What Worked Best for You in Your Preparation?

Northwestern University Feinberg School of Medicine students who scored more than one standard deviation above the national mean on the United States Medical Licensing Examination Step 1 share what worked best for them in their test preparation:

• I started early. In the fall (around Thanksgiving), I started rewatching all the sketchy videos with my printout and took notes to make it more active learning. I also started using Kaplan Q-bank around this time. Starting early isn't for everyone, but if someone thinks they can manage their time during the last four of five modules, I highly recommend starting on Micro and Q-banks early.
• Be cognizant of areas of weakness during the first two years. Those ended up being my best sections on NBMEs/the real thing because I spent more time on them.
• Having a fixed schedule (even before dedicated) was the only way I could keep myself on track and not lose motivation (the type A in me hates seeing things not crossed off on my to-do list). I started studying a little around November and legitimately during winter break. It's hard to balance the second half of the year of classes and step studying, but I think it was worth it because I was a lot less stressed during dedicated than a lot of my friends. Figure out how many passes you want to do of each resource and divide up the pages/questions/videos to make sure you get through them (but make sure you're being realistic), and stick to that schedule. However, don't forget to schedule in time to hang with friends. And go to the gym or do whatever your hobbies are. Definitely hang out with people or you will get isolated and stuck in a rut really quickly.
• Dedicated study time is stressful, and it's tough to see things clearly at times. If your home family/friends are down to earth, go there. We feed off each other’s stress in med school, and I think isolating myself from this helped a ton.  Don't do too many NBMEs. They are assessments, not learning tools. Get one score you can be somewhat comfortable with (a 20-point range) and that's it. UWorld's questions are plenty similar to the real test. Take breaks. I worked out every day. When I found myself getting too stressed out, I went to visit my friends from college. I did no work for a whole weekend, and I felt rejuvenated when I got back to it on Monday.
• I honestly think your score will reflect the work you put in. Not talking about just the study period, but all the work you put in over the two years of your medical school. Putting in work, doing tons of questions, spaced repetitio and being able to analyze and identify your weaknesses and improve them are the keys to this test.
• I made Anki cards for everything I didn’t know from Pathoma, First Aid or UWorld on my first pass, and made Anki card for anything that Dr. Sattar said was “high-yield for exam purposes,” even if I thought I knew it already.
• A big key was always keeping my mind active and quizzing myself. If you have a question asking to identify why a patient has dyspnea, orthopnea, elevated JVD, you want to not only identify that it is CHF, but also think through other etiologies, how you would treat and then keep testing yourself. For example, test yourself on etiologies like: What is wet beri beri? Or what else can Chagas cause? This is very important to solidify and connect your knowledge, especially in earlier stages of review. Also read through and understand why every wrong answer in UWorld is incorrect.
• I believe making a realistic schedule and sticking to it is the most important thing during the dedicated period. The time we are given for dedicated studying doesn't seem like a lot of time, but if you are able to take advantage of each day and work efficiently, you can enormous strides during this period. If you are studying, buckle down and get work done. If you are taking a break, remove yourself from any study materials and do your best to truly relax. Just stick to your plan and you will see improvement.
• I started reviewing Step 1 during Winter break of M2 year. Specifically, I focused on watching all of the SketchyMicro videos and making flashcards out of them. I knew I was weak on microbiology and because there is an enormous amount of information to memorize, so I wanted to get a head start on that as soon as possible. During the Repro/GU module, I started reviewing past organ modules and prioritized subjects that I felt weak on. When dedicated period began, I switched gears and focused on doing practice questions in UWorld. My schedule revolved around doing three timed blocks of 40 questions every day (120 questions per day). I did organ-specific blocks as well as random blocks. It's especially important to do random, timed blocks because these simulate what you will see during the real test. After finishing each block, I reviewed each question and read the explanations for the answers. Reading the explanations took the most amount of time but was also the most helpful aspect of using Uworld, because it filled the gaps in my knowledge and helped me become a better test taker.
• I scheduled days to take practice exams to assess my progress and pinpoint areas of weakness. The two most important times to take practice exams are the midpoint period and several days before the actual test. Taking a practice test at the midpoint period gives you a sense of where you are in terms of preparation. And the practice test several days before the real thing will give you an accurate prediction of what your score will be. If possible, schedule more days to take practice tests in between these periods. I took a total of five (three NBME and two UWorld) practice tests. These practice tests, however, don't run for the full seven hours. I did one practice run consisting of a four-hour practice test and three Uworld blocks, which total seven hours. I found this helpful because it gave me a sense of what the full test would feel like and helped me develop endurance.
• I found that identifying my optimal study environment and building a routine around it was very important. For example, talking to other medical students was stressful for me during the time leading up to Step 1. It was impossible for me not to compare my study methods with classmates, which in turn made me question my approach. Accordingly, going home for designated study time, not keeping in touch with classmates, but instead surrounding myself with non-medical school friends/family was instrumental for me. Similarly, choosing to study in the same place every day (my dad’s office, as they had an extra desk) for the same amount of time each day was valuable for me in staying focused and keeping in a rhythm. With that said, this approach may not work for everyone, so it’s important to figure out what works for you and plan a routine accordingly.
• I am really happy that I came up with a study plan in early December and studied a little bit most mornings during winter break. It made January and February a lot less stressful and was a more low-key way to just study for an hour or so most days. It wasn't fun at the time, but I'm glad that I went through FirstAid and the RX question bank before dedicated time started. It meant I had a decent foundation and didn't start doing UWorld without knowing anything and getting really discouraged. And it gets painfully boring, but it is true that the more times you see something the better. I used Anki both for UWorld questions that I got wrong, and I made cards for subject areas that I thought were more memorization as opposed to understanding concepts (i.e., Micro). I found that helpful, but I've also always learned well from both making and doing Anki, and it was a nice change of pace from just reading and UWorld.
• I think what worked best for me was identifying what were the resources I really wanted to get through. I really set out a goal for myself that I wanted to complete a first pass of UWorld and, at the least, be able to go through all the questions I got wrong a second time around before my test date. I also wanted to go through First Aid once in January prior to starting dedicated. Doing UWorld little by little starting in January, along with reading 10 pages of First Aid a day, really made my dedicated study period much smoother. By the time my five-week dedicated period came around, I already had a good idea of what my weak spots were and what I needed to work on. I focused on making flashcards on my weak spots or on things on UWorld that I wanted to reinforce.
• UWorld was by far the most useful. I started doing 20 questions a day in January to get in the groove. I think starting early was very important because it made me feel confident about my progress. I never thought about pushing my test back. I think it is important to pick a few resources you like using and study those completely. I ended up doing UWorld twice, as well as all of the questions I got wrong, which ended up being around 6,000 questions. I did not use any type of flash cards. I supplemented UWorld with the Boards & Beyond Videos, Sketchy and Pathoma. I found First Aid useful more as a reference than as a primary study aide. The Boards & Beyond video series is similar to Pathoma, but it covers all of the topics in First Aid, so I would follow in First Aid when I watched the videos. I started watching those videos in January to get better at topics I knew I was bad at (biochemistry, microbiology). It was a pretty easy and passive way to get a head start on studying.
• The best thing I did was start doing a little each day in late December. I watched about an hour of videos and did some UWorld questions (a little more on one weekend day) so that by the time I got to dedicated study time I was going through the material for the second time. Also, I timed this review so I was going through the organ systems we were learning about in class about two-thirds of the way through the unit, so I could study for both the Feinberg test and boards at the same time. I felt like during my second pass during dedicated study time, I picked up on more nuances of the material and was able to focus my studying on the topics that I performed less strongly on during the NBMEs. The UWorld practice tests are more indicative of what it feels like to take the actual Step 1 exam compared to the NBME exams, so I would highly recommend doing those practice exams. Many people say the NBMEs were predictive of their scores, but my UWorld practice tests were much closer to my Step 1 score.
• Alternating reading a section of FA and doing UWorld questions. You can do the questions before you've mastered the particular subject. It helps you learn along the way. And, of course, Sketchymicro when my brain felt broken.
• I kept the same schedule every day starting at 8 a.m. and studying until 10 p.m. when I went to bed. Interspersed were breaks for lunch, working out and dinner. Each weekend, I left the city and spent time with family and friends. All in all, I studied five days per week and any more would have burned me out.
• I learn by reorganizing information my own way, so I made study sheets from First Aid that consolidated info and laid it out in a way that could better understand. I also learn by repetition, so I'd go through those sheets multiple times. The USMLE World question bank was good, but I preferred to use it as a way to test myself, rather than learn from it. I always set it to "all topics" because that's what the real test is like. For each question I got wrong or found very challenging, I wrote the general punch-line on a piece of paper. I organized these by topic, having one page dedicated to Cardio, another Micro, another Biochem, etc. This made it easy to review the questions I got wrong.
• Mixing up my study materials worked well. When I got tired of reading or annotating, I'd take a walk and listen to Dr. Goljan. I found he was a great way to both start and break up my day so I didn't get as bored. Also, doing qbank nearly every day was really helpful in focusing my studying (even if it's only 20 questions). I took the practice tests like the real thing. I think this helped my stamina. Taking a practice test halfway through my studying helped me focus the second half of my time better.
• I found my comfort zone mentally and physically. I didn't have a rigid schedule, but rather did things when I was comfortable doing them. For example, I wanted to keep working out during boards, but I didn't make myself go to the gym each day. Some days I was on a roll studying, so I just kept at it. Other days, I hit a wall and would go for a run, watch TV and then pick up studying later in the day. Listen to your body and mind.
• A combination of individual and group study was the only way I knew that I'd stay on track for Step 1. My study group (which I'd been apart of for all of M1 and M2 years) had begun our start toward Boards review in late February. In addition to our normal study schedule, we'd meet up one extra time per week to cover a chapter in First Aid (or half a chapter for the really long ones like Biochem and Micro). Each one of the four of us would take a quarter of the material for that week, annotate First Aid based on the BRS Physio and Path (or Goljan Path, it's a personal preference), and then we'd spend an hour or two going through our notes. We tended to pick chapters during the unit that corresponded to them, as well as a few mutually agreed upon weak points. Being familiar with First Aid before the end of the school year made the last month of study a lot less intimidating.
• It was important to me to have a two-week vacation, so I decided to give myself three weeks of studying before I took the boards. Since that is on the shorter end of study time, I did not really take any days off and instead just studied pretty much all day for 20 days in a row. I would get up really early because I was more efficient in the mornings. I think this study schedule was only possible because I had a trip to look forward to. Also I worked out every single day, which was absolutely necessary for keeping balance and feeling good.
• Grab a study partner. This depends on how you study best and works for some people. For me, it kept me motivated and challenged. It is much easier to stick to a planned schedule with a study partner. It also allowed me to clarify any uncertain points with the material at hand. It is important that your study partner is similar to you in terms of your goals and study techniques.
• I did a few things that I think that were really helpful. First, I went home to study, which was nice because I felt less stressed and I was able to spend time with my family each day. I kept a pretty strict schedule to keep myself motivated. I tried to start studying each day at 8 a.m. I always took an hour for lunch and an hour for dinner, which I spent with friends or my family. Some days I would just read for fun over lunch. I also made a schedule of chapters to study in First Aid. I read through all of First Aid, trying to do one topic a day (I spent two days on Micro and two days on Biochemistry). The neurology chapter has a lot of drugs, so I restudied these when I covered pharmacology. A basic day involved doing all the questions in USMLE World Q bank and reading through First Aid. Sometimes I made flashcards; it all depended on the subject and how much time I had. I went through almost all the subjects twice as I need repetition to learn. The second time went faster and I skipped a few subjects. I was finished studying in less than four weeks.