HealthMarch 24, 2015

Last two weeks before the USMLE Step 1

“This is your test. Every path you have trod through wilderness, through war, has led to this road. The enemy will never let (insert your name) score high on USMLE Step 1.”

Who recognizes the above quote (with a few changes)?

I am a HUGE fan of fantasy and science fiction. One of my favorite stories is Lord of the Rings. I read the books in junior high, and the movies are some of my favorites. Elrond says the above when referring to Aragorn becoming king of the human race.

And yet, it is so representative of Step 1 board prep.

Everything in medical school up to this point is for the purpose of getting the USMLE score you want. You’re at the end of your dedicated study time. You only have two weeks before your USMLE step 1. What can you do with only a few weeks that will improve your score? Anything?


It would have made for a pretty horrible book/movie ending if Aragorn had thrown in the towel because he was tired or felt like there was nothing else he could do. Same for you! Now’s not the time to give in to fatigue. Nor is it the time to bulldoze ahead with your eyes closed. Now is the time to be smart and strategic in your board exam prep.

I hear so many students ask what they can do in the last 2 weeks of studying, and I hear many answers that aren’t helpful. So I’d like to give a few practical and specific suggestions so that you can sprint to the finish line. These are from multiple people who did well on Step 1:

  • Work on endurance (intelligently).
  • Memorize minutia that you only need for the test and can then promptly forget.
  • Wisely utilize question banks.

Build your endurance

Step 1 is a grueling 8-hour test that makes you ask yourself “remind me why I’m paying money to torture myself?” It’s common for students to get questions wrong even though they know the material in and out. It’s because they get mentally fatigued and make careless errors. So how can you avoid “hitting the wall?” Just like with sports, you have to “exercise” to improve your stamina. For the two weeks leading up to Step 1:

  • I did 6 different full 7-block exams. I combined NBME exams I purchased with UWorld blocks and UWorld SA exams.
  • I slept at least 9 hours a night. Your body can’t heal from a workout without adequate rest. Same for your mind.
  • I did 7 UWorld blocks in 5 hours without any breaks, except for maybe 2 quick bathroom breaks. I wanted to force myself to stay focused even when I was exhausted and had a headache from staring at the screen.

The result? Game day was a breeze. I didn’t get tired. It felt easy to me, especially compared to my 7-block 5-hour experience a few days prior. My careless errors were at a minimum.

But remember, to effectively build endurance you have to include rest. Even Aragorn slept during his quest.

Memorize minutia

The short time before your test is when you want to memorize topics that require rote-memorization. Here are some suggestions from others who did well on Step 1:

  • I combined my Firecracker studying with the images from Picmonic. So whenever a topic came up that had a card on Picmonic, I would review that image. This meant I would see the image multiple times before the exam.
  • The most helpful rote memorization tool was re-writing diagrams over and over again. The drawings included flowcharts (e.g. microbiology classifications), pathways (e.g. biochem, endocrine), and pictures (e.g. anatomy). It’s surprising how much info and logic you can cram into a drawing with distilled, high-yield info. Same goes for biochem DRQs; whenever a DRQ for a biochem topic came up, I would draw out the entire pathway. I’d re-write the papers I drew stuff on every 2-3 days as needed.

Use question banks

One simple thing to do during your last 2 weeks is to just do a bunch of questions. And many people find that helpful. I preferred a slightly different approach. I actually did question bank questions during all of 2nd year and continued during my dedicated Step 1 prep period. Whenever I got a question wrong, I would add it to a spreadsheet I had. In the spreadsheet I indicated the following:

  • Question ID and date I took it so I could easily look it up.
  • The main topic of the question.
  • Why I got it wrong: did I just forget a fact, or did I misapply a concept?
  • An explanation in my own words as to why the correct choice was correct and why the incorrect choice I selected was wrong.

I then spent a lot of time during my last 2 weeks reviewing this spreadsheet I had put together. It was extremely helpful, and was a quick, painless way to review concepts that gave me problems during the last 6 months of studying.


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