Hello!

I just finished my first clerkship of third year - internal medicine! It was 12 weeks long and thankfully every clerkship from now on will be 6 weeks, except for neurology, psych, and my surgical subspecialty elective (anesthesia) which are 3 weeks. Studying for the internal medicine shelf exam (we have national NBME exams at the end of each rotation) felt a lot like studying for step 1 and brought back a lot of memories. Now that it's been three months since I took step 1 I feel like I can share some honest study advice, particularly in terms of scheduling and what resources I used. I think that the emotional struggle of step 1 prep is worthy of a post of its own so I won't be focusing on that just yet.

There are many resources available and it really just depends on what works for you. Personally I used five:  1)  Firecracker, 2) Pathoma, 3) First Aid, 4) Picmonic, and of course 5) UWorld.  I used a combination of these during my first and second year. When I started second year I tried to be more proactive and began going through approximately 300 Firecracker questions every day when I started  to to supplement what I was learning in the current block and to help me remember older topics. By the time winter break of MSII rolled around I started to get nervous about the huge challenge of studying for step 1 even though the actual exam was 6 months away at the time. Making a schedule helped me plan my time and set goals for myself. I officially started studying for Step 1 at the beginning of my last semester of MSII. Since my dedicated 6-week study period started at the beginning of May, I had January through April to set a good foundation for myself. 

At the beginning of January, we took a practice NBME (NBME 12) through our school. I used my score as a starting point for my studying and as well as source of motivation for improvement. From January to the end of April I went through all of First Aid once. I did this by covering one section a week, which was tough since some were much longer than others! I would start by flagging all of the corresponding topics on Firecracker and reviewing them as I read through & annotated First Aid (annotating was really important since it helped me make a better mental map of the material!). I also watched the associated Pathoma videos for each section if there was one. As you might imagine, the Firecracker questions really piled up. I often struggled to get through my sometimes massive number of questions per day but I think it was worth it in the end. I have friends who stopped using Firecracker at this stage because it was too much, and they did just fine. I used Picmonic religiously for the microbiology section, particularly the bacteria and parasites.

In order to get through all of the studying I had to do during those three months I had to prioritize step 1 over my block studying. In order to do this I scheduled the First Aid sections that matched my block material a week before the block exam so I could multi-task. Personally I found that First Aid and my other resources highlighted what was actually important whereas block material can be more broad. In the end, I did better than my personal average on those last two blocks without even looking at class notes or listening to podcasts. This approach worked for me but remember to stick with whatever works for you!

By the end of April I had finished Pathoma, First Aid, Picmonic (the microbiology specifically) and Firecracker. I had also done about 693 UWorld questions sporadically throughout. Before I entered into my 6 week dedicated study period I re-evaluated by resources and made my official step 1 study schedule. Firecracker had been a foundation for my learning in the blocks and during my first pass review of everything. I decided to stop using it during by 6 weeks, however, because I didn't have time for it anymore. I also officially added UWorld to the mix. UWorld is indispensable as far as step 1 studying goes. Looking back, I learned more from it than anything else.  One of the most challenging topics for me was pharmacology - there are SO many drugs you need to know! - and I found the pharmacology flash cards by Lange to be extremely helpful. I got mine from an upperclassman and they had already written important additional information on them which was very useful.

Scheduling my 6 weeks seemed like a daunting task but thankfully there was an excel sheet circling around my class from a third year at the time. Using it as an example was so helpful and I was able to tailor it to fit my personal needs. I've linked it here and at the bottom of this post! Using this schedule I was able to get through approximately 1 section of First Aid with the associated Pathoma & pharm flash cards, and a few sets of 44 UWorld questions per day four the first four weeks.  One of my goals for the first four weeks was to get through all of UWorld once, so some days I did more questions than others. During this time I did questions according to what section I was reviewing. Overall, this was a time of heavy review and solidifying high-yield concepts. The last two weeks were dedicated to reviewing the material once more while getting through as many timed-tutor "random" sets of UWorld questions as a I could. I purposefully scheduled sections that I thought were difficult towards the end so that I would see them closer to my test date. For me, these were neuro, biochem and micro.

In terms of practice tests, I used four: NBME 13, 17 and the UWorld Self-Assessment Forms 1 & 2. I scheduled these at different points during my 6 weeks. The UWSA are famed for being difficult but having a very generous curve so UWSA 1 was the first one I took. It helped my confidence but also showed me my weaker areas. I took NBME 13 and NBME 17 next. These had a different question style than UWorld and had no curve. They were hard and definitely didn't give me confidence boost like UWSA 1, lol. I think NBME 13 and 12 (which I took in January) were a lot more realistic than NBME 17. I finished off with UWSA 2. Overall I think Step 1 was much more like UWorld in terms of question style and difficulty than the NBME exams.

Throughout my 6 weeks I kept a "UWorld Journal" in the form of a Google doc as well as handwritten notes. I would go through each completed quiz and write down the key facts that I was asked about. I think this was the single most helpful thing I did. I was able to review these notes throughout my study period and commit tons of high-yield material to memory.

Compared to my NBME 12 practice exam score in January, my actual step 1 score improved 68 points overall. Step 1 studying will be a very challenging time in your life but use it as an opportunity to grow and surprise yourself. It was honestly the hardest I've ever worked and it challenged me in ways that go beyond intellect. The only thing I would have changed about my approach is I would have started going through First Aid during first year.  If I could offer one piece of advice about this entire process from the bottom of my heart it would be to try your best every single day even if you feel like you can't because you want to be able to look back on this fragile time without any regrets.

Below is a dropbox link to my 6-week schedule complete with a sheet called "checklist" which helped me track what I was doing and what I needed to complete next. Feel free to download it, share it and edit it to fit your needs!

https://www.dropbox.com/s/ffv6f9qpnfsjid5/Step%201%20Study%20Schedule%20Blog.xlsx?dl=0

If you have any questions please leave a comment below or email me!