The Step 1 Diaries

I would consider apologizing for my absence the last couple of weeks, but I have been too busy trying to crawl out from under the weight of my course work. First year was sort of nice because they kind of took it easy on students for the first couple of weeks (at least at my school). However as an MS2, the first day consisted of an hour orientation followed by 4 straight info-dense lectures. The information overload hasn't stopped since. Interestingly, one of the few things covered during orientation was an introduction to the first step of the United States Medical Licensing Examination (USMLE), which will now forever be known on this blog as Step 1 or the Boards. The most popular posts I have ever written are about the MCAT, and now with less than 10 months to go before I sit for an even bigger exam, I want to officially start a new feature on this blog: "The Step 1 Diaries."

The Step 1 Diaries will be my chance to write about my thoughts, plans, expectations, fears, and experiences with studying for and taking the Boards. I think it will be useful for me to decompress, and have a recorded history about my time as a second year medical student. I also hope that it can serve as useful material for any other medical students going through the same thing. If nothing else, maybe it can open interested reader's eyes to the realities of medical education in the United States.

What exactly is Step 1? 

Step 1 is a 322-question, 8-hour long, multiple choice test that is a major factor in determining one's future in the medical field. A score of 188 is required to "pass." However, as of July 2013, the national mean score is 227 with a standard deviation of 22. This national mean score has steadily been rising for years now, as competition gets fiercer and test-prep gets better (on a bit of a side-note: no one is exactly sure what a perfect score is, but I will be researching this for a future post).

How Important is Step 1?

Uh...very important. Residency directors love seeing applicants with high Step 1 scores. In fact, a lot of institutions usually have "score floors" where your application will only get looked at if it is above a certain threshold. Also, obviously, some specialties have higher average scores than others:

Another point worth mentioning comes from a story in CNNMoney a few months back:

"[In 2013] nearly 17,500 graduates of U.S.-based medical schools applied to the National Resident Matching Program, which uses an algorithm that pairs student and hospital preferences with available openings at teaching hospitals around the country...1,100 U.S. graduates did not find a match this year -- and about half of those didn't land a spot in the informal period afterward. Medical groups say the disparity between students and slots will only grow in coming years."

So Step 1 is pretty much on every second year medical student's mind, and it probably should be. Especially with the enormous cost of medical education in this country (for more read this Bloomberg article)

"The median four-year cost to attend medical school -- which includes outlays like living expenses and books -- for the class of 2013 is $278,455 at private schools and $207,868 at public ones"

There is pressure to not only pass your Boards, but to excel on them.Can you imagine being that much in debt, and then not matching into the medical field that interests you most? Or worse, not matching anywhere and being a doctor without a residency/specialty?

The test is also significant to medical school administrators and professors, as they want their school to have amazing Step 1 pass rates and average scores.

What is on the exam? 

Step 1 is meant to cover everything learned during the "basic science" years of medical school: anatomy, biochemistry, biostatistics, ethics, pathology, physiology, pharmacology, and everything in-between. Generally speaking, pathology (and understanding the mechanisms behind the diseases) is the most heavily tested subject. At my school that means 2nd year is much higher yield than year one.

At the end of the second year of medical school, most institutions (mine included) will give students 4-6 weeks of dedicated study time before the start of 3rd year. My last exam/day of MS2 is May 9th, 2014 and hospital orientation takes place sometime during the last week of June, so I will have up to 6 weeks to study for Step 1.

This first post was just a primer for the rest of the Step 1 Diaries. I am still aiming for a 260+ and think that I can do it. We will find out together over the next 10 months.