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The Best Winter Break Step 1 Study Plan

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by Alec Palmerton, MD in Uncategorized

Studying without a clear Step 1 study plan is miserable. For many students, it is the low point of medical school, but with the right approach, it can be enjoyable! How you spend the 6 months leading up to your dedicated study period can bend your trajectory towards USMLE joy or misery.

If studying for the USMLE Step 1 is like a marathon, the winter break before the exam would be like the 3/4 mark. You’ve covered most of the relevant material, but there’s still enough time that small changes to your approach/plan can have a large cumulative effect on your final score.

Students that I tutor, as well as the Yousmle community, have asked about the best winter break Step 1 study plan.  Here are my top recommendations for how you can spend your time preparing for the final leg to get the best score possible.

To read about my Ten Habit Step 1 Study Plan, click here.

1. Define Study Duration to Ensure Rest

Winter Break Step 1 Study Plan: Include Some Rest!

Be sure to include some rest!

It’s the curse of the medical student to have this never-ending feeling that there is always more we should be studying.  It’s understandable why we feel this way; it is literally impossible to know everything in medicine/Step 1, and it is hard to find a natural end-point to one’s studies.  The problem with this is that with one wary eye on our textbooks, it can feel nearly impossible to relax or to be present with friends/family during the holiday season.

Most students I know studied at least a bit during their winter break, and given how difficult it can be to go back to review old material during the school term, it’s hard to fault them.

My recommendation if you’re going to study over the holidays?  Limit your studying to less than 5 hours a day.

Before you dismiss this as fluffy, “you need to take care of yourself” type advice, consider that your USMLE Step 1 score will be higher if you aren’t burned out by the start of your dedicated study period.  Prior to medical school, I had never truly burned out from studying, even though I worked quite hard.  However, during my second year, I burned out twice, once during the winter term (Stanford is on a quarter system), and the second during the last week of studying for Step 1.  I would open a book, and literally not be able to bring myself to study; my eyes would move across the words on the page, but no matter how hard I tried, I didn’t understand what I was reading.

In response, both times I took time off, shut my mind down, and did nothing more than do my Anki cards for the day, and gave myself time to recover mentally.  Had I not taken time off during winter break, and a week off prior to my dedicated study period, I’m sure I would not have been able to study effectively enough to raise my Step 1 score to 270.

Plus, your family loves you – it’s ok to put the books down to spend some quality time with them.

2. Start Learning Pharmacology and Microbiology

Another regret that is as common as it is avoidable: leaving pharmacology until your dedicated study period.  One of my best friends, who scored 260+, is brilliant, and had a phenomenal understanding of pathophysiology and mechanisms.  However, he told me many times during the month leading up to Step 1 that he regretted never having learned pharmacology properly.  Because he had simply crammed the drugs prior to our exams and had never committed to retaining the details, he spent a disproportionate amount of time studying pharmacology during his study period.  To this day, even though he is in one of the most prestigious neurosurgery residencies in the country, he still laments his lack of broad knowledge of pharmacology.

If my friend, who is brilliant, and can slide by without studying most things, struggled with pharmacology, where does that leave the rest of us?  Learning pharmacology the same way you’re supposed to eat an elephant – one small bite at a time.

Break down pharmacology into small, digestible bits, and start early, and your dedicated Step 1 period will go MUCH more smoothly.  Remember, much of pharmacology for Step 1 depends on straight knowledge – rather than having difficult vignettes to interpret, many of the pharmacology questions can be answered with simple learning.  With Anki, pharmacology essentially becomes free points on your exam, but only if you prepare the right way.

Curious how to best learn pharmacology?  Check out this article here.

3. Will You Stay or Will You Go?

When dealing with studying for Step 1, one of the most important questions is where you will be studying.  For most, the choice is between two places: school and home.  Let me explain why I originally planned to study at school, and why I finally (and very quickly) decided to go home.

Initially, I was attracted to the idea of studying at school.  All of my favorite study places were well known to me.  I had a group of friends that would be taking the test at the same time, and I even had a routine with a friend where we would go on runs together, and quiz each other as we went.  I had stocked up on a large amount of my favorite bakeable/microwaveable foods, and living in a studio, I could completely control my environment.

USMLE Step 1 Study Frustration

Studying for Step 1 can be a very lonely process – reach out to friends/family to maintain sanity.

3 days into studying, and my entire plan blew up.  Like me, most of my friends had holed themselves in, and we didn’t actually study together as much as we’d thought.  Without having classes to go to, or required small groups, the campus became quite lonely, particularly with the weight of the beast that is Step 1 hanging over my head.  Plus, it turns out I don’t like eating curly fries and other junk food as much as I thought.

I was on the next flight home.  There can certainly be more distractions, and not everyone has the option of going home, but ultimately, you need to find your own balance of company vs. solitude, of having a parent who might be able to help with the daily necessities of life vs. having a more controlled environment.  Being home, and having the time to spend with my mom after 8 years outside of my Minnesota home, made my Step 1 study period so much more tolerable, and even enjoyable.

Whatever you decide, spend more time thinking through the pros and cons than I did.  Also, if you decide to go home, you may want to establish expectations, both for yourself and others; I had a friend who went home, only to get bugged by his brothers every other day to go play golf, which to this day he still regrets.

4. Fill in Gaps in Your Foundation

Contrary to what you may have heard, your dedicated Step 1 time is NOT the time to learn how the nephron works.  Nor is it the time to figure out what determines the resting membrane potential, or why conjugate vaccines work.

When I was a first-year medical student, one of the second-year students had told us that he didn’t study for his exams, but crammed in the material and memorized enough to pass.  He told us that he would forget it all anyway, and have to learn it for when he was studying for Step 1, so why bother?  Maybe he was so smart that he could somehow manage it, but among the students who delayed their test, some of whom had to delay graduating by an entire year, a large number came from the “it’s ok, I can learn it all later” school of thought.

I’ve never heard a student say they regretted spending so much time understanding the body, but the number of students who regretted mindlessly memorizing lists and facts is staggering.

Among the students I’ve tutored, the students who do best are always the ones who come in with the strongest fundamentals.  People don’t “accidentally” increase their NBME practice exam score from 170 to 240 by mindlessly reading and re-reading First Aid.  Even students who make huge jumps in their scores, like a recent student I tutored who went from 175 on the first NBME practice exam to 247 as their final score, in virtually every case their foundation was already quite strong.  While they still had gaps in their knowledge, their bigger issue was struggling with applying their knowledge to questions, and interpreting the question stem.

Consider this: I’ve never heard a student say they regretted spending so much time understanding the body, but the number of students who regretted mindlessly memorizing lists and facts is staggering.

Want to learn more about how to nail the fundamentals?  Read this article here.

BONUS: Get FREE Pharmacology Principle Cards


What Next?

Remember, you can set yourself up for Step 1 success by both solidifying harder topics as well as resting up for the long haul.  A solid plan well-executed now can make your dedicated study period much more productive and enjoyable.

  1. If you haven’t read the article on nailing the fundamentals, do so now.
  2. Sign up for the Yousmle newsletter (link below) to get a free micro starter Anki deck and exclusive tips on how to maximize your Step 1 score
  3. Read how I mastered pharmacology over a glass of wine.
  4. Check out the Resources page to see what I used to efficiently boost my Step 1 score.

Photos by: Eflon, peddhapati

What is your plan for your winter break?  Is it worth it to study from home?  If your break is already past, how would you recommend making the most of your break?  Let us know in the comments!

  1. Bronxbomma says:

    Hi Alec,

    I am having a difficult time studying and have fallen off the proverbial study mountain many times over the last few years and am mentally drained and exhausted. Now when I learn system, I know it cold and can answer 85-90 percent of any q bank but two weeks later, if you ask me the same Q bank question, I forget how to answer it or even the material which had studied. Is that normal? I am not sure if it’s me or my study method. I have also found it difficult to concentrate and focus on sentences I am reading in the text. I am it sure if it’s a learning issue. Anyway, I am an old IMG with dreams of applying for MATCH In September. I have both steps to complete. I need some direction.


    1. Yousmle says:

      Hi SS,

      Thanks for your question. I can only imagine how distressed and discouraged you must feel for having studied for so long and yet not see the results (retention, ability to concentrate, etc.) you desire. Knowing a system well and then forgetting it is expected if you aren’t using a technique to retain the information, like spaced repetition. As far as difficulty concentrating/focusing, especially given your difficulties so far, may very well be due to burnout. I use this as a means to track burnout in the students I work with (and myself) and it may be useful for you to assess how much burnout is affecting your studying:

      Dr. P

      1. Sun Singh says:

        Thank you for the expeditious reply DR. P.

        Update: Wow. I scored a 67 (extremely to close to being burned out if not already. This is very challenging and quite debilitating, though, not shocking). I am pretty spent and tired. But I can’t quit and won’t quit. How can I overcome this as far at the steps are concerned? Do I need guidance or a tutor? I have read every subject over the past few years but have never made one meaningful, focused, and consolidated effort due to “life getting in the way.” Any help or guidance would be appreciated.

        Thanks you for the responses!


        1. Yousmle says:

          Your burnout score is extremely high – it is not surprising that you have such a hard time focusing. Most people that are that burned out will feel overwhelmed, despondent, lash out at those around them, and have a very difficult time focusing, let alone master the material properly to do well on the USMLEs. It may feel like you’re at the bottom of a deep pit, but there are definitely ways that you can (eventually) crawl out.

          It’s very difficult to give specific advice, without working with you one-on-one. Generally, though, for students that I tutor, if you’re that burned out, the best thing you can do is take a significant period of time off and do activities that give you flow – if you’re that burned out, I’d say probably at least a week:

          Once you’re done with that, if you’re interested in tutoring, you can set up a free consultation here:

          Dr. P

  2. Maddie Ellis says:

    Hi Alec, I tried using the link for the sample ANS Pharm cards and the dropbox page is saying there is an error with the link. Is there anyway to sort this out so that I can download the cards?

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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.