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5 Critical Lessons Learned
My STEP1 Dedicated Period
First Study Strategy: Re-learn Material
My Experience Failing STEP1
What happens if you fail?
Accommodations & Accessibility
Second Study Strategy: Practice Questions
Analyzing Second Step1 Failure
Social Determinates of Learning
Studying & Passing Step2 on first Try
What is the best way to get information on how to not fail STEP? I promise you it’s not from someone who scored super well on the exam (even though it is now Pass/Fail). Instead consider listening to someone who has actually failed the medical school board exam. How about someone who has failed twice, but then passed! We all know that only through failing and making mistakes do you learn and grow.
So follow me on my journey and read about the lessons I learned for future Board exams...
***Check out my NEW Medical School Hidden Curriculum workbook which includes pages to study for STEP1, reviewing exams, and dealing with STEP Failure.
****If you would like to meet with me to discuss your unique situation, develop a STEP study schedule, you can sign up for personalized coaching and tutoring here.
5 Critical Lessons Learned:
1. Do multiple UWorld (UW) questions (Q) at a time in a row
Practice without getting up for an hour then take a break of 5-10min (or more if you get accommodations)
2. Begin doing 40Q at a time during the actual test time allowed on test day
60 min (if no accommodations)
Start this early in your studying because your body and brain have to get used to it.
As a UWorld Affiliate can share 10% Savings on New Library feature with code: STEP10
3. Use UWorld and First Aid as your 2 most important resources!!
THEN use secondary ones for extra practice
Learning all Subjects: Boards & Beyond, Osmosis, AMBOSS, OnlineMedEd (25% off with code: medpsycmoss25)
Pathology: Pathoma (book and online videos)
Histology: Histology Guide (free)
Memorize with Pictures (Biochem, Micro, Pathology, Pharmacology): Sketchy Medical, Pixorize, Picmonic (20% off with link)
Anatomy: University of Michigan Pictures (free)
Cardiology: UMich Heart Sounds (free)
Quizzing YourSelf: Anki (free)
Dermatology: DermNet (free)
Psychiatry: NowYouKnow-Psych (20% off with code: medpsycmoss)
Neurology: NowYouKnow - Nuro (20% off with code: medpsycmoss)
4. DO NOT take the exam until you are consistently scoring above the passing score
Around 95% - 99% chance of passing
Preferably multiple times more than 10 points (example score of 206) to account for additional stress and things you can not control on test day
Again: IF YOU ARE NOT SCORING ABOVE PASS ON MORE THAN 2 PRACTICE EXAMS DO NOT TAKE IT - EXTEND TEST DATE! From experience and conversation with many other medical students who have failed, it is better to extend your exam date than fail the exam.
5. If you fail it will be ok!
See more below on the Failure Section
Read my blog posts and associated Video recordings:Emotionally Processing Failure: How one's identity is impacted by FailureSurviving the Taboos of Medical SchoolSpecifically excerpt from "#3 Failing Quizzes, Exams, Courses, & STEP"
Emotionally Processing Failure: How one's identity is impacted by Failure
Surviving the Taboos of Medical SchoolSpecifically excerpt from "#3 Failing Quizzes, Exams, Courses, & STEP"
Specifically excerpt from "#3 Failing Quizzes, Exams, Courses, & STEP"
My Step1 Dedicated Experience:
From the first month of my M2 year I tried to do some UW to review. However, this led me to get behind on my curriculum so I changed to only doing questions correlating with the curriculum we were currently learning.
At my Medical College in the Spring of our M2 year we are given the First Aid Step 1 book and provided 2 months (8 weeks) of "Dedicated" study time where we were supposed to study and take STEP1.
At my school there is specialized tutoring services and extra NBME practice exam vouchers BUT YOU NEED TO ASK for them.
February was our "complex cases" block. I thought I should start doing more UW review so I did more and did not spend enough time on learning the new materials in this unit. This led me to fail the summative and then spend 2 weeks of my dedicated STEP1 studying period retaking it. Thankfully I passed the summative exam the second time around. However, this led me to only have 6 weeks to take Step1 before my M3 year started.
From my first couple practice exams during my “dedicated time” I realized that I did not have a strong foundation of the material. Therefore, I used the First Aid Chapters and Sketchy Videos to determine write down a list which topics I was least comfortable to most comfortable with. I then focussed on the topics that I needed more time on.
Strategies to re-learn and learn the material:
Each day I would focus on reading, watching review videos and doing some questions on a set topic.
Best and number one reading source that everyone recommended was First Aid. Which I usually could read and digest about 10 pages per hour. Other readings I acquired and kept on hand: Crush Step1, Dirty USMLE Rocks, Rapid Review, Golden High Yield
Other readings I acquired and kept on hand: Crush Step1, Dirty USMLE Rocks, Rapid Review, Golden High Yield
For videos for review I used OnlineMedEd (25% off with code medpsycmoss25), Osmosis, Boards&Beyond, Sketchy, and Pixorize depending on the topic.
I tired Osmosis, Boards & Beyond, and Amboss questions but the questions most similar to the actual exam was UWorld so focused on them and did others if wanted more practice questions.
I did UWorld on one topic in tutur mode at a time. At first I could only do 40 Q in tutor mode (4 hours) per day to allow enough time to read and watch videos in the afternoon (4-6 hours). Over time I was able to do 20Q in tutor mode in an hour because I was getting more right and could go onto the next step.
When I received around 50-60% correct I knew that I knew the material and could move on.
Downsides to this strategy:
Through only focussing on one topic at a time I would not get the practice of seeing questions mixed just like the exam.
This strategy took a LONG time because each major topic has many questions which can take almost a week to do if only doing 40 Questions a day.
I also struggled with anxiety that I had to finish all the questions on each topic which lead to me a longer time to get through them before I would move on to another material I was uncomfortable with.
Reading, podcasts, and watching videos is not active enough and is not what the exam is like so to some extent it can waste precious question time. The hour of video/reading could have been 10 UWorld questions learning it as in depth as you need.
I would try to take one practice exam every week to see my progress. Unfortunately my scores barely improved each week because I either didn’t know all the material yet and/or I hadn’t practiced in mixed timed mode.
Transition to mixed questions:
First, 40Q mixed in tutor mode.
Originally I would do 40 questions in 4 hours (1hr per 10 Q), but over time I got it down to review 40 Q in 2 hours.
Second, 40Q mixed in timed mode (1 hour). Then review the questions which took 3-4hours.
This was around the time that I just took Step1 because I passed my deadline to take it and unfortunately failed it by 1 point.
Here is a blog post on the below video on dealing with the failure and how my identity was shaped through it
At most US Medical schools you must TAKE and PASS this exam between the 2nd and 3rd year of Medical School (some schools after your 3rd year). However, every school is a bit different on their requirements, resources, and expectations.
At my US MD medical school there is an opportunity to ask for an extension of time to study for STEP. One option is using the first month of M3 Clerkships (May) as your 4 week elective. However, if you don't take it during this time, you fail, or need more time you will have to take a Leave of Absence (LOA). At my school at least 5 people did this in my class alone.
If you Fail Step 1 you have the opportunity to study and retake Step 1 again for a second time. However, each school is different on how many times they will allow you to fail before sending you in front of the Medical School Board to offer you the opportunity to take it a 3rd or 4th time before dismissal from medical school. The AAMC only allows you to retake the Step1 exam 6 times.
I hate that word, "failing." That just means you didn't score the minimum that the school or Academic Board put in place. The NBME decided that a "Pass" was a score of 196 on the STEP 1 exam and a 214 on the STEP2 exam .
If you score below that or "Fail," first YOU WILL BE OK! From my experience talking to other medical students and reading the AAMC report, at least 6% of medical students fail on their first attempt!
From the AAMC: "No, a Step 1 failure won’t doom your medical career"
"In 2017, 72% of U.S. MD applicants (including both U.S. MD seniors and prior graduates) who failed Step 1 on the first attempt went on to a residency, compared to 94% of applicants who passed on the first attempt."
"However, we know from longitudinal data that within six years after graduation from medical school, more than 99% of all graduates have records of graduate medical education training and/or are in practice in the United States."
This means that at least 6% of medical students fail Step 1, and if you keep trying and graduate you will get into residency
Requesting Accommodations
While planning on taking STEP1 Again I learned I was eligible for disability accommodations which included extra break time
Check out my blog post on Requesting Disability Accommodations in Medical School & Step1
Check out Docs with Disabilities Webinars on How to Request Disabilities Accommodations for NBME
Don't be afraid to ask for Accommodations
You have to have a documented/diagnosed disability (mental or physical health condition)
You will have to write a personal statement showing why you believe you need accommodations and use evidence from previous academic struggles
Check out my own Personal Statement for STEP2 Accommodations Here
During the Second round at studying for Step1, I knew it was time try a new strategy for studying.
Every day I did two 40Q mixed (80 Q in 2 hours) back to back with a 5-10min break in between then review (6-8hours)
Then three 40Q mixed (120Q in 2 hours) back to back with 5-10min break in between then review (9-12hours). Obviously this started to be impossible to do 120Q every day plus reviewing them so I only did this a couple times a week. However, when I did this my scores consistently improved! The days I felt most successful was when I did 80 Q in the morning back to back then reviewed them because I was not overworking myself but still got a significant amount of practice.
I did all the practice tests available and eventually had to do them all twice since I ran out of practice tests.
Analyzing Second STEP1 Failure
At this point it was 2022 and the NBME had switched to Pass/Fail
Again failed by 1 point (line was slightly to the left of the pass)
I did know they increased the required passing score by 2 points than the first time I took it from 194 to 196
Continued to work 30-40 hours a week at two different jobs to pay for rent, health care, and food
Had to go to the medical school board to ask to take it a 3rd time
YOU ARE NOT ALONE if you FAIL twice
You can overcome this struggle, match, and graduate as a doctor - I did!
Check out my Medical School Hidden Curriculum workbook which includes pages to study for STEP1, reviewing exams, and dealing with STEP Failure (example below)
Managed anxiety and external life stressors
Received accommodations of double break time
Didn't work part time nor full time
Able to continue on with 3rd year of medical school
Studied for 6 weeks in June and JulyStudied using UW Step2 using the above lessons learned Took 2 NBME Practice tests and passed both timesPracticed as if didn't have any accommodations
Studied using UW Step2 using the above lessons learned
Took 2 NBME Practice tests and passed both times
Practiced as if didn't have any accommodations
STEP 2: I thought it was WAY easier but this was because I had been using UW during all my clerkships and our end of clerkships exams were the official NBME exams
Took the Exam in July of M4 year before applying to Residency in SeptemberHad accommodations for 2x break time and 1.25 testing time
Had accommodations for 2x break time and 1.25 testing time
Received Passing score of 229 in August
The Social Determinants of Learning:
This is a great time to briefly touch on how the Social Determinants of Learning (SDOL) affect student academic success. The Social Determinants of Learning include 6 main categories: physical health, psychosocial health, physical environment, social environment, economic stability and self-motivation. When students suffer from these social and health inequities they are more likely to struggle with higher educational requirements including doing well on standardized exams (like STEP).
Read more includding the published papers by the Chamberlin University https://www.chamberlain.edu/about/social-determinants-of-learning
https://www.chamberlain.edu/social-determinants-of-learning/Primer
SODL Challenges during my STEP1 Studying:
We are all human and still have to live life while we go through medical school. Following, the world doesn't stop when are studying for the board exams. It is important to recognize when you need to slow down and take a moment to address those external stressors before going back to your educational stressors. Sometimes this means taking a day off from studying, but sometimes one must recognize when it is time to take more time off. For me it was best to take a leave of absence (LOA) between my second and third year of medical school. However, what I didn't realize was not only was I adding an additional year of my medical training, but had to deal with the financial and health consequences of taking an LOA:
Financial —> not being able to pay for food, healthcare or rent Worked 20-40 hours while also studying Stress Exasperated health challenges Emotional and relationship challenges of watching my husband & friends go through their M3 year without meUnsupportive mentors: “you should have been studying 100% of the time not working”
What Social Determinants of Learning impact your studying? Analyze yours in my Workbook
More on my medical school journey on my Podcast: "Life as a Patient-Doctor"
UWorld Affiliate get 10% Savings with Code: STEPH10
If you would like to meet with me to discuss your unique situation, develop a STEP study schedule, you can sign up for personalized coaching, advising and tutoring here.