Sunday, January 18, 2009

My USMLE Step 1 Study Strategy

I've been busy traveling for residency interviews, but I figured I should take some time to talk about my own strategy for studying for USMLE Step 1. While others have already posted study guides, I figured I would add my own two cents in, not because I have any revolutionary new ideas on how to study for the Step, but rather because I think there are a few suggestions I have that could make things a bit more efficient for you. Although I took the exam in early 2008, I feel this advice will be quite applicable for those of you taking USMLE Step 1 in 2009 and for years to come (heh, until they change the exam structure up, as they always do about every 10 years).

Before I get into this, I should note that I am simply describing my own experience and what worked and did not work for me. I hope you take away something useful from it, but do not feel that there is only one way to study successfully for the Step. Everyone comes into this with different strengths and weaknesses, depending on their medical school's basic science education as well as their own aptitude and experiences. Everyone also has their own learning style: some people are visual learners; others, aural. Another thing that people are less likely to admit, but is clearly true: while we all want to score well on the Step, not everyone shares the exact same goal as far as their score goes. Read as much advice as you feel necessary, but do what feels right for you, first and foremost. As for general advice on what subjects to study and how to budget your time, I feel these have been discussed quite well elsewhere, so check out 21+ Online Resources for USMLE Step 1.

Kaplan Test Prep and Admissions (Kaptest.com)


My Daily USMLE Step 1 Study Schedule

If you do look at other sites, you'll see there are various study guides for people who have 4, 6, or 8 weeks to study for the exam. What some sites don't mention though is that the hours you're willing to study per day matter as well. Some people can go 8 hours straight; others can only be highly productive for an hour or two. Personally, I aimed to do three 3-hour chunks per day. I'd study one topic from roughly 9am to noon, take an hour break for lunch, study from 1 to 4pm, take 2-3 hrs break to exercise and eat dinner, then do practice questions from 7 or 8pm until I felt tired. Some days were better than others, but I think I averaged around 9 hrs a day, which seemed appropriate to me. I also took a half day or whole day off each week to catch up with friends and family. It is key to schedule in breaks in order to maintain your health and sanity. Jam-packing your schedule with unrealistic study expectations will only demoralize you later on when you cannot keep up.

My Six Week Strategy For USMLE Step 1

Due to the structure of my school's curriculum, in theory I had up to 10 weeks to study for the Step. However, in reality I probably spent about 7.5 weeks studying, and really peaked around the 6th week and plateaued after that. Sometimes I wonder if my score actually went down due to that extra 1-2 weeks of studying just because of burnout! Anyway, based on the general advice for Step 1 I found online as well as talking to upperclassmen friends who had recently taken the test, my basic strategy was to read through First Aid for the USMLE Step 1 in order to get comfortable with all the general topics covered in the exam. Some students try to start studying by picking a topic area and delving into it. I understand the rationale behind this, but the reason I avoided it is that there is so much information out there, you easily start to feel overwhelmed as you study one area, which leads you to become demoralized. By studying First Aid initially, not only did I get a general refreshed on all the major topics covered on the exam, but I also felt more comfortable in judging the depth to which I needed to study particular subject areas. Since the questions on the exam are integrative, having reviewed all the subjects was often helpful when I took practice tests, as I got more questions right as compared to studying one subject alone, which helped build my confidence. I budgeted about a week for this, which was sufficient for me.

After going through First Aid, I prioritized each major subject area covered in Step 1, and covered them week to week, starting with the subject I was least comfortable with, biochemistry. As I mentioned above, I'd spend about 6 hours per day studying the subjects, and then spend the rest of the time doing practice from Kaplan Qbank and then later on, USMLE World. While I do not want to belabor what subjects to study and how much they appear on the exam, I feel that in general, memorizing First Aid in its ENTIRETY and doing LOTS of practice questions from one of the qbanks is sufficient to get a great score on the Step. You don't need any fancy combination of books or vast detailed knowledge about esoteric zebra diseases. Just know the basics really really really well. That's it! But, of course, no one would feel comfortable studying just one book and doing questions so we all use other resources. If you're interested in the books I found useful, check out Books For USMLE Step 1.


Kaplan Test Prep and Admissions (Kaptest.com)

I repeated this pattern of studying for particular subjects for about 6 weeks, but I made sure to reserve the last week before the exam to go through First Aid again. Doing so really helped solidify all the material in my mind. Also, as I had been taking notes in First Aid as I did review questions, I had a much richer resource to study from during that last week, and did not have to waste time hunting for notes in other resources. The day before the test itself, you really should try to just relax, watch a movie, hang out with friends. If you really feel the urge to study, just do some light review in order to calm your nerves and build your confidence. Do NOT try learning tons of new things. The rapid review section at the back of First Aid is good for this in my opinion. 


The USMLE Step 1 Aftermath

After taking the test, I felt pretty good about my strategy and I think it prepared me well to answer most of the questions on the exam. There is no perfect strategy out there, and the test will always throw some real curveballs at you. But, don't worry, many of these questions are experimental and will not affect your actual score. Focus on answering the questions you know you should be able to answer and you'll sail through. The best part about taking the Step is that no matter how the test went, you have a great reason to CELEBRATE afterwards! All those weeks of hard work will have paid off. Go out and reconnect with all those parts of your life you put on hold!

If you have any specific questions about how to study for the Step, feel free to comment below or email scrubnotes(AT)gmail(DOT)com with the subject "USMLE Step 1"

15 comments:

  1. Great article! I actually think I feel a little less scared after reading this. I am taking step 1 in April, with 5.5 weeks of solid time to study on my own after a 2 week review course. When you say know FA, do you mean like be able to recite it and understand it, because I assume with only one book, it might actually be possible to do both.

    Do you think you were able to retain info well over such a long period of time? Did you have a day at the end of each week, for instance, to do a rapid fire review of that week's materials?

    Thanks for the info!

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  2. I'm glad to hear it helped calm you down =) Your schedule sounds quite reasonable. As for FA, while understanding is ideal, at the very least you should be able to associate it to the point where if you see something relevant in a question, you can get the right answer. And by know it, I mean, really know every detail. You'll see as you do practice q's and look them in up in FA what I mean.

    I didn't schedule in rapid reviews after a fixed period of time, but I liked studying a subject during the day and then doing random qbanks at night, so every night kind of served as a review of everything (vs just reviewing that one subject at some point). I preferred that b/c honestly on the test, that's how it is: random. There is no "cardiology section" and then a "biochem section," so why practice that way? Review it the way you'll be tested on it so you don't fool yourself into thinking you're doing better than you really are. Some ppl study a topic all day, then take a quiz, and of COURSE they'll score well, b/c they just studied it all day. Their qbank scores will necessarily be inflated relative to what they truly retained.

    Anyway, if you have more qs, feel free to comment here or email scrubnotes(AT)gmail. Good luck!

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  3. Can you offer any advice for someone (me) who will have 4 or 4.5 weeks to study? I know I can work 6 days a week, probably 8-9 hrs a day- but I think the most overwhelming thing for me is just figuring out how to organize my time in different areas... I don't know if I should just go through FA as many times as I can during that period, or what- advice?

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  4. Four weeks is doable, but you really have to be diligent about making the most out of everyday. If you can do the work, the key to organizing the topics is to basically be honest with yourself about areas you do not know well. I'd say, spend half of the first week going through those weaker areas in FA (well, as much of FA as possible, really), then focus on studying those subject areas for the next 2.5 weeks during the day (while doing practice qbanks at night), and then spend the last week going through ALL of FA over again. Maximize your QBank time by taking notes in FA about everything the qbank solution guides say (for more info on this, look at Kaplan Qbank Tips for USMLE Step 1). Basically, use FA as a framework/reference to bookend your studying, with FA studying being more "memorization", with more detailed studying for "understanding" by subject area in the middle weeks. Hope that helped! Feel free to email me at scrubnotes (AT) gmail with more specific questions.

    For more opinions on different study schedules, check out this discussion on the SDN Forums.

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  5. since its anonymous, can you tell us how you scored?

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  6. This is not fully anonymous, so I will not disclose my score. I'll say, I did fine and do not believe my score on its own would prevent me from being considered at practically any program. That being said, like anything on the Net, take it with a grain of salt and make your own judgment. This is simply my experience, and I hope people find some value in it.

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  8. Hi
    I'm a first year finishing up this June. I was hoping to do a little review of the material we've cov'd up to this point in prep for MS2 and boards. Our school is P/NP...and really doesn't teach to the boards. How might you suggest I approach the summer?

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  9. Anon, do something you find interesting related to medicine, whether that be doing research in a lab, traveling abroad to do international health, or heck, even vegging on the couch and watching the random episode of 'House.'

    However, whatever you do, always have First Aid nearby. Look up the topic being discussed, read what FA has to say, and add your notes to cover things not included in FA. By the time Step 1 rolls around, you will know your FA inside-out and you will have all these great annotations. Good luck!

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  10. Is it better to study subject by subject or by systems when you can make the integration of anathomy, path, pharmaco, etc.. into the systems (e.g. Cardiovascular)? thanks

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  11. I have around 5 weeks for the exam. I am worried. do you have sum suggestion of last min preps. please let me knw. I am really worried and am thinkin of posponing my exam.

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  12. @Nadeem - You are not alone in getting last minute jitters. My suggestion would be to take a practice exam and then see if your score is near your target. If you are close, then go ahead and study hard and take the exam.

    If you need more work to reach your goal, then consider postponing your exam date, but only if you feel the additional time will help your score. Remember, you risk losing momentum and actually lowering your score through burnout.

    @Lorena - Sorry for the delayed response, but I think systems makes more sense. Hopefully that helps.

    If you want a more prompt response, I suggest emailing us at scrubnotes at gmail dot com or via Twitter.

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  13. i am an indian med graduate and planning to take step1 in around 15 weeks....but i have to start basic sciences from scrap....dont knw wat to go after...

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