Step 1 Preparation and Experience

Step1 238 Write-up – Complete with a baby and a horse with amaurosis fugax

Vent? Step1 advice? Both.

I’ve been leeching off of others Step 1 posts for a long time to prepare for my own dedicated. While my dedicated study time was super unorthodox (I’ll jump into that in a bit), I hope whatever advice I have to give helps someone and I hope that spilling my guts will help give me some closure on finishing the beast. I apologize, this will be long. If you want to just scroll down, near to the end is a list of my practice exams and scores and a short breakdown of my study plan. Additionally, I have a massive excel spreadsheet with my original schedule, data and such if anyone needs help planning and mapping their Step1 time.

Here’s the deal. Originally Step1 was scheduled for Dec 2020 and third year clerkships were supposed to start in April. Then the Rona changed everything- clerkships delayed til July, dedicated moved up to May-June. Not a deal breaker but for me it was a helluv an ordeal because… I had a baby in December. I had planned out the baby to the day of the ovulation so he would be born over winter break, so he’d be older when I did dedicated, etc. It takes a lot of planning to be like, “I’m dumb enough to think having a baby in medical school is a great idea,” heavy on the sarcasm y’all. That was stressor #1– my ultimate plan/schedule was jacked.

Stressor #2 was the school deciding to give us a lecture series during dedicated (all online but we had to be present/participate nonetheless). Like generally annoying but whatever, I’ll hold my kid on my lap for as much of it as we can tolerate.

Stressor #3– the Rona. My husband and my son (5mo old at the time) get covid. My husband has asthma; I was terrified he was going to take a wrong turn and get worse suddenly. Hubby is out of work for 12 days, kiddo is febrile and fussy and coughing. They recover. I take a deep breath (I already had Covid a month prior and had prevented spread in my home by wearing a mask and isolating even from my baby- it broke my effing heart).

Stressor #4– Thanos snapped. Can’t reschedule for over a week. Contemplated taking a year off from medical school, even talked to Ed. Admin. to formulate my backup plan. Rescheduling meant I had to take step a week into my first clerkship. Barf.

Stressor #5– my oldest horse has been working as a therapy horse for the disabled in a local program. I get an email that he has Lyme disease and it’s caused him massive polyarthropathy and sudden blindness in one eye. I have to arrange for transporting him back to my place with my other horse and for treating him q12 with Doxycycline and pain meds among other things; my horses live about 25min away from my house. This is a massive time suck. And I feel bad for the poor dude- he’s been an amazing horse for my family for over 12 years.

Stressor #6– nearly everyone at my husbands job gets Thanos snapped. He survives the reaping but now has to work more hours to cover all those who were laid off. Who’s gonna watch the kiddo now? Bringing a stranger into your home to babysit during the pandemic sounds nice… but yeah, hired a nice undergrad student for a few weeks to watch kiddo while I studied in my office/nursery/guest room lol. Expensive, but worth it; it was the closest thing to a real dedicated I got (she did 4 hours a day, 5 days a week).

Stressor #7– my practice scores are all over the place; they skyrocket and fall with lustful abandon. What if I don’t get my goal score? I want to go into gen Surg- I need at least an average score to have hope because while I have good extracurriculars for my CV, I don’t have any research except some unrelated publications from undergrad.

Stressor #8– sleep and time and comparing myself to others. Everywhere I looked for advice on dedicated and Step1, the advice was “get 8+ hours of quality sleep! Don’t drink too much caffeine! Aim to study for 8-10 hours per day! Really focus! Go through FA 3x! Take all your practice exams exactly as you would take step!Go through UW 2x!” Y’all, I did exactly none of that. And I’m saying this because as you prepare, you’re gonna wonder if someone has the perfect formula to ace Step1. The answer is no. The best advice I have is figure out what kind of studying works best for you, be flexible, be forgiving, be unafraid to fail, and stop comparing yourself to everyone else. Do your best at that moment- because sometimes at that moment your absolute best is just crawling through 20 questions and watching a few YouTube videos on topics you’re shaky on for the day. There were some days my son woke me up four or five times through the night and I tell you what, those days, if I got anything done, I considered it a win.

And… I digress. I have expelled my guts into the Reddit hive mind. There was so much more but I’m not going to make the world suffer my musings any longer. So, as promised, here are the metrics.

Dedicated length: 9 weeks

Main resources

USMLE-RX (super inexpensive, questions were very close to real deal; should have used it all through M1/2 to learn FA basics better), Amboss (also cheaper than UWorld, and I felt like I learned a lot more from Amboss than any other source because of the way the interface works with imbedded resources), YouTube (Cognitionis Global, NinjaNerd, DirtyMed, Crash review are all EXCELLENT and FREE- Cognitionis is my favorite; I watched at least 100 hours of YouTube review because it was the easiest way to sort of study while also taking care of a baby) GASP I didn’t use UWorld, Sketchy, or Anki. I tried Anki and Sketchy in M1 and didn’t care for either. UWorld was prohibitively expensive; I had budgeted it into my M3 year for use during our original dedicated and after our finances stabilized after having a baby. I did have the chance to do some UWorld questions with a classmate via virtual meetings a few times.of practice exams: 19 (scores in the line graph from my Excel workbook with moving average graph superimposed)

Best exam forms

22, 23, 24, free120 (closest to real deal)

Student position/standing

Right around 65th percentile for my M1/2 grades. I could have learned a lot more in M1/2 and made it easier- but alas, I thought getting married in M1 and having a baby in M2 would be a great idea (I still have no idea how I passed immunology five days before the wedding and passed psych 4 weeks postpartum). If I could have changed anything in M1/2 it would be to start question blocks associated with the material we were covering from the beginning. Learning from step type questions is invaluable and really solidified the concepts- USMLE-RX is perfect for this, is inexpensive AND has links directly to FA pages for topics covered in the questions; has a great iPhone app interface too. I did most of these questions on my phone one handed while caring for my kid. USMLE-RX is the only question bank I got all the way through. Overall I think my percentage was like 71%.

Overall, because hindsight is 20/20, I could have probably scored higher than 238/63rd percentile if I had put more effort in early on and hadn’t banked on the dedicated my school originally planned for and if I had used question banks the entirety of my M1/2 years. But, with this that I’ve laid open for you all, I’m more than happy with my score. I never entered medical school looking to be a gunner, and I will never be an Anki-bro, but I did go in with the goal of being a “positive deviant.” If you’ve ever read Atul Gawande’s “Better,” you know.

On to Clerkships and beyond!



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