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Studying for the USMLE Step 1: Five Big Mistakes Students Make

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There isn't one right way to study for the United States Medical Licensing Examination (USMLE) Step 1, but there are plenty of ways to go wrong when preparing for this important test. I recently took stock of my experiences helping others prepare for Step 1, and my own experience studying for the exam, to craft this list of common Step 1 mistakes—and how to avoid them.

1. Not taking time to take care of yourself.

I found preparing for Step 1 difficult not only because of the vast amount of content, but also because it becomes your only focus for months on end. Self-care often falls by the wayside, but it's actually vital to performing your best on Step 1. No amount of energy drinks or coffee will help you if you aren't getting adequate rest, so make sure to get those 7 to 8 hours a night and stop studying at least one hour before bedtime. You don't have to give up things you enjoy. Taking restorative breaks (especially to exercise, do yoga, meditate, or spend time with friends) will allow you to be more productive in the long run. It can be tempting to "reward" yourself with sugary study snacks, but you'll thank yourself later for avoiding the sugar crash and choosing healthier options (like almonds, fruit, or cheese). If your body doesn't feel good, your mind won't either. Stick to a schedule, get adequate rest, exercise, eat healthy, and take breaks doing things that you enjoy. Taking time to care for yourself will help you avoid Step 1 burnout and ultimately, you'll be far more likely to study efficiently and score higher.


2. Not learning from the practice questions you get wrong.

Does this sound familiar? You get a question wrong, the question looks easy in retrospect, and you're frustrated that you "just read this earlier." It's okay to miss a question once. The first time you get a question wrong is actually a valuable learning opportunity. Often, it's helpful to analyze _why _you got the question wrong: was it because you misread the stem, confused two things, or forgot part of a disease presentation? For my students, I recommend that they make their own flashcards based on the questions they answered incorrectly. This requires more activation energy than simply using a pre-made Anki deck that isn't tailored to your specific weaknesses. Once you get the hang of it, when you answer a question correctly, you'll find yourself saying, "I remember this from my card!"


3. Prioritizing memorization over understanding.

A big mistake I see over and over again is that students initially try to memorize facts without attempting to understand underlying principles. The types of questions that you are given on the USMLE often do not reward word-for-word recall. You must be able to put concepts together, apply different fields in tandem, and be able to manipulate information at a tertiary level. You need to be able to tie together related topics, even if they are in different sections, which is part of the reason it's a huge mistake to memorize by section. Students often try to memorize lists of information (e.g., lists of side effects or symptoms) without understanding how different aspects of a disease (e.g., symptomatology and treatment) relate to each other. Whether you are making flashcards based on UWorld questions or annotating Pathoma, try to take a second look before moving on to a new question or page. Go through the effort of making some additional notes that tie in the pharmacology (for example) with the pathology or physiology that you've already learned.


4. Not doing UWorld as timed, random blocks.

Another mistake students make is not understanding the importance of timed, random blocks. To put it simply, it's easier to do tutored, subject blocks related to the subjects that were most recently covered. We are more likely to get freshly-covered questions right, and it makes us feel good about ourselves. But this won't help you in the long run. You're really doing yourself a disservice if you never do random and timed blocks. I did UWorld exclusively this way, as did many of my co-tutors who scored above 260 on Step 1. A big part of exam day is understanding how to take the test under time pressure, and practicing under test conditions repeatedly will make you better. Blocks will not be organized by subject on test day, and practicing by subject only leads to the bad habit of relying too much on context to get a question right. It takes time to optimize your test-taking approach. In order to correctly answer random questions in a short amount of time, you need to practice—again and again.


5. Spending too much time on low-yield minutiae in First Aid.

I spent far too much time trying to memorize each and every bullet point in First Aid. I did most of this in my final week of studying, time that I felt I needed to "fill in" with cramming before my test. It's easy to fall into this trap when the fear of missing something sets in days before the exam. But the idea that you need to memorize all of First Aid to succeed on Step 1 is nothing more than a dangerous myth, perpetuated by students who excelled on Step 1, despite spending far too much time on First Aid. Several of my co-tutors scored above 260 on Step 1 by spending very little time on First Aid and focusing instead on practice questions. UWorld is tailored to teach you high yield information in a way that can be applied on test day. There are so many low yield factoids in First Aid that are unlikely to be tested. Your time is better spent trying to improve your ability to apply knowledge and answer questions strategically. In short: don't sweat the small stuff.

This article appeared previously at USMLE Pro.

Nikhil Dhall is an MS3 at the University of Missouri-Kansas City who scored a 254 on the USMLE Step 1. He tutors for Step 1 with USMLE Pro.

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