How I set myself up to score 250+ on Step 1 before even starting my dedicated study period

As you already know from my previous post, my MCAT score was very average (with an EIGHT in one of the sections – old MCAT had 3 sections worth 15 points each). But once I got into med school, I saw how close I was to the finish, saw the community I wanted to join, and made the conscious effort to excel.

I’m sharing my score to show that someone who slacked off in college can still do well on USMLE Step 1. I wasn’t born a genius (to my knowledge…). I don’t have all the time in the world. What I can control is how hard I work. Medical school was a fresh start to try out this new mantra of “hard work will pay off!”. They say that Step 1 is one of the most important factors of residency! In fact, in the 2016 survey to Program Directors, Step 1 is the most important factor for interview selection.

Snippet from 2016 NRMP Director Survey:

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By working hard from the beginning, I succeeded in obtaining a competitive score in the most important factor for interview selection. I significantly increased my chances to interview at my dream schools! Impressing them on interview day, however, is a whole other beast…

My efforts were successful and I scored a 255 on Step 1. Based on the latest released USMLE Step Score Interpretation Guide, the average Step 1 in 2015 was 229 (I took the exam in 2016).

Following tables from usmle.org

 

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Table 2 – USMLE Score and Percentile for first time test-takers in US/Canada medical schools from Jan 1, 2013 to Dec 31, 2015

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Again, I’m sharing my experience in order to encourage you to continue working HARD towards a career in medicine. It’s a CHALLENGING road to get there. I, for one, know how hard it can be. Like most students tasting freedom for the first time, I went a little overboard during college. Although it took a few extra years to get back on track, I gained important experiences that shaped me to who I am today (and met my fiance 🙂). In retrospect, I can appreciate that extra time, as it taught me that hard work does pay off.

So here is my Step 1 study plan for pre-clinical years that took me from the 50 percentile on MCAT to the 91 percentile on USMLE Step 1! My advice for you is to take the parts that work with your study habits, be realistic about your progress throughout and manage your time carefully.

Plan

This plan is based on the curriculum at my school, which involved several courses overlapping during the first two years of basic science. For example, I had microanatomy (histology) and gross anatomy all year, physiology most of the year, and about a month of neuroscience, and a few months of biochemistry. Some schools condense the basic sciences into 1.5 years. Other schools take one course at a time, eg all of biochemistry, then all of gross anatomy, etc.

Note: First Aid for the USMLE Step 1 (FA) = the tome of Step 1. All high yield ← a term you’ll be hearing a lot of in medical school.

YEAR 1

That’s right. It sounds ridiculously early but I encourage you to start studying during your first year of medical school. This is when you build a foundation for understanding pathology and pathophysiology. First, you gotta understand the basic structure and function of the human body in order to understand how it can go wrong. You gotta learn the vocabulary of the human body to understand the medical language! This foundation is important, but not directly tested on Step 1. It might feel so irrelevant and low yield for Step 1, but learning it well will prepare you to do well in your second year.

General resources and strategy:

  • General: I used First Aid as an outline to learn my class material. The tables and images on FA organized many complex ideas into an easily digestible (and memorizable) unit. Check your library for printed or digital textbooks. I didn’t purchase any textbooks!
  • Anatomy: use flashcards and repetition, memorize the clinical pearls such as what causes winged scapula or the significance of the middle meningeal artery. Or perhaps you learn best from the cold bodies laying in your anatomy lab. In terms of textbook, I think it’s best to try different ones to see what works best for you. Moore’s Anatomy has “clinical pearls” that really make anatomy more interesting, and testable.
    • Quick tip: Learn the spatial relationship between muscles, artery, nerves. There are many well known ones (NAVEL, Water under the bridge). Check Google! TheBodyOnline website.
  • Physiology: BRS Physiology. Everybody loves this book! It definitely helps distill the physiology concepts to the basics. It’s useful if you want to avoid getting bogged down by details. This is one of the courses where I heavily relied on a whiteboard. Drawing out the concepts really helped me survive! I also used Kaplan, and Boards and Beyond, videos for physiology.
    • Quick tip: Draw things out. When you think you know it, do some questions.
  • Biochemistry: This is a very dense, conceptual course. It’s a beast that polarizes the class into lovers and haters of biochem. I learned it best through Kaplan, and some Boards and Beyond, videos. I drew out the pathways many, many times. Although I took this course three years prior during my masters, it was still very challenging the second time!
    • Quick tip: Learn the most important piece of information (such as the rate limiting step). Hinge new details to this anchor. Draw things out!
  • Neuroscience: Our course had tutorials that really helped a lot, so this doesn’t help 99% of you! I abused my whiteboard by drawing and redrawing all the pathways!
    • Quick tip: Draw things out! Make tables, memorize them.
  • Histology/Microanatomy: Extremely tough if you aren’t a visual person. Everything looks pink and purple!! Spend extra time on Google to get many different pictures of histology. Having taken this course in my masters, I can safely say repetition really is key.
    • Quick tip: Look at LOTS of variations of the same thing a la Google. LUMEN website.

Figure out your learning/studying system. I discovered that I learn best with questions, and that when I simply read, I don’t retain (any) information. I found that flashcard apps hold my attention and offer flexibility to study anytime, anywhere. There are many different flashcards apps out there but I prefer Anki because of the customizability. (Post to come on what I put on my flashcards!) Figure out what works best FOR YOU. I used Anki primarily with simple (mechanism of action, function, what is this structure) and pathophysiology (WHY does something happen).

Goal of year 1: Figure out how you learn best and get amazing at it.

YEAR 2

Use Pathoma, Sketchy (or Picmonic), FA first before lectures. These might seem like garble of nonsensical words during year 1, but when you start looking into Step1 material, these words pop up everywhere. Pathoma is a must. You’ll thank Dr. Sattar when you graduate medical school. Sketchy or Picmonic are visual mnemonics that condense seemingly disparate material into fun images. You memorize the picture and suddenly you know everything you need to know about Staph Aureus. It’s amazing. Use any other board review resources to prime your brain. It gives you the basics you need to know, and a good outline to follow. Supplement this with your course.

  • Example: I watched the relevant Pathoma before a Pathology lecture. I made a separate flashcard deck for class details.

Finish all the board review material as soon as you can, preferably in the first half of the unit. I actually had a free trial of USMLE Rx videos at the time, which was helpful in teaching me the “basics” of my classes. (USMLE Rx is the question bank made by the makers of First Aid. They also sell flashcards and videos which I didn’t use). I used Boards & Beyond and Kaplan videos as well. I don’t recommend one particular board review video over another – try to find which works best for you..you might not have a preference! Then I would study by answering relevant questions for that unit. Remember that you’re using the questions to also learn, not only to review.

  • Example: I watched all the cardiology videos, then worked on the cardiology Rx questions. It was not in sync with the order of the school cardiology lectures, but I was able to establish a good foundation by using this method. Then after watching all the school cardiology lectures, I’d work on UWorld questions. This takes a lot of time but TRUST IN THE FORCE.

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If you’re daring, use UWorld and Kaplan QBank (I used Rx), during your courses. I find that these questions provide a good clinical framework of the basic sciences. This does require a lot of faith that it will pay off and it did for me. I performed above average in my classes, but even better on Step 1.

Year 2 goal: Use a system where you can integrate board review first, and supplement with class material.

Breaks

Winter:

Take a break! Not just with Kit-Kats. At minimum, use 1-2 hours a day to catch up on your questions and study lightly with flashcards.

Spring:

Take a break if you need it. You’re buckling down for the craziest ride of your life and you’re probably reeeeally starting to feel the pressure at this point. Catch up on UW, get ahead if you can. You’re going to reset the beast that is UW for the dedicated study period.

Finally, avoid discouraging people/place/things. Surround yourself with motivation and support! Keep your goal in mind. If shooting for a “high” step 1 score seems unattainable, pick a more tangible goal, like a number. Mine was to hit 250, although I’ll admit during dedicated I was happy with 240s, then 230s, then just passing.. It’s all worth it! Find what works best and stick with it.

More to come about my specific dedicated study plan!

Questions about resources or classes? Let me know below!

GOOD LUCK!