts

    First Aid is a mighty beast. At times she will be your greatest ally, and at other times, nothing more than a daunting tome. Get to know the book early on in medical school, and become familiar with what is included in it, and what it fails to mention. Understand the structure of the book (i.e., anatomy/embryology, physiology, pathophysiology, pharmacology) for each system, and use it to create a framework for your learning. You can even make some notes in it, but do not stress yourself out by trying to commit it to memory. The time for that will come. During your basic science years, it can help with testing material, and serve as a solid reference. The more familiar you are, the easier it will be to revisit during prep time. (Here’s a more detailed plan on how to do this.)

    3. Start doing some UWorld/Qbank questions as you learn each subject, but don’t go nuts

    You will come to learn that UWorld and Qbank questions are priceless and serve as phenomenal learning tools. Become accustomed to the way that questions are asked, and how deep you should know the material. These questions will also help you for test questions in your classes. However, there is no need to work through these banks in their entirety before your devoted study time. Let them serve as acquaintances as opposed to best friends. The bulk of your basic science study should revolve around your lectures and classwork readings.

    4. Read textbooks

    In today’s world, we always want more for less. Why bother with 520 pages of Costanzo’s Physiology when she has distilled this down into 300 pages of BRS Physiology, keeping what’s important and trimming the fat? Well, in those 200+ pages of “fat” are connections that you might not have otherwise made. There will be answers to questions that you wouldn’t have even thought to ask. As a general rule, you should not eschew primary texts and only read review books.

    5. Along the way, develop your own mnemonics

    I absolutely love mnemonics, perhaps more than I should. They may seem unnecessary and even a little silly. Your pride might get the better of you as you tell yourself, “I will memorize cytochrome inducers and inhibitors by proper name alone, and not with a foolish made-up sentence.” Get over yourself and swallow your pride! It may not seem like it now, but when you are attempting to internalize the compendiums of all things medicine, you will be glad that ACID helps you handle hypersensitivities and that MUDPILES makes metabolic acidosis manageable. (Not to mention how grateful you’ll be for the flashcards you use to drill these mnemonics and other rote memorization facts.)

    With a little hard work and foresight, you can kill two birds with one stone. Getting great grades in class, doing awesome on shelf exams, making Step 1 prep easier, and excelling at the actual exam are all on the same continuum. They all require the same knowledge. The only thing you have to do is have a plan in place, and let these two worlds collide. Keep Step 1 in mind without fretting about it, and by the time it rolls around, you will be totally comfortable with the material and the style of the test.

    In the second part of this series, we’ll talk about a few more ways to do well both in class and on Step 1, and ultimately transform yourself into a more knowledgeable physician.