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Stepping Into the Ring with Step 1

Tony Maltagliati, MS

American College of Cardiology Medical Student Leadership Group

MD Candidate // Class of 2021

University of Arizona College of Medicine - Tucson

Disclosures & Funding

I am currently a fourth-year medical student and have no conflicts of interest, financial or otherwise.

The advice in this presentation is a combination of many resources and insights. This worked for me, but

adjustments may be needed to fit your Step 1 goals and learning style, and there are certainly other strategies

that may work as well or even better for you!

In February 2020, the National Board of Medical Examiners announced the USMLE Step 1 exam would

transition to a pass/fail scoring format rather than the three-digit score, with this change occurring no earlier

than January 2022. Details including changes to the minimum passing score or specific implementation,

particularly given the impact of the COVID-19 crisis on the timeline, were not available as of July 2020.

USMLE Step 1

2018 NRMP Program Director Survey^2 Response Rate 29.3%

Critical Components of Match

Summary from University of Michigan Website 3

Class A Criteria: Step 1, Step 2, clerkship grades

Step 1 Passing-215: Low

215-230: OK to good

230-245: Good

245-255: Very good

250+: Excellent

Class B Criteria: Interview

Class C Criteria: Research, extracurriculars, leadership, personal statement, LORs, MSPE

Study Guide

Amalgam from: ”DermGuy” youtube videos (no longer posted), Reddit,

advisors, peers.

Think of this as a job with 8-10 hours of pure work most days.

Study by organ system, with day 1 being reading through First Aid chapter,

distilling your own “master notes” into a notebook, and listening to

relevant Goljan lectures. Days 2 and 3 are going through Uworld on that

topic. I preferred doing sets of 40 questions, untimed, on tutor mode.

Pros: focus learning and mastering one system at a time, periodically

revisit your “master notes” and never look at First Aid again*.

Cons: this is dedicated study, so any way you slice it if you’re doing it right,

it is going to be tiring.

Reddit Search: “Step 1 Score Calculator” & “Step 1 Score Correlation”

UWorld Q Bank c. 2018 Systems

of Q's

(with all subject boxes checked) Allergy & Immunology 39 Biostatistics and Epidemiology 58 Cardiovascular 314 Dermatology 66 ENT 15 Endocrine, Diabetes & Metabolism 187 Female Reproductive System & Breast 65 Gastrointestinal & Nutrition 228 General Principles 75 Hematology & Oncology 224 Infectious Diseases 173 Male Reproductive System 24 Miscellanoues (Multisystem) 31 Nervous System 299 Ophthalmology 12 Poisoning & Environmental Exposure 7 Pregnancy, Childbirth & Puerperium 28 Psychiatric/Behavioral & Substance Abuse 132 Pulmonary & Critical Care 189 Renal, Urinary Systems & Electrolytes 148 Rheumatology/Orthopedics & Sports 126 Social Sciences (Ethics/Legal/Professional) 45 Total 2485

Study Guide

Day Subject

1 Cardio Day 1 2 Cardio Day 2 3 Cardio Day 3 4 Pulm Day 1 5 Pulm Day 2 6 Pulm Day 3

1/2 Day off, 1/2 day GI Day 1 8 GI Day 2 9 GI Day 3 10 Renal Day 1 11 Renal Day 2 12 Renal Day 3

13

Stats, Public Health, Psychiatry Day 1

14

Stats, Public Health, Psychiatry Day 2

15

Stats, Public Health, Psychiatry Day 3 16 Biochem Day 1 (^17) Biochem Day 2

18

Catch up on everything - free time if you're caught up

19 NBME Form 15 and review answers 20 Micro/Immun, Day 1 21 Micro/Immun, Day 2 22 Micro/Immun, Day 3 23 MSK & Derm Day 1 24 MSK & Derm Day 2 25 MSK half day off

Catch up (Derm, MSK, Micro notes, misc) - free time if you're caught up

Catch up (Derm, MSK, Micro notes, misc) - free time if you're caught up 28 Hem/Onc Day 1 29 Hem/Omc Day 2 30 Hem/OncDay 3 31 Read master notes. NBME Form 18. 32 Review NBME Form 18 answers -> short day 33 NS Day 1 34 NS Day 2 35 NS Day 3 36 Endo/Repro Day 1 37 Endo/Repro Day 2 38 Endo/Repro Day 3 39 UWorld 2 & Review answers

Finish master notes…this is a free day if you stay on top of everything

41 NBME 120 & review it 42 NBME 16 & Review 43 Pharm chapter -> master notes 44 UWSA #1 & review it

Review old NBMEs (Forms 19 & 15) our school made us take these earlier in our curriculum

Can do NBME 17, I planned to but felt I was running out of steam so took the day off

Read through 1/2 of master notes, take your time to digest it. Mine was ~90 notebook pages.

Finish reading through master notes & go through First Aid’s “Rapid Review” section. This should make you feel very confident, as it is the core information tested on Step 1 and from my experience ~85% of the questions on my test was this content. Pack your snacks and drinks, have omega 3s with dinner, try to get good sleep.

Step 1 Exam!!! Wake @ 5:30, have coffee and re-read First Aid’s “Rapid Review” section

Every day: eat nutritious food, sleep well, take breaks,

stay connected with friends/family, exercise and go outside.

Test Day

• If you see a Q with a huge stem, quickly look at the last line for their question and glance

at the choices to give you context. Otherwise you may have to re-read the whole question.

• Highlight salient parts of the questions as you go. Questions can become a blur, so

highlighting can help you focus, identify key features, and save time when reviewing marked questions.

• Mark questions as needed and try to finish each block with ~5 minutes to revisit
• Take 5-10 minute breaks between each block
• Do not dwell on questions you’re unsure about or on questions that bother you after a

block is over, just continue and do your best. Focus on how much you DO know, which will be a ton!

Final Thoughts

Everyone is different, so don’t force yourself to do this plan exactly.

Anki is a love/hate thing and a lot of extra work. Had I done it, maybe I could have scored 5-10 points higher on Step 1 but would have felt overworked and unhappy. I personally would choose to use energy on Q banks than on flashcards since they are more reflective of the test.

If you do Kaplan x1, Uworld x2, NBME practice tests, the free 120, and the questions in your curriculum, you will have done ~10,000 questions. The test is 280 questions.

Step 1 is 2.8% of all the questions you have already done. Let that sink in.

You are ready and you will do great!

There is more to your pre-clerkship medical school experience than Step 1, so explore what interests you

and get involved in research, leadership, activities & community outreach. A stellar Step 1 score with no personalization or interesting experiences is not holistically impressive, so set realistic goals and have fun discovering your path!

Feel free to email me with questions or comments: AJM@email.arizona.edu