Surviving Step 1: Approach to Preparation

By Walter Wiggins

Recently, Luke Murray wrote the first post in his series “Med School Done Right,” which is all about maximizing your experience in medical school based on your broader goals and aspirations. One of the key tenets to his approach to med school is determining what you want to get out of each individual experience in your training and why that will help you achieve your broader goals. When it comes time to start thinking about your approach to preparing for the USMLE Step 1 (or COMLEX Level 1), I recommend you consider these two questions:

1. What do you want to get out of Step 1?
2. Why will that help you achieve your broader goals?

Let’s assume for a minute that you’re not too far into your 2^nd year in med school. Now, think back over 1^st year and maybe the initial part of 2^nd year and try to assess how well you’ve done so far. Are you at the top of your class? Are you at the bottom? How does where you are compare with where you want to be…or, perhaps more reasonable, where you think you should be? Even if you’ve been graded on a “Pass/Fail” scheme, you should still be able to get a feel of how well you’ve performed on your assessments/exams.

Your school should have information on previous classes’ performance on Step 1 available for you. Check out the results from the most recent class or two. Using what you’ve discovered about your own performance from the previous exercise, try to estimate where you’d fall on the curve and the score you’d receive if that were the case. Would you be happy with that score? If you have a good idea of which specialty you might choose for residency, would that score be sufficient for you to match somewhere? If you aren’t sure what you’d like to do, would a score like that leave your options sufficiently open?

These are the types of questions that should guide the “what” and the “why” of your Step 1 preparation. The exercises above, or a similar approach, can help you prepare mentally for the task ahead. In the coming months, you’ll need to decide on which resources to use, study schedules, and routines for your dedicated Step 1 study period. Knowing whether you’ll need to maintain your current level of performance or, to quote chef Emeril Lagasse, “kick it up a notch” can make all the difference in determining your level of investment (mentally, physically and financially) in the process.

Do you have a way to approach preparing for Step 1 that you’d like to share? Post it below!