Monthly Archives: May 2015

For those who asked: My Step 1 Study Methods

Now that I have my results back I feel more comfortable blogging about the methods I used to study for the exam. Major disclaimer: this is a sample size of 1 person and in the end you really have to do what works best for you personally. I wouldn’t go out and try some new study techniques you have never used before. Stick to what you know works well for YOU. That being said, here is what I did. In the end I scored above average and was happy with my performance.

My test day: May 4th

My first official day studying: March 13th

I really didn’t study much specifically for Step 1 before March. I focused on my MS2 classes and did well on all the shelves leading up to the end of the year which got me honors in all my classes except for one and also laid a solid foundation for Step 1. I did use the UWorld question bank to study for shelves so I had already gone through about 40% of the Q bank.

Resources I used and my opinion on them:

Uworld Question bank: Absolutely the best resource you will use. Start using the questions as soon as possible and repeat questions many many many times.

Kaplan: I purchased their review course and stopped using this about mid-way through my dedicated studying. Not sure if it was that helpful. Just another way to see the same information. If you like Kaplan, use it, but nothing new that helped me on the exam came ONLY from Kaplan.

Pathoma: This is why I honored Path. I continued to re-read my Pathoma and watch some videos during dedicated studying. It is essential for pathology.

First Aid: Whether you like it or not this book has ALMOST everything you need to score incredibly well on the exam. If you can focus on anything just make sure you know everything in this book. I had only a handful of questions on the exam that could not have been answered by looking up First Aid but otherwise it was pretty spot on.

Behavioral Science Review Book: Probably worth going through a quick review book like BRS. You will notice once you start taking the NBME practice exams that you are getting really easy BS questions wrong simply because you don’t know how Step 1 wants you to answer them. These will be easy points so prepare for them! Don’t ignore Behavioral Science or the statistics stuff. Also, go over things like the stages of clinical trials.

SketchyMicro: This is why I honored Micro. A really fun and easy way to remember microbiology stuff.

NBME practice exams: These are ESSENTIAL. I took 4 NBME exams and 2 UWorld practice exams. My 2nd UWorld practice exam was about 10 points higher than my actual score, which is what I have heard from a couple of people. The best predictor, in my own experience were the NBMEs. I scored 2 points higher than my best one and almost 20 points higher than my first NBME practice exam that I took 2 weeks into studying. When you buy them spend the extra $10 and get the version that lets you see which questions you got wrong.

My Daily Schedule:

Before you begin studying it is essential that you make a plan for yourself. For me, I did my review by organ system so I would review all the pharm, path and physio within each of those. I gave myself between 3-4 days for each organ. In that time I completed every UWorld question for that topic and read that specific section in First Aid at least once or twice.

AM: I would start with 1 or 2 question blocks in UWorld. If it was day 1 of a new organ system I did tutor mode and would just spend time reading the answers. Otherwise I would do the questions then go through and read each answer at the end. I took notes on things that I had forgotten and then reviewed those notes every couple days.

PM: I read First Aid. I read Pathoma. I did more question blocks.

There is no magic secret to Step 1 studying. Literally just spend 10 hours a day either doing questions or reading First Aid and you will be fine. Periodically (I did every Saturday) take a practice exam to make sure your score is continuing to go up. Remember to review information you have already gone over. Do this by doing random question blocks, question blocks with missed questions. question blocks with marked questions and re-read your notes as much as you can. The key is repetition.

A few things I wish I had done differently:

-Probably not wasted my time with Kaplan, I would have done just fine with out it

-Started UWorld questions even earlier

-Reviewed my notes more often

-Been more relaxed in general; my anxiety was through the roof and that was not conducive to studying

-Made sure I really knew the biochem pathways: THEY WILL COME UP!

-Been conscious of trying to eliminate stupid mistakes- these will be what brings your score down from your absolute possible maximum. I know I made MANY stupid mistakes. Not sure if you can avoid them, but try!

-Don’t use too many resources. If you give yourself too much to do or cover this will backfire. Pick 3 or 4 (max) essentials and stick to those. You have to use First Aid and Uworld- KNOW THESE WELL. Other than that, you can pick 1 or 2 more things that will help you in your weaker areas.

-Enjoy it! This is your time to put everything together. Somewhere mid-way through everything will come together and things will just click. It’s really awesome when that happens and you may actually enjoy this nice time you have to learn medicine.

Good luck!!!


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I am here to put you at ease…

I am going to cut right to the chase and let you know that if you took Step 1 and felt so bad about the potential outcome you questioned your entire existence and the last 2-6 years of your life….RELAX. It will actually be OK. I don’t think anyone could have felt worse after their exam than I did. There were tears, PTSD, depression and three weeks of sleepless nights. In the end, I actually did better than any of my NBME practice exams and scored exactly my goal score. So there you go. I think the post-exam depression is just part of the deal. Every single one of the classmates I spoke with felt exactly the same and in the end, here we are, we made it to the other side and now we are 3rd year med students!

The last week has been a blur. Back to the hectic pace of medicine. I was on for 6 days straight and have not gotten out of the hospital before 7:30 pm. The best part is–I don’t even mind it. Here’s a break down of what my new life in Inpatient Medicine looks like:

5:20 am: Wake up and race to get ready. I am one of those people who would rather sleep an extra 10 minutes than waste time in the morning. My beauty routine is a bun/pony tail and some mascara to make my eyes look less sleepy. Alright, I also need some blush because my face hasn’t seen the sun in a week.

6:10 am: Arrive at the hospital. I am on a giant medical campus so walking to my building will take another 5-6 minutes.

6:15 am: Log onto my computer and check any overnight labs that came in on my patients. I might also get lucky and see some notes from the overnight nurse (these are notoriously input later in the day).

6:30 am: Get hand-off from the overnight team and learn if anything happened to my patients over night.

6:35-7:55am: This is the only time I have in the morning to see my patients and talk to them about how they are feeling. I find out if they have any new symptoms or if their condition is getting better or worse. I also do an abbreviated physical exam. Right now I have 2-3 patients at a time, so this amount of time is perfect to do my initial checking in. I also check on various lab work and notes in the computer. After I do my information gathering I have to start thinking about a new plan for the day. This is by far the hardest part for a 3rd year medical student because we haven’t been trained in the nitty gritty of treatment plans. This is also the best part as learning what the protocol is for various conditions is why we are here.

8:00 am-9:00 am: Go to morning report. This is a time when the attendings, residents and medical students come together to go through a case. For example, someone might share an actual patient that came through our ward with his/her presenting symptoms, the labs and work-up that was done and we’ll just discuss the various differentials (things that could be wrong with them). This is kind of like a House episode. You imagine that patient in your head and as a team talk through what was wrong with them and how to fix it.

9:15 am: Morning Rounds. This is when the attending physician (the person ultimately signing off and overseeing the residents and medical students) comes in and we present our patients and assessments and plans. Because this is such a pivotal part of inpatient medicine I’ll spend a little time explaining the process.

For most medical students, this is the most anxiety provoking time of the day as this is our chance to shine in front of the attending (who is evaluating you). Even if you don’t know what you are talking about, if you can present well you can come off seemingly brilliant. In medicine, there is an art to presenting your patient. The presentation has to follow a specific format but despite its rigid guidelines it should still tell a natural story and you don’t want to sound like a robot who is spitting off facts. The best presentations keep your listener engaged, are clear, concise and to the point.

The trouble most 3rd year medical students have is knowing what is actually pertinent to your patient’s condition. You need to know EVERYTHING about your patient. Including their mother’s medical history, the surgery they had 30 years ago, the medications they took last week, their vital signs for the past week and the random phosphate lab that just came in–the skill is knowing which of those facts (which took you 45 minutes to gather) should be included in your 5 minute presentation. I found that if I focus on the true reason the patient is there– say it is heart failure– this helps to guide me in not including too many things that may be wrong with them (maybe a 10 year history of diabetes) but that is better handled outpatient and is not a priority for their current hospitalization. In any case, during Morning Rounds the attending will listen to you present your patient and will then ask you questions (known colloquially as PIMP’ING or putting you in your place) in order to see if you know anything about medicine. Most of the time you get lucky and the questions may be basic but there are often details which you learned 8 months ago and haven’t thought of since. Rounding is a grueling process that usually takes 4-5 hours, although there are stories of rounds lasting from 9 am to 6 pm!

12-1pm: Noon conference. This is when the medical students, residents and attendings meet again to listen to a noon lecture (it can be anything from Hepatitis C, Ebola to how to read an EKG). The best part is you get free food.

1pm-3pm: If you didn’t finish rounding you continue to do that. Some attendings will want to do physical exam rounds at this time, which means you go with the attending to see your patient and perform a physical exam. When you see your patient with an attending 1 of 4 scenarios is almost guaranteed to happen:

1. Your patient’s condition will have changed and everything you told your attending is no longer accurate. Result: you look like you don’t know your patient but it’s not your fault because the circumstance was out of your control.

2. The attending performs a physical exam and finds a physical exam finding that you missed. Result: You are reminded you are a third year medical student and have not yet perfected your heart auscultation skills to the point of detecting a 2/6 heart murmur.

3. Your patient suddenly remembers a new fact or completely changes their mind about their medical history because someone new with a longer white coat is now asking them. Result: You look like an idiot that doesn’t know your patient. Luckily, most people understand that being hospitalized is a high stress situation and people may remember things differently every time they are asked.

4. Your patient is excited to see you, you have a great rapport with them, which is easily noticed by your attending. Your physical exam findings and history for the patient exactly match the situation that is seen by the physician and you are able to truly help your patient get better. Result: You feel like a rock star and mentally high-five yourself. This is the rare situation we work towards!

3 pm-6 pm: This is the time you have to complete your to-do list for your patient. This is also when you chart. For each of my patients I am required to put in a progress note or a full history of present illness note if it’s a new admit. As always, there is a very specific format for how things should be written. Again, the hardest part is the Assessment and Plan, in which you synthesize the facts into a problem list for each patient. For each of their main problems (let’s say 1. Chest pain, 2. Hypothyroid, 3. Low calcium levels) you develop a strategy of what you plan to do to treat them. During this time you may also get a new admit from the Emergency Department. If someone is getting admitted that will now be my new patient, I will go down to the ER and do my initial evaluation. I then have to come back and write a History of Present Illness note and talk with my resident about the orders we think are appropriate.

6 pm-8 pm: Depending on when you get your last admit you may be staying late to finish up. If your shift is ending at 5:30pm, the rules of the universe will guarantee a new admit at 5:20pm and you will be there til 7:30pm writing notes and orders. Despite these long hours the process is the most fun I’ve ever had in my life. Time flies by.

9 pm: Shower. Debate if I have the energy to do some practice questions (yes, we have a big final shelf exam at the end of the rotation) and typically decide it’s better to spend 45 minutes watching tv with my husband before I do it all over again.

So that’s my new life! I wake up each morning excited for the day to come. I don’t get a minute to myself. My day is constantly challenging me and making me feel like I have volumes of knowledge still missing but it is the happiest I have been in a very long time. Guess I made the right choice 🙂

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My Step 1 Experience

I’ve hesitated writing about Step 1 mainly because I didn’t want to think about it. It’s over now. What’s done is done. I wish I could say that after 7 weeks of dutiful studying, thousands and thousands of practice questions, multiple practice exams and nothing else in my life– I conquered it. What I feel happened was just the opposite. I walked out feeling like someone just punched me in the stomach.

Over the last two months I’ve had a singular purpose driving me–to do incredibly well on this exam. There wasn’t a single moment when I slacked off, gave up or strayed from my self-prescribed study schedule. I knew this material. I did nothing but study. Over time, as my knowledge base grew I improved my practice exam scores from a 223 to a 252. In terms of studying, I don’t think there is anything I could have done differently. The problem, it turned out, was something I completely failed to prepare for-I was my own worst enemy.

I may have written elsewhere on the blog but when it comes to long, important standardized exams my brain very consistently decides to turn on me. In the comfort of my house, with absolutely nothing to lose, I am able to answer questions with such ease. But being in the exam, everything changed. I let my nerves and the exhausting process leading up to the exam get the best of me. I just didn’t feel sharp. Anxiety is obviously no excuse to not perform to your true potential, so I feel incredibly disappointed in myself and all the work I put in. Instead of eliminating the handful of stupid mistakes I was making on practice exams, I multiplied them. I keep having flashbacks, like some kind of PTSD, of questions I answered incorrectly. Easy questions that my brain has known the answer to for months. Of course, when it counts, like some kind of zombie I picked the exact opposite of the correct one.

I know that feeling like you failed Step 1 is what everybody feels. It’s natural that after 8 hours of questions your brain will focus only on the ones you were unsure of and remember the questions you blanked on, omitting the easy ones you breezed right through. So yeah, that makes me feel a little better. But I also know that my question count of incorrect items is getting high, it seems I am constantly remembering questions and wanting to kick myself for what I put. I have no idea what to expect.

The only thing I know is that no matter what happened with this exam, it was just one moment in time. It doesn’t erase any of the successes I’ve had in medical school up to now or have any bearing on how I’ll do in clerkships. It feels like I had a bad day, but in the end I won’t know anything until I get my score back. I am already looking forward to everything I will learn once rotations start. I am just trying not to lose sight of why I am here. These last 7 weeks I’ve learned so much and created a truly solid foundation of medical knowledge for myself. Whether my exam score shows that or not, I am not sure. What I am sure of is how much I love learning and how that has been consistently shown in my performance in the last 2 years, and hopefully will translate to success on the wards.

3rd year here I come!

Also, I know that several of my readers would love to have a detailed break-down of the study schedule I used and tips and tricks. I’ve jotted down some notes and will get this information out to you once I’ve processed this whole ordeal. It has been so stressful not only on me, but on my husband and family. I think the most frustrating thing of all is feeling like I just wasted so much potential. I definitely need a good week or two to recover. Thankfully, I have family visiting and an exciting trip planned with my husband to help me put this exam behind me.


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