Return to Blog Homepage

Think JUST Studying for the USMLE Step 1 is Enough? Think Again.


Since becoming a tutor for the USMLE Step 1 and Step 2 CK exams, there have been a few times when I’ve found myself confused by a student’s lack of progress. They’re “doing everything right”  following their schedule to a T, completing each assigned USMLE World question block, taking NBME practice exams with reasonable intervals in between to enable me to track their progression….

But something is off; their scores are not budging and their anxiety is mounting.

At first, I never knew what to make of this. I assumed that the answer was to work harder, and would inquire about whether they were actually completing their daily assignment of flashcards. Often times, my students would suggest that they were “poor test takers,” which I respected while also quietly believing that we’d devised a sufficiently active study method to counteract their previously passive study habits. Hmmph. Confused, anyone?



Then I started to ask about what they were doing when they weren’t studying, and I began to uncover answers.

Most of us who have made it to the point in life where we’re lucky enough to be stressed about taking Step 1 (yes, lucky being a doctor is an awesome privilege!) have something in common: We know how to work our way down a checklist. We are good at making to-do lists. We are good at being productive. We get stuff done. This strength has the potential to turn us into obsessive, mindful physicians. I say “obsessive” here as a good thing, because in some ways, if we’re worrying about our patients and digging deeper for components of the history and physical exam that may be contributing to their clinical presentations, our patients don’t have to worry as much. And that is a goal worthy of a little obsession.

However, this goal-oriented mentality may also beget our downfall.

If you center your life on the rush that comes from achieving goals both small and large, many good things will fall by the wayside. I call this the collateral damage of medical school. Early in my first year, a physician preceptor asked me what I did for fun. I replied with a sincere but socially awkward, “Fun?” He laughed and then decried the medical school experience for taking a myriad of interesting, unique humans and turning them into automatons. He called this the “sausage factory.”

Otto van Bismarck famously linked (haha get it?) laws and sausages:

“Laws are like sausages, it is better not to see them being made.”

The legislative process is a messy one. Anyone who reads the New York Times headlines can verify that. But so is the process of becoming a doctor. It can feel at times like we have to sell our unique identity (or the quest to find it, which most people do during their early twenties) for the rights to become a purveyor of health. What’s ironic about this is that many physicians work so hard that their health suffers severely; they develop the very chronic diseases they aim to prevent in their patients.

When my preceptor called medical school the “sausage factory,” he was also referring to a loss of individuality inherent in medical education. As much as I want to say that this shouldn’t happen, my true thoughts are that substantial sacrifice is necessary, particularly during the Step 1 study period. This is not the time to become a guitarist, or to run a marathon, or try out OK Cupid. This is the time to work.

What I do want to say, however, is that part of meaningful work is taking good care of you. The high that comes from conventional markers of success an extra 30 minutes of flashcards, scoring higher on your USMLE world block or receiving positive feedback from an instructor is fleeting and will never be enough. Many times in the last eight years, I found myself stressed out and anxious leading up to a test, only to do well afterwards and then find myself yearning for the next high mark. We are addicted to numerical, objective, short-term markers of success.

But if we treat short-term success as an end rather than a means, we find ourselves in trouble. Even if we treat these as the means to a worthy end—becoming a physician—we are in trouble. We will be burnt out, tired and bitter when we inevitably discover that being a doctor is a process rather than a final destination. We won’t get there any sooner by studying a little more and working out a little less.

At some point, life has to happen. There are long-term goals worthy of our attention as well, although these might not be as readily achievable, and may be difficult to work into our checklist manner of perceiving the world around us. Foremost among these long-term goals are good health and supportive relationships.

Good health comes from balancing a reasonable exercise routine with adequate sleep and a diet that isn’t dominated by processed carbohydrates and caffeine.

(I know. BLASPHEMY! ) This means making sleep just as much a part of your study schedule as flashcards and UWorld question blocks. This means 30 minutes of aerobic exercise 3 to 5 days a week. This means going to the grocery store.

Speaking of the grocery store, here’s some food for thought. Recently, the New York Times has paid a lot of credence to the role of sleep in laying the intellectual groundwork required to be a thoughtful, reasoned test taker (and human being). The article’s definitely worth your while to give it a read.

All groceries and articles aside, though, here’s what I want you to take away from this post: In order to take care of those around you, you MUST take care of yourself first. No one else can do that for you.

More to come!

In the following weeks, MST will be exploring the role that lifestyle plays in establishing a successful USMLE study period. Stay tuned!