My First Step


The time has finally come.  There is only one thing on the mind of a second year medical student at this stage in his or her education: USMLE Step I.  Pop your head into any of the few Starbucks coffee shops around Loma Linda sometime this week and I guarantee you’ll see a couple wide-eyed, fear driven students feverishly scribbling in a giant binder or answering practice question #1,532 as the date of their test quickly approaches.

Rewind to about 3 1/2 weeks ago.  There I was sitting in my last lecture of MS2 as Dr. Werner finished up his epic course in pathophysiology by teaching us about complement disorders.  To be honest, my mind was on anything but the immune system.  Over the next two weeks, we would be spending our time taking test after test to wrap up the in-house portion of our medical education, after which we had 2-3 weeks “off” to finish preparing for Step I. It was going to take a lot of discipline and time management to juggle studying and just staying alive! Before I knew it, Dr. Werner was giving his last bits of advice, reassuring our abilities, and ending with a simple, “Well, have a good life!” And so it began. The beginning of the end of the beginning.


The Very Last Lecture…


Dr. Werner Gives Me a Good Sendoff

Flash forward to the present day.  This time around, I survived my in-house exams, and excelled! The relief (and realization that I was crazy enough to do 2nd year TWICE) was only short lived, as I knew I couldn’t celebrate a finish line until I had passed through the final gate of Step I. Onward and forward!

“Now hold on a minute Ryan,” you may be saying to yourself, “What exactly is Step 1?” For those of you who don’t know, the United States Medical Licensing Exam, or USMLE for short, is an intense, three part set of examinations that every MD student must pass in order to become a board-certified physician.  Step 1 is taken after the 2nd year of medical school, Step 2 is taken after your 3rd year of medical school, and Step 3 is taken after you have your intern year of residency (after being a doctor for a full year).


A Typical Prometric Testing Center

As for Step 1 itself, it is an eight-hour, standardized exam that consists of seven 1-hour blocks of 46 questions, with one hour of break time that can be taken whenever the examinee so desires.  Along with clinical performance, interviews, and letters of recommendation, Step 1 is widely said to be one of the most important factors in determining where a medical student works after medical school.  Score too low and a lot residency programs won’t give you a second glance; score high enough and you will be considered a competitive candidate; what constitutes a “good” score depends on what specialty a medical student wants to pursue after medical school. It takes a score of 188 to pass, with most examinees scoring around a 225.  As you can see, there is a LOT riding on this exam.

I take Step 1 on May 29, so my time to review is growing shorter and shorter. Step 1 could throw anything from the basic medical sciences, from neurology to anatomy to pathology to pharmacology, etc etc etc.  If you think that sounds overwhelming, let me assure you, it is!  Because this test is so expansive, there are many different ways students can review for it.  The majority of medical students stick to one main resource, supplemented by other books that can help areas of deficiency.  Behold, First Aid:


This 600+ page text attempts to take all the most commonly tested material (referred to over and over again as “high yield”) and squish it into one easy to read manual.  But even though it’s very accurate about what should be reviewed, most students choose to supplement their studies with additional resources, just to be thorough.  Other resources I am using include a pathology review text called “Pathoma,” the USMLE World Question Bank, an online course called “Doctors In Training,” and official NBME practice exams.  After I take Step 1, I’ll let you other medical students who may be reading know how well, and hopefully not how poorly, these resources prepared me for Step 1!

Dedicated Step I study time... 2 1/2  weeks of DIT & Qbanks all day long weeeeeeee #step1 #doctorsintraining #medstudentproblems #medschool

An Afternoon of Studying At Starbucks

So as the seconds count down to facing off against this monster of a test, I have been trying to maintain a fairly regular schedule. I’ve been waking up at around the same time every morning, I’ll spend a couple hours doing my online review course, then I’ll do a block of 46 practice questions, review those, go back over my day’s work, go to sleep, rinse and repeat! It’s pretty rigorous work trying to hit all the high points before Step 1, but as my practice exam scores have shown, review is going well so far, and my biggest challenge will be to avoid burning out.  Only 8 days left to go!


Study, Study, Study…

In other news, Loma Linda was recently visited by a representative of the Be the Match bone marrow donation program.  As you probably already know, Be the Match maintains a registry of people who could be used as possible donors to those in need of a transplant.  The need of these patients is highly specific, so only a perfect matching donor can safely donate his or her marrow.  Most who join the registry never match with someone, or if they do it is usually 10-15 years after they have joined. Well to make a long story short, I joined the registry along with a couple of my classmates, and after having been listed as a donor for less than a month, I have already matched with a patient!  My blood was drawn for confirmatory testing to ensure that I am indeed the best match, and if all goes well, I could help out a 71-year-old male with myelodysplastic syndrome! I can’t believe how fast it happened and am feeling incredibly honored that I have the ability to donate for someone.

Ok, back to it! See you on the other side!


My Upgraded White Coat Awaits…