A Guide for USMLE Step 1; What you should know

I've gotten a lot of questions from friends and colleagues on how to prepare for USMLE step 1 examination so this is dedicated to those who are curious about the exam and those who are preparing for the exam. I'll be sharing tips and information that will help and hopefully make your journey easier. There'll also be sprinkles of my own personal experience and what I learned along the way

• Overview; The USMLE stands for United States Medical Licensing Examination. It is an examination you have to write if you want to practice medicine in the United States of America and if you want to do a residency program in the US. This examination is written by IMGs and non IMGs, it's basically a rite of passage for anyone that wants to practice in the US. There are 3 steps to this exam. Step 1, Step 2 CK and Step 3. The focus of attention today is Step 1. 

Step 1 is one of the most dreaded exams cause most people believe that it is very difficult and there's a pressure not to just pass the exam but to perform exceedingly well as this is one of the criteria that is put into consideration when you're applying for residency. I will not lie to you, preparing for the exam is very tasking but it is doable and you can pass and perform very well. I've done it, I know friends and colleagues that have also done it and if we can do it, you can too. The Step 1 tests your knowledge of the basic medical sciences which includes; Anatomy, Physiology, Pathology, Pathophysiology, Pharmacology, Microbiology, Biochemistry and Genetics, Epidemiology and Biostatistics. Your knowledge of all these courses have to be very sound, It's not enough to memorize facts, you have to know and understand how things work, you also have to pay attention to details. Preparation takes a lot of work, dedication and time.

• Preparation; The time required for preparation varies from person to person, I can't really recommend for you how long you should take to prepare for the examination. I will advice that you have a time frame and have a plan. I took my Step 1 in March 2019 and I started preparing in the middle of 2018, I started gathering the materials that I needed and going through them. It wasn't a hard core super studying when I started, I basically took my time with it. I was still a medical student, in my 4th year in the middle of clinical rotations while I prepared for this exam and whatever time I had from when I got back from the hospital, I would study with it. Time management is very important. so for preparation I will advice the following;

• Have a time frame of when you would like to write this exam and work towards it, if you have no idea of when you want to write it will be difficult to strategize and manage your time. You have to make up your mind for example "I will like to take my step 1 December 2021, What can I do to start preparing now"

• Gather your materials and resources

• Remain focused

• Have a dedicated study period, I mentioned earlier that I did the bulk of my preparation as a medical student while doing clinical rotations. I eventually took a 3 weeks break from rotations to revise. During this three weeks I did nothing else but wake up everyday and study, I was almost always in my room or the reading room/library studying. you choose however long you want for your dedicated study period, take as much time as you need.

• Materials for preparation; To be honest there are a lot of materials geared towards preparing for the exam. You have to use what works for you. I will share the must haves; you need to get your First Aid for USMLE step 1 , I'll advise you get the one for the year you're going to write, there's usually a new edition every year. If you intend on writing this year for example, get the one for 2021. 

1. 

   This book is a gold standard for anyone writing the step 1, you can't do without it. It contains high yield facts, things you must know for the exam. Go through it as many times as possible, you won't regret it. You need a Question Bank, this is very very important, I can't overemphasize how much you need this, you need to be familiar with how question are asked, how to reason through them and how to rule out wrong options, Start using your question bank as soon as possible, do not delay, don't wait until you know all the stuff, the earlier you start the better for you. Don't be discouraged while practicing questions, it can be really brutal but don't let it weigh you down. The purpose of doing questions is not to show off how much you know, it is to learn how much you don't know. Go with that mindset. 

There are several Question banks out there, I'm very familiar with Uworld, I used it while preparing for my step 1 and step 2 CK, I can vouch for it. Subscribe to a Question bank for new fresh questions. There's Amboss, Kaplan, several others. Use what works for you and practice often, practice questions timed, practice them mixed. You don't need all the massive medical textbooks, you need review books, I used Kaplan notes to cover most of the courses, Pathoma for pathology, I also watched videos, Kaplan videos, DIT, to aid my understanding in some areas. Videos can come in handy also. I will advice you don't bombard yourself with too many materials, find the one that works for you and stick to it.

• Take mock exams; When it's a few weeks to your exam, you can take a mock exam to check your preparedness, NBMEs are really good for this purpose. Uworld also has self  assessment mock questions attached to their question banks, you can make use of this also. Identify your areas of weakness and work on them

• Take time to focus on your areas of weakness, you can't take anything for granted. I struggled with epidemiology and Biostatistics. I had to take extra time to study these areas very well and understand it. You may have a lot of questions in your area of weakness on the exam so don't over look anything, take everything seriously.

• .Cost and Registration; To register for the exam you need to go through ECFMG as an international medical graduate. you need to do your ecfmg registration first, this costs about 125$, you will be given an identification number. It is after this process is complete that you can register for the exam and the ecfmg registration can take about 2 weeks. Once this is complete, you register for the exam on ECFMG through the interactive website applications on the ecfmg website. just follow the instructions, it is quite easy to get through. The Step 1 examination costs about 1090$ if you're writing outside the US and about nine hundred and something if you're writing in the US. You will choose your testing region; where you will like to take your exam using Prometric, You will get guidance on all of this on ecfmg website. You will also be required to choose your eligibility period, a period of time between 3-6 months of when you'll like to take this examination. You will choose an examination date within this period depending on the availability of your examination center

• The day before the exam; I'll advice that a day before the exam, don't do any serious studying. focus on getting your body and mind relaxed for the exam. Take a walk, watch movies, spend time with family, pray. Do something nice for yourself, anything that will keep you in a good mood and keep you relaxed. You can't give in to anxiety or be anxious, best believe you have everything you need for your exam. Eat good food, just relax, you've got this. If you're going to be travelling for your exam, don't do it last minute. I travelled from Nigeria to Accra, Ghana for my exam, got to Accra two days before my exam. I had a whole day to relax and get familiar with the environment. figure out how you're going to get to the venue for your exam on time and know the place before the day to prevent unnecessary lateness or delay on the D-day. Go to bed on time, this is very important, trust me when i say you have a long day ahead, your focus and concentration needs to be optimal, you can't be sleep deprived. Get a good night's rest, no need to wake up in the middle of the night to read, you need to sleep well.

• The D-day; Wake up early, of course. Make sure you eat breakfast. Please don't overlook your breakfast. You need all your energy, don't leave home without eating. You don't want to over eat either, you need to be at alert and not sleepy during the exam. Get your scheduling permit, make sure it's already printed out, You can't forget it at home, as well as your international passport/ means of identification. Get to your examination venue on time. I will advise you to pack some snacks, energy drink, water, in your bag. you will need it trust me. There'll be a locker for you to store it and you'll have access to it during your break time. Step 1 exam is about 8 hours long. you're going to have 7 blocks of questions and about 1 hour for each block of questions, you can have about 40 questions or more per block. The remaining hour is your break time and you can split this 1 hour however you like it. During my exam, I took a total of 3 breaks about 20 minutes each, I took a break after every 2 blocks of questions. You can allocate your break time as you please. Your questions are going to be randomized, a block of questions can be a combination of different questions under different courses. Be cautious of your time, don't use more than your 1hr of allocated break time

• After the exam; You're a Champ, you've done all the hard work and you've made it through the exam. It's easy for your mind to wander  on all the difficult questions you didn't know or the ones you were confused about and beat yourself up. The truth is it doesn't matter anymore. It is not the time to carry your first aid and be checking if you got some things right or wrong. You should allow yourself to rest, put your mind to rest and hope for the best. Go and enjoy yourself, relax, writing the exam is a breakthrough trust me. The relief is sweet. You can finally rest. You should expect your result 3 weeks after you have written the exam, it can take longer though but i got my results exactly 3 weeks after my exam. Results are released on Wednesdays so expect it on a Wednesday. The minimum passing score for USMLE step 1 is 194, you should aim to score much higher than that. Things are changing and from next year 2022, it'll be a pass/fail thing and there'll be no more scores. I'm not too sure how it's going to change things but I'll advise you put in your best regardless. Once you've written and gotten a passing score you can't retake the exam, so you have to really put in your best and get a really good score if you're going to be taking the exam before this year runs out.

I hope that this post answers most of the questions you have about USMLE step 1. I hope I have been able to help in my own little way. There's nothing to be scared of, so many people have written this exam and succeeded, myself included. You can do it, remain focused, prepare adequately and Pray. Surround yourself with supportive friends and family that can encourage you during your preparation. Take breaks from studying to avoid a burnout, rest when you need to rest. if you're preparing and you're reading this, You can do it, I wish you all the best, I wish you outstanding success in your exam. If you have any questions please ask below in the comment section, I'll be sure to address it and please share with your friends and colleagues. Thank you for reading.