If you’ve been keeping up all the way through, you probably have a pretty good idea about how to study for Step 1. (If you’re just joining us, we recommend starting here with Part 1). At this point in your timeline, you’ve already taken a few NBME tests and finished your first pass of material. You find yourself saying “I never knew as much about medicine as I do right here and now.” And the good news is, you are about to learn even more, and cement all of those concepts into place, so that they are easily accessible from your memory banks on Test Day.

In Part 5, we talked about creating a framework for the enormous amount of knowledge you are storing on your mental hard drive. At the end of your first pass, you’ll have most of the information you need to pass Step 1 within your calvaria. But this guide isn’t written to have you squeaking by or hoping to pass. Our goal is to give you the tools to blow your goal score out of the water. Ergo, a second pass through the material is essential. The goals of and approach to the second pass through Step 1 material are a bit more difficult to define than those of the first pass. We will elucidate them here for you – your very own Top 7 considerations on how to study for Step 1 during your second pass.

Part 6: Utilize the final third of your dedicated study period to make a second pass through the material, keeping momentum going strong into Test Day.

The second pass:

IS NOT the time to decelerate or coast

By this point, you have (hopefully) completed UWorld in its entirety, and worked your way all the way through First Aid. While you might feel like giving yourself a few high-fives at this point, it is important to keep moving forward with the same drive that you started with. Sure, take a day off after you’ve completed the first pass, but fire right into your question bank when Monday rolls around. You will really want to hit your stride early in the second pass if you haven’t already, and bring this winning attitude with you on Test Day. Stay strong…you’re almost there.

IS about finding balance between fortitude and saving something for the finish

That said, don’t burn out. While you do want to continue bringing a strong sense of desire and drive with you to every study session, you need to ensure that something remains for the actual test itself, and you are not dragging yourself to the test center against your will. If you feel yourself running out of gas, slow down a little bit and take solace in the fact that you are getting ever closer to a much needed break.

IS the time make inter-system connections

In the first pass, we were treating most system-based studying as separate compartments. You likely allotted a few days to only studying cardiovascular, and another few days to focusing only on renal. Now it’s time to make connections between the material, and approach your days in a similar fashion. You will be best served by doing many more mixed blocks of questions this time through (instead of staying subject-specific). Now’s the time to think about a hemodialysis patient who is a few sessions behind as having multi-systemic problems (e.g., pulmonary edema/fluid overload, nausea/vomiting, mental status changes from uremia, poor platelet function). Connect the dots!

IS laden with much more questions than reading

Students are often curious, “How many questions should I be doing per day at this point?” The short answer – heaps! If your second pass is about 2 weeks long, and you’ve got roughly 2000 questions to cover, you are looking at 150 questions per day. Ambitious yet feasible. You will be spending less time doing straight reading from First Aid, and review of blocks should be quicker (less note taking and First Aid referencing).

As a caveat, depending on how your memory works, you may find little value in repeating UWorld; you will be surprised how much you remember about individual questions. If you find yourself immediately selecting the correct answer without completely reading the question just because you “remember this one,” strongly consider starting a new question bank.

If you are short on time and cannot manage that many questions per day, consider focusing solely on your incorrects or putting more time and effort into your problem subject areas. As a last resort, you can always extend your study period (or start with a longer study period from the get go).

IS the time to hit the crammable subjects.

As you have learned the art of how to study for Step 1, you probably have dropped the word “cram” from your lexicon. Strong work. But don’t be afraid to pack your head with those annoying facts which the brain only likes hanging onto for a few days, tops. You will never forget the pathophysiology of heart failure, but reaction intermediates in the urea cycle or pathophysiology of maple syrup urine disease might disappear at a moments notice. Biochemistry and biostats have historically been the best to cram in the week or so leading up to Test Day.

IS a time to consider some parallel studying

We’ve discussed parallel studying in depth in this post, as well as in Part Two. After you build a firm knowledge base during the first pass, you will be more receptive and better at teaching Step 1 concepts, so parallel studying works best at this time. And it affords you some much needed company during an otherwise isolating time.

IS the time to, once and for all, approach concepts which have always given you grief

While we never encourage throwing in the towel, triage is as important in the ED as it is for Step 1. If, despite hours and hours of trying, you still can’t memorize your antiarrhythmics (or electron transport chain complexes, neuromuscular blockers, etc.), the higher road might be focusing your efforts elsewhere. You are unlikely to get multiple questions on small finite topics. Be smart about how to utilize your limited time so that you are being most effective.

By the same token, some concepts just need an extra 15 minutes of dedicated study to become unlocked. Give it the old college try before throwing on the pile of “nevermind.”

Only one part remains… the unequivocally most-important part of the entire series: Part 7, TEST DAY