1. Track topics that are “archetypal” and know them. The Step 1 exam only really tests you on archetypal (or classic) examples of diseases.
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For instance, it is unlikely that you will see a question about a male patient with lupus. The question scenario will present a female who is most likely African American since demographically, this is the population of greatest incidence. These archetypal examples make up the vast majority of the Step 1 exam. Pay particular attention to identify these classic examples – get with a group of friends to expand your list – write these down and study accordingly.
2. Answer A LOT of Questions… Start early and slowly build the intensity of your study. Take 6 months to prepare; this can be accomplished alongside your coursework. During the process, make notes in your First Aid for Step 1 book. Begin studying at an easy pace and build up to an intense schedule. Don’t take on 10-hour days until 4-6 weeks before you are scheduled to take the exam and you have a break from your regular school schedule to focus entirely on studying for Step 1. You can do question bank questions by subject but don’t exhaust your question pool, save some for board preparation. Another option is to use a brand such as Kaplan for subject review and UWorld for board preparation. It is common in recent years for students to complete a question bank 2-3 times or to complete more than one question bank in their preparations for Step 1. All strategies yield great success. They key seems to be to complete the question bank and STUDY THE EXPLANATIONS CAREFULLY to discover and unveil other possible questions that may occur on the actual exam.
Note: There is disagreement among students as to whether it is wise to exhaust your question pool during this phase of study preparation or to save them for your board prep period. Just go into this knowing that if you answer questions by subject during coursework, you will score higher on blocks than if you answer the questions in random mode, since your answers will be biased toward the subject you have been studying. Many students have reported that when they have gone back to do the questions again during their preparation period in mixed mode, they remembered the answers, and therefore their scores were biased. Other students are convinced that in their experience, given the vast number of questions, they have not remembered any of the answer choices and it is a true test of knowledge acquisition. You must decide which strategy is right for YOU.
3. Study the subject you are currently studying in class. This is especially true if you begin studying for Step 1 while you are still in basic science courses. It is ideal to begin this during your first year of medical school. Example: if you are in Cardiology, be sure to go to First Aid and see what is and is not covered in your class that is needed for board exams. Add important notes to your First Aid for later study. Compare what you are doing in class to what is in First Aid and study both. Learn deeply what you need to know for class as it will help you with boards. It is important to use question banks to apply the information you are studying as you go through your courses during the first years of training. To do so, utilize question banks that allow the option of choosing questions based on the system and/or subject being covered in class (USMLE World and Kaplan both have this option). There are also multiple workbooks designed to help apply the information. For example, Linda Costanzo’s Physiology Cases and Problems is an excellent addition to any student in physiology and is a wonderful substitute for, and in addition to, assigned textbooks for application. This is essential to taking learning to the next level for top grades in class and on Step 1.
4. Repetition and rehearsal have been shown to be especially effective learning methods for board exams. They are particularly successful if the repetition of a topic or concept is practiced orally. Quizzing incorporated at the end of a study session further solidifies the information in your brain. As you proceed through your board prep studies, keep an ongoing list of the topics that are problematic for you (and the page number in First Aid) and go over these topics several times in the weeks before the exam. Repetition will help you remember the facts and will create “ah-ha” moments where you suddenly understand concepts that previously eluded you.
5. Study the most difficult subjects first so you can get them out of the way. The most successful students have recommended studying the most challenging topic first when your energy is high rather than later when you are tired of studying for the exam and ready to throw in the towel. Many students make the mistake of choosing to study the subjects that are easy for them and they know the best, but it is better to move on to the subjects that make you feel uneasy. Conquer these in order to make a high score.
6. Periodically review subject with high rates of memorization required. If your hardest area is a subject that requires a lot of memorization and therefore has a higher rate of memory degradation, then you must periodically rehearse the material and schedule in another review of the topic before the exam. (This hardest subject is often Biochemistry or Microbiology). Flashcards can often help with these with review for 15 minutes each day.
7. Follow and complete a schedule: there is no way you will adhere to a schedule with complete faith. You will get behind, things will come up, etc. The key is to FINISH. You can get behind and take days off, but finish your schedule. This ties into the previous advice of starting early. If you have lots of buffer time, you will be able to take more time away for unexpected events.
8. Do your question bank in MIXED MODE and in timed block sessions. When preparing for Step 1, you are in training for an intellectual marathon. Start this training from the beginning of your board preparations. To do so, refrain doing your question bank in tutor mode or by subject as the questions on your exam will not be categorized nor will it be untimed. Switching from topic to topic requires flexible thinking and integrating information across several subjects. It is best to begin training your brain to “change subject sets” from the outset of your use of your question bank.
9. Study with friends. Find a friend or group to start a regular study schedule with. Having peers to prepare with helps you stay motivated and goal oriented. It helps you keep your energy for preparing for the toughest testing challenge of your medical career. In working toward this common goal, the companionship can be lifesaving. It can make a big difference in your stress levels and can keep you from going crazy. A group also helps you decide what is essential to know and what can be set aside.
10. Be resolved to the fact that on each block of Step 1 there will be 10 questions where you will have absolutely no idea of the answer, 5 you’ve at least heard of, and the rest you’ll be ok with. You are studying and learning to make the best educated guesses possible. Students still tell me that this is some of the best advice they could get going into their exam so they can stay calm. So get over those 10 questions now… realize those questions are going to be there and don’t get stuck… keep moving on.
– Melodee G. Mancuso, Ph.D. and Victor Tovar, M.D, Founder, ProMEDeus LLC
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