Definitely true, and I will admit that the main flaw in this approach is that I am definitely missing out on material that, though perhaps not required for step 1 studying, would no doubt be helpful to have. That's part of the sacrifice I've made. However, based on discussions with older students I don't see this as having much of an effect; it will be learned on the wards anyway, though I might be a little clueless initially compared to those that did learn and memorize all this stuff.
It comes down to priorities and what's important. For me, it was important that I don't kill myself during the pre-clinical years with work and studying. I wanted to have a life, and I refused to let school define how I spend my time or really anything. Many people take the opposite approach - school is the ONLY thing they're focused on, and all else is secondary. And of course many/most folks lie somewhere in between. I found that 1) not attending class and 2) studying the "boards relevant" material gave me a happy mix of doing well enough on in-class exams, building a reasonable knowledge base for step 1 and the wards, and having lots of free time to do with whatever I want. No, I'm not going to be at the top or even near the top of my class, but that's something that I've had to come to accept because of what is more important than that (to me).
As far as what's important/not, you're right, that's a tough call to make. My approach has been that whatever I will be exposed to on the wards and in residency is what is important. This attitude was built on many discussions that I've had with MS3s/MS4s, residents, and even some attendings and their responses on hearing what we were studying (90% of the time it was, "wow, I don't remember any of that" - at least for the M1 material).
I guess that's a good point to make, which is that this applies mostly to the classic M1 material - all of the basic sciences excluding path and pathophys. I 100% agree that all of the details, etc. are critical to the classic M2 material because those details are necessary to distinguish many different disease processes. However, I find it extremely hard to believe that knowing all of the intricacies of the PPP pathway or which cyclin/CDK complexes cause progression in the various points of the cell cycle are even remotely relevant to most practices of medicine.
As the saying goes, "everything is important, but some things are more important than others." I focus on the things that are more important than others, with the understanding that what is "more important" will constantly change as my role and responsibilities change with the level of my training.
