Whether you are just starting up your second semester of medical school or knee-deep in second year, you’ve probably started to think about that next big hurdle: Step 1. Not only do you need to pass to become a doctor, but a good score can open doors to competitive residency programs while a poor score can close them. With so much weight placed on a single exam, you would expect programs and lecturers to emphasize the material tested on this end-all-be-all test. In most cases, you would be wrong. While some programs provide a bit more Step 1 focus in courses, many teach details that are tangentially relevant to Step 1 topics, but miss key points that are frequently tested, often referring students to review this test material during their dedicated study period. And it can be frustrating! You’ve made it this far by thinking ahead, planning early, and trying to avoid cramming unless absolutely necessary. Why should this be any different? So as a student, you may be faced with a difficult choice: study for your courses or study for Step 1. But there are effective and efficient ways to begin preparing for Step 1 well before your dedicated study period, while incorporating material that will be tested on course exams. Here are some key tips for beginning your Step 1 prep during your coursework: