My Step 1 journey || Step 1 Pass/Fail || Dedicated || SGU

Written By Rainee

Table of contents

My phone countdown to keep spirits high (:

It took me an incredibly long time to write this incredibly long post. This is probably my longest post ever, so if you’re looking for something in particular:

Life Update

I even bought a posture corrector because I sit like a gargoyle :(

8 weeks sounds spacious. There were no more class lectures. It sounded like a luxury to purely study at my own pace. The reality is 2 months to remember 2 years is a tiny bit more challenging than I expected.

It was mentally challenging, but it quickly slapped a physical toll on me. Initially, my bad habits took over. My skin was so bumpy, I thought I was 13 again! It was easy to compromise an hour of sleep or a workout session to chase those improved NBME or UW scores.

I was fortunate in my health coaching classes we had constant conversations about how to live healthier. I remember describing my situation to another coaching student. They said, “Is sacrificing your health helping you?” A couple more completed Anki cards didn’t make the difference compared to the amount of sleep I gave up. Without their support, I would have easily slipped into a downward spiral.

Health & Fitness

One of the goals designed to keep me afloat was working out a certain amount of times a week. I would start my day with exercise to clear my mind and protect that time for me. It’s too easy to boot myself off my priority list. There were definitely days when I was too exhausted, but sometimes I would supplement that with a walk outside or yoga. I believe in this small study, it was noted that low-intensity exercise preceding a memory task would help retention. Whether that’s reality or not, I’ll just keep doing it for the placebo effect.

I do most of the cooking. Cooking to me is a labor of love. It often doesn’t help to maximize studying time, but you have to eat well to feel good, right? I bought this fridge meal planner and mapped out lunch and dinner for the rest of the week. I would cook large meals to last 2-3 more meals to save time. Here are some of my favorite quick/bulk meals, or a Costco rotisserie chicken works great too! My go-to is honestly the Costco Cauliflower pizza. I add hot links, bell peppers, and mushrooms (we miss the all-dressed pizza at Costco!).

Balance for me isn't always in exercise or meal prepping. I took time off! At least once a week, I'd spend an afternoon or a day spending time with my loved ones, go hiking, go out to eat. It's essential to protect your humanity! 

My favorite mindfulness apps include Tappy, Rootd, and Balance. Tappy is my virtual fidget spinner. Sometimes when I was watching videos, I felt so anxious. Tappy basically let me do something with my hands while trying to take information in. I loved Rootd. I get panic attacks, especially close to exams. It walks me through breathing exercises, it's encouraging, and it's heckin' cute. Balance is my maintenance meditation app. Each meditation which can range from 3 minutes to 15 minutes, builds on specific meditation skills. As someone who likes checkpoints, it's very encouraging. The first year is free too!

My pomodoro timer & stress squishies

Sustaining productivity in dedicated Step Prep

My attention span has always fluctuated. I have loved the Pomodoro method of studying. You study for 20-25 minutes and then break for 5 minutes. After a couple of rounds, you usually do a more extended break. I’ve used “Study with me” youtube videos with café sounds when I get lonely. I used Pomodoro computer apps like Be Focused App, but it’s too easy for me to ignore. Ultimately, I loved my cube timer! Placing my physical (and cute) timer across the room so I’d have to get up was the best way to get me to stop.

I have also used Todoist for the past couple of years! I’d set up my to-do list every night, so I knew what to expect the next day. It’s free! It also integrates with google calendar so I can see my schedule. Love integrations!

Also…ya girl got engaged! Okay onto step stuff.

Dedicated:

If you haven’t read my last post about starting dedicated, that might be a great place to start! I frankensteined a bunch of other spreadsheets I found on Reddit to make this spreadsheet that worked as a calendar, NBME tracker, and resource checklist. Hopefully, it’s helpful to someone. There is a link to my google drive with all the spreadsheets as well.

How i made my dedicated step 1 schedule

I consumed too many dedicated step prep youtube videos and blogs in Term 5. It was my inspiration to hold on. Sources said the optimal prep time would be between 7 and 12 weeks, likely 8 weeks. So, of course, my irrational fear of failing to get a residency pushed me to schedule a 6.5 week dedicated study period with only a couple of days of a break after Term 5. That was a sure and quick route to burnout (we love the Dunning-Kruger effect) but did make a pretty darn good schedule for me. Ultimately, I tacked on 3 weeks onto my dedicated prep because I didn’t feel ready. To be honest, that feeling never actually came.

My prep was systems-based because my baseline NBME confirmed that I was comprehensively weak in all areas. I mapped out how many weeks I had and divided the number of days by systems. The calculation came out to a 3-4 days per system baseline. Some subjects like GI felt more contained to me. I’d spend less time on that, but topics like Cardio I took more time for.

Things that worked: 

  • Staggered schedule: My day 1 of prep was just Heme. A couple of days later, I added Endo to the mix. I found my first days on a topic were heavy on review and time-consuming. At the start of each week, I’d plan which videos (i.e., Dirty Medicine, Pathoma, etc.) I wanted to watch. As the allotted time for the subject progressed, I would focus more on the questions and what they said were my weaknesses. So the staggered schedule allowed the review period of one subject aligns with the question period with the other subject.

  • Out with the completionist attitude. Only review what you need to, whether videos or Anki cards.

  • Anki: I had 3 decks I used in this priority: Incorrect > subject/Anatomy/NBME images > Rapid Review First Aid deck. I limited myself by time.

  • If you don’t have Anki, I recommend making a system where your weak topics come back. It was surprising how many times I had to learn what changes a heart murmur.

  • Have a home base! Whether it be first aid or a Uworld journal. Stick with one place where you’ll write goodies and that you’ll actually review these things

  • My balance rules: I stop studying every day by 10 PM and don’t study on Sundays. (8 out of 11 score on adherence here).


I ended up doing a two-phase dedicated.

Phase 1 of My Dedicated Step Prep

Phase 2 of My Dedicated Step Prep

Phase 1: content review > questions

  • My brain was so tired after a few weeks of dedicated! So I prioritized questions at the beginning of the day and lower energy activities like reviewing for the end of the day.

  • I did 2-3 sets of 40 Uworld questions per day. Since I knew my prep was short, I focused my question review on things that I missed or marked

  • Topic Review could include anything from related Boards & Beyond, Sketchy, Pathoma, Youtube. In Term 5, I would watch resources to completion but I had to switch to watching only relevant videos to spend more time on questions

  • I had to carve out time for sketchy micro and pharm because these topics didn’t always nicely coincide with systems

  • There were a lot of random resources I wanted to include like 100 Concepts of Anatomy and BRS. I had to dedicate a certain amount of time in my calendar

  • Adding a buffer to my schedule saved me so much anxiety because life happens!

Phase 2: questions, questions, questions

Not much to say but this phase was hard and monotonous, but I felt like I learned more in this phase.

How i reviewed questions

I knew reviewing Uworld questions was something I needed a system for. In Term 5, I researched how to do a Uworld journal. That also had to change, but here’s all the iterations that I tried:

  1. Annotate First Aid: I started doing this in Term 3. I put little mnemonics and buzzwords in the margins. However during dedicated, it was too time-consuming to find the pages both for annotating and reviewing.

  2. Paper UWorld Journal: I saw in MahaDotCom’s Step 1 vlog she started a small journal with nifty things to know. I even tried this and bought 12 college-ruled notebooks so I could do this by the system. Well, I have 11 blank notebooks because some charts were just too good not to have but too extensive to copy into my journal.

  3. Spreadsheet: I made a correction table to accompany my Uworld reviews. It was helpful in Term 5, but not so helpful in dedicated. The two helpful things I did learn what subjects I had content gaps verus test taking issues and how accurate my gut feeling is. Funny enough, my gut is either right or I’m going to change my wrong answer to another wrong answer. So might as well stick with my gut right?

4. Online UWorld Journal: This is the system I eventually stuck with. An example of the things I wrote in my journal are below. I organized the journal by system. It was mostly random stuff I wanted to remember or kept forgetting. It was also another opportunity to do a “teach-back” to myself. Without looking at the resource, I tried to write the concept in my own words.

Practice exams

I took NBME 16 and 17 at the end of Term 5 to get a baseline and for BFSCR prep. Also, I knew I would excuse any low scores with “I haven’t even started reviewing yet”. When I started dedicated, I took USMLE-Rx Self assessment #1 and #2 to get into the mood. I felt the USMLE-Rx exams are closer to the BFSCR.

Practice exams were a nightmare for me. My reactions to scores were more dramatic than I anticipated. I would study 10-12 hours a day and it was my sole purpose. So I expected that with undivided attention, there should be a steady trend upwards, right? I mean during the term, I had the excuse of small groups and busywork. However, routinely I would only see a 1-5 point increase or stagnation - it was rough. I felt like I fought for every point. There was no magical study tip that gave me the 20 point increase.

Order of practice ecams

Like PR-ing in weightlifting, it’s important to plan your practice exams with two goals. Yes, you want to know where you stand, but you also want to keep the momentum going. I did my research on the order, AKA this is what I learned from reddit:

  • Take the NBME forms in order, but leave NBME 25 for the middle of prep since it can be harder

  • UWSA1 is often an overestimator. I took it before NBME 25 so it worked as a confidence booster

  • My last tests were UWSA 2 and NBME 30 which I heard were more predictive

  • I took Free 120 a couple of days before my exam. It was helpful to see the testing format. It gives you a percentage correct. People recommend taking it at the Prometric site as a simulation, but my center was an hour away.

Ultimately, I don’t think you can really hurt yourself with the order of exams so don’t overthink it!

My Step 1 experience

Logistical prep

  • When I took NBME exams, I tried to practice the routine I would do on exam day to get used to waking up early and using my brain

  • The night before, I prepped everything so in the morning I could move on autopilot. I packed my bag and lunch bag and I laid out my outfit. Wearing things without pockets saved a bit of time for security checks.

  • I packed a bunch of snacks because I didn’t know exactly how much time I would give myself to break or how I would feel

  • If your testing site is close, it can’t hurt to visit it beforehand. Mine was an hour away so I just looked around via google maps

The day of Step 1

I woke up around 6 AM. I did a short bike ride with my girl Jess King. Her EDM rides give me life. I ate something small to get my brain working. My exam started at 8:30 AM on a Friday. The center was packed! There was a line out the door to check in. I was surprised that only two other people were taking Step. The staff gave me a key to a small locker where I could fit a very small bag. To guestimate, my water bottle barely cleared the height. They called my name and assigned me to 1 of 2 rooms.

The first step was security clearance, they asked if I had any pockets, to pull up my leggings, and scanned me with a metal detector. This was a routine I completed every time I came into the testing room. My testing site was just a bunch of cubicles like the old computer labs from grade school. They gave me those airplane headphones and another set that I could hear the audio in. The noise-canceling headphones hurt my head, but they were very helpful because people were constantly moving in and out of the room.

Whiteboard

My testing site gave us 2 laminated sheets as a whiteboard. I was told not to erase it, but to raise my hand if I need a replacement.

Breaks

I had two timers on my computer. One was a timer for the block. The other timer was for the whole day. I had 45 minutes of break for the whole day and how I used it was up to me. I used every opportunity for a break. To get up, stretch, go outside and breathe air, use the restroom. I mostly took 5-minute breaks and took 1 twenty-minute breaks to eat lunch.

I had seen so many people come in and take their tests and leave. The testing site staff even changed. It was finally my time to leave around 4:30 PM. Like a lot of others, I was sure I failed. The feeling that I couldn’t do anything else was comforting for the first couple of days.

Also, we were required to wear our masks the entire time. (Feb 2022)

Getting my results

I took Step on 2/11/22. I would break out in random hives, just rethinking all my answers. I would highly discourage you from religiously checking the Step 1 subreddit and reading horror stories of people with 240+ practice scores failing. It was a waiting room of neurotic people yelling their random anxieties. I couldn’t look away.

The Reddit grapevine mentioned that IMGs could see their scores early on FCVS. Exam release days are Wednesdays. So the second Tuesday after my test, I couldn’t think at all. I just watched Tik toks and tried to distract myself with Love is Blind 2 and Love is Blind Japan. When the clock struck 10 PM PST, I refreshed the FCVS site like crazy. Then it appeared - “Pass.” I couldn’t believe it. It felt like every NBME I took was a fluke, so how could I pass? I only told my fiancé and held my breath until the following day. 

I woke up at 7 AM. Results usually show between 5 AM PST to 8 AM PST. Again with the neurotic refreshing until my client appointment at 8 AM. As soon as our meeting concluded, I clicked on that email app. At 9 AM, I got the confirmation email! Embarrassingly enough, I wanted to tell the whole world because maybe that would make it more real. I thought perhaps I’d get an email saying it was all an error. 

I received my result on 2/23/22. I heard it could take 3-4 weeks! It feels like the P/F results are coming much faster, especially since there is no personalized feedback like weak areas or strengths. 

Outside resources for dedicated

I watched most of Boards & Beyond, Sketchy, and Pathoma prior to dedicated, but here are the other resources I loved.

  • Blogs I loved:

    • Sincerely Millie: I love this blog! I read the Step post before Term 5 to guide how I approached Term 5. It was incredibly helpful to get an idea of resources, timing, and what to expect.

    • StepsToUSMD: If you’re looking for a treasure chest of resources and study schedules, this is a great blog.

  • Cumulative Reviews I would listen to while doing chores/working out

    • Dr. Rahul Damania’s youtube videos: pretty good comprehensive reviews on systems. I especially love the high yield topic videos which were so helpful for tying in clinical features, imaging, and pathology.

    • Divine Podcasts: I definitely earned a couple of points each NBME from little tidbits Divine would work into his podcasts.

  • Must Review (IMO):

  • Other cool stuff:

Things i would say to my past self

To you who are just starting this dedicated journey or in the midst of it, please don’t let it consume you. You are more than your practice exams. Medical school requires us to give up a lot of life to master our craft, but don’t forget to live your life! It’s okay to take those breaks, be with people you love, and do things that make you happy. There is time for that, even when it feels like there isn’t. And when you feel the struggle, know that there’s a point where you’ll be past this, and you’ll have conquered Step. I’m rooting for you!

Warmly, Rainee

Enjoy my crazy post-exam selfie!

Rainee
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Half-way through all my mistakes || Dedicated || Sgu