I apologize for this taking so long, but I’m finally getting around to sharing my USMLE Step One Advice!
For those of you unfamiliar, USMLE stands for United States Medical Licensing Exam. There are three steps involved, and the first (and arguably most important) one is usually taken after the second year of medical school. The score you receive on step one plays a huge role in your residency application. The most competitive specialties, like dermatology and orthopedic surgery, require extremely high performance on this test. Of course it’s always possible to Match with any passing score that you receive, but lots of people wind up with crushed dreams when they don’t score as high as they would have liked. As you can imagine, USMLE step one is very stressful for medical students and proper studying takes many months.
I want to preface my advice by sharing that I was disappointed in my score. I didn’t perform as well as I wanted to or I thought I could. Looking back, I was a little naive to the difficulty of the test and how much studying I would need to do. There are lots of reasons for that, but the main is that I’m an older medical student that didn’t go through the traditional premed pathway. There were a lot of things I learned in the process and things I would have done things differently. So, today I can share my tips for what I should have done. My advice is based on what I truly think it would take to do well and stay sane in the process.
USMLE Step One Advice
You’ll hear that the best thing you can do to prepare is to do well in your classes. While it’s definitely good to succeed in your classes, just doing that alone won’t sufficiently prepare you. The nature of most medical school curricula means that you’ll be tests on subjects you studied over a year ago, sometimes things you studied in undergrad. You’re going to need to relearn those things.
I don’t think you need to start studying during your first year. First year is about adapting to medical education, learning how to study the increased amount of material, and figuring out your balance. My only tip here is to use SketchyMicro and SketchyPharm during those classes. Most medical schools are pass/fail at this point, so enjoy the more relaxed pace. Learn as much as you can, join clubs and volunteer. You won’t have that kind of time much longer!
Once you hit your second year things will have to be kicked up a notch. It’s difficult to balance studying for your classes and studying for step one. You might fight it. I didn’t start as early as I should have and I regret it now. If I could do it again, this is the timeline and process I would have used:
Summer Before Second Year
Go through Sketchy Micro and Sketchy Pharm, slowly and carefully, to really nail down those topics. Even the details that seem minute and insignificant matter. Micro and pharm are always a big challenge. Knocking those out (or at least getting a solid foundation) early will help you with both your second year classes and on the step one.
During Second Year Classes
Buy FirstAid, Pathoma, and Uworld at the beginning of your second year, or whenever you start your organ system based classes. (You may need to do this earlier if you aren’t systems-based.) I know Uworld is expensive, but just do it. Then during each class, use First Aid and Pathoma as guides to determine which topics are going to be the most important for step one. They aren’t always the same as what your teachers focus on!
Use Uworld to study for your tests. You can use the filters to only get questions on the class you’re in. I know it might not be exactly what your test is on, but remember that you are probably pass/fall right now. It’s not really in a medical student’s nature to not get the highest score possible, I get it. But in this situation you can actually take advantage of the pass/fail system to spend more time preparing for step one. This will also allow you nearly an entire pass through the UWorld questions prior to your designated study period.
As a bonus, keep including questions from your previous classes when you use UWorld. We get so much thrown at us that it takes an astonishingly small amount of time to completely block out things we learned before. Maybe just a few here and there, but try to keep up that knowledge as much as possible.
A Few Months Before Your Designated Study Period
This is one of my biggest tips. I know your designated period will feel like a long amount of time, but there is SO MUCH to study. For me, repetition is key, so get at least one comprehensive review in before your study period. You could use Doctors in Training for this or just try to go through all of First Aid. Obviously you’ll have some topics you haven’t learned yet, but you should be finishing up.
You’ll be busy with your other classes, but it’s time to start making some sacrifices. Schedule time each day or each week to really focus on this review. Don’t just skim and think, “I’ll come back to that later.” Really learn the stuff on this pass through the material. That way you’ll just be able to review and focus on your pain spots during your designated period. It’ll save you so much stress later on.
Additionally, if your school doesn’t require it, take an NBME practice test a month or two before your designated period. You might not do well, but if nothing else it’ll provide some study motivation! The results will let you know where your strengths and weaknesses are and that can guide your studying.
During Your Designated Study Period
Most schools offer 4-6 weeks of time off to study for Step One. Each person uses a different amount of time, so meet with an adviser and share your progress and practice test score to set a realistic timeline for yourself. How each person chooses to use and structure their designated study time varies.
- Most people will try to get through Uworld once (or a second time if you’ve taken my previous advice.) Spend just as much time reviewing your right answers as your wrongs – the explanations contain lots of good information.
- You will also likely want to use the first few weeks to get another good pass through all the material using First Aid and Pathoma. Once you feel like you have a really solid foundation, you can start to focus your trouble spots.
- Take at least a couple of practice tests. Some people suggest taking two in a row to mimic a full length test, if you can handle it! I would suggest taking one standard 4 hour test a week, either a Uworld or an NBME. They both have benefits, even though the structure and question style is a little different.
I made a big color coded excel sheet to plan out my days. Your daily plan doesn’t matter so long as you accomplish what you need to. Be realistic with yourself and how much you can do each day. Some people pushed through for 10 hours and then took the nights off, while others preferred to take a lunch break and dinner break, but study into the evening. Some people take an entire day off each week, but that made others too nervous. (Wasted time!!) I would say most people ended up studying at least 6 days per week and at least 8-10 hours each day.
Do what’s best for you and try not to let other people’s plans get in your way. This is so key that many people just choose not to talk or share a whole lot about their studying. The stress levels are already so high that adding in comparison is the last thing anyone needs.
How To Stay Sane
Studying for step one is awful. Unless you are one of the few lucky people that can memorize things immediately, this test will likely be stressful and difficult. I am not at all exaggerating when I say that depression and anxiety run rampant during this time. I know a number of people that had to start taking medication just to sleep. There can be lots of tears. I was fairly miserable by the end of it all. So please, please make an effort to take care of yourself. This test is important, yes, but nothing is more important than your health.
If you know that you struggle with your mental health, talk to a doctor and therapist ahead of time to set yourself up for success. If you need to, continue therapy sessions during your study period. Therapy is a good idea even if you don’t normally struggle! I know it’s time you could be studying, but it will actually be beneficial in the long run.
Oh my goodness, sleep! Your brain is going to be fried by this process, and giving it time to recover and recharge is so necessary. I tried to schedule 8 hours each night, but often times would give myself more if I needed it. I’m fairly useless if I’m exhausted, so getting up to try to study wouldn’t have been productive anyway.
Nutrition is always important for optimal functioning, but especially now. Some of my classmates did a massive Costco run and took an entire day to prep freezer meals to last them 6 weeks. Some people actually go live at their parents’ house so their parents can cook for them. They just didn’t want the stress of trying to cook or go buy good meals while they were studying (and had really nice parents!) I used my weekends to shop and meal prep. I also brought tons of snacks with me, because sitting in one place and studying makes me starving.
I didn’t do my usual hour long classes, but tried to make it to the school gym daily for 30ish minutes of yoga or circuits. Sometimes I walked on the treadmill while studying because I was just too anxious to lose that time, but I really tried to keep my workout as a mental break.
Schedule Some Fun
Whether it’s a nightly TV show or a weekly afternoon off, you have to give yourself little breaks. A bunch of us planned a few activities together, like an Escape Room and bubble soccer. It’s incredible what just a few hours can do for your psyche.
Find Someone You Can Talk To
I mentioned before that sometimes talking to classmates can cause even more stress during this time. However, it’s really important to have at least someone you can talk to. It might not be your best friend, either! You’ll find someone struggling with similar things that can commiserate with you. A good friend or parent that will let you vent. Someone you can just be honest with about how you’re doing and what you’re stressed about. I got really close to some unexpected people during my designated period.
A Few Other Small Tips
- Get your First Aid spiral bound. It makes using it SO much easier!
- I LOVE these pens for annotating.
- You don’t have to use every resource. First Aid, Pathoma, Sketchy & UWorld are the big four that the majority of students use. If you want to try out other books or resources go for it. And if they work for you, great! But choose what you will use and stick to it.
Step One is hard. I actually think it’s unnecessarily hard and tests on information that isn’t very relevant to the practice of medicine. There are lots of strong opinions about step one and it’s importance, but we can save that for another day. Just know that how you do on this test does NOT determine what kind of doctor you’ll be. There is a lot more to being a good physician than getting a good grade on a 9 hour multiple choice test. And no one will care how you did years down the road when you’re practicing medicine. It matters for residency, so do as best as you can, but don’t let it tear you down.
You can do this, you WILL do this, and you’re going to be an AMAZING doctor!