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® share their study techniques, hindsight advice and words of wisdom regarding Step 1 preparation.
Review First Aid, Sketchy Micro and Sketchy Pharm early on
I wish I would have started earlier just focusing on some simple memorization things like "bugs and drugs" using sketchy micro and pharm. Having those two topics solidly down would have made dedicated simpler since I felt I was still getting relatively simple micro and pharm things wrong that tend to be more memorization than conceptualization.
- 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 is 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.
- 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.
- Read First Aid regularly as you go through the Feinberg curriculum. This way, I would have read First Aid twice before dedicated.
- My strategy was to build a strong foundation before dedicated. I wanted to come in to dedicated confident in the two areas people often cite as their biggest struggles, micro & pharm. This helped a lot because I never felt stressed by either of those during studying. Going through FA once before dedicated also was a huge help because the second time through I was focusing on more minute details than the larger topics
- Identify areas of weakness
- I started seriously studying early (Thanksgiving Break) and got through one pass of First Aid, Pathoma and UWorld before dedicated period began. This allowed me to relax and pick out the material I was weakest in during dedicated.
- Be cognizant of areas of weakness during the first two years. Those ended up being my best sections on NBMEs/the real thing because I spent more time on them.
- I started reviewing Step 1 during winter break of M2 year. Specifically, I focused on watching all of the SketchyMicro videos and making flashcards out of them. I knew I was weak on microbiology and because there is an enormous amount of information to memorize, so I wanted to get a head start on that as soon as possible.
- A little goes a long way
- The best thing I did was start doing a little each day in late December. I watched about an hour of videos and did some UWorld questions (a little more on one weekend day) so that by the time I got to dedicated study time I was going through the material for the second time.
- I am really happy that I came up with a study plan in early December and studied a little bit most mornings during winter break. It made January and February a lot less stressful and was a more low-key way to just study for an hour or so most days.
- Develop a study calendar
- Following a schedule made me feel accomplished every day and not overwhelmed.
- Know that it's okay if you don't reach all the goals you set out to in the beginning. Adapt throughout and move on.
- Be flexible with your schedule. It's easy to get stressed if you get behind schedule and to not let yourself do non-studying activities because you're so caught up in staying exactly on schedule. You don't need to.
- I purchased Cramfighter during winter break. The goal was to start studying 2-3 weeks before the Feinberg NBME on Feb 9th and set it such that by start of dedicated, I had completed one pass through First Aid, watched all of Sketchy Micro and watched all Pathoma videos. This sounds like a lot, but I had 6-7 weeks and thus Cramfighter helped me spread everything out accordingly and not have to work more than 2-3 hours per day on Step1 studying. I could manage the coursework, OSCE, small groups, everything needed for Feinberg curriculum without, and I want to emphasize this, considering it less important or needing less of my attention. Cramfighter helped me two-fold. One, with spacing out the schedule, and two, with setting me a goal for the day in a way. It felt satisfying to cross off the tasks for the day and I felt like every day was an achievement as a result and a small step towards finishing the marathon. By getting a first pass of Pathoma and First Aid before dedicated, I had reviewed the material and knew where I was lacking and what to focus on during dedicated. During dedicated I no longer used Cramfighter, however.
- Incorporate study breaks
- Even if you sleep eight hours a day, you have 16 hours left during those weeks, and nobody can study 16 hours a day. That leaves plenty of hours to eat good food, see a friend, and watch lots of TV.
- Take at least one full day off a week (whether that's one full day, two mornings, two afternoons, whatever). Schedule it so you don't feel guilty, and actually do it.
- It is a really long haul, and you need to take care of yourself. I did only half days of studying on the weekends and then would do something fun, work out, hang out with my boyfriend, etc., for the rest of those days. It can be hard to take time off, because there's always something else to do, but you will burn out.
- If you are taking a break, remove yourself from any study materials and do your best to truly relax.
- Find something you actually enjoy doing.
- Don't forget to schedule in time to hang with friends. And go to the gym or do whatever your hobbies are. Definitely hang out with people or you will get isolated and stuck in a rut really quickly.
- See your friends (especially those not in med school because they truthfully couldn't care less that you're taking boards, and that is a great thing).
- Get plenty of sleep and exercise
- I don't care if I'm the 1,000th person to say this, but it's important so I'll say it again: Sleep, eat well and exercise. Honestly, I think that was the most important thing I did. I absolutely focused better and learned better on days when I was doing all those things.
- 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 worked out every single day, which was absolutely necessary for keeping balance and feeling good.
- Minimize other commitments and responsibilities
- Be free of responsibilities besides Feinberg exams and Step studying by February if at all possible. Do not multitask during the dedicated study period.
- 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.
- Create a schedule that works best for you
- Do not be afraid of taking less time to study than others. If you like studying at a heavier pace, do not feel pressured to schedule your Step 1 date as late as your friends/classmates do.
- While you should listen to people's advice, you know yourself best and the way you are most productive studying. Don't be stressed by how other people are studying or what other people tell you to be doing to study. Be confident and do what works best for you.
- Don’t push back test date
- I would caution everyone against pushing back their test, there reaches a point in time where you just need to be proud of the work you put in and confident in your test taking ability. Studying more would not have gotten me a higher score.
- If you give yourself the luxury of having the option to change your test date, you might slack off and not study as hard as you could. Commit to a date, work hard, work efficiently and believe you will perform when the time comes.
- 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.
- 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.
- 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.
Use of Resources
- Be aware of resource overload
- Don't overload on resources (UWorld, First Aid, Pathoma and Sketchy are a lot as it is). Trust your preparation going into the test, and be confident.
- Many people feel the need to try out several different resources. I suggest sticking to the few resources (three to four) that are most highly rated and master those as opposed to adequately studying too many resources.
- I think it is important to pick a few resources you like using and study those completely.
- Pick only a few resources and stick with those. Just because your friend is using this or that, does not mean that you need to use every resource that other students are using.
Try not to overload on resources. In the beginning, I wanted to finish all of the resources at least once. However, you'll start to realize that your time is best spent focusing on things that worked for you during the first two years of medical school. I also highly recommend taking all of the NBMEs/doing as many unique practice questions as you can. Practice makes perfect.
- Trial and Error
- 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.
- Practice Exams
- The two most important times to take practice exams are the midpoint period and several days before the actual test. Taking a practice test at the midpoint period gives you a sense of where you are in terms of preparation. And the practice test several days before the real thing will give you an accurate prediction of what your score will be.
- The UWorld practice tests are more indicative of what it feels like to take the actual Step 1 exam compared to the NBME exams, so I would highly recommend doing those practice exams.
- I highly recommend going to the test site and doing the practice exam. Even though the practice questions there may not be entirely useful, knowing where everything is and how everything works is essential to decreasing the stress level.
- I made Anki cards for everything I didn’t know from Pathoma, First Aid or UWorld on my first pass, and made Anki card for anything that Dr. Sattar said was “high-yield for exam purposes,” even if I thought I knew it already.
- UWorld was by far the most useful. I started doing 20 questions a day in January to get in the groove. I think starting early was very important because it made me feel confident about my progress.
Do questions. Do questions. Do questions. The more questions you see, the better you get at figuring out how to eliminate answers and select the best answer even if you don't actually know the answer. UWorld questions are incredible, but make sure you use them right. READ THROUGH ALL THE EXPLANATIONS, even if you get a question correct. Answers to other questions will be found in the explanations of the wrong answers. And then redo all the questions you get wrong. You're not going to know everything on Step 1, not everything is in First Aid. But if you get good enough at answering questions, you'll be able to use process of elimination on Step and get most of the questions right.
Words of Wisdom
- This is just an exam. Really. It's one exam — an important one, but still just one single exam. We've all taken exams before. Try not to work it up to be something that it's not.
- Try not to let other people scare you. Everyone finds studying for Step 1 challenging; just because they are using another resource does not mean you are doing anything wrong.
- If you're super anxious about your score and feel like you're not improving on UWorld, you're not the only one. If you take an NBME practice test and do much worse than you expected, you're not alone. So many of us had moments where we hit the wall and seriously doubted our ability to make it through to the end. But we did. And so will you.
- I never believed people when they told me that Step 1 was going to be just fine, but I'll share the same advice I was given. Study hard during your second year, and you will do well on Step 1. Sure, a lot of what we learn second year is not going to be on Step 1, but it will give you a framework to learn what is required for the boards.
- Don't get frustrated if you feel like you're not making progress during the year. The time during dedicated is so much longer than you think. Scores that stall during the year start shooting up during dedicated, what takes you a week to get through during the year takes a day during dedicated.
- Try not to let NBMEs discourage you. I know that it's not always true, but those scores were not indicative for me, and I wish that someone had told me that it's important to consider not just what you get on an NBME, but also how you're doing on UWorld. Take the whole picture into account, and try not to let it get you too down (easier said than done though).
- You will never feel like you know every detail about everything, or even most details. At a certain point you will take the test, and you will do well if you pick a plan and stick to it.
- Remember that the boards is an endurance test. Don't let the seven to eight hours of testing wear you out. Do all those smart test-taking things (eat snacks, use your break time, etc.). Give each question a fair shot, but if you don't know it, pick an answer and move on (and pray that it was a pilot question anyway). Remember that there are easy questions at the end of the block that you don't want to run out of time on. And when you're finished, celebrate.
No matter what you do, the actual test is going to have stuff you won't have ever seen or been taught before. At the beginning I expected first aid to have pretty much all the details I'd need, but this isn't the case. So just don't let it throw you off on test day, that's how everyone feels.
Listen to what others have to say about their experiences, but don't expect your experience to be the same as theirs. I frequently had to remind myself that I'm not like this person or that person and that what worked for them might not be what works for me and that's okay.