Modern Medicine

A couple weeks ago, I found out I passed step 1 –which if you don’t know, it’s like the first big licensing exam you need to take to become a medical doctor in the US.

First, I am going to start off talking about my personal experience leading up to the exam. Then, I will provide a concise list of the resources that I found most useful in my studying, and why each resource was helpful. My hope is that you can learn from my mistakes and to ultimately take the exam with confidence knowing that you prepared well. As a disclaimer, this topic is subjective, I am just telling you what worked well in my experience.

So let’s jump right into my experience.

I began my dedicated studying on January 1st 2024 and took the exam on February 13th 2024. I scheduled my date far out in advance –like around September 2023 since this was when our school suggested we sign up– and I stuck with my original plan throughout dedicated.

My first week of studying was not serious at all, I spent about 4 hours a day actually studying and watching Netflix or working out during my other hours awake. In retrospect, this was very stupid. I didn’t realize it was a mistake until I took my baseline exam on Jan 7th. I ended up scoring 44% which is pretty low given the passing rate is 60%. Obviously, there was a lot that I needed to learn and to be honest, I was pretty scared I might not pass.

For the subsequent days leading up to my exam, I studied on average 12 hours a day. I took a 4 day break 2 weeks before my exam to go to a conference in LA to present some research and spend time with my partner, but other than that, I was 100% dialed into my studying.

I doubted myself more during this 1.5 months than I ever have in my life. This was the hardest part of the exam. After the exam, I knew I passed and felt very well prepared for it in terms of my understanding of concepts, but the psychological battle really wore me down and if I had not taken measures to eradicate that self doubt, I am unsure if I would have passed.

I am someone who doesn’t like to follow convention for the sake of it. I didn’t use First Aid –which people consider to be the Bible of step 1. Every step of the way, I asked myself what the best use of my time would be, and I think this allowed me to increase my practice scores dramatically in a short amount of time (in one week I went from 44% on an nbme -> 60%). Since there are a plethora of resources to use for studying for step 1, it is really challenging to know which ones to commit to. I personally experimented a lot and found some resources to be much higher value than others.

To avoid taking up too much of your time, I’m going to move on to the resources I used and why. Then, I’ll end by giving some general tips.

**Resources ranked by order of importance (according to me)**

NBME

There are a bunch of NBME exams you can take online at the USMLE website which are just condensed practiced exams –200 questions instead of 280 on the real exam. These questions have shorter question stems than something you will see on UWorld or likely on real exam, but the content is very good. If you think about it intuitively, these are practice exams that the actual writers of the exam made, so they are bound to cover important topics they want you to know for the real deal. I feel like people don’t really stress the importance of taking these exams enough. There are a bunch of practice exams too that each take a full day to really take and review. I ended up doing 4 full practice exams, but there are many more available than that if you want to be more prepared.

UWorld

This is the most tried and tested Qbank that gives you a good sense of how the exam will be. I personally don’t think you have to finish all of it to be prepared for your exam. I ended up doing 70% before taking my exam and felt prepared. Our school paid for our subscription, but if yours didn’t, I highly recommend you purchase it. As a note, the questions are more challenging than questions on the real test in my experience, so don’t be discouraged when you are starting off. It feels terrible when you start off getting so many questions wrong and it is natural to want to avoid doing questions because of it –hence why I was binge watching Netflix shows my first week. But, you gotta keep moving forward even though it hurts your ego.

Mehlman PDFs

There is a step 1 tutor who went through tons and tons of practice NBME questions and identified patterns in what the examiners like to test. He put together free pdfs that you could download where he breaks down all the concepts by topic (e.g., Pharmacology, Risk factors, Neuroanatomy, Immunology). This was such a helpful resource and he writes everything out in an accessible way with enough background info on each topic where you are easily able to follow his logic. He pretty much breaks every concept down to the bare bones of the what the examiners want you to know. Doing 1 pass through these documents based on your areas of weakness will be very helpful to do before exam day. I found that the Immunology, Neuroanatomy, and Risk Factors pdfs were the most helpful in my studying. You can just google the pdfs and he has them free on his website.

Pathoma

Pathology makes up 50% of the exam so it is hands down the most important topic to understand well. Pathoma is the most concise, comprehensive, and well-explained resource for learning pathology content. The video lectures take a long time so I just scrolled through the pdf once before the exam (~200 pages) and similar to the Mehlman docs, the pathoma content helps you piece together all your learning so that it is cohesive. The connections come together beautifully at this point after having done the practice questions first, then doing the content review.

Sketchy & Pixorize Anki Deck

I found that doing the premade anki decks floating around reddit for sketchy micro and Pixorize biochem and Immunology to be very helpful. There are some random disease and associated facts that you need to memorize for step 1 and these decks do a great job at reinforcing a mental image of what you need to know for most of the diseases you will encounter. I would also prioritize use of the deck over watching the lectures as the lectures can be time consuming and really aren’t that necessary to understand and reinforce the content. The decks are also freely available online.

General Tips

• Be smart about what resources you use and how you spend your time
• Look at exam distribution by topic and your weakness to to figure out what topics to prioritize (image of distribution below)

• If you want to look on reddit for advice on how to plan your studying, do that at the beginning, not during dedicated. After you commit to a plan, stick with it and have faith that it will work out because the reality is that there are so many ways to get to the same point, namely being able to confidently pass step 1.
• Do practice problems everyday –even if it hurts in the beginning, practice exams are generally a better use of time than watching lectures.
• Try not to think too much about the totality of the exam, it can be overwhelming. Focus on what is in front of you one day at a time.
• Don’t be discouraged, you can do this, you are smart and have taken many exams before. Remind yourself that this is just another exam.
• Make sure you are able to sleep the night before –I went on a really long run the day before
• Understand the logistics of test day –the testing sites can be a bit daunting since they have a metal detector and make your follow a strict protocol with breaks.
• Skip the tutorial (gives you extra break time) and take all your breaks. Make sure to bring small snacks and coffee –if you drink coffee
• When you are taking the exam always be on offense, not defense. Trust your gut.
• This is a tough exam, take it seriously and don’t underestimate it. But, don’t go to the opposite extreme and make it more than licensing exam that over 90% of med students pass every year.

Goodluck everyone! I hope my personal experience can help at least one person out there! 🙂

Also, let me know if you have any questions, I’d be happy to help answer your questions.