By Richard A. Giovane, M.D.
Whether it is today or months down the road, everyone preparing to take the Step 1 board exam will one day wake up and realize that the test is only 2 weeks away! And, trust me, you need to be ready to handle the tidal wave of panic that accompanies this critical med student moment.
I remember finishing my second year of medical school, packing up all of my books and clothes, and moving back home with my parents with a good friend of mine to tackle Step 1 during a very frigid Canadian winter. The days were long, the information felt endless, and the stress of the big day kept creeping up on us ever so slowly.
The days played out with a consistent rhythm:
- Up at 6am
- Breakfast at my place with my Nonna (grandmother in Italian) who would make sure we ate a lot to “survive the winter” (I really wish I was kidding, but she grew up in the Great Depression, so she has a different mentality)
- Off to the library from 7:30am to 7pm, with breaks in between for lunch, snacks, and coffee breaks
- Return home and eat with my folks, who would ask us what we were studying and offer words of encouragement.
My friend and I would continue this routine until test day. We never broke our study schedule, however daunting it was. We did find solace in the fact that if we didn’t understand something that day, we could “always come back to it later.” Eventually, the calendar betrays you and this strategy breaks down. When you pull out your notes and review books during those last few weeks, it hits you like a ton of bricks and you will say to yourself, “This is the LAST time I am looking at this material before the test.” An intense panic settles in as your “buffer” days begin to evaporate.
But you are committed to this mission, so you continue your review anyway. As you skim your notes, you may even realize you forgot some material and you tell yourself, “If I didn’t remember it last time, how am I going to remember it this time?” You will often be caught muttering, “I hope this isn’t on the test.” You tell yourself not to panic—and you shouldn’t—but as a medical student, you panic anyway because it’s second nature! You then realize that the sense of panic can be leveraged as a means of motivation, and may be just what you need to finish this marathon after studying for so long and getting burned out. So you use it to your advantage…and all goes according to plan.
When I was studying for the Step 1, my dad asked me, in his thick Italian accent, why my friend and I were “always talking about the Uworld, carrying that yellow, red, and blue book stuffed with paper, and making plans to do more questions.” I told him that studying for this test is like studying a chess master (although my dad prefers checkers): you are learning the openers, the counters, the traps, and how things will be asked. You know the material but are preparing for how it will be presented to you.
As the test gets closer, don’t get discouraged when you have bad days. You will have bad days. It is simply a part of the process. To fight the bad days—and even keep sane during the entire process of studying for this test of tests—I recommend the following:
- Take “active” breaks. By “active” I mean do something that will engage your brain so that you are focused on it only and not thinking about step 1 concepts or that tricky practice question you got wrong yesterday. I am sure you will find what works best for you for how to take breaks and de-stress, whether it is yoga, going out to eat, or spending time with friends. I found solace in lifting weights at the gym; it was a great stress relief. Plus, having a classic Italian diet of pizza, pasta, and prosciutto while living at home led to packing on more pounds than I wanted, so it was a much-needed active break.
- Second, believe it or not, video games helped me de-stress. While in the moment of playing them, I wasn’t concerned about Frank-Starling curves or the pharyngeal pouch derivatives. I was strictly focused on my KDA, CS and rank in League of legends (don’t worry if you don’t know what any of this gamer talk means).
You might ask yourself, “What should I do the day before the test?” The answer is simple: just relax. Maybe, if you must, look over something light in the morning, but set a boundary for yourself. After lunch, look at nothing USMLE-related. Catch a movie, go out on a date, spend time with your family, just keep your mind off of it. At this point, you have done all you can do; you would never run a full marathon the day before the actual race…the same principle applies here! Trust in yourself and trust that the preparation you have done will get you where you need to go!
About the author: Richard Giovane is a current PGY-3 in Family Medicine at the University of Alabama, at Tuscaloosa (Roll Tide!). He was born in Canada but has an Italian background, and yes, he does talk with his hands a lot and has difficulty grasping the concept of the volume of his voice! He enjoys reading, writing, playing video games, and has a strong passion for medical education. He is currently the Senior Editor for Step 1 Qmax and has served as an author for several First Aid books.