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Medical Student Perspectives: Preparing for the USMLE Step 1 Exam

For medical students, preparing for Step 1 means something completely different depending upon your class level. If you are a first year medical student, preparing for Step 1 really doesn't interest you because anatomy lab is quickly taking over your life and finals are rapidly approaching. Second year students react with instant tachycardia or complete denial of the approaching storm. For those of you who are unaware, or in need of a wakeup call, the United States Medical Licensing Examination comes in three doses during your medical education. USMLE Step 1 is the test taken usually at the end of the second year of medical school after basic science education. USMLE Step 2 is administered in two parts—somehow one day of testing is too brief—and they are taken during the fourth year before you graduate. Step 2 focuses more on clinical knowledge than Step 1, which focuses on basic medical knowledge. USMLE Step 3 is taken during your residency training after internship year and tests your ability to manage diagnoses and treatment plans. Step 1 is considered by most students and residency programs as the most important exam of the three. The Step 1 score has become a large component of determining the competitiveness of residency for which you will be able to apply. This was not the original intent of the exam but nonetheless has become the reality of the process of becoming a doctor.

So where do you start tackling one of the most important exams in your life? You have to start with a plan and start early. Everyone has a different studying style and way they learn information. The most important thing to remember is to do what has been successful for you so far. If you have a routine or a study group that works for you, keep that going since it has been successful for you in the past. The Step 1 test is cumulative for both the first and second years of medical school so it will be necessary to give yourself ample time to review. Most people I know who took the test scheduled to take it after their second year in June. Students usually begin studying around three months before they take the test. Committing to studying every single day for a set block of hours is necessary to keep your mind engaged and will foster better cohesiveness of the material. Some schools give their students the opportunity to have time off to prepare for the exam. If you have this luxury, use this time to your advantage. A break from school allows you to completely focus on preparing to do well on Step 1. An increasing number of schools are providing mock exams which have helped a lot of students with their preparation. You should schedule your test at least one week after your finals and not around any huge life events to ensure the least amount of distraction.

After you have scheduled your exam and allocated ample time to prepare without life's distractions, your next priority is to decide what resources you will study. Most students agree that going through all the material you have used for classes is a waste of your time. There are many great review resources available that highlight the important information in a great format. The Step 1 exam will not be like your home institution's tests and the test makers will stress high-yield information. The phrase “high-yield” may cause strong reactions for you at the end of this process since it will be so overused by your instructors. Students who have scored well in the past agree that using some sort of question bank is one of the best options for preparing. Many students use Kaplan QBank or USMLE World question banks. These question banks are computerized and are formatted to look as similar as possible to the FRED software that Step 1 uses. This allows the student to become familiar with the format and will ease your test-day anxiety. In-depth answers are provided, allowing you to learn from your mistakes, which will compound the knowledge you are obtaining through your daily studying. These question banks are a key component to scoring well and I do not know a single student who feels that they were not worth their time.

Another popular and highly successful way to prepare for the Step 1 exam is by using a review book. There are several books available, such as First Aid for the Step 1, Step 1 Secrets, and Step Up to Step 1. Each resource uses a different format to present the material the authors feel is high-yield. There will be pictures, radiographs, electron micrographs, and also audio/video questions on the exam. Make sure you choose a resource that provides as many of these types of material as possible. I have not seen a resource that offers audio/video yet but that will surely be provided in the future. When choosing a book, I recommend talking to students you know who have already taken the exam and ask what they think was a good resource for them. After talking with many students, it seems that each school has different popular review books. Most students would agree that you should only choose one or two review books and read them at least twice each. Do not get bogged down in trying to read five books and not knowing them very well. Knowing the material cold in one book is more important than skimming five books.

Students also like to use resources they are familiar with from first and second year. Individual subject review books such as Board Review Series for Biochemistry, Pathology, etc., and Goljan Rapid Review are great resources that students used while preparing for their classes. These provide great in-depth reviews in subject areas that you may have forgotten or need to brush up on. Only choose two or three of these in which you feel you need the most complete review and use them at the beginning of your studying plan. Do not feel obligated to finish the whole series as this can be a very large and time consuming task during which you may be covering material that will not appear on the exam. Time efficient studying is more important than logging hours and hours of time reviewing material that is obscure and too detailed. If you have your set of notes or review materials that you used during your classes, these can be a great weapon in your studying arsenal. Using familiar diagrams, charts, or notes can be a quick way to review material. Be certain to follow up with review books and questions to be sure you are covering the right material.

Succeeding on Step 1 is absolutely a possibility and should be your major goal throughout your studying process. With the right plan of adequate timing and trying to minimize distractions, you will be able to prepare the best way possible. Question banks have been a key component to most students’ success and allow you to become familiar with the testing format. Remember to use review books you feel comfortable with and read them all the way through several times. Also, make sure you have a good support group to keep your spirits up when you may feel overwhelmed. Spending some time each week with people preparing in the same way will also provide motivation and encouragement to keep pressing for your goal of doing well. As you get to the end of your studying, you will probably feel somewhat burned out. Pace yourself and make sure you keep doing the things you enjoy, like exercising, eating with friends and family, and the routine things in life. As long as you maintain some normalcy in your daily studying regime, you will be on your way to the best outcome.

Many students told me to plan some sort of event or trip after my exam. This was a great idea and something I was able to look forward to after all the hard work I did. Once you have finished those pivotal nine hours of testing, surround yourself with those who make you happy. Stay focused and confident. You are on your way to becoming a doctor.

Gates Colbert, MSIV
Southwestern Representative, Council of Student Members
University of Texas Medical School at Houston, 2010
E-mail: Gates.B.Colbert@uth.tmc.edu

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