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Relearning Everything During Step 1 Study

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by Alec Palmerton, MD in Plan

Relearning everything during Step 1 study may seem like an impossible task. Maybe your school didn’t teach much – if any – Step 1 content. Perhaps you graduated years (or decades) ago. Or maybe you had learned it all but are just freaking out because relearning it all feels overwhelming. Regardless, if you’re reading this, you likely have concerns. Rest assured, relearning everything during Step 1 study is possible.

One of the largest groups of students we work with comprises those who need to rebuild their foundation to take Step 1. What follows is our advice on how to do so in the most efficient – and least painful – manner while simultaneously setting yourself up for Step 2 CK success.

In this article, you will learn:

  • What to do if you genuinely have forgotten everything,
  • How to approach relearning everything during Step 1 study if you never actually knew it in the first place,
  • The best approach to dealing with much rust,
  • What clinically savvy medical veterans can do to study for Step 1, even if your basic science is weak, and
  • Much more

Table of Contents

Relearning Everything During Step 1 Study Goes Beyond Simply Re-Learning Material

The content of Step 1 can be daunting to re-learn. However, what most people overlook is that the way they learn is equally, if not more important, for their Step 1 study.

Most schools – particularly international ones – test and reward students for memorizing minutiae. There are many reasons for this – including a lack of pay/incentives/training for teaching. The result is that many med school exams end up as simply a list of facts to regurgitate.

However, by adapting to tests of rote memorization, students are set up to do poorly on the USMLEs.

Step 1 Questions Are More Conceptual and Less About Minutiae

One of the biggest misconceptions we see about Step 1 is that you need to memorize many minutiae. We have found the opposite to be true.

In fact, the NBME – writers of the USMLEs and Shelf exams – publish the rules they follow for making Step 1 questions. Called the NBME Item-Writing Guide, the USMLE question writers are clear:

    • Rule 1: Each item should focus on an important concept or testing point.
    • Rule 2: Each item should assess application of knowledge, not recall of an isolated fact.
    • Rule 3: The item lead-in should be focused, closed, and clear; the test-taker should be able to answer the item based on the vignette and lead-in alone

In other words, the questions focus on the application of concepts – not the recall of minutiae.

Thus, if you are trying to relearn everything during your Step 1 study, you must also consider the WAY you are learning that material. (Read: don’t just memorize; focus on concept mastery/application).

First, Take an NBME Practice Test to Assess Your Baseline

Before we discuss how to relearn everything for Step 1, you should take an NBME Self Assessment. Doing this will allow you to see in which category you fall:

  • You genuinely have forgotten everything/need to re-learn most of Step 1,
  • You learned it all but likely need a refresher and/or
  • You’re strong clinically but need to focus on the basic science

You may know exactly which category you fall under. However, in our experience, our fears and anxieties can cloud our judgment. Having an NBME will give you:

  • A predicted score,
  • Estimates of your relative strengths in the various areas, and
  • A baseline against which you can measure your progress

Scenario #1: You Truly Have Forgotten / Never Learned Most Everything

There are times when you genuinely need to relearn everything during your Step 1 study. These situations include:

  • You went to a non-US med school, where large amounts of Step 1 material weren’t covered,
  • People who have been in clinical practice for years and have forgotten most of the Step 1 material and/or
  • Students who relied almost exclusively on cramming during their preclinical years

Whatever the reason, there are situations where you need to relearn most/all of the Step 1 material. If you’ve taken an NBME, your score may be below 150 or 160.

The Standard Approach for Relearning Everything During Step 1 Study:

What standard approach will most students use for relearning everything during Step 1 study?

When we hear from students, we often hear that they want to find a set of videos/books and do a “first pass” through the material. Then once they’ve given themselves enough time to learn the material, most people will start to do a QBank, typically Kaplan, Amboss, or UWorld.

The first-pass-before-practice-questions approach is entirely valid and relatable. Most people feel like doing Qbank questions when they feel weak on the material is simply “wasting” questions. And it’s hard to disagree.

The downside of doing an entire first pass before questions is that the “first pass” often doesn’t have a precise end date. Questions are scary – and getting them wrong challenges even the least insecure of us. No matter how much you know, getting questions wrong when we’re already feeling inadequate and unsure of ourselves is challenging. And so many of us will end up delaying when we start doing questions.

How to Relearn Everything for Step 1 So You Don’t Have to Keep Relearning it All

Instead of waiting to do questions after our “first pass,” consider doing questions along with your initial learning of the material. Doing questions and studying allows us to solve the ” transfer problem.”

Transfer means that when I learn a particular topic, I can use it in a different context. An example would be memorizing the equation MAP = CO x TPR. I might remember this. However, an example of transfer would be if I could use it to consider why a patient in the emergency department might be tachycardic and hypotensive.

Learning through videos and books feels safe, so many of us gravitate toward this. Instead, it’s better to test our learning and use questions as a way to diagnose our weaknesses and allow us to deepen our knowledge.

See this article for more on how to gain depth through a combination of QBanks and other resources.

What Resources Should You Use for Your First Pass?

We are highly biased. However, we believe the Yousmle Online Course is the best way to learn Step 1 from scratch while simultaneously learning to apply it. Most lectures are based on clinical vignettes so that you can master the topics and immediately see how they appear on your exam. This immediate mastery and application address the transfer problem and shortens the time from when you learn something and can get questions right on it.

Regardless of whether you use the Course or other videos/resources, we recommend interspersing your days with QBank questions in the topic you’re studying. So if you’re learning cardiology, do QBank questions on cardiology.

Initially, you’ll want to do more learning than QBank. As you develop more mastery, you will dial up the number of questions you’re doing per day.

Scenario #2: You’re Rusty and Need a Refresher

What if you’ve learned much of the Step 1 material but are rusty? Most medical students who have recently finished their preclinical curricula will fall in this category.

If you took an NBME and haven’t done a lot of QBank questions, your score may be in the 170-190 range.

In this situation, you will likely have things you’ll need to re-learn/learn for the first time and things you knew but need to refresh.

To refresh your knowledge and diagnose the things you need to study, QBanks are likely the most effective way. See this article for more on how to use QBanks to diagnose and treat your weaknesses.

Scenario #3: You’re Much Stronger At Some Things But Very Weak At Others (e.g., Clinically Strong But Weak at Basic Science)

Many students are solid at some things but also weak at others. Perhaps you have strong clinical knowledge but need to relearn the Step 1 basic science material. You may have weaknesses in genetics, biochemistry, immunology, microbiology, or embryology. Or maybe you are excellent at basic science but are very weak in the clinical sciences.

Our recommended approach here would be a combination of Scenario #1 and Scenario #2 above:

  • For the things you know well, use QBanks to refresh, as well as diagnose/treat your weaknesses while
  • For the things, you don’t know well, use a combination of lectures/books to learn the material with QBanks to ensure you are constantly applying what you’re learning

Have a Realistic Timeline; Slow is Fast

A common mistake we see students make is that they don’t plan enough time to study. A phrase we often hear is:

“I have to re-learn all of Step 1, and my permit expires in two months – how can I cover everything in that timeframe?”

At the core, these people usually realize that their goal is unrealistic and that they need much more time to study. However, because of external pressures and deadlines, taking the time necessary to learn isn’t easy.

See this article to learn more about how slowing down and taking the time to learn things well can help you study faster. And if you want help with a Step 1 study schedule, see this article.

Make Excellent Anki Cards to Shorten Your Step 1 Studying Time and Set Yourself Up for Step 2 CK Success

Relearning everything during your Step 1 study can be a long and painful process. The only thing worse than having to relearn everything once is having to re-learn it all again.

This need to re-learn everything multiple times can happen if you forget the material and need to re-learn it while studying for Step 1. It can also occur if you can’t remember it and need to re-learn it for Step 2 CK.

To avoid studying everything again, we highly recommend making excellent Anki cards – and doing them – so you never have to forget the material. We also recommend avoiding the pre-made Anki decks that would have you memorize everything on Step 1 as if it is a list of details to remember. (Remember, the USMLEs are about applying critical clinical concepts – NOT the regurgitation of facts). That is why we focus on connections and the application of foundational concepts for the Yousmle Step 1, Step 2 CK, and Pharmacology cards. Of course, there are things you have to memorize. However, mastery should be your default; memorization should be a last resort.

Concluding Thoughts

Relearning everything during your Step 1 study is daunting. There are reasons we don’t know it well in the first place. Often our schools did a poor job of teaching us the material. In addition, it’s hard not to fall behind and get into the cycle of cramming/forgetting for each test. Whatever the reason, know that if you’re trying to relearn everything, you won’t be the first and won’t be the last.

The most important takeaway is that whatever you learn, make sure you master it and never forget it. You can make many mistakes – and trust me, I’ve made a ton. However, if you make sure to understand what you’re learning and retain it forever, you can cover for a lot of other deficiencies.

If you’re feeling overwhelmed and want help relearning the Step 1 material, we’d love to help. We offer free individualized consultations to help you – no obligations. If you decide you’d like to work with us, either by using our pre-made Anki cards, our Never Forget Program, or one-on-one tutoring, we’d love to help you, master – rather than memorize – for impressive Board scores and a more meaningful career.

To sign up for your one-on-one consultation, go to this link here.

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.