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| Tips to Prepare for USMLE Step 1 by Dr. Teoria Murray. |
God has truly blessed me with strong, phenomenal, professional young women who are open to sharing their experiences and encouraging others in their journey. Today's post was written by Dr. Teoria Murray; may you find useful tips as you prepare for the USMLE Step 1 exam.
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Tackling the USMLE Step 1- One IMG’s Story
If you are a medical student or graduate anywhere in the world, chances are you have heard of the dreaded United States Medical Licensing Examination. This 3 step hurdle has been known to stir up fear, anxiety and frustration in the hearts of those with the goal of entering a US residency program. As a 2018 graduate of the University of the West Indies in The Bahamas, I was no exception to this rule. After completing medical school and then internship, I set my sights on the Goliath USMLE Step 1 and completed this task (mostly) unscathed. In this post I will share with you the insights I gained in the process so you can hopefully have an easier experience than I did.
1. Set clear, realistic goals
Medicine is vast with an estimate of over 120 specialties and subspecialties in the United States. What is the specialty of your dreams? Based on your research and experience thus far, what area do you think you could wake up and still enjoy practicing for decades to come? You may not have a clear frontrunner in mind and that’s okay. Maybe there are two or three that spark a light in you. Do not set a low bar for yourself because of the perceived disadvantage of being an international medical graduate. Look up the average IMG Step 1 score for your target specialty and aim above that. As you take practice tests, track your progress toward this goal. Work towards it. Pray about it. Hang it high in your mind as an achievable goal.
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| Source: Charting Outcomes in the Match: International Medical Graduates, Characteristics of International Medical Graduates Who Matched to Their Preferred Specialty in the 2018 Main Residency Match. https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf |
2. Create a study schedule
Once you know your goal score, you also need to decide the amount of time you will dedicate to studying. Generally, it is recommended that IMGs spend at least 6-8 months studying for Step 1 for 6-8 hours a day on most days. When I made the decision to take Step 1, I realized that the long days of hospital-based medicine led to exhausted nights and I wouldn’t have the discipline or energy to study like I needed to. This led to the tough decision of taking 5 months away from work for dedicated study. If you can do this, that’s great! However, many persons can’t realistically afford to do so. In that case, study time will have to be structured around your work schedule and other responsibilities. Towards the end of the study period, set aside a dedicated study time for serious review.
There are lots of study schedules out there than you can adapt to your personal needs and it may take some trial and error to find one that works for you. There are templates for 6 weeks, 3 months, 6 months, 12 months and everything in between. I settled on Cram Fighter’s 4 month schedule because of the time left before my exam at that point, but if I could do it again I would have chosen the 6 month option. You can have a look at some sample schedules here.
3. Choose your resources wisely
The amount of information that’s available to us in the 21st century can be both a blessing and a curse. On one hand, there’s so much useful information. On the other hand, there’s just SO MUCH useful information. How do you choose? The key isn’t how many resources you use but how well you utilize them. In this case, less really is more (especially since you will likely go through the material multiple times). For Step 1, the core resources are UWORLD, First Aid, and Pathoma (UFAP). To supplement these, I found Sketchy Microbiology and Pharmacology useful. Picmonic is also a good visual aid to cement these concepts. However, take consideration of your learning style as well. If you find yourself to be a more visual learner, you may use online learning systems like AMBOSS, Boards & Beyond or Lecturio to guide you through UFAP. The possibilities are endless, so the best advice I can give here is to CHOOSE EARLY. Then evaluate your decision and decide if changes need to be made but do this within the first weeks of study because changing tactics late in the process can be a costly mistake.
4. Spend more time on weaker areas
Step 1 is divided into the major areas of Anatomy, Behavioral sciences, Biochemistry, Biostatistics and epidemiology, Immunology, Microbiology, Molecular and cell biology, Pathology, Pharmacology, and Physiology, with some genetics and nutrition sprinkled in. We all have those subjects that come easier to us. I would find myself almost enjoying studying behavioral sciences and pathology most days, but other areas of study seemed more painful than pulling teeth. (Biochemistry, I’m looking at you.) This is a discomfort you want to face head on. The subjects that you least enjoy studying and that you score lower on in practice tests are the ones that need your attention. Review them early and often.
5. Practice, practice, practice
Get UWORLD early in your study period. You may be tempted to wait until you have seen all the information to start practicing exam questions. After all, that’s usually the way most of us did things up until now. You learn the information then practice exam questions when you almost feel ready. Step 1 is a whole different ball game. UWORLD is a useful tool with over 2000 questions and explanations. The questions are very close to those that will appear on the real thing so you want to give yourself time to get comfortable with the question format and the thinking that goes into answering them. The UWORLD subscription also comes with a simulated exam (UWSA) that is a bit shorter than the real thing but can give you a taste of what it will be like.
You will also want to take NBME exams. These are the closest to the real deal you will see before exam day and tend to approximate your Step 1 score +/- 9 points. It is recommended that you take at least 3 or 4 of these prior to the actual exam as a concrete way of measuring how effective your studying is. If your NBME score 1 month from the big day is still a far cry from your goal, it may be a good idea to postpone your exam and give yourself more time to study.
6. Take care of your health
As robotic as the rigors of USMLE prep can make you feel, you aren’t a machine. You will still need sunshine, fresh air, water, exercise, and some social interaction. In the era of COVID-19 this may take some creativity, but a healthy body, mind and soul will go a long way in boosting your productivity. Set fixed times for study and stick to them, without multitasking. Schedule study breaks and take them. Eat healthy foods that can fuel your brain whenever possible instead of junk food that can make your brain feel foggy. Don’t use caffeine as a substitute for sleep. This is a marathon not a sprint and you don’t want to burn out. Do things you love. Stay in touch with your loved ones. Read a book or watch a show that has nothing to do with medicine, even if only for 30 minutes every day.
7. Give yourself grace
Preparing for and passing the USMLE is taxing. Some days you won’t feel like studying. Study anyway. Some days you won’t meet all of your goals. You may score lower than you expected on a UWORLD question block. Your NBMEs may be less than stellar. You may doubt yourself, your abilities, your goals, your calling, and all the signs that led you to believe you were on the right path. Don’t beat yourself up. Take a deep breath. Stretch. Pray. Reach out to someone you know is always in your corner for a pep talk. Talk things through with other colleagues preparing for the exam or who have taken it recently. But whatever you do, don’t give up. You already know that you are capable of amazing things. God has brought you this far and it’s only up from here. So keep pushing and at the top of this mountain, when you realize it was all worth it, reach back and encourage those still climbing.
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Dr. Murray is a recent graduate of the University of the West Indies, currently practicing medicine in The Bahamas. Feel free to post your comments below if you would like to hear more from here in reference to the USMLE Step 1 examination.