How to balance Step 1 prep and rotations?

[Goljan90210]

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To start off, board prep was an absolute disaster at my COM this year. We were given 4 weeks of dedicated study period in May but had about 7-10 days of required on-campus BS during this same period. Although I had planned (and scheduled) to take both Step 1 and Level 1, about 2 weeks into dedicated, I realized that a thorough and complete prep for Step 1 in the allocated time was futile and cancelled my Step 1. I spend the last 2 weeks going through COMBANK, Sketchy, and Pathoma, which served me well on the COMLEX. I don't have my score on Level 1 yet but I thought the exam went very well.

The problem is I am interested in applying to ACGME programs in a moderately-competitive specialty, and, due to my wife's work, am picky about location. I need to prep for and take Step 1 while on rotations but am having a really hard time finding advice from upperclassmen and even SDN. I don't really have any idea on how much time to dedicate (considering I'm on rotation until 4-5 PM M-F), how to organize a study schedule, or even when to schedule the beast. Luckily, my next two rotations are in IM which I hope will help with the exam. Any advice or guidance on how to proceed? Do you know any classmates that were in a similar situation? Thanks!

EDIT: I've done about 300 UWorld Qs and the UWorld Self Assessment #2 which estimated my score at 220 (this was done a week after my COMLEX, right before I started my current rotation). Aiming for a 230+ and want to get this done in 2-2.5 months.

 

[JamesPotterMS-3]

Come home, rest, do 2 blocks of UWorld, review, browse through FA/Pathoma/Sketchy. Take 1 NBME every Sat or Sun. You'll be ready in 2 months. Only problem I see is fatigue. It's going to be hard to sit down and do UWorld after working in an IM clinic for 6-8 hours.

 

[ortnakas]

Take an NBME and figure out what your baseline is before you decide how to tackle this or if it’s even feasible.

 

[Goljan90210]

Take an NBME and figure out what your baseline is before you decide how to tackle this or if it’s even feasible.

Can I ask what would make this unfeasible? I'm not too far out from the COMLEX and I have the motivation/drive to buckle down and prep for this. Like I said, I'm interested in a moderately competitive specialty and I really want to rock this. I'm assuming this has been done before? Of DO students taking Step 1 after Level 1 during rotations?

 

[Oh_Gee]

Can I ask what would make this unfeasible? I'm not too far out from the COMLEX and I have the motivation/drive to buckle down and prep for this. Like I said, I'm interested in a moderately competitive specialty and I really want to rock this. I'm assuming this has been done before? Of DO students taking Step 1 after Level 1 during rotations?

i've heard of it being done. make sure to post on reddit also to get as much info as possible

 

[smukke]

I know some people who took step 1 towards the end of 3rd year, either by lining up a some easy rotations and a few weeks of vacation or bundling it in with whatever dedicated time + vacation time they had for level 2. A lot of it depends on when you have vacation, "easy" rotations, rotations that can substitute as dedicated time (ie research; spend every other day on board study if it's a project you can do from home), dedicated time off for level 2, etc. I will say that there is a fair amount of overlap between level 2 and level 1/step 1 that after studying for shelfs/level 2 a good number of step 1 questions seem like easy points (and a fair number will be of the "wtf do I care about the mechanism if I know the effect...I guess I have to go memorize it...FML...")

Also consider discussing your plans from the residents/interns on your rotations. Some won't care, some will be dicks. But there are some who still remember what it was like and want to see you succeed, and can be flexible about you "disappearing" for a couple of hours to "follow up" on a patient as long as you don't cause more headaches. But be careful who you tell because like I said some will be dicks about it.

 

[AlbinoHawk DO]

How do you plan on surviving your shelf exams and doing well on the rotation? I can't imagine anyone doing IM, surgery or OB with a strong performance while also trying to increase their step 1 by 10 points coming from dedicated.

I would recommend studying for step 1 alongside step 2 and taking both tests close to each other after third year. I would find a way to schedule 2 easy rotations and a study month toward the end of 3rd. Might need to compromise on electives

 

[Goljan90210]

But be careful who you tell because like I said some will be dicks about it.

Yeah...my fellow classmates have all already told me I should give up (despite none of them having only taken COMLEX) and they give the whole "residency programs accept the COMLEX because of the merger" bs.

How do you plan on surviving your shelf exams and doing well on the rotation?

My current rotation (geriatric medicine) and my August rotation don't have a shelf, which is why I'm hoping to get this done sooner rather than later. Another reason why I'm hoping to get this done sooner is because most of Step 1 stuff is still fresh in my mind because I already took Level 1 ~3 weeks ago.

 

[AlbinoHawk DO]

My current rotation (geriatric medicine) and my August rotation don't have a shelf, which is why I'm hoping to get this done sooner rather than later. Another reason why I'm hoping to get this done sooner is because most of Step 1 stuff is still fresh in my mind because I already took Level 1 ~3 weeks ago.

Then I say schedule the test. Work hard and crazy for step 1 even if it means just getting "pass" on your first 2 useless rotations and take a practice test a week before. If you're hitting your goal, go for it. If not, definitely consider the delay or accept a 210-220 range test and move on. It'll be a lot easier to have a USMLE than not

If the preceptor is nice, ask if you can bring your tablet to do flashcards to study on down time. I did this for level/step 2

 

[PlasticBag]

I did something similar last year. Took the COMLEX end of 2nd year, then had one easy rotation that didn’t involve much shelf studying, and a vacation. Took Step 1 at the end of vacation. It was definitely the right thing for me (except for not having any real vacation for the next year, that part sucked).

However, some friends who had a tougher schedule (IM, OB/gyn) at the beginning had to keep postponing the test because it was just too hard to be at the hospital/clinic all day, study for the shelf, and on top of that study for step 1. And don’t think it’s just shelf studying - you generally need to study for each rotation so you don’t look stupid and get a bad eval.

 

[Drrrrrr. Celty]

Come home, rest, do 2 blocks of UWorld, review, browse through FA/Pathoma/Sketchy. Take 1 NBME every Sat or Sun. You'll be ready in 2 months. Only problem I see is fatigue. It's going to be hard to sit down and do UWorld after working in an IM clinic for 6-8 hours.

Doing 2 blocks takes 2 hours just by itself. Reviewing, and I mean doing it in the legitimate way will take 4. Going through multiple chapters in FA/Pathoma/Sketchy in a way that actually gets things in your head and relates it to step is by itself something that will take the whole evening.

He should take a practice NBME. If he's above a 210 then maybe this plan might work.

 

[Goljan90210]

Then I say schedule the test. Work hard and crazy for step 1 even if it means just getting "pass" on your first 2 useless rotations and take a practice test a week before. If you're hitting your goal, go for it. If not, definitely consider the delay or accept a 210-220 range test and move on. It'll be a lot easier to have a USMLE than not

Thanks; that's the plan.

I did something similar last year. Took the COMLEX end of 2nd year, then had one easy rotation that didn’t involve much shelf studying, and a vacation. Took Step 1 at the end of vacation. It was definitely the right thing for me (except for not having any real vacation for the next year, that part sucked).

Nice!! Good to hear I'm not the only one trying to do this! Glad to hear it worked out for you.

 

[MedicineN'Jazz]

Good luck Goljan90210!! It freaking sucks that you have to take both COMLEX and Step. I know it’s not “absolutely necessary,” but if we’re going to be honest...

Hopefully with the new merger, we’ll be finally able to agree on one freaking test. Although, I doubt it 🙁

 

[Goro]

To start off, board prep was an absolute disaster at my COM this year. We were given 4 weeks of dedicated study period in May but had about 7-10 days of required on-campus BS during this same period. Although I had planned (and scheduled) to take both Step 1 and Level 1, about 2 weeks into dedicated, I realized that a thorough and complete prep for Step 1 in the allocated time was futile and cancelled my Step 1. I spend the last 2 weeks going through COMBANK, Sketchy, and Pathoma, which served me well on the COMLEX. I don't have my score on Level 1 yet but I thought the exam went very well.

The problem is I am interested in applying to ACGME programs in a moderately-competitive specialty, and, due to my wife's work, am picky about location. I need to prep for and take Step 1 while on rotations but am having a really hard time finding advice from upperclassmen and even SDN. I don't really have any idea on how much time to dedicate (considering I'm on rotation until 4-5 PM M-F), how to organize a study schedule, or even when to schedule the beast. Luckily, my next two rotations are in IM which I hope will help with the exam. Any advice or guidance on how to proceed? Do you know any classmates that were in a similar situation? Thanks!

EDIT: I've done about 300 UWorld Qs and the UWorld Self Assessment #2 which estimated my score at 220 (this was done a week after my COMLEX, right before I started my current rotation). Aiming for a 230+ and want to get this done in 2-2.5 months.

Can you take an elective and use that for Step I study time?

 

[Mel_Saye]

To start off, board prep was an absolute disaster at my COM this year. We were given 4 weeks of dedicated study period in May but had about 7-10 days of required on-campus BS during this same period. Although I had planned (and scheduled) to take both Step 1 and Level 1, about 2 weeks into dedicated, I realized that a thorough and complete prep for Step 1 in the allocated time was futile and cancelled my Step 1. I spend the last 2 weeks going through COMBANK, Sketchy, and Pathoma, which served me well on the COMLEX. I don't have my score on Level 1 yet but I thought the exam went very well.

The problem is I am interested in applying to ACGME programs in a moderately-competitive specialty, and, due to my wife's work, am picky about location. I need to prep for and take Step 1 while on rotations but am having a really hard time finding advice from upperclassmen and even SDN. I don't really have any idea on how much time to dedicate (considering I'm on rotation until 4-5 PM M-F), how to organize a study schedule, or even when to schedule the beast. Luckily, my next two rotations are in IM which I hope will help with the exam. Any advice or guidance on how to proceed? Do you know any classmates that were in a similar situation? Thanks!

EDIT: I've done about 300 UWorld Qs and the UWorld Self Assessment #2 which estimated my score at 220 (this was done a week after my COMLEX, right before I started my current rotation). Aiming for a 230+ and want to get this done in 2-2.5 months.

I know it's literally a year later, but I made this account to ask how this worked for you. I'm in the same position and not sure what to do. I start off with 2 FM rotations and am planning to take Step 1 between the two. My test date was originally in 5 days, however, I was ~15 points from my goal, so I postponed until Aug 2 (wanted to take it first week of July but something came up.) So what I'm trying to get at was did studying during rotations work for you and was it worth it? Thank you in advance!! Hope you killed both exams!!

 

[Spectreman]

I know it's literally a year later, but I made this account to ask how this worked for you. I'm in the same position and not sure what to do. I start off with 2 FM rotations and am planning to take Step 1 between the two. My test date was originally in 5 days, however, I was ~15 points from my goal, so I postponed until Aug 2 (wanted to take it first week of July but something came up.) So what I'm trying to get at was did studying during rotations work for you and was it worth it? Thank you in advance!! Hope you killed both exams!!

I’m also in the exact same boat, just got a 211 on NBME 24 and rescheduled for end of my Geriatrics rotation so I’ll take it in Aug 30. I’m on retain mode with Anki for big chunks of material, still have some stuff to get through and am only 65% through Uworld first pass with a 65% avg and currently hitting high 70’s to low 80’s on most blocks. Point is I feel like I can mostly worry about filling in first year material + biostats junk and work on my testing skills till end of Aug. very nervous about doing this, but I hate the idea of throwing in the towel on this. My 4 blocks on 24 were 70/76/74/54 -> one super bad block dropping me way down makes me think I’m not a lost cause here.

 

[UnoMas]

Took Step 1 at the end of 3rd year/beginning of 4th year, did very well.

My advice is to put that **** on hold and study hard for your shelf exams/rotations. Know your IM/OB/Peds/Psy etc. cold. Schedule your 3rd year vacation at the end of 3rd year, 4th year rotation at the beginning or use your Level 2 time off to study for Step 1, that way you will have 4-8 weeks of dedicated again. Your clinical knowledge will serve you very very well on Step 1. Step 1 has so many clinical freebies. Relearning Biochem, Immuno, Micro again at the end of 3rd year will be painful but it will be worth it. If you study hard during 3rd year, you will need 2 weeks top to study for Level 2/ Step 2. If you need more time you can still take it later.

Studying for Step 1 during 3rd year while on rotation is counterproductive IMO.

The downside of my recommendation is you won't have a Step 1 score to put on VSAS if you plan to apply to audition rotations.

This is exactly what I did. My NBME at the end of 2nd year was in the 220s. At the end of 3rd year, I spent a week rewatching Pathoma and skimmed through the Basic Science section in FA, took an NBME scored a 238. My real score is in the 250s, I attribute my good score to doing well 3rd year and I am a very very average student


Edit: WAS a student. I graduated but I still refer to myself as a medical student all the time lol

 

[UnoMas]

IMO if you are going to take it late might as well wait until you finished your clinical stuff. Taking after haphazardly studying for it during rotations is not a good way to go.

 

[Neopolymath]

Took Step 1 at the end of 3rd year/beginning of 4th year, did very well.

My advice is to put that **** on hold and study hard for your shelf exams/rotations. Know your IM/OB/Peds/Psy etc. cold. Schedule your 3rd year vacation at the end of 3rd year, 4th year rotation at the beginning or use your Level 2 time off to study for Step 1, that way you will have 4-8 weeks of dedicated again. Your clinical knowledge will serve you very very well on Step 1. Step 1 has so many clinical freebies. Relearning Biochem, Immuno, Micro again at the end of 3rd year will be painful but it will be worth it. If you study hard during 3rd year, you will need 2 weeks top to study for Level 2/ Step 2. If you need more time you can still take it later.

Studying for Step 1 during 3rd year while on rotation is counterproductive IMO.

The downside of my recommendation is you won't have a Step 1 score to put on VSAS if you plan to apply to audition rotations.

This is exactly what I did. My NBME at the end of 2nd year was in the 220s. At the end of 3rd year, I spent a week rewatching Pathoma and skimmed through the Basic Science section in FA, took an NBME scored a 238. My real score is in the 250s, I attribute my good score to doing well 3rd year and I am a very very average student


Edit: WAS a student. I graduated but I still refer to myself as a medical student all time lol

Not in this position but I can agree that I picked up a ton of UWorld questions just from having previous experience. Being able to work backwards makes the questions easier too because most questions come from some real scenario be it an anatomy question inspired by a procedure or drug physiology. A lot of the "researchers doing x y z discuss this graph" questions are just camouflaged real life I can imagine third year is even better in that regard.

 

[MedicineN'Jazz]

Not in this position but I can agree that I picked up a ton of UWorld questions just from having previous experience. Being able to work backwards makes the questions easier too because most questions come from some real scenario be it an anatomy question inspired by a procedure or drug physiology. A lot of the "researchers doing x y z discuss this graph" questions are just camouflaged real life I can imagine third year is even better in that regard.

For someone who’s not able to take Step before third year (as in literally you can’t advance unless you’ve passed), what would you recommend for us to do? Frankly I feel like I’m drowning. But I saw on reddit about something about watching Emma Holliday’s internal medicine video helped a lot of people to honor shelf. Do you think that’d be enough to fill in clinical vignettes for the exam?

 

[oto8484]

IMO if you are going to take it late might as well wait until you finished your clinical stuff. Taking after haphazardly studying for it during rotations is not a good way to go.

@UnoMas was your highest score a 238 on a practice exam and you ended up in the 250s? Also did you take Step 2 right after Step 1?

 

[UnoMas]

@UnoMas was your highest score a 238 on a practice exam and you ended up in the 250s? Also did you take Step 2 right after Step 1?

No, highest was low 250s on UW2. 2 weeks after yes