STEP 1, Need I Say More?

I meant to originally write this post in the days immediately following my STEP 1 exam. What I did not realize at the time, was that the last thing I wanted to do following the exam was put forth any sort of mental effort whatsoever. Thus, while I’m currently on my 4 week block off for 3rd year, refueling my brain reserves, I am ready to write about the experience itself.


It cannot be seen, cannot be felt, cannot be heard, cannot be smelt, it lies behind stars and under hills, and empty holes it fills, it comes first and follows after, ends life, kills laughter.”

                -Gollum (The Hobbit)


So the answer to Gollum’s riddle is STEP 1. At least when I read Tolkien’s The Hobbit that’s what I think he meant. Literature is up for interpretation right? Okay, I concede the story goes on and the answer is actually “darkness”. But you might be asking, why did I think he meant STEP 1? Did Gollum know about STEP? Does STEP 1 actually = Darkness?

I began really studying for STEP 1 essentially after returning from the winter break last January (2017). I would wake up, study, eat, go number #2, study, workout, study, sleep, repeat. Okay, so that’s a sneak peek into “Neema’s Super Special STEP 1 Study Schedule, Sure to Get You a 290”TM; if you want more then Venmo me $99 and I’ll get it to you sometime by mid-June! Really though, the last thing I want to do is tell everyone all the secrets I used and habits I formed for a “sure-fire” way to get anyone a certain score on the exam. There are plenty of smarter, more intelligent, better looking people out there to be giving out that advice! What I hope to share through this post are the lessons I learned in the midst of the trials I faced preparing for this darkne…I mean exam.

First off, I am by nature an optimist. That doesn’t mean I see the best in people always, and rainbows and sunshine do not in fact routinely distort my perception of reality. What it does mean is that I’m usually running late to places because I think it will only take me five minutes to get ready, but it actually take me 15 minutes. I think I can finally be under budget this month, but I keep exceeding my budget time after time. I think I can score a 270 on STEP…okay I never thought this. My first misperception regarding STEP studying was I thought I could just start full speed on day one. I thought doing 40 UWorld questions, reading 30 pages of First Aid, watching three hours of Pathoma videos, and drinking 17 cups of coffee would just be something I started doing instantly. Instead, I had to start with a little bit, and slowly, slowly build upon that. This was pretty disheartening at first (as many things are to me as the eternal optimist), but the fact is everybody experiences this sort of progression, or mental learning curve if you will (and in many ways, this whole mental learning curve was similar to what I experienced as I transitioned from undergrad to medical school itself). My brain wasn’t ready for the task of an 8-12 hour study day right away. I could barely take on an extra hour on top of what I was already doing for classes, but that was okay. I learned to do what I could manage, and found that as time went on, I was able to add on more and more. Eventually I got to the place where I was studying 8-12 hours a day (real study time, not including FB and ESPN mental breaks) and doing that day after day, with my brain actually absorbing what I was reading. Eventually I took that 8 hour exam and felt as well prepared as I could have ever been. The point is, I realized that although my initial expectations were unrealistic, I was able to work hard towards the goal of studying for X number of hours in a day, and was able to reach that goal steadily. Often time I had to recall my underlying purposes for studying so hard, which enabled me to hit the proverbial wall, and actually keep moving forward. For anyone that goes through studying for STEP, it is key that they find what drives, motivates, and inspires them early on in the studying season.

Another hurdle was my first practice exam I took on my own. I thought, “okay Neema, you’ve been studying hard-ish, you’ve begun to synthesize some of this knowledge, you should be able to at least score a 2**”. In reality, I think I scored about 15-20 points lower than I expected, and this once again set off a red-flashing distress signal in my brain and my optimism turned to pessimism. This time it wasn’t just my optimism that was shattered though. The comparison game began to take full effect. Whenever you take an NBME self-assessment, at the end you are given a score report that allows you to understand how you came to your score. For instance, you can see that you really know your Endocrinology and are scoring above average, but your Cardiology is severely lacking. My first score report looked something like this, “Cardiology – borderline performance, Gastroenterology – below average performance, Neurology – you suck”. I began to immediately think of how well all of my classmates must have done, and how much trouble I must be in for scoring so poorly. I began to walk around as if that practice score was hovering above my head, and everyone else in my classes had a higher score hovering above their own heads. Sadly, this comparison game continued for me, and I’ll assume for many others, all through my exam preparation. I remember mentally distilling the significance of the difference between a 225 or 230 or 235 or 240 or 245 or 250 or 255. At the end of my real test day, I took the exam and scored the score I got. None of my worrying or comparing myself to others did anything to change my score. If I were able to transport myself back in time to last year and tell my past self not to worry about the score, my past self would probably tell me to get the heck out of the room and freak out further from seeing my future self. But seriously, we, as medical students, all take this exam and we will all get a score, and so far as we pass, we will all have a shot a residency. Rather than spending your time worrying about your score, why not just do the best work you can do on any given day, trusting and hoping that will lead to your best possible score. I know this is so much easier said than done, and I failed at it all too miserably. I would simply ask that anyone reading this, especially those that might be finding themselves in a similar circumstance soon, to consider whether they would be better off not worrying quite so much or comparing themselves to the STEP gods of Reddit as many days out of the week as I did (definition for “STEP gods of Reddit”: people who post on Reddit their personal study plan, which included annotating FA and Pathoma 5x, throughout dedicated study period alone. People who went through UWorld, Kaplan, and USMLE Rx 3x each, with >90% scores on each pass. People who created the Anki decks that everyone else uses. People who scored above 260 on STEP 1, and wrote an entire post explaining to the whole Reddit universe about how meticulous and dedicated their study plan was).

Studying for STEP can be a really “dark” time too, and I mean that without any humorous allusion to The Hobbit. Just stop and think for a moment: if you spend an entire day studying by yourself, depriving yourself of much in the way of social interaction and possibly things that actually bring you happiness, you might find yourself in bed that night feeling pretty down. One way or another, I needed to find a way for myself to alieve that feeling of being beat down by the end of a long study day. I crave relationships and interactions with others, and found spending time with family and friends to be a great break. When I found myself within the thick of studying, there were plenty of days where the only other person I saw was my wife, and the interactions with my wife could even be cut short due to needing to study before dinner and after dinner and after she fell asleep. Time with family and friends in general was definitely sacrificed for the sake of more preparation. That’s not something I think anyone should readily sign up for, rather it’s something that I’ve tried to avoid at all costs throughout my entire education (For example, if it’s a Sunday afternoon and I’m with my family, I’m the sort of student who will say, “Let’s just keep hanging out, I’ll get up early tomorrow to study”, which inevitably is never as early as planned.). The single greatest lesson I was able to take away from STEP in order to stave off that “dark” feeling, was with treating time with family and friends (or even by myself, say at the gym) as sacred. By that, I mean that time spent with family and friends is time intended for them exclusively, despite whatever laundry list of tasks to complete for that day remain. I might only have had 30 minutes to spend with my wife, but I found that it was better for me to spend those 30 minutes fully engaged with her than with my mind racing over all the questions I had missed that day on UWorld. I believe this is a lesson that I will continually be re-learning throughout my entire life, and have been trying to learn even within the midst of 3rd year rotations/clerkships. To be able to live your life well, to put off worrying at times when it’s simply not needed, is a practice that we all to develop in. No matter whether it’s during studying for STEP or when our cars breaks down, and the costs associated with that pile up, sometimes it takes all that we have within ourselves to simply relish a meal with another or truly enjoy an episode of The Office (watched for the 7th time, and still laughing out loud).

For anyone about to begin this journey, please do not be disappointed when you cannot keep up with your classmates that are already studying X number of hours or doing X number of questions. Just keep trucking along, knowing that this is a true marathon and not a sprint (as cliché as I know that sounds). Keep faith that you are at this point in your life for a reason (you are smart, you are a good test taker, and you will one day be a physician regardless of whether you make a 200 or 260 on this exam). Please take the time to explore or re-examine what brings you purpose and hope in this life. It might seem unnecessary now, but when the time comes where you are faced with 6 straight weeks of 12 hour study days (not to mention all that came before that), knowing the purpose that drives you and the hope that carries you on will be of the upmost importance.


-Neema Khonsari MS3


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