well thats why i think law2doc said, to study smarter, because studying harder won't achieve anything to that effect, no matter how motivated one is. If the reason why you're not performing to the level you want to be at is because of slacking, then sure, study harder. But odds are, you are already busting your ass studying harder or smarter. But no matter how more "motivated" you are, you're in a class full of Type-A personalities, where p=md is not enough. So though you might be more motivated, you're still running with the equally motivated big fishes. What i think the OP should worry about, or rather focus his or her creative energies into, is finding ways to begin to prepare for step 1. Granted it might be early to prepare that much in advance, but doing things such as making notecards to use later on, to save yourself time, or budgeting money for a Kaplan class for STEP1 are more productive ways to spend his or her time than to gear his or her energy budget into what he or she thinks is the best plan for a derm career. Do your best. And bust your ass doing it. Theres nothing else you can do (unless you resort to cheating lol) that will greatly augment what you havnt been doing already, or that you don't already know yourself.