Step 1 by Kolade Odetoyinbo '21
Overview
Step 1 is the first part of the United States Medical Licensing Examination (USMLE). Its stated purpose, taken from the USMLE website, is to “assess the examinee’s understanding of and ability to apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy”. It is a computer-based exam composed of about 280 multiple choice questions, split into 7, 60-minute blocks. The entire day is approximately 8 hours: a 15-minute tutorial (which can be skipped), 7 hours of testing time, and 45 minutes of break time. Any additional time from ending the tutorial or a test block early is added to the total break time.
The test is administered at Prometric testing centers, similar to the MCAT. The closest local centers are a 25-minute drive from Case, but you may also take the exam in your home state should you choose to go back home for the dedicated period.
Step 1 is a standardized test with a three-digit scoring system. The passing mark is 194 and the 2018 national average for matched U.S allopathic seniors was 233 (1). Of note: if you pass Step 1, you may not retake the exam. The raw percent score needed to pass is not publicized by the USMLE and the raw score-scaled score correlation actually changes from test to test. The test does contain some experimental questions that the writers use to create future exams and these do not count towards your overall score (though you have no way of knowing which questions are experimental during the exam).
Where it fits in the Case curriculum
Step 1 is traditionally taken during the spring/summer between the end of M2 and start of M3. We are scheduled for eight weeks of dedicated study time, during which there are no classes and your only responsibility is to prepare for the exam. Depending on your level of preparedness, you may take fewer or more than eight weeks. There is some flexibility for extending the study period into the research block, but some changes may need to be approved by your society dean.
Why you should care about Step 1
As part of the USMLE examinations, passing Step 1 is required to practice as a physician in the United States. However, it has also become a much more prominent factor in the residency matching process. According to the 2018 Program Director Survey conducted by the National Residency Matching Program, Step 1 score was the most commonly cited factor in selecting applicants to interview (2). There are enough total residency positions to accommodate the increasing number of medical school graduates, but there are more applicants vying for positions in competitive subspecialty programs located in metropolitan areas. As a result, the mean Step 1 score for accepted applicants in these specialties-- orthopedics, dermatology, otolaryngology and radiology, to name a few-- is consistently above the national average. Even for specialties that are not as competitive overall, more prestigious programs may again be looking for applicants with scores above the national average.
While there are many elements that factor into residency matching, the importance of Step 1 cannot be understated. Scoring well keeps many doors wide open and gives you some cushion should you fall in love with one of the more competitive subspecialties later in medical school.
Studying for the Test
Studying in advance
We’re very fortunate that Case offers a really flexible curriculum that allows you to include board preparation materials easily. Review books such as First Aid and Step 1 Secrets can be great for getting the quick and dirty facts for a concept to kick off IQ research before using more detailed resources to flesh out your knowledge base. Popular video resources such as Pathoma and Boards & Beyond can be very helpful in that an expert teaches you the important information while contextualizing things clinically and emphasizes concepts that are often tested (i.e. “high yield”). Anki, a spaced-repetition flashcard program is also an increasingly popular study tool. There are several pre-made flashcard decks for Step 1, such as Zanki and Lightyear, created by medical students who have graciously shared their work with the masses. I’d recommend trying different decks out to see which flashcard style works for you, or you can create your own! It’s a great way to actively learn and review material throughout the preclinical years.
The Case curriculum makes a point of not “teaching for the boards” and instead places more value on developing clinical thinking skills. This is reflected in our short-answer style exams that allow for explanation and justification, in contrast to the multiple-choice Step 1 exam. It may seem that they are at odds with each other, but Step 1 is moving away from rote recall-type questions and now testing clinical application with multi-step reasoning. Taking the Case approach to problem (i.e. asking yourself the right questions) can be beneficial when Step 1 comes around.
While it may be tempting to completely focus on board studying for the preclinical years, I’d still recommend giving the Case curriculum the bulk of your attention. IQ works best when people are invested in learning from each other and asking questions beyond Step 1 content. Further, block exams are based on IQ and lecture material that may not always have the same information as board exam books so you’ll need to defer to the curriculum when these discrepancies pop up. With a little bit of forward planning and integrating resources effectively, you can ace Case’s block exams and put yourself in a great spot as you go into dedicated study period.
Step 1 is the first part of the United States Medical Licensing Examination (USMLE). Its stated purpose, taken from the USMLE website, is to “assess the examinee’s understanding of and ability to apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy”. It is a computer-based exam composed of about 280 multiple choice questions, split into 7, 60-minute blocks. The entire day is approximately 8 hours: a 15-minute tutorial (which can be skipped), 7 hours of testing time, and 45 minutes of break time. Any additional time from ending the tutorial or a test block early is added to the total break time.
The test is administered at Prometric testing centers, similar to the MCAT. The closest local centers are a 25-minute drive from Case, but you may also take the exam in your home state should you choose to go back home for the dedicated period.
Step 1 is a standardized test with a three-digit scoring system. The passing mark is 194 and the 2018 national average for matched U.S allopathic seniors was 233 (1). Of note: if you pass Step 1, you may not retake the exam. The raw percent score needed to pass is not publicized by the USMLE and the raw score-scaled score correlation actually changes from test to test. The test does contain some experimental questions that the writers use to create future exams and these do not count towards your overall score (though you have no way of knowing which questions are experimental during the exam).
Where it fits in the Case curriculum
Step 1 is traditionally taken during the spring/summer between the end of M2 and start of M3. We are scheduled for eight weeks of dedicated study time, during which there are no classes and your only responsibility is to prepare for the exam. Depending on your level of preparedness, you may take fewer or more than eight weeks. There is some flexibility for extending the study period into the research block, but some changes may need to be approved by your society dean.
Why you should care about Step 1
As part of the USMLE examinations, passing Step 1 is required to practice as a physician in the United States. However, it has also become a much more prominent factor in the residency matching process. According to the 2018 Program Director Survey conducted by the National Residency Matching Program, Step 1 score was the most commonly cited factor in selecting applicants to interview (2). There are enough total residency positions to accommodate the increasing number of medical school graduates, but there are more applicants vying for positions in competitive subspecialty programs located in metropolitan areas. As a result, the mean Step 1 score for accepted applicants in these specialties-- orthopedics, dermatology, otolaryngology and radiology, to name a few-- is consistently above the national average. Even for specialties that are not as competitive overall, more prestigious programs may again be looking for applicants with scores above the national average.
While there are many elements that factor into residency matching, the importance of Step 1 cannot be understated. Scoring well keeps many doors wide open and gives you some cushion should you fall in love with one of the more competitive subspecialties later in medical school.
Studying for the Test
Studying in advance
We’re very fortunate that Case offers a really flexible curriculum that allows you to include board preparation materials easily. Review books such as First Aid and Step 1 Secrets can be great for getting the quick and dirty facts for a concept to kick off IQ research before using more detailed resources to flesh out your knowledge base. Popular video resources such as Pathoma and Boards & Beyond can be very helpful in that an expert teaches you the important information while contextualizing things clinically and emphasizes concepts that are often tested (i.e. “high yield”). Anki, a spaced-repetition flashcard program is also an increasingly popular study tool. There are several pre-made flashcard decks for Step 1, such as Zanki and Lightyear, created by medical students who have graciously shared their work with the masses. I’d recommend trying different decks out to see which flashcard style works for you, or you can create your own! It’s a great way to actively learn and review material throughout the preclinical years.
The Case curriculum makes a point of not “teaching for the boards” and instead places more value on developing clinical thinking skills. This is reflected in our short-answer style exams that allow for explanation and justification, in contrast to the multiple-choice Step 1 exam. It may seem that they are at odds with each other, but Step 1 is moving away from rote recall-type questions and now testing clinical application with multi-step reasoning. Taking the Case approach to problem (i.e. asking yourself the right questions) can be beneficial when Step 1 comes around.
While it may be tempting to completely focus on board studying for the preclinical years, I’d still recommend giving the Case curriculum the bulk of your attention. IQ works best when people are invested in learning from each other and asking questions beyond Step 1 content. Further, block exams are based on IQ and lecture material that may not always have the same information as board exam books so you’ll need to defer to the curriculum when these discrepancies pop up. With a little bit of forward planning and integrating resources effectively, you can ace Case’s block exams and put yourself in a great spot as you go into dedicated study period.