Αξιον Ωφελειν τους Αλγουντας.” --Be Worthy to Serve the Suffering.

Member Profile

Elisa Lund (2015)
Member Type: Student, Junior Member Campus: Chicago
Specialty: Anesthesiology Program: Virginia Mason Medical Center (WA)
Going from Average to Excellent. How a 31 MCAT turned into a 264 Step 1.

Studying for Step 1 and considering it's impact on your future career can be overwhelming at times. This results in some students using ineffective study techniques and sometimes giving up. But excelling on Step 1 is not limited to Einstein level geniuses. I'm no genius and based on my MCAT score, my predicted Step 1 should have been 235. That's a good score, acceptable for competitive residencies. But during M1 and M2 year, I realized that score did not represent my diligence during medical school. And it doesn't represent you. Don't sell yourself short. If I can score an extra 30 points, so can you. How?

First off, be sure you are in the right place mentally. When I took my MCAT, I was scared, uncertain I wanted to go to medical school and intimidated by fellow pre-meds who seemed brilliant and completely put-together. I lacked confidence, and had to learn to be proud of my accomplishments during medical school. This begins the first day of medical school. Focus on your personal best and your performance, not your fellow classmates. Each exam I took, I made a goal to improve from the previous. I didn't care how that correlated to honors; I cared if it matched my focus and study habits. My confidence built every day, especially when taking practice Step 1 exams that improved each time (believe me, your's will too). By the last month of studying, I felt like Rocky jumping on the Steps of Philadelphia. Some people struggled with confidence like me, along with anxiety and fear. Recognize when your mental health is not at its best, find help and use cognitive behavioral therapy.

Next, how did I study? Step 1 studying starts on the first day of M2 year but gradually increases through the year. Use M2 curriculum as a study guide for Step 1 studying. A great way to recognize the level of intensity in Step 1 studying is by using "First Aid for Step 1" as a gauge. I had completed about 25% of First Aid including a thorough review of sections titled Microbiology, Immunology, Behavioral Science and Cardiology by the end of the first semester M2 year. This correlated with M2 courses during the first semester. By the beginning of April (and M2 finals), I have fully read all of First Aid at least twice in conjunction with the Pathology schedule. I then re-read First Aid during the final 6 week Step 1 study push.

Let's give an example. Since many of you will be studying Renal pathology as you read this, I will use Kidneys as my example. Before the pathology module on Kidneys, I re-read the Kidney section in BRS Physiology and reviewed anatomy using High-yield anatomy. It's a great way to remember important equations and landmarks. Next, I watched Pathoma on Kidney pathology. Quick, simple, easy to watch and understand. I never read a textbook-I get too distracted. Instead, I would then do the Robbin's Review of Pathology Qbook on Kidneys. The explanations typically had as good an explanation as the actual textbook, and kept me engaged. This prepared me to watch the actual lectures by professors. If I still didn't understand something after watching the UIC lectures, I would watch Kaplan videos on the subject. To review before the Kidney Pathology and CPP exam, I would read the Renal section in First Aid, again a good review of the physiology, pharmacology and pathology. Speaking of pharmacology, don't forget to watch Kaplan Pharmacology and make your own flaschards on drugs related to kidneys. I would also do all the Renal questions in USMLE UWorld Qbank before the exam, reading each explanation thoroughly. Repeat the questions, making blocks using incorrect and "marked" questions. At this point, you have essentially completed an entire, thorough review of all pertinent information regarding Renal. When your 6 week Step 1 study push happens in April/May, you will already have reviewed all M1 and M2 material once.

This systematic review using pathology as your study guide covers almost all material of M1 and M2 year except biochemistry. Don't downplay the importance of biochemistry, and try to fit in review throughout M2 year. Kaplan Biochemistry videos were the best.

What about practice tests and questions? Fitting UWorld Qbank into your M2 studying is the best as described above, but I did have to intentionally schedule taking self-assessment exams throughout the spring semester. This requires dedication, especially when you don't want to study. Often, the only time I could take a practice exam was after midterms or exams, the last time you mentally want to voluntarily take a practice test. While specifics will not help you schedule your own studying, it does give a good example so bear with me for a paragraph. I used NBME self-assessment exams as I found them most similar to Step 1, and appreciated their clinical focus. I did every single assessment (what's 60 bucks in the grand scheme of medical school finance?). The first was scheduled on Jan 12, the weekend after Jan practicum. Then, I tried scheduling a self-assessment exam once a month depending on M2 exams and my own personal obligations. Thus, I did exams on Mar 1 (the day after M2 midterms), Mar 27, and Apr 22 (the actual in-house practice exam-see the next paragraph). This brought me to the 6 week study push where I began scheduling the exams approximately every 9-10 days, which were scheduled on Apr 30, May 10 and May 19. Doing all NBME exams were extremely helpful as I did encounter some questions surprisingly similar on the actual Step 1. I treated these exams like "long-runs" in marathon training. I tried to make them realistic, but if there were questions I had never encountered before, I did look up information on-line during the exams, as this is "allowed." This does inflate your scores unrealistically, however the overall progress from exam to exam shows whether your study habits are effective. For myself and most classmates, each exam showed great improvement, boosting my confidence. That confidence is priceless and worth the multiple practice exams.

Speaking of confidence, when you register for Step 1, you also can register for a practice exam at the same site you take your exam. While the exam is free online, I chose to take it in person at the test-center to help my confidence. This was done on Apr 22. I didn't want to be anxious about where to park, how to get into the testing service, where to put my backpack on the actual day. This let me know exactly what the room would look like, how the process of fingerprinting during the exam works and in general made me less anxious during the exam. I highly recommend this, particularly if you are questioning your own confidence at this time.

For Qbanks, I had completed all of UWorld by the end of April and M2 final exams as described above. However, do not do Uworld just once. Repeat Uworld multiple times making new tests using all incorrect questions. Since I wanted to see new questions during my 6 week study push, I also did Kaplan Qbank starting the end of April through May. As the Kaplan Qbank gives you access to 2 self-assessments, I also did these. However, I treated Kaplan's self-assessments more like the regular Qbank- they were not marathon training long-runs. They focus more on specifics and memorization, ideal for the cram stage of studying.

This finally brings me to how I studied during the 6 week study push. If you study like I did, you'll have already finished Uworld Qbank, read First Aid and reviewed BRS Physiology/High Yield Anatomy and should have a strong grasp on conceptual knowledge. This 6 weeks is icing on the cake of your already effective studying and should be used for memorization and quick re-call. I did not have a pre-set study schedule (such as biochemistry on days 1-3, renal pathology on days 12-15, etc). I wanted to be able to adapt to my weaknesses as exposed by practice questions and tests, and was worried a pre-set schedule would cause me to "zone-out." A typical day started with me waking up and immediately doing a 1 hour (44 questions) block of questions with either Uworld or Kaplan set on tutor mode while eating breakfast. I then walked me dog (while listening to CPP reviews or talking to my husband), came back and watched about 2 hours of either DIT, Kaplan videos (primarily pharmacology and biochemistry) while making notes in First Aid. Whenever I would get tired or distracted, I would switch to another activity such as doing 10 questions, going over flashcards on microbiology or pharmacology, or 10 push-ups (my upper body strength was great by Step 1!). For lunch I typically ate while doing another 1 hour block of questions. This brought me to doing another 2 hours of videos (DIT, Kaplan, CPP reviews, etc) while reading along with First Aid. If there was a specific concept I was confused by, I would go back to review books including Micro Made Ridiculously Simple or BRS Physio. However, I never officially read straight through any of these books during the 6 week study push. They were only reference. Around 4 pm, I'd be super tired and would either walk my dog again or work out-but no studying during this time. Dinner was set aside for no studying. I finished the day by a final 44 question block in the evening. Thus, every day I typically was doing 150 questions, reviewing the answers, and making sure I understood all questions. On days of practice exams during the 6 week study push, I took the exams in the morning. They last 3-4 hours and I would then take the rest of the day off. Remember to take time to relax during this time. Usually the day after a practice exam was a light study day of only reviewing the previous day's practice exam and incorrect Qbank questions I had marked for review.

The day of your exam. Remember how much effort you have put into studying, how smart you had to be to even be accepted to medical school and that you truly are capable of an amazing score. If you did the practice exam, you already know where to park, where to put your backpack and how to do the fingerprinting process. Even better, do the exam at a smaller testing center like Deerfield instead of Chicago, and the staff are literally the same on practice day and exam day. Mine remembered me and were cheering me on throughout the exam day, which is a great encouragement. Bring your First Aid book and any flashcards along with a lunch. During breaks, you actually can look up material and call family members. If there was a particular question in block 1 you just couldn't figure out but knew exactly where it was in First Aid, look it up. Don't let the uncertainty hinder your focus for the rest of your exam. Call your loved ones. Hear their voices and words of encouragement. As far as when to take your breaks, base it off how your concentration is. I ended up doing 3 blocks, a small break, 2 more blocks, lunch, 2 blocks, small break calling my husband for motivation for the final block, and then the final block. If this works for you, do it. However, do not choose to push through without a break if you feel tired. Take the break, recharge, refocus.

And finally, celebrate your hard-work. You've earned it!

Appendix: Here's a list of resources I used, as supplied to Class of 2016 Class Board in September

What Resources did you use?
1. USMLE UWorld.  ****
2. Robbin's Review of Pathology Qbook.
3. Pathoma
4. Kaplan Pharmacology Videos
5. Kaplan Biochemistry Videos
6. Kaplan Qbank
7. NBME Self­-assessments (ALL OF THEM!!!!)
8. High Yield Anatomy
9. High Yield Neuroanatomy
10. BRS Physio
11. Flashcards (make your own, don't waste money buying official ones)

Describe how and when you used these resources.

****1. USMLE UWorld.  Nuff said. Awesome! Do the questions during M2 year and then repeat them based on ones incorrect and "marked." Use the tutor mode.

2. Robbin's Review of Pathology Qbook.  Similarly phrased questions to Step 1 and good for both M2
Pathology and Step 1.

3.  Pathoma.  Didn't touch pathoma during actual Step 1 studying, but used it religiously during M2 year.
Great for introductions to material before you've really learned it.

4. Kaplan Pharm Videos.  Used through M2 year so you know what is actually important to study over
frantically trying to study all the useless side­-effect profiles.

5. Kaplan Biochemistry Videos.  Let's be honest, everyone needs a hardcore refresher after ignoring
Biochem for over a year.  Start going over this as early as January, otherwise you'll be wasting your entire
Step 1 devoted study time on Biochem.

6. Kaplan Qbank.  By Step 1 studying, ideally Uworld Qbank will have been scoured over multiple times.
Thus, this resource gives you a bunch more questions.  It's not as good as Uworld, focuses on little details
while Uworld focuses on conceptual understanding, it forces you to realize, "I don't know all the biomarkers" or "I should make a flashcard with all the chromosomal mutations for key diseases"

7. NBME Self­assessments (ALL OF THEM!!!!!).  I took my first NBME at the end of January Practicum and
then did one about every month  (Until actual Step 1 studying when I did 1 every 9-10 days).  The first one is
both demoralizing and reassuring.  Most people do a little better on their first than they expect which gives
you hope you can crush this exam, and motivation to continue studying to add points to your score.  The
more assessments you do, the more questions you've seen.  Honestly, there were A LOT (!!!!!) of very
similar questions from the self­-assessments as on the actual Step 1.

8/9. High Yield Anatomy/High Yield Neuro.  First Aid does not do Anatomy justice.  You need something
else to review the high yield concepts.  Surprisingly, Anatomy is not that heavily tested, so knowing the
concepts from these two books will cover 90% of your questions.

10. BRS Physio.  Do this before each section of pathology (ie, do Kidney physio right before studying
kidney pathology).  It helps cement phsyio and improve your M2 grades all at the same time.

11. Flashcards.  Nuff said.  It's all about active learning.

Explain why you chose these resources over other popular resources (DIT, Kaplan, First Aid Rx
QBank, etc.)

By now, you should see I really really like videos and questions.  I can't read textbooks (even Micro Made
Ridiculously Simple was almost too much text for me).  Both these venues (Kaplan videos and Qbanks)
became perfect guides that forced me to re­look at concepts I didn't fully understand.  For things I didn't
remember, I would re­look them up on Wikipedia, textbooks, etc.  For things that required mere
memorization, flashcards became my friend.  Thus, I chose resources that forced some form of active
participation.  Minus High Yield books, all my main resources were in question format.  Even the kaplan
videos gave a level of active participation because I would pause them constantly to draw biochem pathways
or make flashcards on pharm.  I never just stared at a screen thinking that would be successful studying.