Before I get into it, I want to preface this by saying this is my advice and my advice
alone. This is not the be-all end-all of what you should or should not do moving
forward, it’s just the advice I would give myself if I could go back to late summer of
last year before 2nd year started. This is also not intended to give you a clear path to
honoring everything and getting a 270 on step. The reason I am typing this up is
because I believe it would have only been a little extra work to do the things I’m
advising, and the payout would be huge. It would have made me feel considerably
more confident about 2nd year material, and made my life during the spring
semester much less stressful. You will get no shortage of advice on how to approach
2nd year/step 1 and everyone has their own insight, based on their own experience. I
encourage you to ask around, ask as many people as you can, and go with what
works for you. With that being said, let’s get on with it.
General 2nd year advice:
1. Your first block of 2nd year is called GPMSDC, which stands General Principles
of Multisystem Disorders and Cancer. The name is not very illuminating in
terms of what material the course covers so I am going to give you a brief
overview. Last year (Fall 2016) the class was divided into three tests:
a. 1st test covered general pharmacology, pharmacodynamics,
pharmacokinetics, and antimicrobial drugs (all bacteria, virus, fungal,
and parasites drugs).
b. 2nd test covered genetics, hematology, general cellular and cancer
pathology, and cancer drugs.
c. 3rd test was solid tumors and more cancer, autoimmune disorders and
all the drugs related to them, and a bunch of random lectures like
forensics, and orthopedics related material.
2. By the time second year starts, watch and read the first 4 chapters of
Pathoma, several times. I am not sure how many of you have looked at
Pathoma, but the chapters are only 10-12 pages long. If you only watch/read
one chapter every other day you would be able to repeat it several times, no
problem. I emphasize that you should specifically try and go over these 4
chapters because the entirety of organ based pathophysiology in 2nd year is
based on concepts found in these 4 chapters. These chapters encompass
basic cellular pathology/pathophysiology, autoimmunity, basic cancer
processes, and hemostasis. If you understand these concepts well before
starting 2nd year, you will feel 10 times more confident.
3. Review all of Sketchy Micro, starting 2 weeks before GPMSDC begins.
The reason why is because it will make the first test of GPMSDC, much, much
easier. What makes this test, and most 2nd year tests for that matter, more
difficult than 1st year is that more questions will become 2nd and 3rd order.
Most questions will assume you know what they are asking about more often
than not. For example instead of a question explaining symptoms, then
stating, “cultures reveal S. aureus” and asking how to treat the patient, it will
only explain the symptoms, then ask you how to treat the patient. It’s not a
big difference, but if you forgot which symptoms each bug causes over the
summer, then it makes the first test a struggle because you have to review
while still learning new material. Trust me on this, and review Sketchy Micro.
Micro was at least 10% of my Step exam, and it shows up, over and over in
every class.
4. Follow along all 2nd year classes with First Aid (FA). Looking back, I wish I
always had a copy of FA open when I was studying. No one wants to buy a
physical copy of FA too early since an updated version comes out in January,
but if you can afford it, I would definitely get a 2017 copy as well as a 2018
copy. If you cannot afford buying both, there is a PDF version of FA 2017
floating around somewhere that you can easily find and use until you buy the
updated, 2018 version. While studying, annotate material from lecture,
Pathoma, Boards & Beyond, and pretty much any source you use into the
corresponding section of FA. Half the difficulty in using FA is finding
information in the book and remembering where it is located. I can’t tell you
the number of times I spent 10-15 minutes searching for something in FA
without being able to find it. I would eventually give up looking, and convince
myself that it isn’t in the book, only to come across the info a week later while
reading a different chapter. Annotating information throughout the year will
not completely solve the maze that is FA, but it will cut down study time
tremendously in the spring.
a. If you buy the 2017 version of FA, make sure to copy everything you
annotated over to the 2018 version. I know this seems ridiculous, but
it won’t take that long and it will be worth it for reasons I’ll explain
below, in step 1 advice.
b. If you opt to use the PDF of 2017 FA before buying 2018, then buy a
spiral notebook and annotate everything into the notebook, along
with the page numbers for whatever page the information is on. Then,
copy the information into 2018 FA.
c. Also, a caveat: You need to accept the fact that class material and
board material will disagree, a lot. When this happens, go with class
material for block exams, and board materials for NBME/Step.
5. Pay attention to lectures, and lecture slides. I actually heard this quite a bit
from several people who were successful. No one wants to study lectures,
and that’s understandable. No matter how good a professor is, learning from
Boards & Beyond, Pathoma, or another source will always be easier.
However, there ended up being a ton of important information in lecture that
was not available in any of the popular board materials people use for step.
Do not try and memorize every slide, but you should watch every lecture at
least once (with FA open) and annotate anything they emphasize in lecture
into FA throughout the year.
Step 1 advice:
1. Start doing UWorld questions in August. Only do 5-10 questions per day, or
every other day, and only do questions that cover material you’ve already
seen, like anatomy, biochem, etc. As you progress through 2nd year, add
topics you have covered like neuro, etc. No one likes to answer questions
when they are not confident about the material, and I completely understand
why, but I would do these questions anyway. You will feel like you are
answering questions about subjects you have not covered, even if you choose
to do only anatomy questions, or only microbiology questions, but I would do
them anyway. Each UWorld question should take around 1.5-2 minutes to
answer. Do not spend anymore than 2 minutes answering each question.
You’re going to miss questions, and you’re going to miss a lot of them. It
doesn’t matter. Your UWorld percentage does NOT matter. It is significantly
more important to attempt answering questions to the best of your ability,
followed by 4-5 minutes reading every word in the explanation. Even if you
got the question right, I would read the entire explanation. UWorld is a
textbook, disguised as a question bank. Most question explanations are
extremely dense and informative but they’re explained so clearly they’d
make Ganapathy envious. In total, 5-10 questions should take between
30min-1hr to complete. If you do the minimum of what I am recommending
(5 questions every other day), you will still be able to get through around
500 questions by the time you begin dedicated studying. The reason I would
start UWorld so early is because it will put material into context for you,
especially in regards to how step questions look, and what you are expected
to know.
2. While you do these 5-10 UWorld questions, make notes of the underlying
principle each question is testing. For example, if you get a question that asks
the most common genetic cause of Down syndrome, rather than writing,
“what is the most common cause of Down syndrome? trisomy 21”, write a
note that says, “what are the most common genetic causes of down
syndrome?” Followed by the 3 causes the UWorld explanation will list. You
can make these notes in whatever format you wish, but write them in a
manner that will allow you to review them quickly. An Anki deck, word
document, or hand written note will all do the job. Review these notes every
so often for 10-15 minutes before you go to bed throughout the year and it
will greatly help your retention.
3. FA might possibly be the shittiest book that has ever been written. It looks
like it was formatted by people with anencephaly. Information is randomly
scattered, and a lot of the time it’s in areas you would never expect. With that
being said, FA is the most important non-question bank resource for step. FA
is essentially a car manual, and other board sources are like drivers ed. No
one learns to use a car from the manual, but almost everyone has a manual in
their car, and typically, the car manual contains all the ins-and-outs of that
car. In my opinion, FA is best used as a reference that you read
through/annotate while you are using other resources. Your goal by the time
dedicated step studying rolls around should be to have all the information
from Pathoma, Boards & Beyond, or whatever source you learn from
annotated into FA. You don’t want to waste time, and add to your frustration
by having to flip through several books or resources at a time. If you follow
the advice from above, and annotate the information from other sources into
corresponding sections of FA throughout the year, this will easily be
accomplished by dedicated study time. What day you decide to begin
dedicated step studying is entirely your decision. There is no right or wrong
time to abandon mainly studying for class and focus your attention on step.
Ask around, listen to people’s advice, and align your study schedule with
someone who learns similarly to you.
4. Your health, both physical and mental, is the most important thing,
period. If you don’t like the advice I gave, ignore it. If you don’t like the
advice someone else gives, ignore it. I know this is much easier said than
done, but try your hardest not to compare how you are doing or what you are
doing to your classmates. Step is either miserable, not that bad, or
somewhere in between, depending on whom you ask. In my opinion, people’s
perception of step has a lot to do with the situation each person was in when
they started studying/took the exam. There is no shame in regards to
struggling through step. I cruised through 1st and 2nd year, but had a
miserable experience, and an unbelievably difficult time getting myself to
study or care about the exam. It was probably burn out, but regardless of the
reason, and regardless of how strong of a student you are, if you struggle,
then know that this is common and that it’s okay. Everyone understands the
struggle that is step 1. I sincerely implore you to reach out to anyone and
everyone if you are struggling or starting to feel like the test is wearing you
down. Reach out to family, friends, classmates, people you wouldn’t generally
reach out to, and even administrators/professors at the school. Let everyone
in your life know that you will be extremely selfish with your time for 3-6
months and that it’s a necessary evil to accomplish your goals. Reduce your
obligations to almost nothing by spring. Of all the advice you hear, and of all
the trite things you’ll hear about step, focusing on your health is BY FAR the
most important.
There are probably more tidbits here and there but these are the main things to
consider, in my opinion. I learned that it is better to approach step as a marathon
rather than a sprint. Again, my classmates might have completely different
opinions and some probably think my advice is flat out wrong. No one is
completely right, or completely wrong. The only wrong in this whole experience
is USMLE Step 1. I hope this ends up being useful for you over the next year. I
hope you all crush step, or get the score you’re aiming for. And above all else, I
hope you realize that there is a light at the end of the 2nd year tunnel. If you have
any questions about anything, please feel free to message me. Have a blessing.
Adham