Step 1 in 2 Months I don't know anything O_O

[Shjanzey]

NOTE: I know this is non-trad "premed", but I consider it just non-trad. I value the advice in this section of the forum mainly because we have all lived life and people generally have a more well-rounded advice to give.

We are coming into boards and I feel like I have forgotten everything. I want to get 240+, but at this point I don't think that is even possible. Any other non-trads having already walked through this have any advice?

I am currently ignoring my courses to focus on board prep and I still feel like it isn't enough. There are just so many tiny details I can't remember. To make it worse we had a practice step in January. I hit the class average, which was below my goal, and some other student dropped a 250, in January. How is that even possible?

I am scared that I don't have enough time to do decent on this exam. I am killing myself to have a general total review done by dedicated study time so I can just do qbanks until I take the exam. So those of you further along...in hindsight what would you have done different going into Step?

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[New_Slang]

Okay breathe and stop comparing yourself to others. I am not in the same shoes as you so I can't offer Step specific advice, but you are more than capable. You did NOT forget everything, you are simply too worked up to remember the details. Breathe, exercise, and take it one day at a time. Do you have a good schedule set up? Do you have a dean/advisor you can talk to about revising your study schedule to cover your weaker areas?

So what if someone got a 250? There will always be that person - a bell curve is a bell curve and there's always people at the top and people at the bottom. You are likely not thinking about the literal 50% of the class that scored below you (if you scored the average). Compare yourself to your own progress, not the work of others.

 

[Shjanzey]

Okay breathe and stop comparing yourself to others. I am not in the same shoes as you so I can't offer Step specific advice, but you are more than capable. You did NOT forget everything, you are simply too worked up to remember the details. Breathe, exercise, and take it one day at a time. Do you have a good schedule set up? Do you have a dean/advisor you can talk to about revising your study schedule to cover your weaker areas?

So what if someone got a 250? There will always be that person - a bell curve is a bell curve and there's always people at the top and people at the bottom. You are likely not thinking about the literal 50% of the class that scored below you (if you scored the average). Compare yourself to your own progress, not the work of others.

It matters because I want to be that person, so I don't have to be so stressed right now

My study schedule isn't the problem. I have literally maxed what I can do at this point, it is just a grind to try and recover every little detail. I review over and over and over and then when I review again I realize I forgot something yet again. Are you in med school yet? The information is easy, it is just that there is so much to keep track of. I am not worried about understanding...I am worried about retention. I literally sit and memorize for hours every day

 

[eteshoe]

Practice exams (and practice problems) will help point out where you're still deficient

 

[CaffeineTwitch]

It is a shame that guy blew his 250 on a practice test; good thing you saved yours for the real deal. I have never taken a step exam but in general, practice problems and trying not to freak out seems to help me a lot.

 

[NontradICUdoc]

practice tests, practice tests, more practice tests.

 

[DrMidlife]

So what you're saying is that you want to compete with the guy who TELLS PEOPLE he got a 250.

That guy is a dick.

Also, at my school? With one of the guys who bragged about his 250 around January of 2nd year? He didn't match on Monday.

Because he's a dick.

 

[QofQuimica]

OP, let's start with first steps first here. The first and most important thing is that you pass the exam, and ideally, on the first try. So, was your practice test score passing? And if so, that's a good thing. Be happy about that. It means you will be able to be a practicing physician one day.

Second, just as with the MCAT, everyone has an asymptote that is the highest they can score, and these asymptotes are not identical. Some people are naturally better test-takers than others. These are the people who kill the MCAT and do well but not amazingly stellar on Step 1. Some people are naturally better memorizers than others. These people often do better on Step 1 than they did on the MCAT. Some people are both great memorizers and great standardized test-takers, and they are the ones who kill tests that are both standardized and memorization-intensive like Step 1. Odds are good, however, that you are not in this third category; if you were, you probably wouldn't be a nontrad. And finally, some people are not particularly good at standardized tests or memorization, and these are the plebes who have to bust their butts just to get an average score. Most nontrads will be in this category. (FWIW, so will most trads.)

Third, it is ok to be in that last category. You can still be a doc, and you can still do reasonably well on the test. You will just have to work really hard. You will also have to accept that even after working really hard, you may just be average when it comes to taking tests like Step 1. And really, that's ok. Somehow, we have come to have this crazy idea that being average isn't ever good enough. But sometimes it has to be good enough. Exams like Step 1 are called "standardized" for a reason: the test is designed such that only a small percentage of people will get the crazy sky high top scores. Most people, probably including you, will score somewhere in the average middle.

Fourth, assuming you pass, your score on Step 1 has NO correlation to how good of a physician you will be. Not passing (especially not passing after several attempts) is a travesty because it means you can't get a license and practice medicine. Passing with an average score means nothing except that you cleared yet another hoop en route to getting licensed.

Finally, pre-studying for Step 1 by ignoring your coursework is just as foolish as trying to pre-study for the MCAT instead of doing your pre-req coursework. That class material you are ignoring is going to be on Step 1, and you can't expect to remember material you never learned properly in the first place. So stop ignoring it. Focus on your class work while you're in classes, and do extra practice questions outside of your class study time. Save the minutiae cramming for right before the test. It's way too early to be doing that BS now.

 

[Esquire]

So those of you further along...in hindsight what would you have done different going into Step?

It's going to be ok, not everyone is cut out to be a neurodermatoplasticnuclear surgeon. In hindsight, I would've cut back my dedicated study time to 4 weeks and taken a long vacay.

 

[Esquire]

Also, at my school? With one of the guys who bragged about his 250 around January of 2nd year? He didn't match on Monday.

Because he's a dick.

If being a dick precluded people from matching, no one would match OB or gen surg. Ironically, people with 250s probably have a lower shot of matching because they're more likely to limit themselves to the most selective residencies and specialties.

 

[Mad Jack]

If you're weak on micro, sketchy micro is amazing. I get like, 70% of my micro questions right now, whereas I used to get like 25% of them right. I'm just doing tons of practice questions myself currently, slowly but surely getting better.

Annotate your First Aid with everything you get wrong. When you finish a QBank, go back through and redo all of the questions you got incorrect. That's what I'm doing- no clue how it will work out for me.

 

[operaman]

1) everyone has to find their own path. I was one of those 250 in January folks though I didn't broadcast it at the time. Im lucky that I just a good test taker. Plenty of classmates who scored lower at the time ended up in the 260s when it counted. We all got to the same place; just different paths. Plenty of others with more average scores still matched very very well.

2) I would caution against forsaking classes to focus on board prep. If you're in a traditional curriculum, 67% of the material is taught in ms2. I don't get the logic of blowing off 33% of the step one material to focus on minutiae that may ultimately make up 10% of the questions. I would make a strong argument for really diving in to your classes and making sure your foundation is solid. Definitely supplement with boards stuff like UWorld and pathoma and some comprehensive review source and whatever other products work for you, but give the bulk of your time to learning and understanding the new material you're seeing in class.

3) standardized test pearl #153: save rote memorization of minutiae for the very end. There's zero chance you will remember much of the minutiae you're wasting time memorizing now. I can guarantee you will forget minutiae you memorize at the start of your dedicated study period. Save that crap for the end of your review period.

4) the trick to scoring 250+ in January is knowing the big picture concepts cold. It allows you to extrapolate to answer questions on material you haven't even covered yet.

5)beware of the common pitfall of so many: spending time trying to learn 10% of the toughest most obscure minutiae while neglecting the 80-90% that represents the highest yield big picture stuff. Once your practice test scores are in the 250s, then start think about minutiae. Until then, your biggest bang for the buck will come from bigger picture concepts.

 

[Shjanzey]

If you're weak on micro, sketchy micro is amazing. I get like, 70% of my micro questions right now, whereas I used to get like 25% of them right. I'm just doing tons of practice questions myself currently, slowly but surely getting better.

Annotate your First Aid with everything you get wrong. When you finish a QBank, go back through and redo all of the questions you got incorrect. That's what I'm doing- no clue how it will work out for me.

Haha yea, sketchy is god. I dominate the micro/pharm stuff they have material for. I am still working through their latest update, but I love it. Right now I am scrambling to get through a full review of path again....apparently I forgot it all

 

[Shjanzey]

1) everyone has to find their own path. I was one of those 250 in January folks though I didn't broadcast it at the time. Im lucky that I just a good test taker. Plenty of classmates who scored lower at the time ended up in the 260s when it counted. We all got to the same place; just different paths. Plenty of others with more average scores still matched very very well.

2) I would caution against forsaking classes to focus on board prep. If you're in a traditional curriculum, 67% of the material is taught in ms2. I don't get the logic of blowing off 33% of the step one material to focus on minutiae that may ultimately make up 10% of the questions. I would make a strong argument for really diving in to your classes and making sure your foundation is solid. Definitely supplement with boards stuff like UWorld and pathoma and some comprehensive review source and whatever other products work for you, but give the bulk of your time to learning and understanding the new material you're seeing in class.

3) standardized test pearl #153: save rote memorization of minutiae for the very end. There's zero chance you will remember much of the minutiae you're wasting time memorizing now. I can guarantee you will forget minutiae you memorize at the start of your dedicated study period. Save that crap for the end of your review period.

4) the trick to scoring 250+ in January is knowing the big picture concepts cold. It allows you to extrapolate to answer questions on material you haven't even covered yet.

5)beware of the common pitfall of so many: spending time trying to learn 10% of the toughest most obscure minutiae while neglecting the 80-90% that represents the highest yield big picture stuff. Once your practice test scores are in the 250s, then start think about minutiae. Until then, your biggest bang for the buck will come from bigger picture concepts.

Solid advice. Thanks a ton. I feel like everything is minutiae at this point lol. The hardest thing for me right now are drugs. I love knowing the mechanisms, but I soon get lost with all the ridiculous names that have no meaning to me. To me that is minutiae that cannot be avoided. An example of other stuff that I am "memorizing" or perhaps relearning are the different type of rapidly progressive glomerulonephritis. Surely that isn't minutiae, but rather high yield that you need to know the difference between to stand a chance at answering many renal questions.

I don't know why, but for me if I don't constantly review this stuff, it quickly disappears from my brain. I wish I had a longer retention, but that is how it goes for me. I have pretty much switched to mainly Anki as my learning aid because it constantly forces me to make going over lecture and concepts an active recall exercise rather than passively reading. I was having too many problems trying to learn via passive reading (e.g. even less retention).

Trust me, I am not ignoring the big for the little. I am rushing as fast as I can to get a complete review of my medicine done before dedicated study starts. I feel like this will put me in a great position to really tackle the things I am weak on, instead of doing what I am right now which is relearning material I should already know. I should not be relearning anything new by the time I am in dedicated. I just hope I find enough time to finish this review in the next 3 weeks. I am very behind, but I think it is possible.

Personally I have chosen to ignore our lectures at this point except for what is applicable to the board. Fortunately (or maybe unfortunately) our school is currently throwing all the pharm at us, while calling it an "integration" course. The only thing I hate is that they have also chosen to throw a bunch of geriatric and pediatric stuff not suited to step in there as well. I know it is important to medicine, but it is not important to my current goals right now, so I have to choose to spend my time on learning things other than mini mental status exams for the elderly. Strangely in that geriatric info they ignored dementia, alzheimers, and other high yield topics that would be awesome for step prep, but I digress.

 

[operaman]

Solid advice. Thanks a ton. I feel like everything is minutiae at this point lol. The hardest thing for me right now are drugs. I love knowing the mechanisms, but I soon get lost with all the ridiculous names that have no meaning to me. To me that is minutiae that cannot be avoided. An example of other stuff that I am "memorizing" or perhaps relearning are the different type of rapidly progressive glomerulonephritis. Surely that isn't minutiae, but rather high yield that you need to know the difference between to stand a chance at answering many renal questions.

I don't know why, but for me if I don't constantly review this stuff, it quickly disappears from my brain. I wish I had a longer retention, but that is how it goes for me. I have pretty much switched to mainly Anki as my learning aid because it constantly forces me to make going over lecture and concepts an active recall exercise rather than passively reading. I was having too many problems trying to learn via passive reading (e.g. even less retention).

Trust me, I am not ignoring the big for the little. I am rushing as fast as I can to get a complete review of my medicine done before dedicated study starts. I feel like this will put me in a great position to really tackle the things I am weak on, instead of doing what I am right now which is relearning material I should already know. I should not be relearning anything new by the time I am in dedicated. I just hope I find enough time to finish this review in the next 3 weeks. I am very behind, but I think it is possible.

Personally I have chosen to ignore our lectures at this point except for what is applicable to the board. Fortunately (or maybe unfortunately) our school is currently throwing all the pharm at us, while calling it an "integration" course. The only thing I hate is that they have also chosen to throw a bunch of geriatric and pediatric stuff not suited to step in there as well. I know it is important to medicine, but it is not important to my current goals right now, so I have to choose to spend my time on learning things other than mini mental status exams for the elderly. Strangely in that geriatric info they ignored dementia, alzheimers, and other high yield topics that would be awesome for step prep, but I digress.

I'd be really careful thinking something isn't suited to to step -- people are often surprised at what shows up. MMSE would totally be fair game for step 1, though it's more likely to function as a way of eliminating distractors (ie. elderly pt whose is altered, recent MMSE 28/30. Blah blah lots of other info. You can bet alzheimer's dementia is one of the answer choices). All the step exams (including step 1) now include questions on quality improvement, safety, social sciences, etc., so even those seemingly fluffy lectures are step worthy. Sadly, a lot of people blow it in the behavioral science section. It's a huge chunk of your final score (on the order of 10-20 points of your 3-digit score).

Props to you for using anki - easily one of the best tools out there. Especially powerful for pharmacology. Another thing you may be doing but just in case: be sure to learn all the patterns for drug names. Know these absolutely cold. Then learn the handful of exceptions. Things like all the "olol" drugs are beta blockers and if the first letter is A-M, it's selective; N-Z is non-selective. "-chol" are cholinergics. "-opril" are the ACEIs. "-artan" are the ARBs. Etc. Etc. Makes it way easier. Beyond that you have the random chemo drugs, neuro drugs, and psych meds.

For types of RPGN, know the big picture - one type is antibodies against the GBM, another is immune complex deposition, and the other is WTF is happening/ANCA. 3 types, each very distinctive on IF. Then you just have to think of all the diseases that fall in each category, but if you know the mechanisms, it's easy enough to figure out. Beyond that, know what the IF looks like, know the crescents, and think about how renal failure looks clinically (elevated creatinine, sx of uremia, etc.). They can ask you for a diagnosis, they can ask for a mechanism, they can ask for the basics of treatment, they can integrate with other topics - that's about it. They can dress it up a zillion ways, but they can't change the underlying facts.

Try to think in broader strokes that are easier to learn and remember. Don't fall into that trap of trying to memorize all the causes of Type II RPGN - just know the mechanism is immune complex deposition and you're set. Make sure you watch the Pathoma videos so many times your eyes bleed.

 

[yeasureyoubetcha]

Holy s***!!! I've gotta get some good supplemental study materials figured out!