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I know this is a medical school blog, but I think it’s about time we talk fitness. No, I’m not about to start telling you how to get into shape. Let’s be honest, I’m still working on that myself. In fact, in recent weeks, I have found it harder and harder to accomplish my fitness goals and it got me thinking. Preparing to ace the USMLE is a lot like trying to get into shape. Both have a relatively straightforward “formula” for success. Most people know what they “have to do” for both of them, and both can be very frustrating, emotional, and full of setbacks. Let's talk about them and then go over 4 foolproof ways to hold yourself accountable while studying.

Literal and Figurative Treadmills

I don’t know about you, but in the past, I have had numerous excuses for why I’m not progressing the way I should. In the physical fitness arena, I have said to myself, “I don’t understand why I’m not losing weight… Even though I’m not working out, I’m still eating very well!” The truth is, though, if I had been actually keeping a food journal I would see… Oh crap, there were those cheese sticks in the cafeteria I just had without even thinking about it. Or, Wow, not only have I not exercised in a while, but I’m actually completely sedentary these days! YIKES!  In this case, my denial about my efforts only does one thing: it sabotages my results. By not holding myself accountable, I am really only cheating myself out of the opportunity to make some real progress! This is literally the EXACT same concept when it comes to studying.  

When it comes to exams, we've all said, “But I don’t understand… I'm doing everything right!”  

Well...are you? Ultimately, there is a straightforward recipe for success when it comes to USMLE studying (read the book, do the questions), and if you are properly doing both, you should be making progress. Now, it is completely possible that you are just going through the motions… you are ‘going to the gym’, but you are really just playing Pokémon Go on the elliptical and not even breaking a sweat. Techniques for effective studying is an entirely different topic, but there are a few very common ways that we cheat ourselves that fall under the umbrella of accountability. Are you really doing everything it takes to improve, or are you actually in denial and sabotaging your score?

Here are 4 surefire ways to hold yourself accountable while studying:

1. Set Tangible Study Goals

When it comes to your dedicated study period, you pretty much have complete control of all variables.  Saying, “I'm going to wake up early” is often not enough. Setting an alarm for 7:30 am and promising that you will get to work by 8:00 am is a tangible goal that you can set for yourself right from the get go. Furthermore, saying, "I'm going to do renal today” is not enough.  You must set tangible goals for yourself such as, “I’m going to read the first aid chapter in Renal, do one 44 question block of renal questions, and read the BRS chapter on Renal.”  

I recommend creating an entire list of what you would like to accomplish over the course of your study period and distribute it across your study schedule to make a detailed checklist for each day. Does that mean this can’t be changed or adapted? Absolutely not! In fact, you constantly should reassess your efforts. But to go into a day, week or the general study period without a plan that includes boxes to check off is going to leave you feeling disorganized, frantic, and unaccomplished. Plus, it’s just fun in general to check off items on a to-do list!

2. Clock Your Study and Break Time

Some may call me crazy on this one and I gladly accept that as a compliment. When I started step studying, I remember I would get up and go to the library and I would essentially be there all day, 10 hours at least. There would be days that I got a lot done, but there were also many days where I would leave going, “How did I not even finish that chapter today?”

In the pursuit of answers, I bought myself a stopwatch. (Note: I didn’t use my cell phone.) While my head was in a book, question, or any other learning activity, the time would be going. Anytime I took a break to use the restroom, check my email, stare into space or weep quietly to myself, I would stop the clock. Well guess what? After 12 hours of being at the library I had only clocked an actual 6 hours of REAL studying. If you think I’m exaggerating, you should try it yourself. I highly recommend this.  From this point forward, my goal every day was to clock more hours studying. My goal was always 10 hours of real studying, but I always hovered around eight and a half. But a week before my test, I was clocking 14 hours a day, and man, was I getting a lot done. This really helped me see how my own distraction was actually interfering with my study time and I was able to fix it.

3. Use “Self Control”

So first of all, I don’t know HOW people went through medical school without the internet or searchable PDFs. The Internet is the most amazing resource. You can literally find any answer to a medical question are looking for with a simple search. But you know what you can also find? Shoes. Wikipedia articles about paramilitary operations in the Sudan. Shoes. Ten great chicken recipes for meals to be made in 10 minutes or less… and Amazon. The Internet can be your best friend or your worst enemy. If you are like me, there is just a compulsion to check Facebook or my email for no reason that is very difficult to overcome.

Well guess what? There's an app for that. For MacBooks, it's called "SelfControl” which allows the user to block certain websites for a certain preset (by you) block of time. And the best part? It can’t be overridden even if you delete it! I would often set my self control app to 3 hours — enough time to do a question set in UWorld and review it without distraction.

Now as for the cell phone: turn it off, delete Facebook, Instagram, Snapchat, and literally just put your powered down phone in another room in a drawer where you will be less likely to check constantly. This is the study equivalent of getting all the junk food out of the cupboard: it sucks, but it is necessary!

4. Track Your Learning Progress

There is nothing like a good self-assessment to determine if what you have been doing really is working for you. There are many ways to gauge your fitness progress: body fat, weight, strength testing, measurements. There are fewer ways to really determine your progress with step studying. In fact, the only real way is to do UWorld questions, and most importantly NBME exams.

Many people don’t like to take an NBME until they are feeling more confident about their knowledge, but that doesn’t make any sense! Why do we take before pictures or take baseline measurements? To track our progress and hold ourselves accountable! While it can be cringe-worthy, it is essential to hold yourself accountable in this way. If you have done “everything right” and your NBME exam scores aren’t improving at all… well, guess what? You probably are doing something wrong, and it’s time to make a change.


In summation, just like when you are working to get into shape, when you are studying, cutting corners and making excuses really only cheats yourself. I have often said that studying for Step 1 was the most emotionally rigorous time of my life. It is a time full of insecurity, setbacks and emotional breakdowns. At the end of the day, however, no matter what you are trying to be when you graduate, your Step score is the key to open any door, and it will be worth the effort. By taking the time and effort (and sometimes discomfort) to truly hold yourself accountable, you are setting the stage to achieve your maximum potential! On that note, I’m going put down this laptop and go to the gym.

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Leila Javidi

Leila Javidi

Leila Javidi, MD, MPH is a graduate of Saint George's University, a Family Medicine resident at Mount Carmel Health System, and a certified consultant with MST Consulting. Although she had never before considered herself a “standardized test guru,” over the course of her first few years of medical school she developed a fool-proof study style — and crushed her exams. She loves to teach and she prides herself on her ability to motivate students to achieve their maximum potential. She is most known by her students for her sense of humor, her ‘pep talks’ and her ‘no-excuses’ study mentality.
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