Step 1: Get to it and through it

Tags: Paging Student Dr. Kendra, Kendra Williams, McGovern Medical School in Houston, texas, Step 1

By Student Dr. Kendra

Step 1, the rite of passage for every medical student. It seems like torture to get to and go through, but it’s the one thing that can affect the trajectory of your whole career in medicine. It’s a daunting task but it seems like everyone — for the most part — has gotten through it pretty well. The journey to it and through it can be ugly, but hopefully, I can offer you some preparation tips that will successfully get you where you want to be. It can seem overwhelming, but focusing on your schedule and the resources available to you can help get past. I will outline my schedule, the resources I choose, and the review techniques that worked best for me.

A few things to note first:

  • Find what study method works for you. Figure out if you do best with videos, reading books, answering prep test questions, or attending a Step Prep Class.
  • Preparing for Step 1 is a marathon, not a sprint. You must study and review, review, review. There’s no way around it and there’s no such thing as cramming for this exam. You are essentially being tested on the first two years of medical school. I couldn’t even memorize material after one block if I didn’t commit to it.
  • Some things will work for you and some things will not. If you find something doesn’t make a concept stick, don’t force it, move on to something else. There are tons of resources you may benefit from. Something that worked for your classmate might not work for you at all, and that’s okay.

Let’s get started!

 

Resources I used

First Aid
First Aid is the cream of the crop when it comes to high yield information for Step 1. It offers info in a bullet-point format and gives you the “meat-and-potatoes” concepts relevant to Step 1. For certain concepts, I found myself having to search out other resources to fill in the gaps in order to have a complete understanding of particular concepts. Use First Aid to follow along in class during you second year. When you get to your dedicated study time, it isn’t so hard to get through because you pretty much already know what’s there — and your notes are already there. Most people recommend going through First Aid two or three times. Keep up with it for class — go through it when you actually begin studying for Step 1 — and do a quick pass through during your dedicated study time.

UWorld
If First Aid is the cream of the crop when it comes to high yield information, UWorld is the cream of the crop for question banks. Many recommend if you don’t do anything else, do questions! UWorld allows you to solidify concepts as well as review why an answer is correct or why it’s incorrect. If you can afford it, start doing UWorld questions early, but if all else fails, begin at least three-to-six months before your exam. You want to finish UWorld by the time your test rolls around.

USMLERx
USMLERx is another great question bank you can use. It was written by the same people who wrote First Aid and it pairs quite well with your First Aid study. I used this to get through First Aid and since it’s a lot cheaper than UWorld, I had access to it a lot longer. It helped to get through First Aid when I began studying. These questions are a little more detailed because they’re testing you to see if you know what’s in First Aid, whereas UWorld tests to see if you know the concepts.

Pathoma
Pathoma is the ultimate video resource for pathology in class and for Step 1. Use this for your class study. Make a point to note the differences between each disease. Dr. Husain Sattar does an amazing job of grouping diseases together for memorization purposes, then combing through each disease to delineate it from different disease processes. It gives you a holistic view of pathology to include disease processes, histology, and pathology. I never would have been able to identify different diseases by simply looking at chest X-rays, microscopic slides, or solid organs without the help of Pathoma. This is good tool for Step 1 and for starting rotations. I’m a third-year medical student and still look at Pathoma from time to time.

Sketchy Medical
If you haven’t used Sketchy Medical for didactics yet, I’m going to take a guess and say that you don’t have any problem with pure memorization of dry material. Sketchy was my saving grace in microbiology. Sketchy is a video service that teaches material through cartoons, illustrations, and recurring themes. It offers a way to remember material that you would otherwise have no way to compartmentalize. After watching videos, even outside of the school setting, I’d find myself associating things I learned on Sketchy to everyday things I encountered. For example, anytime I would see a cane or “staff,” I would think of “Staphylococcus.” Even now I find myself recalling facts from Sketchy. I primarily used Sketchy for all of microbiology and some pharmacology but they now offer pathology as well. I haven’t used it for pathology personally, but I’ve heard only good things about it from classmates.

Kiss Pharmacology
I used Kiss Pharmacology to give me a quick and dirty review of pharm since it was kind of my problem child. It’s not holistic, but it definitely gives you a brief review before delving into the concepts of pharmacology. It is a nice resource to use early on.

 

Resources I didn’t use but others found helpful

Picmonic
Firecracker
Kaplan
Doctors in Training

 

General tips

  • Plan your calendar early. Plan when and what you’ll be studying, schedule time to catch up if something comes up, and schedule time off.
  • Make a schedule and stick to it.
  • Make an effort to follow along with First Aid during didactics.
  • Learn to tie in various concepts and topics. Biochem pathways and pathology is high yield. No book will give you every explicit “connection.” Learn to think through concepts and how they could affect large-scale disease processes.
  • Those pharmacology mechanisms of action and side effects are real and are tested like no other.
  • I cannot stress doing questions enough.
  • Learn to pace yourself.
  • Make every effort to learn in didactics. You don’t want to force yourself to learn a difficult concept in the two-or-three weeks before your exam.
  • Epidemiology and physician skills questions are freebies — learn these concepts early.
  • This is important:  No matter how difficult it is to prepare for this exam make every effort to maintain your health, mental health, sleep, and hygiene. Do not forget to utilize your support systems.

Remember, this is a marathon not a sprint. The test itself is long and you won’t be able to blaze through it. Try to build up stamina during your study period.

Also keep in mind there will be a few things on the exam that you’ve never seen before. Don’t freak out! Sometimes you’ll be able to deduce the answer, sometimes you’ll have to make an educated guess. Pick one and move on. Don’t let it jolt you too much.

 

Study strategy

The method that worked best for me was to do the questions and then notate things I didn’t know — which also provides insight into what you’ll be asked and how it will be asked. I would go through specific First Aid sections and then complete UWorld questions. Reviewing questions before you begin reading provides insight into what you should be getting out of each concept.

Example:

  1. Complete a block of USMLERx questions on cardiovascular pharmacology.
  2. Take notes from questions with emphasis on concepts you are unfamiliar with.
  3. Read the cardio-pharm section of First Aid
    • Use the notes you took on cardiovascular pharmacology to curate your reading. Read with a purpose.
    • Use supplements, such as Sketchy or Kiss Pharm, to solidify the material.
  4. Complete the UWorld Block for cardiovascular pharmacology.

 

Schedule

I completed the steps above for every section of First Aid.

Monday through Friday, I would complete a section of First Aid. Sometimes I would complete multiple sections if they were short, like embryology and anatomy. Weekdays consisted of doing USMLERx, First Aid, supplement resources, and UWorld for each section.

On Saturdays, I would only do questions and at least two UWorld blocks. One UWorld block was always the past week’s work because I usually finished a specific subject, like gastrointestinal or cardio, in one week. The other was always a cumulative block that consisted of all of my studying for the past weeks.

Sundays were my official days off.

 

Dedicated study time

My dedicated study time was three weeks prior to the exam. I did a quick run through First Aid again but I mainly focused on tons of questions.

I took my test, got my results back, and I got the pass! I did far better than I had imagined. Adhering to this schedule took dedication and there were definitely some setbacks, but I got through it. I know if I did it, you can too.

I hope this post sets you on the right track to successfully ACE Step 1. Be on the lookout for a post outlining my experience while taking Step 1 on my blog, Paging Student Dr. Kendra.

It’s tough getting to the test and even tougher getting through it but you’ll make it. Keep pushing hard and set yourself up for success.

 

Kendra Williams is a third-year medical student at McGovern Medical School in Houston, Texas. She uses her blog, Paging Student Dr. Kendra, and her social media platforms on Twitter and Instagram to share about the rewards and struggles of being a medical student. She uses her platforms as a discussion forum about issues especially relevant to women and students of color.

1 Comment

  • Justin Riojas said

    My specific details on a particular study strategy I think gets left out. I got this from Online Med Ed. I also used that as a supplement for tough subjects that I just couldn't get to stick; example I might watch renal subject and get the organization for AKI and follow up with reading First Aid to fill in the details.

    Still, back to what I think was the best advice. About three weeks out I started taking 5-7 blocks of 40Q UWorld a day. I started my morning by reviewing one liners on questions I missed the day before, and began questions at the time my test was scheduled for, I would also vary the breaks to try and nail down how I wanted to time the exam. My one liner review would be simple sentence like "physical exam that is painful in endocarditis and distractors." If I couldn't think through the question in my head, I would pull uWorld question and re-read the explanation. Reviewing the previous days missed questions (which were often a lot) never took over one hour. On Friday I would take an NBME followed by 2 question blocks. After that I went to eat burgers and fries. Saturday off. And back to testing Sunday. 3 days before the test I stopped. I still studied but no questions. If I could go back I would just do micro and biochem questions.

    I believe this paramount because STEP 1 is a grind. The test is long, it's hard, and you have to have stamina plus a shooter's mentality. After weeks of taking a lot of questions, it was easy to keep moving. My test taking strategy was in rhythm. I still felt fatigued during the test, but I had simulated being tired and taking 2-3 more blocks of questions.

    Some objections to this strategy are you don't want to waste questions or if you have seen questions already it's not a true test of knowledge. I'm not blessed with a read once and remember it forever memory. But also going through 1300Q in 2-3 weeks will ensure you're as sharp as possible for test day.

    Other more practical tips:
    1. Take FA and have pages book marked. If you get a question on a topic you feel weak on. Go read that page. You might have more questions late on that.
    2. Do all the NBME.
    3. KissPharm songs or sayings made side effect, immuno and cancer drug questions feel like free points. I mostly listened to him while driving and working out.
    4. Go to onlinemeded website and you can get more insight for why the 3 week tons of question/simulate test day strategy is recommended. For me, it was a life saver.

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