As I’m writing this, I’m sitting at a classy dining table on the 52nd floor of the Prudential Tower in Boston. There’s an amazing view overlooking the Boston Harbor in front of my and a view of the swirling pattern of buildings to my right. I’m sipping on a delightfully refreshing New England cider, and I can’t help but realize that exactly one week ago I was in the middle of my 3rd block of STEP 1. It’s only been one week, but it already feels like I took that exam years ago. Life post-STEP is very, very different from life pre-STEP. It’s actually very, very nice! I forgot what it was like to have free time, laugh with friends, and be a pleasant human to be around!
For those who are new readers or unfamiliar, USMLE STEP 1 is the first part of the board exams for medical students in the United States. Students take it at the end of their second year of medical school before starting the clinical rotations that make up the last two years of medical school. It’s supposed to be a comprehensive exam that covers basic sciences and the medical school curriculum from the first two years of school. It’s divided into 7, one-hour blocks of 40 questions each, but with breaks, it turns into an 8-hour experience (assuming everything starts on time). The score you get plays a big role in determining which fields of medicine you can apply for, or which residency programs you can apply to. All in all, it’s a BFD.
Most of my classmates and I much spent most of the semester studying for it. You read that right, a semester spent studying for one exam. During the first few months, we were still in school. We were trying to master the fine art of learning new material while simultaneously reviewing old material. When the semester officially ended, we entered a “dedicated study period” and focused solely on studying for STEP 1. That meant: wake up, study, eat, study, eat, study, go to the gym (maybe), study, eat, study, study, study, sleep. Repeat.
The months I spent studying for STEP were not the most enjoyable. They were grueling and difficult, to say the least. At times I felt very disconnected from not just my friends and family, but the world, and at others I felt like the effort I put in was amounting to stagnant outcomes. I felt like my life revolved around that single day, and as someone who has valued (and written about) finding the balance in medical school, it was difficult to maintain that perspective. I missed conversing with my friends about topics unrelated to STEP and medicine. I missed visiting the beach and having unplanned, spontaneous adventures with my classmates. I missed visiting my family and having long phone calls with friends just because. During STEP days, conversations were short and usually ended with a stressed and rushed goodbye.
In addition to learning how to accept the new, but temporary, state of affairs, I also had to learn to accept the growth process. I was aggravated that I wasn’t progressing at the rate I wanted or expected. I would get discouraged for scoring less than expected, or for missing “easy questions.” As mentioned in a classmate’s post, I played the comparison game and struggled to stay objective. The hard thing about studying for STEP is that it’s a personal process and results may vary. What works for someone else, might take longer for others. I found that though I knew concepts and information, I was having difficulty recognizing them in certain contexts and would at times overanalyze or misinterpret answers and the vignettes. Much like practicing medicine, the process of studying medicine requires reflection, diagnostics, assessments, and plans. You have to give yourself time to measure the outcomes before changing course, but once something isn’t working, it must be changed. We rarely prescribe medications with very adverse effects or low efficacy rates to patients, so why stick to a study tool that doesn’t work? Making changes, though, takes time- time to analyze what isn’t working, hypothesize why, and suggest an alternative plan, and time to see if the changes are as desired. Changing plans can be difficult too, for fear of it not working out and running out of time.
As I reflect back, I am most thankful for my friends and family during this period. I was probably at my worst- confidence and personality wise. I began to doubt the things I knew and second-guess myself. I took my annoyance out on family and became short and snappy with them. I’d like to think I’m a pretty optimistic person, but I was definitely more negative during this period. If you’re an MS2 and reading this, this might resonate with you. I warned some friends early on what I might need from them- time to vent or talk about mindless things, and put moratoriums on certain lines of conversation. Your support system will be your saving grace, and I encourage you to reach out to those will be there for you and communicate what you need before you enter dedicated studying.
In addition, I hope that you go easy on yourself. Be kind to yourself and remember, if you wouldn’t say it to your friend, then you shouldn’t be saying it to yourself. Make sure you take breaks and spend a little time outside and with loved ones. You’re about to enter the hardest part of medical school. The process is not one I would actively recommend to others, but I would emphatically say is necessary. The learning is difficult, but beautiful. Students and residents often say they were the smartest they ever were/will ever be right after they took STEP. Whatever carries over from this study period will be the foundation for clinical rotations and your future career*. Stay objective, keep perspective, and know that others have gone through it and survived, so you can too. Remember also, that this process is extremely personal. If you feel like you need more time, take it. The only person you’d be hurting by cutting your time short or hedging bets is yourself. Talk to students in the year above (like me! I took a few extra weeks for STEP and don’t have any regrets) or your counselor and be honest about your goals, progress, and the work you’ve put in. And lastly, remember that hard work does pay off.
Sitting at this fancy bar, with this beautiful view, I can’t help but feel proud. I don’t know how I did, but I went through hell and back and I’m still doing pretty well. I’d say if you’re getting ready to take it soon, chances are you’ll get through too.
*Now that I’m almost done with third year clerkships and coming back to this piece, I can say this sentiment is true. I already feel like I’ve forgotten so much, but I do surprise myself when I pull pieces of information from what seems like the recesses of my mind. Sketchy, Picmonic, and Dr. Sattar’s funny sayings really come in handy!
Cover photo taken along Charles River (silly me, can’t find any pictures from the Pru overlooking harbor, oops). Other photos taken during my trip in Boston post-STEP for your viewing pleasure! 10/10 rec a trip after STEP before rotations!