Step 1 is arguably the most difficult from the USMLE board exam trio. Whether that is because it is the first one or because most of us loathe studying biochemistry, there is no doubt that this exam is tough and undoubtedly a mental challenge. After having navigated this minefield, here are some wise words I wish someone had told me about the journey.  


Progress is not linear

As with any rollercoaster, there will be highs and lows. There will be days where you are crushing your UWorld blocks, firing through Anki reviews and feeling on top of the world. There will also be days where you get a devastatingly low practice test score and it seems like you will never reach the end.

It is important to remember that progress will never be linear. You are not a machine and you shouldn’t expect yourself to work or progress like one. As long as you are seeing a general upwards trend, be proud of yourself. Celebrate the small wins on your journey, like the first time you beat the average question bank percentage or the time you kept going even though an NBME threw you off your game. These achievements are just as big and notable progress!
Success- step 1


One size does not fit all

If two people study in the exact same way using the exact same resources, they still would not get the same scores. No two people are the same. There is a reason they say ‘comparison is the thief of joy’. What works for one person may not work for another so there is no reason to feel demotivated if you are doing something slightly different to your friends.

Anki was a game changer for me but it isn’t for everyone. NBME practice exams were predictive within one point for most of my friends but I found the UWorld assessments to be more accurate for me. The best advice I can give to someone and I wish someone told me is to understand what kind of learner you are and stick with it. Don’t change study techniques just because someone else is doing something different.


Know when to ask for help

Having said the above, my next piece of advice is to know when to ask for help. To complete this exam successfully, you need a support system. Keep friends and mentors close so that you can ask for help when you feel lost or it seems like things are not improving. Rely on trusted people who know you and can give you genuine, honest advice about this whole process. I was lucky enough to have a sibling who has already been through this but I hope with this article I can also be that person for someone.


Put your mental health first

It is important to remember that, although this exam is a major factor for residency applications, it is not the only factor. At the end of the day, it is still an exam. This is not the be-all and end-all! 

Over the course of Step 1 preparation, make sure you are looking after yourself. Prioritise your mental and physical health. The internet is filled with self care tips on making study periods manageable. Some of my favorite things to do were taking a walk, calling a friend or simply just treating myself to a day off from studying. It is astounding how big a difference small things like this can make to your mood. 

In addition, looking after yourself and having a healthy outlet for stress will ensure your best performance on test day. Going in feeling confident makes the biggest difference – fake it ‘til you make it! 


Celebrate the end

Once you finally cross the hurdle, you must celebrate! Regardless of how your exam went, getting to the finish line is a big enough achievement to be acknowledged. 

Do not look up answers to things you were unsure about! This creates unnecessary anxiety and really, there is nothing you can do to change your score now. Instead, celebrate! Of course, you might have to scale down celebrations due to the pandemic, but now is the time you can finally binge-watch Netflix and catch up on everything you have put aside for the last few weeks. 


You don’t have to be at the top to be proud

Once the dreaded two weeks are over, score-report day comes. Fingers crossed, this is where your big celebration comes in. Seeing months of hard work and dedication paying off is the best feeling!

However, if you end up with a score you aren’t happy with, the journey still isn’t over. You don’t have to be at the top to be proud. Finishing an 8-hour exam and getting one step closer to becoming an MD is still a huge achievement. 

So again, whatever the score, celebrate the end! Be proud of yourself and continue the hard work. It will always pay off. 


Pay it forward 

Not so much advice, but my final message would be to pay it forward. Once you have taken your exam, there are probably so many things you wish you knew earlier. Maybe I have covered them in this article, maybe not. There is a lot of misinformation on the internet and often while in dedicated study mode it can feel like there is nobody who understands what you are going through. Be that person for someone else! 

While I was studying, I made a vlog every week of how I was feeling and talked about the exhaustion, nerves and motivation through my journey. It was helpful for my friends who watched it knowing everyone feels the exact same way in the weeks leading up to the exam.

These have been my most valuable pearls of wisdom I learnt over the time preparing for USMLE Step 1. These are things I wish someone told me when I was studying and I hope that now for someone else, the journey is a little easier. 


Good luck! 

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