HealthMarch 03, 2016

From the editors: Preparing for the Step 1

It’s that time of year...time for many M2 students to prepare to take the Step 1 exam this spring. Over the next few weeks we’ll be publishing a series of guides by Firecracker editors about their experiences studying for the Step 1. This guide is by Jeff Cooney, an MD candidate at University of Texas Health Science Center at San Antonio who scored > 240 on his Step 1. Remember, you can try Firecracker for free for 30 days.

First off, congratulations to making it to the end of your MS2 year—that alone is a huge accomplishment. I believe that anyone smart enough to make it through 2 years of medical school has the potential to do very well on STEP 1. It’s important to remember that STEP 1 isn’t an IQ test—the problem solving that you’re required to do is fairly straightforward. The challenge lies almost entirely in learning (i.e. memorizing) the massive volume of testable information. In my opinion, there is a nearly linear relationship between the amount of time/effort you put into preparing for the test and your score. This is when the years/months of Firecracker questions that you’ve been doing will pay dividends.

Next, some advice on maintaining your well-being. This has been repeated to the point of being trite, but it’s true. Take care of yourself during this time. Once classes ended, I studied 6 days/week, 8-9 hours/day, with lots of breaks. (That’s right—I took one day per week completely off). Some of my peers studied 7 days/week, 12+ hours/day, and I suspect that this did more harm than good by leaving them burnt out. You need to work hard, but you also have to be smart about how you study. Take breaks when you need to. Sleep 7-8 hours per night. Exercise and socialize with friends. If you do this, not only will you be happier, but you will be more likely to synthesize, consolidate, and recall information and ultimately, do better on test day.

Study resources

In my opinion, it is better to master a smaller number of resources than to spread yourself too thin with a more superficial knowledge of numerous study resources. I had many classmates that freaked out when they came across someone using a resource that they had not covered. Keep focused on mastering the handful of resources that you find most valuable. The 4 resources I used were: First Aid, Firecracker, UWorld, and Pathoma. Each of these resources is effective at accomplishing different things and is best used at different times in test prep.

This is a sample study schedule totaling 16 weeks consisting of 8 weeks pre-dedicated prep and 8 weeks dedicated prep. Many of you will likely be balancing classes during the 8 weeks of pre-dedicated prep. During this time, your #1 priority should be learning the new STEP 1-testable topics presented in your classes. My strategy during MS1 and MS2 was to reference Firecracker and First Aid during lecture and flag the topic(s) covered in that lecture immediately after it ended. When lecturers focused on information not included in these resources, I dedicated less (or no) time to studying it. While classes should be your #1 priority, try to find a few hours a day to begin reviewing previously learned STEP 1-pertinent material.

Weeks 1-4: Continue doing your daily questions in Firecracker and ensure that the topics within this list are flagged. These are some of the highest-yield topics in Firecracker and you are likely to see multiple questions covering this material on practice questions and on STEP 1. In addition to Firecracker, I found that a full pass through Pathoma—watching the videos and making annotations in the accompanying text—was useful at this stage in my STEP 1 prep. I did about a chapter in Pathoma per day.

Weeks 5-8: During these weeks, continue doing your daily questions in Firecracker, and start a dedicated subject review on a single subject. When picking the subject to study, I recommend starting off with either your weakest subject or the subject that you are furthest-removed from (this may be biochemistry for many medical school curriculums). Flag any necessary cards in Firecracker and do UWorld questions on these subjects. Do these questions on tutor mode, untimed, with the primary goal of learning the information. Read (don’t skim) the explanations. Unless you’re a savant, the questions will seem very difficult at first. Don’t get discouraged and don’t obsess over your percentages. Your primary goal at this point is to learn and not to compete with other UWorld users.

You may find Firecracker practice exams helpful at this point for assessing your mastery overall or on specific topics. Practice exams are also good for getting used to the USMLE test format and environment. Firecracker has a full STEP practice exam, as well as dedicated Anatomy and Anatomy & Embryology shelf exams. Unless you consider yourself weak in anatomy and/or embryology, I would recommend taking the full STEP practice exam at this point since anatomy and embryology are typically emphasized less than other subjects on STEP 1. To access these exams, go to Study Something Specific and choose ‘Take an Exam’.

Dedicated test prep: This is when you should reduce and eventually stop doing Firecracker review questions. These questions have built and sustained your fund of knowledge; now it’s time to focus on question banks. Ed note: Firecracker is creating a new dedicated test prep product at this time, due for release in early April.

Weeks 9-12: Do 3 full blocks (44 questions) of UWorld per day on timed, random mode. UWorld states that they have 2350 STEP 1 questions; this schedule will allow you more than enough time to complete a full pass through the question bank. Since questions on STEP 1 are presented at random, I reasoned that it was best for me to do questions in a similar manner. Notably, during this time, I did little to no dedicated subject review in a traditional sense. I referenced, read, and annotated the First Aid sections associated with each question, but I never spent days reviewing a particular topic or reading First Aid section-by-section. I chose this style of studying deliberately—I’m an active learner and passively reading First Aid would have done little to help me retain information.

Dedicate one of your six study days per week to doing a NBME practice exam. This will allow you to assess where you’re at and track your progress over time. The drawback with these exams is that they don’t include answers to questions, so while they’re great for benchmarking your performance, they are less of a learning opportunity.

Weeks 13-16: Reset UWorld and repeat the process from weeks 9-12: ~3 blocks of questions per day on timed, random mode. Annotate and reference First Aid as needed. Two weeks prior to the test, I began practicing my sheet of “white board” topics: topics that I planned to immediately transcribe onto the provided scratch paper at the beginning of the exam. I found tricky mnemonics, statistics equations, and a drawing of the cerebral arteries were particularly useful for my white board. The last two weeks prior to the test, I did the UWorld self-assessment exams (one exam per week). The week prior to the test, I took a practice NBME exam at a the same testing center that I was scheduled to take my real exam at. This was useful to familiarize me with all the logistical elements of getting to the testing center, etc.

Finally, take the vast majority of the day prior to the test off. I reviewed a handful of questions/facts that I had been struggling with that morning and spent the rest of the day exercising, hanging out with friends, and cooking a good dinner.

Good luck.


A personalized, digital tutoring experience brought to you by Lippincott.

We put together content and resources written by experts—specifically, medical students who scored high on their own exams and have experience-based insights—and provide it to students in MD, PA, and DO programs to unclog exam prep and curb Stage 4 panic.