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Why Is It So Hard to Study for Step 1 During Clerkships?

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by Alec Palmerton, MD in Clerkships, Plan, Step 1 Pass-Fail

Do you ever get to the end of the day, exhausted and maybe even overwhelmed? Do you ever feel like you SHOULD be doing more…but never seem to measure up? Are your 15-minute breaks stretching well beyond your allotted time? If so, you may be struggling with studying for Step 1 during clerkships.

Why is it so hard to study for Step 1 during clerkships? Some students may have delayed their Step 1 test because they felt they were not ready. Others may go to a school where all/most students take Step 1 after their first clerkship year. Regardless of why you may be trying to study for Step 1 during clerkships, you’re left with an inescapable fact: it’s hard!

During the height of Step 1 dedicated studying, it’s easy to imagine, “oh, it’s ok, I’ll just do a few Step 1 questions every day.” The reality of clerkships, though, is that most people struggle to keep up with the work for that rotation, let alone add anything else.

To Understand How to Study for Step 1 on Clerkships, First Understand Why It’s So Hard

As we’ve discussed here, though, it IS possible to study for Step 1 during clerkships. That said, wishful thinking doesn’t change how difficult it is.

We need to make peace with what is going wrong to move forward. It also helps to acknowledge what is realistic – and what is not – especially when caught in a negative spiral of self-doubt and insecurities that accompany us when we don’t do what we “know” we “should” be doing.

To help you move forward in a more self-compassionate and effective way, in this article, we will discuss:

  • Why most people struggle to study for Step 1 during clerkships,
  • How clerkships make learning hard in general – let alone adding Step 1 in addition,
  • The #1 misconception about Step 1 studying during rotations,
  • How to overcome the negative feelings that prevent us from getting work done, and
  • Much much, more

Table of Contents

Most People’s Clerkship Step 1 Study Approach Is Wrong

“In theory, theory and practice are the same. In practice, they are not.” – Albert Einstein

Let me begin with a seemingly contradictory claim: studying for Step 1 while on clerkships is virtually impossible. Or rather, the way most people THINK they should prepare for Step 1 on rotations will only cause them pain and frustration.

In theory, studying for Step 1 should be straightforward. Rotations may have long days, but how many of us use every available minute to learn new things? None of us. So, in theory, we could spare 10 or 15 minutes to do a few Step 1 questions every day. Or so we think naively before we enter clerkships.

Why Preparing for Step 1 During Rotations Is So Hard

However, there are myriad reasons none of us uses even close to every available minute to study.

Rotations Are Exhausting

First, rotations themselves are exhausting. Every few weeks (or less), you may have to adapt to an entirely new team – each with its unique quirks and neuroses. You’re the lowest on the totem pole, may constantly feel like you know too little and are capable of not enough. On top of that, you have grades that have a significant impact on your future residency application, which may feel subjective or even capricious. To expect that after a long, draining day of accommodating those around you that you can study is ludicrous.

Studying Something That Isn’t Relevant to Clerkships Is Miserable

Second, most people study for Step 1 during clerkships in a way that makes them miserable. Learning the Kreb’s cycle will make you want to gouge your eyes out if you’re on a busy surgical service. Rather than pick up your microbiology textbook, most of us will do ANYTHING to avoid it. Most will prioritize anything – email, Netflix, Youtube, even cleaning your apartment studying – over a painful basic science concept that has minimal relevance to your hospital day-to-day.

For more on how to overlap your studying with Step 1 and clerkships, click here.

The More Miserable the Task, the Less Likely We Will Start

Finally, the likelihood of starting – and completing – a task is inversely proportional to how unpleasant it is. To put it bluntly, studying for clerkships may already suck. To add to it, the weight of a Board exam – and the regrets, inadequacy, and other baggage it may bring up – will only make studying feel more overwhelming. And the more overwhelming something is, the less likely we will do it.

To summarize so far:

Studying for clerkships is hard enough. Mix in the feeling that we “should” be preparing for Step 1, and it gets even worse. Then sprinkle on the morass of guilt, regret, inadequacy, and constant comparisons to our peers, and it’s no wonder that studying for Step 1 on clerkships is so challenging.

When we’re feeling a strong negative emotion, most of us will do anything to avoid provoking it further. If studying makes me feel inadequate because my scores aren’t improving or I regret all of the time I’m wasting, what will I do when I try to open a QBank block? Anything to escape from that negative feeling – checking my email, calling a friend, binging Netflix, or even cleaning my room.

The longer this period of emotional turmoil goes, the less I study. Most of us know how to calm ourselves down. The problem is that our “coping” mechanisms often either 1) take a long time and/or 2) involve avoiding the thing causing us distress. When the source of our distress is studying – and not studying makes us feel even worse – then it is a recipe for disaster.

Overcoming those Negative Feelings

So, what do I do to pull myself out of a funk and get to studying sooner and more effectively? When I recognize that what I’m going through is normal – and even expected – it helps me calm the raging self-doubt and insecurity that prevents me from working effectively. Once I’ve identified the causes – and named/acknowledged my feelings – I can start the process of making a plan and moving forward.

So, if you’re feeling guilty about not doing more on clerkships, take a minute to acknowledge your feelings. Maybe you regret not having done what you feel like you should have done. Perhaps there is shame that you do not measure up to those around you or an imaginary standard you have. Maybe you feel scared that you won’t do OK – or worse, fail – and that fear paralyzes you. Many of us in health care struggle with feelings of insecurity or inadequacy – the ever-present “imposter syndrome.” Or maybe you have feelings of anger or even resentment towards your school, health care team, or other circumstances.

Whatever negative feelings may be hindering mastery of content, start by acknowledging your emotions. Research from UCLA has shown that we immediately start to calm down when we name our feelings. (

If you can relate to having negative thoughts and emotions that make studying harder, take 5 minutes to name them. Even better, write them down.

I’ll wait.

Once you come back, you can learn to study for Step 1 during clerkships.

Concluding Thoughts

Studying during clerkships is not for the faint of heart. It is hard. There is just no way around it. Add in negative self-talk, and it can feel like a downward spiral. No one likes to feel alone. Even worse is when we compare ourselves to others and find ourselves lacking.

If you aren’t accomplishing as much as you’d like – or aren’t feeling fulfilled with your studying – sign up for a free consultation now. You’ve chosen a career in health care devoted to helping others. However, that health care system is strained in many ways and may not honor your sacrifices in the way it should. We would love to understand and help you overcome your unique circumstances to become more competent, happy, and excited in your desired specialty. To schedule a free consultation, click 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.