This past weekend marked the halfway point of clerkship (MS3) year. This past weekend also marked yet another weekend that flew by without a blog post. I promise that I’ve drafted and edited posts in what little spare time I have. Third year is exhilarating albeit exhausting – a topic I’ll touch on in a post to come. Today, I wanted to share just a little bit about my preparation for USMLE 1 and some general advice for the big exam.

I often get emails and direct messages (on Twitter and Instagram – you guys are relentless) about USMLE 1 and my score. I have never been the kind of person to share specifics regarding standardized test scores but I will say this: I only took the advice of upperclassmen who scored 245 and above. And so, I would take my own advice.

To preface my advice: you know yourself best. At this point, you’ve come to understand what sort of student you are. You know how to prepare for standardized tests. USMLE 1 is no different from the MCAT or SAT/ACT/AP. Don’t forget that!

The worst thing you can do is get into your head. I think a lot of medical students get so worried about the exam and freak out (preemptively) about their ability to match into xyz specialty that they forget that it’s just a test. An important test, but still…just a test. With that in mind, the best advice I can give is to try your hardest to learn material well the first time it is introduced.

One of my classmates took extra time off to study for USMLE 1 and of course when we caught up to chat, I asked him why. He told me: “I took pass/fail at heart first and second year, and so I had to teach myself a lot of material for the first time. I just needed more than 6-8 weeks to prepare.” Totally valid.

Before you launch into this post, take a peek at my general approach to MS2 and how I handled each MS2 course.

Plan: If you haven’t realized this by now, I like lists. I am a huge fan of making study schedules and to-do lists. If I need to be extremely productive, I make to-do lists by the hour — I know that’s a little bit obsessive. Even if you aren’t a huge fan of schedules, I promise it’ll help keep the anxiety levels down. Things will seem a lot more manageable.

• Register: I was annoyed when I found out (early November) that I would have to pay $600 to register for the examination and that the application process takes 2-3 weeks (if you apply on the early side) before you can select your date. I tell everyone who is taking an examination in the spring to start the process now. You don’t wanna be in the situation where you have to take USMLE 1 on a day that isn’t ideal.
• Resources: Decide on what resources you plan to use. If you’re the type of person you learn primarily through Q&A, you’ll certainly want UWORLD and perhaps other question banks as well (USMLE Rx). Try NOT to introduce new resources for USMLE 1 preparation. Try to be a minimalist re: resources. You don’t want to stretch yourself too thin.
• Calendar: Once you know which resources you plan to use and the day you want to take the exam, you can build your calendar. Try to be reasonable about how much you can accomplish in a day. Decide if you want to go through UWORLD 2X or just go through the questions you got wrong 2X (this will change how many blocks you’ll want to do each day). My approach to my study calendar was to make weekly goals. Some days you’ll work slower than others and you just can’t get as much done as more productive days — weekly (instead of daily) goals helped me to stay sane. My schedule is detailed here. If it’s difficult for you to come up with a schedule, you can have Cram Fighter to build one for you based on your selected resources. There are also a TON of sample study schedules online.
• Vacation: Schedule a vacation after the examination (if your finances allow for it) not only so you can decompress before you hit the wards but also so you don’t fall into the temptation of moving your exam date back. Seriously… don’t do it.

Study: Coming up with the plan is the relatively easy part. Sticking with the plan is where things get tough. I will say that you sort of have to cut yourself some slack. There were definitely days that I completely took off from studying (even deviating from my one day off a week schedule) just because I felt overwhelmed – thanks ok! You want to make sure you’re not pushing yourself past your limits. Don’t sacrifice sleep or your workout regimen for this exam. I promise you’ll feel better (and test better) if you don’t deviate too much from your norm.

• Winter Break: I spent winter break reviewing biochemistry via First Aid and Firecracker. I annotated information from Firecracker into my copy of First Aid.
• January – March: I approached 1-2 chapters in First Aid a week while I was going through my blocks. I made an effort to annotate Firecracker points into First Aid. I reviewed the corresponding units in Pathoma. I worked through a few blocks of UWORLD a week.
• March – April: In my dedicated period (6 weeks), I made sure to review 1-2 units in First Aid a day and one unit on Firecracker (this would serve as my 2-3rd pass). I started using First Aid Express to have a more guided tour through First Aid. I loved this video series which is remarkably cheaper than Doctors-in-Training. I made sure to complete UWORLD, USMLE Rx, and Osmosis question banks in this period of time. I also started to use Picmonic to force myself to memorize some of the aspects of biochemistry that always escapes me (Gaucher’s, Tay-Sachs, etc.) and anatomy. My dedicated period was when I first started to review anatomy — I was dreading going through all of this again!
• Exam Week: I should have taken my exam a week earlier than I did. I felt myself burning out (I made it through another pass of First Aid during this week…very sluggishly). I reviewed the First Aid High Yield points in the back of First Aid.

• Resources: Just to quickly go over which resources I used to prepare for USMLE 1.
  • Content Review: Firecracker, Sketchy Microbiology, Sketchy Pharmacology, Pathoma, Rapid Review Gross and Developmental Anatomy, Picmonic (for select biochemistry pathways and anatomy), and First Aid (2015 and 2016)
  • Video Series: First Aid Express
  • Question Banks: UWORLD (2433 Qs at the time), Osmosis (2311 Qs at the time), and USMLE Rx (2450 Qs at the time)
  • Practice Exams: Firecracker Diagnostic Examination, NBME Combined Basic Science Shelf (provided by Tulane), NBME USMLE Sample Test.

If I could take USMLE 1 again: well that would be a nightmare but there are a couple of things that I certainly would have done differently.

• I would have used First Aid Express alongside the blocks instead of just during dedicated study period. I think it’s always better to get through something 2X rather than just once.
• I would have reviewed Golijan in the weeks preceding dedicated period. I don’t think that using Pathoma as your sole pathology resource is a handicap but I did worry (perhaps unnecessarily) that I was setting myself up to not know enough pathology.
• I would have used First Aid throughout the year. I annotated Firecracker into my copy  of First Aid which was great (Firecracker had amazing explanations for the WHYS of the random bullet points in First Aid).
• I would have transitioned to the new copy of First Aid sooner.
• I would have reviewed anatomy along with biochemistry over winter break. Anatomy is the bane of my existence and I reviewed it only during dedicated period. I did well on anatomy on my shelf BUT I was very anxious about anatomical questions. I should have just don’t myself a favor and reviewed that material early. With that in mind, biochemistry and anatomy are not well represented on the exam….but those questions are on the easier side (so you don’t want to miss them if you can help it).
• I felt extremely insecure about my resources (would First Aid be enough) but now that I’m on the other side I have come to realize that I shouldn’t have been so concerned. I had a series of moments when I panicked and thought about reading Costanzo to solidify my physiology knowledge. I thought about reading Development of a Human to review embryology. ABSOLUTELY ABSURD. I will say that Firecracker has excellent cards for first-year material and they were more than enough for review. I wish that I knew that.
• Sketchy Pharmacology came out about two weeks before my exam and I made every effort to watch it 2-3X before my exam date. I loved it and if I had the chance to use it throughout the year, I clearly would have done that instead of a desperate sprint through many…many…many hours of videos.
• I would have spent less time around my classmates. I said earlier that people completely forget that USMLE 1 is just a standardized test. I found myself surrounded by people who wanted to compare schedules and strategies. This was non-productive. A lot of these people just wanted to tell me that they didn’t think I was going about studying in an appropriate way. Everyone is freaking out and it’s just not worth it to deal with that sort of energy.

Just a few other points that are not recommendations by any means:

There are just a handful of things you have to decide if you want to get into. I didn’t pay for NBME practice examinations because I was so tired of spending money for this test. Also I’ll add, I don’t like to do practice questions if I can’t immediately find out the correct answer. The NBME practice examinations don’t give you the correct answer at the end — so you sort of have to hunt to figure out what the answer should be. I know that’s not the typical strategy but I knew it would be more of a frustration for me than a helpmate. You might be able to find bootleg copies of the NBMEs with accompanying answers.

Also, I worked through UWORLD on timed tutor. I’m not the type of person who struggles with time on standardized examination and so I worked through the UWORLD questions and annotated at the same time. It made UWORLD a way more efficient practice for me.

One last reminder: it really doesn’t matter how you approach USMLE 1. People employ so many different strategies and we all make it on the other side. What is MOST important is that you’re optimized for test day. What do I mean? Sleep well, eat well, and treat yourself well. You’ll see questions on USMLE 1 that make you think… “I HAVE NEVER SEEN THIS BEFORE?” Make an educated guess and move on! You’ll be fine, I promise. As always feel free to send me questions.