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Impressive Step 1 Scores, Top Preclinical Grades: 9 Common Questions

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by Alec Palmerton, MD in Uncategorized

Studying for Step 1 as a precinical student is a daunting prospect. Dozens of professors each come in teaching their own pet projects. Few if any highlight Boards-relevant material. We cram PowerPoint minutiae to pass our tests, then forget everything the next week.

Even worse, to do well on Step 1 often feels like a different game-plan than to do well in classes. Med school classes tend to be rote learning. Step 1 focuses on applying key concepts. But because we struggle to keep our heads above water, Step 1 preparation is a pipe dream.

If you’ve ever wondered how you could possibly fit in Step 1 studying with preclinical classes, this FAQ is for you. (To read the accompanying article, click here). Here, I address the most common questions students ask, including:

  • When to work in a question bank
  • When is the best time to start preparing for Step 1
  • How to learn so you do well in your classes AND the USMLEs
  • Much more

To read my article on how to use Anki to get a 250+ and crush your preclinical classes, click here.

Frequently Asked Questions

Isn’t it too early to be studying for my USMLE Step 1? Shouldn’t I be focusing on my med school classes instead?

Most students assume the approaches to med school and Step 1 must be different. This is not true!

I’ve finished medical school and residency. I also have tutored medical students at every level of training.

My experience is that if you master the material, you can prepare for any exam.

Step 1 tests your ability to understand and apply your knowledge. Medical school examinations often test your memorization ability. Still, moving beyond memorization allows you to do even better on memorization-heavy exams.

Stanford’s block exams were mostly rote, yet I scored in the top 10% of my class in most. Even if your goal is to understand, you can still excel on tests of memorization.

When should I work in a question bank? How many questions should I be doing a day?

Remember, your primary focus is to establish a daily rhythm of mastery and retention. It’s unlikely that you would have much time for QBanks.

By all means, if you have extra time, work in some blocks of a question bank, like Kaplan or UWorld. However, true mastery takes time. Every action has an opportunity cost. Often when first- or second-years do QBanks too early, they lack time to master the material.

If you follow the Step 1 study schedule above, you will have plenty of time for practice questions. More importantly, if you use spaced repetition, then repeating question banks is a waste.

The amount of extra depth you gain with each additional UWorld review is minimal. Master the topics once instead of going through UWorld three times.

For more thoughts on the topic, read the following article.

Should I be waking up early every day?

I recommend it. You should experiment, but you’ve chosen a very morning-heavy line of work. In my clerkships, it was common to wake up at 5AM. Even in residency, it was a fantastic day when I could wake up at 6:30AM.

Mornings are typically – but not always – the most productive time of day. Waking up may mean more productivity during your preclinical years. It will definitely make the transition to early morning rotations easier.

(Read more about my Ten Habit Step 1 Study Plan here.)

What should you do the night before an exam?

Relax! If you’ve been following this Step 1 study schedule, the day is no different than any other day. In fact, most schools limit how much they try to teach you the day before an exam. Thus, to maintain your daily rhythm of mastery and retention, you should have less to do!

Fight the urge to cram. Instead, try doing a block or two of Kaplan QBank questions, to assess how well you mastered the material. In other words, before your cardiology exam, do a block of 40 cardiology Kaplan questions. A good score would be above 70%.

What exactly does it mean to “master” something?

Mastery is like pornography – hard to define, but you’ll know when you see it. A guiding principle is you’ve mastered something if you can teach it to a beginner, and have them answer questions on it.

Read my guide on how to master USMLE Step 1 material here.

What about resources like Pathoma, Sketchy Micro, or (name-your-favorite-resource)?

Remember, your primary goal is to develop a daily rhythm of mastery and retention.

As such, you must curate your resources.

Most students take an “any benefit” mentality in choosing study aids. If there is any benefit to using it, they will add it to the pile. No wonder our daily to-do’s become so overwhelming.

Don’t think of resources as things that you need to get through cover to cover. Instead, use them as references, something that will help you to master a particular topic.

For example, I wouldn’t read through Pathoma from beginning to end. Instead, I would use it in a targeted way. If I don’t like First Aid’s explanation on heart failure, I can use Pathoma to learn more.

Beware the “any benefit” mentality of studying. Use resources with the intent of answering a particular question. Don’t make them part of a checklist to get through.

How many pages of First Aid should I be reading a week? How about the number of Pathoma lectures?

It is hard to know if you’ve mastered something. Depth is difficult to measure. Instead, we focus on things that are less important, but easy to measure. Things like the number of Pathoma lectures we’ve watched, or First Aid pages we’ve read.

Why is it so stressful to see your first-year classmate halfway through UWorld? Or your anatomy partner “finish” Pathoma? Because there is a clear measuring stick, and we fall short.

That said, numerous e-mails to me start like this. “Alec, I’ve been studying for Step 1 for two years. I’ve done 20,000 practice questions. I’ve done 5x First Aid Reviews. And I just took my first NBME practice exam, and I’m only at a 190. Help!!”

It’s not that you shouldn’t be using these resources. However, it’s the quality of work and not the quantity completed that matters.

What if I take Step 1 after my first year of clerkships, like Harvard, UPenn, and a growing number of medical schools? What if I’ve delayed my Step 1 exam and must take it during clerkships?

A growing number of schools now have students take Step 1 after they enter clerkships. Harvard recently joined the list. Duke and UPenn have long had students register for Step 1 well into rotations. Other students (D.O.’s, second-time test takers, etc.) may also need to take Step 1 during rotations.

If you must take your Step 1 after clerkships have started, what is the ideal Step 1 study schedule?

While the weekly breakdown will be very different, the principles are the same. During your preclinical years, you would focus on mastery and retention of material. Then, during clerkships, you would continue these goals.

During clerkships learn the topics relevant to your patients. Seeing a disease is much better than reading about it. Step 1 and shelf material overlap a lot. This is particularly true with internal medicine. Maximize “double-dipping” Step 1 content with your clerkship studying. This likely will be the organ blocks – cardiology, respiratory, etc.

Save the less-clinical topics for dedicated study. This would be things like biochemistry, immunology, or genetics. As you will see in the next question, the goal isn’t to learn everything before dedicated study. The goal is to minimize topics to master during dedicated study.

How should I use my various breaks, like summer vacation, winter break, or Thanksgiving?

Let’s say you develop a good daily rhythm during your second-year. What do you do for your first-year topics?

As discussed above, you should chase one rabbit at a time. Learn the material from the block you’re on. Don’t go back and try to re-learn everything from first-year.

Instead, use your breaks to re-learn prior blocks. For example, your 3-month summer vacation could support mastery of three first-year blocks. Similarly, spring break is often enough time to master one topic.

Then, by your dedicated study, you will have a manageable number of things to learn.

Concluding Thoughts

Med school feels overwhelming. But it doesn’t have to be. With the right plan, you can do well in your classes and prepare for Step 1.

But are you still overwhelmed by the idea of mastering the most important Boards-relevant material? And is it even harder to imagine making high-quality Anki cards to retain it forever? If so, I’d highly recommend the Yousmle Step 1 Anki cards. Not only do they teach you how to use the most important Boards-relevant topics, they’re already in the pathogenesis to presentation format for time-saving retention.

Now, you can study less, and master more for that impressive Boards score.

What do you think? Let us know in the comments!

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.