STEP 1 No Longer Looms!

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I took STEP 1 yesterday! My perpetual 6 weeks of misery is over, also called ISP, the dedicated time we get to study for the exam. Some say “ISP” stands for Intensive Study Period, but over time I’ve heard it be called a lot of other things that also start with I.S.P. — I won’t repeat them here, it’s a PG website, but you can use your imagination. Over the years, STEP 1 has morphed, from a test you simply need to pass to one you have to do well on. There are a lot of grandfathered clauses like that in medicine, take the MOC for instance (the bane of the modern US physician). I don’t really think most of what I learned for boards is particularly useful, or even practical: can’t tell you how many lectures we had where seasoned physicians would say, I’ve never seen this in my life, but the boards seems to love to ask you about it.


About the exam, I felt like a decent amount I knew cold, some I had to work it out on the fly, and the rest I had to narrow it down and make an educated guess. Upcoming 2nd years have asked what I used, here it is:

  • FA with DIT as a companion – DIT was a game changer for me, I’m thinking about using it for STEP 2.
  • Sketchy Medical – the micro section is strong. Not the fault of the company, but some pharm sections are really hit or miss because people who name pharm drugs hate you.
  • Pathoma – efficient, and really sticks to teaching.
  • Lippincott Pathology – great for pictures you’ve never seen before, and getting used to recognizing gnarly things.
  • UWorld – for the question bank for pathophysiology explanations and what not. For what it’s worth, the test format looks exactly like UWorld; though there were a lot less buzz words to bring you to a snap decision.
  • BRS Physiology/Behavioral Sciences – I only did the problems, whatever I missed I’d go back and read in detail.

List amended 5/18 to include Lippincott and BRS


My biggest tip is listen to those in the class above you, they’ll know what your school failed to emphasize. Then find out what works for you, I really don’t think I should dispensing advice, after all I won’t even get my score back for 6 to 8 weeks. And honestly, even if I did well, STEP 1 prep is an individual experience and the questions you get are sort of random. My only advice, if any, is to study broadly and to keep your confidence up. They’ve changed the test format, there’s about 280 questions now, and with breaks, it takes 8 hours to complete. I used all of my break time, something I didn’t do during any of my practice exams (5 hrs). I was fortunate to have classmates to talk to during break, so it made each break session a good decompression. I brought a thermos of double shot of cappuccino that I made at home, lunch for fat and protein, and plenty of sugary snacks to give me a kick. I also brought enough Advil to ruin my organs, I popped one in the morning because I woke up with an intense headache after not sleeping too well during the night. I woke up several times, and drifted between stress awake and stress light sleep –apparently, my classmates who were also there that morning, also had the same experience. I was never a great sleeper, so it was to be expected.

Now, I have to sort out my life, get my financial aid in order, and complete some mandatory tasks before orientation starts. Next week, we do EPIC training (again for me), another TB test, pick up our pagers, and get our hospital patches to have sewn onto our white coats. My first rotation sent our on-call schedules, I’m scheduled 5 days on call for my first rotation. Besides that, we’ll get training how what to do if we’re jabbed with a needle, and meet our clerkship directors. Thursday, I’m going on vacation to New York (I haven’t left Boston since medical school started, except for a trip to Maine).

Lastly, it was cool to see the whole generation of test takers there, people taking their MCAT, STEP 1, 2, and 3 all in one center. Though, the person who was the most chill was definitely the guy taking STEP 3. It was a nice reminder of how far we’ve come.



5 thoughts on “STEP 1 No Longer Looms!

    steph said:
    May 17, 2016 at 9:24 pm

    Was there topics that were not covered in DIT/FA/UW that were on the exam? I’m scared that what I’m reading isn’t enough and the physio will kill me.

      doctororbust responded:
      May 18, 2016 at 8:55 am

      There were several things that I’ve never heard of from class, Goljan (I bought the book, but only used it for reference), and the rest. I’ve heard that is to be expected.

      I read FA, front to back, twice and I could tell you where to find certain things. But, still, there were a few answer choices I narrowed down that I never heard of but knew what the rest were.

      I think by design, they don’t want you to have a certain number of things memorized. My classmates who were there felt it was random as well.

      For physio, I saw my NMBE go up once I started doing BRS physio again, I found that helpful to figure out where I was messing up.

    MedUtopia said:
    May 19, 2016 at 7:58 am

    Congratulations on getting done with the step! As an IMG embarking on the trip of doing the step, your post makes for interesting reading. Were the questions on your test harder than the NBMEs or the UWorld questions? I wish you all the luck and hope you get a great score. Cheers!

      doctororbust responded:
      May 20, 2016 at 9:23 am

      It’s hard to say, it was definitely a hard exam without question. However, in some ways I found the NMBEs to be all-or-none, you either knew it or you didn’t with very few ways to work through the problem. On the other hand, UWorld definitely has very tricky questions when compared to the NMBEs, but they give a lot more hints/buzzwords. The real test, was written like UWorld, but with less buzzwords, so it felt like a mixture of both of them — except, generally the answer choices weren’t as deliberately tricky IMHO. I think the part that made the test hard, at least for me and the people I spoke to, was not the depth of the material but how broad the exam was. I felt, at least with UWorld/NBMEs there were high yield concepts that I expected to come up during my exam. But, very little of what is considered high yield came up on my exam, with the exception of adult heart sounds.

      So, even if you prepare, expect it to be a beast. Good luck and hoped that was helpful!

        MedUtopia said:
        May 20, 2016 at 10:41 am

        Thank you so much for the detailed response! While it does scare me a little, knowing the enemy is a part of being prepared for the battle, I guess. All the best to you. Keep writing. Look forward to reading more about your life in medical school now that the beast is slain! Cheers!

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