Studying for the USMLE Step 1 While Managing a Mental Illness

  • /Reviewed by: Amy Rontal, MD
  • Blogger and med student Ken Noguchi shares his experiences tutoring students who manage a mental illness in medical school, as well as his thoughts on the medical school community as a whole.

    As an MD/PhD student, a peer tutor, and the author of SideNote, Ken has a lot of experience in the medical school world. But his knowledge of the challenges students face during their medical training is even greater than his CV would suggest. As a student with personal experience in managing a mental illness while studying for the boards, Ken has served as a mentor to students facing the same obstacle. He’s well aware of the challenges posed by managing a mental illness in the already difficult environment of medical school, and he uses his experience to help other students through a tough time in their lives.

    One way Ken is trying to help students deal with stress is by identifying aspects of med school culture he views as problematic. For example, in the time he’s spent with other students, he’s noticed they tend to compare themselves to each other. “Medical school is macho” Ken said. “I think that’s one of the biggest barriers for med students dealing with mental illness.”

    For Ken, this macho attitude is not a useful way to deal with the stresses posed by medical training. In his view, mentoring medical students shouldn’t just be about preparing for the boards, but incorporating part of a larger vision he has for medical school. He sees much value in fostering a medical school community with stronger, team-oriented relationships among students. “When one student goes it alone, it harms the whole” he said.

    With this attitude towards comradery and community in mind, let’s take a look at how Ken prepared for Step 1, how he helped other students prepare for the exam, and what kinds of study materials he recommends for those grappling with mental health issues.

    How Ken prepared for Step 1

    We asked Ken what worked well for him when studying for Step 1. While his peers continued to pull all-nighters during their study period, Ken told us “I had to be very conscious of how I managed my time. I think you have to be a really good planner. You need to know how much studying you can handle.” For Ken, daily exercise was important in dealing with stress. “Exercise helped me feel energized in the morning and kept me conscious of going to sleep” he said.

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    How Ken helped his students prepare for Step 1

    When Ken was mentoring his peers, spending time crafting a plan was a significant part of the solution. “One student I had took the boards twice and failed. For him, studying-related anxiety was the biggest factor” Ken said. “He wouldn’t be able to study for more than four hours or so.” In his mentoring session, Ken proposed a time management solution for his student. “We’d have him study in the morning, workout at lunch, then work with me in the afternoon. That way the day is broken up, and it was good for him to work with me.” Ken remarked on medical student teamwork more generally as well. “Even for people who are more solitary, I would encourage them to do at least some work with their peers.”

    I had to be very conscious of how I managed my time. I think you have to be a really good planner. You need to know how much studying you can handle.

    – Ken Noguchi

    What Ken recommends for Step 1 study materials

    Another obstacle students faced was overemphasizing certain aspects of their study materials. “It’s the obsession that comes with anxiety and depression. It’s easy to get caught up in details that may not have a big impact” said Ken. “One woman I worked with would get overwhelmed when she didn’t understand the details regarding a certain topic. That would send her into a bad cycle of beating herself up and losing motivation to study.”

    Ken suggested carefully choosing a resource that helps you avoid falling into a cycle that could derail your study plan. “Pathoma was the best for this” said Ken. “It was the most streamlined resource I could find. If you are focusing too much on details that you don’t understand, Pathoma can be helpful. I wouldn’t say to only use Pathoma, but you can spend the bulk of your time on it. I found it covered a higher percentage of the topics on the boards, without being too cumbersome.”

    Finally, Ken helped his students realize they don’t have to know everything to be considered a competent medical professional. He said “I also encouraged my students to realize that doing well on Step 1 and being a knowledgeable doctor doesn’t mean that you have to know everything” Ken told us. “I told my students that even if you don’t understand it right now, we can revisit this topic later.”

    The bottom line: if you’re struggling with a mental illness, don’t go it alone on Step 1!

    For Ken, understanding oneself and attending to the personal needs of each student are core values. “When medical students seek treatment, that will not only benefit themselves, but medicine as a whole. Because that’s one more mentally healthy doctor, who can help other doctors, and benefit the community.”

    And so, if you are suffering from a mental illness as you prepare for Step 1, or at any other time during medical school, please do yourself and the medical community a favor. Don’t go it alone! Reach out and seek the help you need. Ken’s tips can point you in the right direction on how to prepare for your exams, and be sure to utilize any mental health resources you may need on your journey to becoming a doctor. It’s not only the best thing for you, it’s best for the medical community as a whole.