How NOT to Take Step 1

By Jocelyn Compton

test anxietyI’d scoured the internet for every last dribble of advice for Step 1 test day. I’d even read some blog posts about MCAT test day mixed in with Step 2 test experiences. I thought about braving the subway versus taking a cab to the test site, a pump-up play list, hydration, food, wearing lucky scrubs, and timing out my blocks perfectly to optimize the adrenaline surge I knew I’d nurse through the seven hour test.

I had anticipated everything. Or so I thought…

About 150 hours before my exam, I knew I had a problem. My study plan had been to generate thousands of flash cards and cram them all in the final week. For the record, this is not a good idea for Step 1. Looking around my apartment, I realized there was no way I would get through the piles and piles and piles of neatly stacked notecards. Anxiety gripped my brain. I was paralyzed.

100 hours before the exam, I got myself together. I tore through flashcards. At t minus 50 hours, I knew I wouldn’t be sleeping before the 8 AM start of the exam. This was also not the best idea I’ve had in my academic career, but I was committed at this point.

But another, more pressing problem had been brewing. The day after Step 1, I’d planned a grand trip to Costa Rica and started taking malaria prophylaxis the week leading up to the trip. What is the major side effect of mefloquinolone? Gastrointestinal distress. GI distress is certainly distressing. Every 40-45 minutes, I was running to the bathroom to eliminate what little matter was in my bowels. I couldn’t make it through a single question block. I was shackled to the toilet. What could I do? Who could help me with this personal problem?

I called my mother for advice. She counseled me thusly: “You already paid for the exam and for your trip. You can’t stop taking the pills, you can’t move your exam, and you can’t cancel your trip. Put on your big girl pants, buy a bag of Depends, grit your teeth and bear it.” Diapers. Could my situation count as a testing anomaly? Could they kick me out of the test site if I continued to experience full force GI distress? These, and many other questions ran through my mind. Throughout the night, flash cards flew as my exam approached.

I made it to the test site 45 minutes early, the last pile of flash cards in hand, haggard, tired, anxious, and dehydrated. Halfway through the exam, my calf cramped… which I, of course, assumed was a DVT. My plans for taking breaks were totally out the window. However, I am proud to report that, in a show of stunning bowel control that I think I learned on my surgery rotation, I did not need any unauthorized breaks or get marked for testing anomalies. Whew.

So, even the best laid plans often go awry. It’s doubtful that your test day will go this painfully, but be ready to change your strategy and adapt to your testing situation. You never know what the universe will throw at you.



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