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About the USMLE Step 1 Exam

If you are nearing the end of your second year, you are likely preparing to take the USMLE Step 1 examination. Because this exam represents the first of the 3 major licensure examinations needed to become a physician and covers the basic science material you have spent the last 2 years grinding through, this is usually a very anxiety-provoking experience for most students. So, if you are nervous, you are not alone! Here are several important things to remember about the exam that may help moderate your stress.

Much of the anxiety comes from not knowing what to expect on the exam, and there are plenty of more advanced students who have already taken it and who will gladly share their experience (either positive or negative) and how they think you should prepare. However, this can significantly increase anxiety levels because of this often markedly different advice. It is usually most helpful for you to review the objective information about the test and prepare for the exam in the way that best suits your own style. A good place to start is by reviewing the USMLE Step 1 overview website, which provides details of what to expect on the exam (in terms of content and structure) and specifically what happens on the day of the test. You can also access information about the structure of the questions, test-taking strategies, and practice materials that may be helpful in your preparation.

It is important to remember that the purpose of the Step 1 exam is to assess whether you understand and can apply the basic sciences to the practice of medicine, with a focus on principles and mechanisms of health, disease, and therapeutic interventions in medicine. Medical schools understand the essential content that will be on the exam and have structured your curriculum for the past 2 years to cover these topics in adequate detail for you to do well. (Remember that your school also has a vested interest in your doing well on the exam!) Therefore, you can be comfortable in knowing that you have been exposed to what you need to know to be successful. If you have worked hard and done well in your coursework, you should already be well prepared. Your primary task in preparing for the exam is to make sure you are comfortable with what you know. How this is done varies by each individual, as learning and study styles differ markedly. However, use what works best for you in terms of study methods and materials.

It is also helpful to know that the Step 1 exam has evolved over the years away from purely ”factoid” basic science questions toward more case-based questions that ask you to apply the information you have learned. Most students who are not basic scientists at heart usually find these types of questions to be more intuitive and relevant to the practice of medicine. And remember, this information really is important—the basic sciences truly are the foundation of medical practice in whichever field you choose, which is why this material is tested. At some point in the future, you will likely look back and reflect on the importance of what you are learning now and better understand why it was so important to master.

And perhaps most importantly, try to keep the exam in greater perspective. Although the Step exams are an important part of the medical training process, some students tend to focus inappropriately on the level of their scores on Step 1 and the other USMLE exams as they relate to their future career opportunities, sometimes to the detriment of their overall medical training. Remember that the USMLE test scores are only one component of your overall medical school performance evaluation and are not a single indicator of your competitiveness for a specific discipline or training program. Although some highly competitive specialties tend to over-emphasize USMLE scores in the application process, your score on Step 1 is rarely a determining factor in itself of how competitive you may be for a particular field of training. Obviously, doing well on all of the Step examinations is helpful because it likely reflects a good grasp of medical content, and a failing or very low score on any of the tests usually raises some concern. However, most programs understand that the level of USMLE scores are not an accurate independent predictor of whether you would make a good physician or not, and they typically rely on the more comprehensive aspects of your application (such as your clinical performance evaluations and letters of recommendation, in addition to your exam scores, when considering your application for residency. So, although it is always preferable to do well on the exams, a focus on attempting to achieve a specific numerical score is often less than helpful, may distract from your overall learning of medicine, and may inordinately increase your anxiety level.

As you approach this important step in your training, study well, do your best, try to relax, and good luck!

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