Current medical students, how would you have changed your studying if you knew you were taking a pass/fail Step 1?

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I’ll be an MS1 this year, so my step 1 will be pass/fail. My understanding of the prevailing study advice is to hit Anki from day 1 and follow along with the curriculum, supplementing with resources like Pathoma, Sketchy, etc. Do you think there’s still utility in the Anki grind in light of p/f step? How might you have changed up your studying?

I’m interested in your thoughts. I thought I knew how I was going to approach studying in medical school, but now I’m not so certain.
 
I'm an average student (like real world average, not sdn average).
I would continue grinding. Studying for step 2 right now and i can't imagine answering these questions without step 1 knowledge. You need to be able to read the stem and figure out what the diagnosis is quickly so you can spend more time thinking about answering the step 2 stuff (management). Without knowing the basics it would take me longer and i would be even more lost than i usually am. Just my $0.02.
 
I would have cut at least 1-2 hours off my 8-hour study days and would have had very little stress going into test day. Step 1 is very easy to pass. I probably would have gone through sketchy and read First Aid a couple times.
 
Average student here. I didn't really go into step 1 mode until a month before dedicated( school do subject specific nbme on most subjects of MS2 as final exam) I had a passing score since the very first step1 practice NBME. My school don't test us on random faculty research question so it helped a little. Overall I would cut one week of dedicated off. Would still use UFAP.
 
camoixu said:
Incoming student, too, and I don't plan on changing my study plans that I had before the P/F announcement. Grind for step 1 still, maybe prioritize classes a bit more since we're internally ranked.
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+1. It would suck if all the work ended up being wasted, but it's very easy to imagine them pushing the P/F date by a year or so. Remember that the announcement said "no earlier than Jan 2022." So until there's more clarity on an actual date, I'm assuming it's going to be graded.
 
wanderingorion said:
Nope, because you can't know what "study intensity/method" would be enough to pass, since we don't know what the threshold is and don't have practice tests that reliably predict your score.
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But there are like 6 pretty accurate NBME practice exams. If Step 1 were pass/fail I would probably procrastinate studying for it until dedicated. If I got a 220+ on two NBMEs I’d go ahead and take it. Don’t think I’d even finish UWorld. Part of the intention of having it pass/fail after all was so students wouldn’t be stressed out about studying.
 
xkcd6330 said:
+1. It would suck if all the work ended up being wasted, but it's very easy to imagine them pushing the P/F date by a year or so. Remember that the announcement said "no earlier than Jan 2022." So until there's more clarity on an actual date, I'm assuming it's going to be graded.
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My thoughts exactly. Wishful thinking but I hope it’s pushed back at least a year or two.
 
ace_inhibitor111 said:
But there are like 6 pretty accurate NBME practice exams. If Step 1 were pass/fail I would probably procrastinate studying for it until dedicated. If I got a 220+ on two NBMEs I’d go ahead and take it. Don’t think I’d even finish UWorld. Part of the intention of having it pass/fail after all was so students wouldn’t be stressed out about studying.
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But you are on the other side of it, knowing you passed. So your advice is not very useful. I think it’s dangerous to tell students to under prepare for an exam that’s tests their competency with medical knowledge.


Sent from my iPhone using SDN
 
If it were P/F when I was starting med school I would have gunned a hell of a lot harder for class rank. I didn't really care about cramming prof minutia to get those 95%+ exam scores, and instead hammered Zanki and did research.
 
Prehealth1011 said:
I'm an average student (like real world average, not sdn average).
I would continue grinding. Studying for step 2 right now and i can't imagine answering these questions without step 1 knowledge. You need to be able to read the stem and figure out what the diagnosis is quickly so you can spend more time thinking about answering the step 2 stuff (management). Without knowing the basics it would take me longer and i would be even more lost than i usually am. Just my $0.02.
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This is very true. I was before the anki craze but i also attribute much of my success on the wards to pathoma and costanzo. My diagnostic CK was pretty high and i imagine most people who do well on step 1 and study decently well for shelf exams end up in the same situation. Granted people will gun on CK in 2 years but ignoring the foundation that basic science material builds would be a huge mistake.
 
This is a tricky one. Reviews take up a ton of time (up to 3 hours a day) especially when you're nearing the exam. If it was just P/F, I personally don't think I would keep up with reviews. I'd probably just do cards from pathoma/sketchy along with my classes but then just dump them once the block is done, and focus more on class rank and research.
 
Would have tried a lot harder during the first two years learning small details to increase my class rank. Did more ECs. May have actually waited till dedicated to start studying
 
Would have ignored cell bio and embryo and all micro outside of sketchy. Beyond that, nothing different. If you just do Zanki and keep up with reviews you can probably pass step1 by February. Then just coast until 3rd year.

alternatively, just don’t keep up with reviews and just watch sketchy and do uworld. Still done before dedicated.

But every incoming MS1 should act like it’s scored until you know for sure it’s not.
 
Prob would've just studied 1 month before and done 1 pass of uworld. If they keep the standard the same, I'd imagine that would probably be enough to pass. Maybe 3 months out, do usmlerx or another qbank..and obviously still do well years 1 and 2.
 
AnatomyGrey12 said:
If it were P/F when I was starting med school I would have gunned a hell of a lot harder for class rank. I didn't really care about cramming prof minutia to get those 95%+ exam scores, and instead hammered Zanki and did research.
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For people going to schools with no internal ranking and P/F preclinical I'm assuming you would then say to focus on doing a lot of research. In this case would you still use zanki as the primary source for learning class material to cover bases, and then not really worry at all about class specific details?

camoixu said:
My thoughts exactly. Wishful thinking but I hope it’s pushed back at least a year or two.
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Also going into M1 with this mentality as well. I feel like a decent amount of people might be going hard on research though during the year while skating on class work. I personally don't think I could do a ton of research while keeping on top of class stuff. So in the event that Step 1 is officially P/F for us but we don't know till after M1 or even during M2 we might be at a disadvantage to the people who were doing a ton of research since M1 while not focusing on class and step1 stuff.

Ho0v-man said:
Would have ignored cell bio and embryo and all micro outside of sketchy. Beyond that, nothing different. If you just do Zanki and keep up with reviews you can probably pass step1 by February. Then just coast until 3rd year.

alternatively, just don’t keep up with reviews and just watch sketchy and do uworld. Still done before dedicated.

But every incoming MS1 should act like it’s scored until you know for sure it’s not.
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I am definitely going to act like it is scored till I know that I am not. Are you recommending to ignore cell bio and embryo because they are not high yield for Step 2?

Assuming that someone keeps up with their zanki reviews until step 1, during 3rd year and studying for the shelves and step 2 do people still keep up with the reviews for their step 1 deck in addition to their step 2 deck?
 
I’m in the fun position of not knowing whether I will take a p/f one or not because I’m an MS1 who goes to a school where we take step 1 in the spring of third year. So for now I’m just going at it like it’s scored. That said, even if I knew it was pass fail I still would. I’d hate to take it easier and then fail lol.
 
Chromium Surfer said:
For people going to schools with no internal ranking and P/F preclinical I'm assuming you would then say to focus on doing a lot of research. In this case would you still use zanki as the primary source for learning class material to cover bases, and then not really worry at all about class specific details?



Also going into M1 with this mentality as well. I feel like a decent amount of people might be going hard on research though during the year while skating on class work. I personally don't think I could do a ton of research while keeping on top of class stuff. So in the event that Step 1 is officially P/F for us but we don't know till after M1 or even during M2 we might be at a disadvantage to the people who were doing a ton of research since M1 while not focusing on class and step1 stuff.



I am definitely going to act like it is scored till I know that I am not. Are you recommending to ignore cell bio and embryo because they are not high yield for Step 2?

Assuming that someone keeps up with their zanki reviews until step 1, during 3rd year and studying for the shelves and step 2 do people still keep up with the reviews for their step 1 deck in addition to their step 2 deck?
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It’s a lot of energy to keep up with embryo and what happens when Rb is phosphorylated and and CDKs yadda yadda yadda. Tons of work for only 5-10 questions if any at all for step 1 and then it’s gone forever. You could probably beat 250 on step 1 without it anyway.
 
Whether or not USMLE is P/F, you should always strive to learn everything you can. Eventually someone's life will be in your hand. What are you going to say to your preceptors on rotations or in residency? "Oooh I didn't study hypertensives because I knew I wasn't going to fail my boards" ??? like what lol
 
Kumorebi said:
M2 who took it yesterday recommended two passes through uworld
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I'm assuming you mean your friend told you this, as your tag says class of 2024.

Ideally you should try do minimum 4500 questions. Review questions you got wrong, but I don't think you necessarily need to do two passes through the same resource - there's a variety of different ways to get those questions in. UWorld definitely helps, but there's many question banks.

Also, since you're DO, you'll want to do COMBANK and COMquest and OMM question banks too.

OMM questions are low hanging fruit for COMLEX so theyre easy questions you should get to raise your score.

You'll find soon enough that balancing board prep and class material is extremely challenging, especially for DOs who need to study for an entire other class.

I think this will be one of the only pros of a Pass/Fail USMLE for DOs in terms of stress for boards. But, many other cons I recognize.
 
KeikoTanaka said:
I'm assuming you mean your friend told you this, as your tag says class of 2024.

Ideally you should try do minimum 4500 questions. Review questions you got wrong, but I don't think you necessarily need to do two passes through the same resource - there's a variety of different ways to get those questions in. UWorld definitely helps, but there's many question banks.

Also, since you're DO, you'll want to do COMBANK and COMquest and OMM question banks too.

OMM questions are low hanging fruit for COMLEX so theyre easy questions you should get to raise your score.

You'll find soon enough that balancing board prep and class material is extremely challenging, especially for DOs who need to study for an entire other class.

I think this will be one of the only pros of a Pass/Fail USMLE for DOs in terms of stress for boards. But, many other cons I recognize.
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Yeah it was from a friend. Said he didn't like flashcards but more people in his class use anki than don't. He also recommended sketchy for micro, like a lot of people do. Thanks for the advice.
 
I wouldn't have changed much. My M1 year would have been exactly the same as it was a fairly intense and detailed curriculum with tons of anatomy and physiology that you would certainly fail trying to just learn First Aid and Pathoma. As for M2 year I think the only change would be when I started phasing out school material and focusing only on Step 1 material. As is, in January or so I made the transition to basically studying only out of the Step 1 review material and using school material as a supplement as-needed. I would prepare with the same intensity during dedicated because the consequences of failing Step 1 are more or less the end of your medical career so I would take it just as seriously.

For all the issues that this change poses, of which there are many, I maintain that this obsession with Step 1 was rotting medical education from the inside out and something needed to be done about it. It started to become completely ridiculous during my year (M4) and the few preceding it, and then it totally spiraled out of control with the next two years. I might be in the minority on this but I didn't come to medical school so that I could pay obscene amounts of money on an education just to devote the absolute bare minimum to it while developing my own parallel "curriculum" where you're expected to spend two years memorizing a review book.
 
For me, medical school is a means to an end: a successful match in my field of choice. May sound callous and shortsighted, but that's my reality. If we were free to match into whatever specialty we wanted, then I might be singing a different tune.

Anything that gets in the way of that is enemy number one (administrators) and is getting shoved to the side, aggressively. I'm not shoving administrators, but you get the point.

As far as the question, I'd probably do the same thing I'm doing now or run a step 2 deck concurrently with a lighter step 1 deck.
 
Another option is to run the smaller step 1 deck at a faster pace, finishing in under a year, do the step 2 deck, keep up with reviews for both, and then do UWorld in the months leading up to step 1 and then do UWorld for step 2 during rotations. Then you'd supplement with Amboss and other high yield step 2/clinical resources (Dr Ryan, we await your BnB step 2 edition!).

I think seeing both decks one after the other would be synergistic because you'd be seeing the clinical side of the pathophys and vice versa all before you reach clinicals.
 
250+ step 1, did all of Rx between first and second year and made my own anki decks I was studying hard from, so definitely poured a lot into step 1 before dedicated. I think this helped me a lot in third year because I felt like I had a better base than most going in and was more prepared for shelves.

Realistically though if I knew it was P/F I wouldn’t have gone near that crazy. Don’t get me wrong, just passing step 1 is not easy, but I would have just studied hard for the classes, probably used Pathoma and FA just to review high yield points for my exams, then gone through UWorld only during dedicated. Very confident I’d easily pass doing that. Unfortunately this would have also left me with less of a solid foundation for step 2CK (scored a 265+ with 4 weeks of dedicated) and that exam is likely to carry the weight for you that step 1 did for me.
 
This is all great, thank you so much. I really appreciate your perspectives so far.

To all those who raised this (exceedingly relevant and good) point: Yes, the fact that the USMLE used the “no earlier than January 2022” step 1 p/f implementation language gives me a lot of pause too. I feel like this is a change that could very easily/casually get pushed out a year or two. Then it’s like, “SURPRISE!!! The 2024 cohort are actually getting scores after all! Hope you were grinding from day one of orientation!”

I guess I’m just still trying to read the tea leaves (as we all are, I know), and you guys are a big help.
 
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Good luck with it, I think the fact that you’re being conscious of the issue now is a good sign that you’ll do fine even if it does wind up being scored. I have a lot of sympathy for you guys in these incoming classes. I think the changes to step 1 were very poorly thought through, and you’ll unfortunately be catching the effects of that. On the plus side, you’ll all be going through it together and things will work themselves out. It sounds cliche, but having a good foundation like you get from step 1 is actually important to taking care of our patients in the future. You won’t ever need every gritty detail but the foundation you get from studying hard for that exam makes you better able to care for people later, so if nothing else I hope you can all fall back on that for some motivation in the midst of all the uncertainty that is likely to come up.

...and above all else, congratulations on being accepted to med school. You really have passed the biggest hurdle to becoming a doctor already.
 
bananafish94 said:
For all the issues that this change poses, of which there are many, I maintain that this obsession with Step 1 was rotting medical education from the inside out and something needed to be done about it. It started to become completely ridiculous during my year (M4) and the few preceding it, and then it totally spiraled out of control with the next two years. I might be in the minority on this but I didn't come to medical school so that I could pay obscene amounts of money on an education just to devote the absolute bare minimum to it while developing my own parallel "curriculum" where you're expected to spend two years memorizing a review book.
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I really appreciate this. Prior to the pass/fail announcement, I was describing the importance of Step 1 to my husband and the strategies students use to get high scores. He was like, “Let me get this straight. So you’re telling me that for the first 2 years of medical school, you don’t really attend the classes you’re paying for or engage with the material, and you instead sit at home on your computer doing flash cards you downloaded for free on Reddit.” I was like “Well.... that seems to be what’s recommended, yes.” It really does seem absurd if you think about it.

I’m definitely not happy about the step 1 change, but I do think a small silver lining is that I’ll get more out of the $150,000 or so that I’m spending on my preclinical medical education. I’m excited that I’ll (apparently) have a little more bandwidth to focus on class material, ECs, and research, things which I enjoy and I’m, you know, paying a life-altering amount of money for.
 
I don't think I would have changed much of how I studied. Partly because my school has some pre-clinical classes as H/P/F and partly because I feel uncomfortable if I'm not comfortable with the material. After going through clerkships, I felt like most pimp questions could be answered with a good pre-clinical foundation. Of course, there are going to be a decent amount of clinically oriented questions, but I was surprised by how many pre-clinical questions I was asked. Some of the best attendings I worked with loved the nitty-gritty basic science/anatomy/physiology concepts and asked me about those for my patients. So in a way, a good foundation is also a way to impress during clerkships IMO.
 
JanetSnakehole said:
I’ll be an MS1 this year, so my step 1 will be pass/fail. My understanding of the prevailing study advice is to hit Anki from day 1 and follow along with the curriculum, supplementing with resources like Pathoma, Sketchy, etc. Do you think there’s still utility in the Anki grind in light of p/f step? How might you have changed up your studying?

I’m interested in your thoughts. I thought I knew how I was going to approach studying in medical school, but now I’m not so certain.
Click to expand...

Anki is by far the most efficient way to study and resources like Pathoma are just overall better structured lectures for you to learn from than what the average med school prof can do. Doing these things right off the bat is not only going to help get you started for step, but also help you do well in your courses. You have nothing to lose and everything to gain by using these. When I finally saw the Pathoma light, my only regret was not starting earlier because it was so much easier to follow and understand than some of my profs.
 
(No longer a med student)

Would have memorized in-house materials like I did anyway and stuck to UWorld and FA.

Would have learned less and partied more.
 
Having just taken by boards...I would have literally done the same thing I did first two years. Worked hard in classes, did sketchy micro and pharm, and did UW first pass throughout second year. With this i could have taken it right after I finished second year. Probably would have focused on research and volunteering more as well.
 
Would have done the absolute minimum in every facet of medical school and resigned myself to matching at some community IM program. Without the great equalizer that is Step I, there is absolutely zero point to gun hard if you're from a lower tier MD school like I am. Literally thousands of hours of your life and unnecessary stress, wasted. Would have just hit the gym more, hiked more, and substituted the historical non-fiction of my choice for anki and PPs.
 
Money-Moniker said:
Would have done the absolute minimum in every facet of medical school and resigned myself to matching at some community IM program. Without the great equalizer that is Step I, there is absolutely zero point to gun hard if you're from a lower tier MD school like I am. Literally thousands of hours of your life and unnecessary stress, wasted. Would have just hit the gym more, hiked more, and substituted the historical non-fiction of my choice for anki and PPs.
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Do you think gunning for step 1 helped you in any way with step 2? Also, was any of it beneficial in terms of your overall medical education?
 
I don't think the strategy changes. I've always been a fan of the study the class material with the understanding that you are learning the fundamentals well - and that you can deal with the minutiae later. The minute details you can Anki starting now or later on in your first year but it's essential to learn the fundamentals because without them, everything just seems like a patchwork of disconnected parts. Really understanding physiology - a prime example is how the nephron works - will help you understand everything after it, from pathophys (AKIs) to pharm (ACEi's, NSAIDs).

Regarding Step 1 - a note of caution - I would not go into this assuming that your Step 1 is P/F. The NBME stated that the "earliest" date that it would change is in 2022. That doesn't mean that it will change in 2022. If it does, then great, you've learned the fundamentals. If it doesn't, you're still prepared for it. And you'll have prepared yourself splendidly for the clinical years that follow.
 
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