Yes and yes to both, of your questions. I felt very well prepared for Step 1, especially the pathology and pathophysiology aspects which comprise the biggest part of the test. We have a really awesome pathophysiology class in the second year that teaches you to think clinically, which is what the boards try to test. After finishing second year I had to do only very minimal review of path, pathophys and pharm. Those three are probably the majority of the exam so that helps a lot. I did have to brush up on some first year courses like anatomy, histo, biochem, physio. Also had to do some review of micro and immuno. Overall the school is great with preaparing students for the boards and for your clinical years. My first rotation was medicine and I felt very well prepared for it both in terms of physical exam skills and clinical reasoning.
As far as away electives, many students do them. Most do them in their fourth year so I haven't done any yet but plan on doing at least two. From what I heard from people that have done them they are relatively easy to schedule and the school is very good with helping you with all the paperwork and giving you credits and such.
We have lots of time for electives and the school allows you to take almost half of your elective credits at away programs. After finishing this year, for example, I will only have to do psych(6wks) and urology(2wk) next year. Thats 2 months and the rest of the time is elective time. Not to mention that by the time I finish this year I will also have already finished about 10 elective credits here at Upstate. Leaving me with most of my fourth year to do away electives. As you can see plenty of time to do them. 👍