Studying for a big exam like Step 1 can be arduous, and take a serious toll on both your mind and body. I recently took stock of my experience studying for Step 1 myself, as well as what I've learned from helping others prepare for Step 1 as a USMLE tutor, to bring together a list of the five biggest mistakes I think that students (myself included) can make when studying for Step 1, and what you can do to avoid these potentially costly errors.
1) Not taking time to take care of yourself
I found preparing for Step 1 to be so difficult not only because of the vast amount of information, but also because it becomes your only focus for the months it takes to study. In talking to other students, it is a common theme that self-care often falls to the wayside and priority is given to studying. Here are some tips for ways you can care for yourself without sacrificing a high score:
Set a stop time: Fatigue is real. No amount of energy drinks or coffee will really fix this. Try to stop studying at least 1 hours before bedtime, and make it a nightly ritual to do something that you enjoy instead.
Take breaks: You don’t have to give up things you enjoy thinking that you will use that time to study--taking time for a class (I did yoga) or being with friends can help you focus more when you do get back into studying the next day, and you wind up being more productive overall. An alternative to this is to find a mindfulness playlist or app (many of our students find the app Headspace helpful for this purpose) and stick to using it every day. I used this in addition to the yoga to help calm my mind while I was in bed so I could fall asleep easier. There are plenty of options for restorative breaks out there, so don't give up if the first one you try doesn't work for you; just experiment until you find one you like. I was doubtful of yoga at first, but found it to actually be instrumental to taking care of my mind and body during my Step 1 studying.
Healthy diet and exercise: I also found that having a set time during the middle of the day to go to the gym helped break up the day. This gave me a goal to focus for 4-5 hours, and I looked forward to going to the gym more because I viewed it as a break. I felt more driven to work the whole time during this shorter block than waiting until the end of the day. Similarly, I tried my best to eat a healthy, wholesome diet and avoid heavily processed foods. It can be very tempting to use sugar as a reward, but you'll thank yourself for choosing healthy study snacks (many students find almonds work particularly well for this purpose) when you avoid the sugar crash later.
The moral of the story is that if your body doesn’t feel good, your mind wont either. Stick to a schedule, find ways to exercise and take breaks that you enjoy, and remember that taking time for your body will help you learn more and better in the long run.
2) Not learning from the practice questions you get wrong
Getting a question wrong sucks, I get it. In retrospect, that question now looks easy, you are frustrated that you “just read this earlier,” and are wondering why nothing ever seems to stick in your memory. Whenever I heard this from a friend, or felt it myself, I was always reminded of this--its OK to miss a question once, but you should never miss the same question twice. What this means is that you should strive to use each incorrect question as a learning opportunity. Some students find it helpful to use a question journal or spreadsheet and to note down why you got the question wrong. Was it because you misread the stem, confused two things, or forgot part of a disease presentation? The reason doesn’t matter as much as taking a note of it, and taking the time to internalize it does. For my students, I recommend that they make their own Anki cards based on the questions they answer incorrectly in UWorld or on an NBME practice test. This can be tricky to master and requires more activation energy than simply using a pre-made Anki deck that isn't tailored to your own specific weaknesses, but once you learn to make effective cards efficiently, you'll find that you get much more out of reviewing your incorrects, and that you often find yourself saying "I remember this from my card" when you answer a question.
3) Prioritizing memorization over understanding
A big mistake that I have seen over and over again with students that I have worked with is that they initially try to only memorize facts without attempting to understand the underlying principles of what questions are really asking. The types of questions that you are given on the exam do not reward learning simply word-for-word recall. You must be able to put concepts together, apply different fields together, and be able to manipulate information at a tertiary level. For example, you are likely to see passages wherein a symptom set describes a pathology, but the question stem asks for the main mechanism of action for the drug of choice to treat this. The point being that you need to tie-in related topics, even if they are in different sections of First Aid. A mistake you can easily make when studying is trying to learn the lists of information--whether that be side effects or symptoms, without learning how different aspects of a disease (such as symptomatology and treatment) relate to each other. Whether you are making Anki cards based on UWorld questions or annotating Pathoma, try to take a second look before moving on to a new question or page. Go through the effort of making some additional notes that tie in the pharmacology (for example) with the pathology or physiology that you've already learned.
4) Not doing UWorld as timed, random blocks
Another mistake students make is not understanding the importance of timed, random blocks. Going back to my last point, we inherently would rather do tutored, subject blocks over what we most recently covered. It's easy to convince yourself that this is the right way to learn, but you're really doing yourself a disservice if you never do random and timed blocks. And, although there is a place for this, I stress the importance of doing timed and random blocks at least one question bank; I did UWorld exclusively this way, as did many of my co-tutors who scored above a 260 on Step 1. A big part of exam day is understanding how to take the test under time pressure, practicing this repeatedly will make you better. Furthermore, blocks will not be organized by subject on test day, and practicing this way leads people into the bad habit of relying too much on context to get a question right. This is one reason people find that they do disproportionately worse on practice tests (in which questions are in a random order) compared to their UWorld blocks. It takes time to optimize your test-taking approach to answer random questions correctly in a short amount of time; you need to practice this, again and again.
5) Spending too much time on low yield minutiae in First Aid
In retrospect, I myself spent far too much time trying to memorize each and every bullet point in First Aid. I did most of this in my final week of studying, time I felt I needed to “fill in” with cramming before my test. It's easy to fall into this trap when the fear of missing something sets in days before the exam. If I can give one final piece of advice here: let the questions guide your learning. So many successful medical students never spend significant time on First Aid. The idea that you need to memorize all of First Aid to succeed on Step 1 is nothing more than a dangerous myth, perpetuated by students who excelled on Step 1 in spite of spending far too much time on First Aid. Several of my co-tutors (as well as USMLE Pro's founder) have scored above a 260 on Step 1 without using First Aid, or by only using it very minimally. UWorld is tailored to teach you high-yield information in a way that you can apply it on test day, and focuses on details that are testable. My rule of thumb is to always connect your learning with a question you’ve seen. There are so many low-yield factoids in First Aid that are very unlikely to be tested, and your time is often better spent on trying to improve your ability to apply your knowledge and answer questions strategically. In short: don't sweat the small stuff.
Nikhil Dhall is an MS3 at the University of Missouri-Kansas City who scored a 254 on the USMLE Step 1. He tutors for Step 1 with USMLE Pro.
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