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From the day most students start medical school, they learn about the USMLE Step 1 exam. As the months go on, talk of the exam becomes an almost daily occurrence. It’s not surprising, then, that many students feel they need to devote as much time and energy to preparing for this exam as possible. For some, this manifests as weekly USMLE practice questions and frequent skimming of review books as early as first year. Others may spend their entire first summer preparing for Step 1. Some students sacrifice Thanksgiving, Christmas, and spring breaks to prepare. On the contrary, other students do little prep before their dedicated Step 1 study period.

So, the question remains – what do you need to know about getting a head start on USMLE Step 1 exam prep? The following offers some myths and truths to guide you through the process.

MYTH: Excessive, early worry about the USMLE Step 1 will lead to a higher score.Students with higher test taking anxiety generally score lower on the USMLE Step 1. A recent study found that greater test taking anxiety was associated with lower USMLE Step 1 scores (1). Students with less anxiety about testing generally achieve higher test scores. The USMLE Step 1 is a high stakes exam, so it is natural that students’ will have a lot of apprehension about this exam. However, worrying about this exam days, months, weeks, or even years in advance may do more harm than good. Students who are months out from the exam should try to focus on their current coursework material rather than stress about Step 1. For students who have trouble quelling their USMLE fears, at the very least, it is important to develop the mental strength to put them aside on test day. As a competitive runner, I often use my experiences racing as a metaphor for life’s challenges. I remind students that it’s ok to be nervous before the race, but when the gun goes off, it’s time to perform. Stand on that starting line calm and confident, knowing you prepared to the best of your ability and be excited to showcase your hard work and talent.

MYTH: The longer you study for Step 1 the better. As a tutor, one of the biggest challenges I face is convincing students that they are ready to sit for the Step 1 exam. All too often, students want to push their exam as late as possible to give them a few more days or weeks to study. Most students feel that more time will give them greater ability to retain more knowledge and potentially earn a higher score. But the reality is that students who push their exam to the very last minute or even delay the next step of their training to allow more time to prepare are typically not the students achieving the highest Step 1 scores. Numerous studies have indicated that increasing the number of days studied does not lead to increased Step 1 scores (2). In fact, Kumar et al. found that students who studied <40 days in their dedicated Step 1 study period achieved higher scores than students preparing longer than 40 days (3). With that said, this doesn’t mean preparing early for Step 1 can be a waste. Rather, it suggests that quality is more important that quantity. Which leads us to our next point . . .


MYTH: It's ok to sacrifice preclinical coursework studying in favor of early rigorous Step 1 prep. It is extremely important for students to learn their coursework material well the first time around. I always tell students that while they are still taking classes and studying for exams prior to their dedicated Step 1 study period, they must make their coursework a priority. Only after they are doing well with their coursework and managing time appropriately can they start to incorporate Step 1 prep. This means that if you are really struggling with a particular subject, it is important to get help. Talk to your professors. Get a tutor. Learn the material well the first time. And, most importantly, don’t sacrifice your course work material in exchange for spending more time on early Step 1 prep. It is important to have a solid basic medical knowledge before one can expect to do well on Step 1. Qbanks and review books are designed to be just that – review sources for material you have already learned.


TRUTH: Completion of more practice questions correlates with higher USMLE Step 1 scores. Learning how to dissect Step 1 questions is key to getting a high score, and there is no better way to learn than by completing many practice questions. Research supports the notion that completion of more practice questions correlates with higher Step 1 scores (3, 4). When I work with students, I challenge them to always question why they missed a question. Knowledge gap? Fell for a distractor? Read the question wrong? Students who complete more practice questions not only review a greater diversity of material but also learn more about themselves and how to better tackle challenging Step 1 questions.

In summary, the decision on when to begin Step 1 preparation ultimately depends on a number of factors. For students looking to get a head start prior to their dedicated Step study period, I encourage the use of a qbank to review questions on material they have already covered or are currently learning in their medical school classes. It is best to set a goal of completing a manageable number of practice questions each day so as to complement, rather than hinder, coursework studying. It is also key to remember that quality of studying is better than quantity. Lastly, and perhaps most importantly, students should focus on finding healthy outlets for managing anxiety and stress and not let it consume them on test day.

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1. Green M, Angoff N, Encandela J. Test anxiety and United States Medical Licensing Examination scores. The clinical teacher. 2016;13(2):142-6.

2. Giordano C, Hutchinson D, Peppler R. A Predictive Model for USMLE Step 1 Scores. Cureus. 2016;8(9):e769.

3. Kumar AD, Shah MK, Maley JH, Evron J, Gyftopoulos A, Miller C. Preparing to take the USMLE Step 1: a survey on medical students' self-reported study habits. Postgraduate medical journal. 2015;91(1075):257-61.

4. Burk-Rafel J, Santen SA, Purkiss J. Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum. Academic medicine : journal of the Association of American Medical Colleges. 2017;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S67-s74.

Lauryn Falcone

Lauryn Falcone

Lauryn Falcone graduated Summa Cum Laude and as co-valedictorian from Rollins College before pursuing an MD/PhD degree at West Virginia University School of Medicine. She is currently working towards a PhD in cellular and integrative physiology at the National Institute of Occupational Safety and Health (NIOSH) in a respiratory toxicology laboratory. Lauryn completed her first two years of medical school as an honors student, scoring a 254 on the USMLE Step 1 examination and achieving above the 90th percentile on eight NBME shelf exams. Lauryn has a strong passion for tutoring and mentoring students and enjoys helping them navigate the challenges of medical school.
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