Studying for boards: USMLE Step 1 + COMLEX Level 1

I have put off writing this post about my USMLE Step 1 & COMLEX Level 1 study strategies for a couple reasons: (1) I wanted to wait until I got my scores back to know whether or not my advice was credible and (2) I do NOT want this post to be about comparison. I want to emphasize that while yes, it is helpful to get an idea of what other’s have done to prepare for these very important exams, you must do what works for you. You know yourself best.

For those of you who don’t know what the heck I’m talking about – in short, the USMLE and COMLEX are both medical licensure exams. USMLE is required for allopathic medical students, while COMLEX is required for osteopathic medical students. Some osteopathic medical students take both so that they can report both scores when applying for residency after med school. If you want to learn more about osteopathic medicine, read my blog post about it.

While I was studying for boards, I posted about how I didn’t want anyone comparing themselves to what I was doing. And on the flip side of that, I didn’t want to hear what anyone else was doing because I didn’t want to compare myself to them. Who’s to say my approach is better or worse than my classmate’s? And even if it worked great for me, that doesn’t mean it will work for everyone. I know MANY people who studied completely different from me and got amazing scores! But if I would have used their study strategy, I would have fallen right on my face. Most importantly, comparison only adds unnecessary stress! Now all this doesn’t mean that I don’t give advice to other people. And my goodness I wouldn’t be where I am today if it weren’t for all the people in my life who gave me advice when I need it! Rather, it’s that when the goal is comparison, the conversation becomes unproductive. I don’t find the benefit in comparing myself to someone (or someone comparing themselves to me) when both of us are doing great with our own strategies. It basically comes down to this: If you are seeking advice truly for improvement, go for it, ask/search away! But if your goal is to compare yourself to someone else, take a deep breath, be confident in yourself, and plug your ears to everyone else’s advice.

Alright, lets do this!

WHEN TO START

I started my “board prep” in January to prepare for my early June exams – so about 5 months in advance. My biggest advice is to start early. And by that I don’t mean a year in advance or during your first year of medical school – med school is hard enough this early on – but simply that you shouldn’t wait until a month before your exam to start prepping.

Personally, 5 months was perfect for me and I wouldn’t have wanted any more or less time. It was just enough time to really dive deep into the material and start making connections between systems – just because you knew it really well when you took the course a few months ago doesn’t mean you know how to integrate that information across all body systems or to other topics. Starting early gives you this advantage – because you will not have time to dive deep into the background behind every disease or concept during your dedicated board study. Struggle with the material early! When your dedicated board study comes around, you want to be filling in the gaps and strengthening your weaknesses, but you can’t do that if you haven’t figured out where your gaps and weaknesses are in the first place.

FIRST AID

I used both the pdf version and print copy of First Aid. Since I didn’t start my board prep until January, I waited to buy the most recent edition so that I had the most relevant version for my exams. I brought my printed copy of First Aid to the FedEx store and asked them to cut the binding and 3-hole punch it (other stores such as Staples and OfficeMax can also do this for you, just ask around). Then I put it in a 3-inch D-ring binder with durable page-dividers to separate the chapters. I would use the FA pdf to ‘control + F’ whatever I was looking for before flipping to the correct page in my printed copy. I felt like this saved me a bunch of time flipping through pages – don’t waste time searching. Contact me if you have difficulty finding the FA pdf and I’ll help you out. As I did practice questions, I would write notes in my First Aid. If I had to add a lot of notes in a particular section, or found some images I liked, I printed pages off and stuck them in my First Aid binder next to the corresponding information. This is why I preferred the binder over a bound/spiraled textbook.

I did NOT read First Aid cover to cover, though I attempted to do so during the first few months of my board prep. I tried to read every word and watch every First Aid Rx video (the lecture series you can purchase to go along with the textbook). As the semester went on, I got more comfortable learning without every single video and started just watching videos for things I didn’t understand or needed someone to walk me through. By the time dedicated came around, I wasn’t watching any of the Rx videos anymore. BYE FELICIA. At the peak of my productivity, I was only referencing First Aid, not reading it like a textbook.

PATHOMA

This book is pathology gold. Get a subscription. Use it not just for board studying, but also for studying for classes throughout medical school. By the time my dedicated board study came along, I had already gone through Pathoma pretty thoroughly and didn’t have to watch the videos much anymore because my notes were pretty good and condensed. I added any Pathoma notes that weren’t already in First Aid to my printed copy.

SKETCHY MEDICAL

SketchyMedical is a resource I used throughout medical school to learn microbiology and pharmacology (SketchyMicro and SketchyPharm). I’m really not sure how I would have learned these subjects without it. I ended up making my own Anki decks out of SketchyMicro and SketchyPharm (more on this later in this post). By the time I got to dedicated board study, I pretty much knew all these sketches by heart, so I really didn’t have to study these subjects hard during dedicated. I never used SketchyPath because it came out after I had already learned pathology and honestly, it looked much more complex/busy than SketchyMicro and SketchyPharm.

KAPLAN Q BANK

During the first part of my Spring semester (January – March), I used Kaplan’s USMLE Step 1 question bank. I didn’t want to start UWorld (the “gold standard” of question banks for Step 1) just yet because I still felt like I had a ton to learn and I spent so much time reviewing questions that I was pretty sure I’d remember the one’s I did (thus making repeating a question bank useless for me). Plus, I knew what would work best for me was doing more raw practice questions, rather than repeats of questions I had already done before. I pretty much used practice questions as a framework for my study sessions. I did all my questions on untimed tutor mode, meaning that the correct answer and explanation was shown immediately after answering each question.  If I came across a topic I felt like I didn’t know a lot about, I took a step away from answering questions, tackled the concept using First Aid, Pathoma, videos (more on these later), etc before returning to questions.

UWORLD Q BANK

In the later part of my Spring semester (March), I started the UWorld USMLE Step 1 question bank. I used UWorld up until my USMLE exam, exactly how I had been using Kaplan – using the questions as my framework for studying, stopping to learn from my other resources when I didn’t understand something, and adding notes to my First Aid with all my pretty colored pens. I only got through UWorld one time (yes, you read that right), which would be a shocker to most people who have taken Step 1. The “general consensus” is that you should repeat the UWorld question bank 2-3 times because it’s basically a textbook put into question bank form. While I agree with how wonderful of a resource it is, I decided to do what I felt would be the smartest choice for me. This is one of many examples where I could have done what everyone else told me to do, but rather made the choice based on my knowledge of how I study best.

ANKI

This is technically a flash card app, but it’s waaaay more than just a flash card app. Anki uses spaced repetition and active recall. Spaced repetition means that every time you answer a question, you tell the program how well you were able to remember it – whether you forgot completely, made a small mistake, remembered with trouble, remembered easily, etc. Then the program uses this feedback to decide the optimal time to show you the question again. Since a memory gets stronger each time you successfully recall it, the time between reviews gets bigger and bigger – so you may see a question for the first time, then 3 days later, 15 days later, 45 days later, and so on. I personally preferred to make my own decks and cards based on practice questions I got wrong and facts that I didn’t think I would remember later, but there are also a bunch of shared decks you can download for free that were made by other medical students! I was thinking about uploading some of the decks I made myself – for example, I made decks for SketchyMicro and SketchyPharm to make it easier for me to remember everything in them – click here to download my Anki decks 🙂

CRAMFIGHTER

I used CramFighter to plan and schedule how I was going to use all the above resources efficiently. It pretty seamlessly allows you to generate a daily to-do list based on when you are taking your exam, which resources you are using, and how you want to study.

SUPPLEMENTAL

The resources above were my primary resources, and the only ones I actively and consistently used. However, there were some resources that I used when I just need a little more information that I couldn’t find in my primary resources. I did not schedule these supplemental items in my Cramfighter/to-do-list since I only used them as needed.

For supplemental videos, I used Boards and Beyond and good ol’ YouTube. DirtyUSMLE is a hilarious YouTube channel that gives some easy-to-remember mnemonics and Osmosis is a great channel for grasping big-picture concepts. I listened to Goljan audio when I was driving in the car – love him! Basically, these were my last-ditch resources, but they were great when I needed them.

COMPUTER APPS

I don’t know about you, but my eyes hurt after looking at my computer screen all day. And studying for 15 hours a day for months straight doesn’t really help with that. F.lux is free and changes the color of your computer’s display to adapt to the room you’re in and the time of day (warm colors at night and sunlight during the day).

I used the free version of the Be Focused timer app on my Mac to break up my study time into 45 minute intervals throughout the day. I would study for 45 minutes straight, then take a 10 minute break, then repeat. Splitting my day up like this was surprisingly effective in maintaining my motivation and focus. You can use any timer to do this, but I just liked that this one showed the timer on the menu bar at the top of the screen so I could see it at all times.

MY AVERAGE STUDY DAY

I got a ton of questions asking what my “average day” during my dedicated board study looked like (when I was not taking classes). While I’ll attempt to outline that for you below, I didn’t create an hour-to-hour breakdown of my days, but rather left room for variability so that I could do what I felt would help me best each day.

6 – 7 am: wake up, drink coffee, stretch, set up my study space for the day (I studied in a private room on campus during the week, and at home on the weekends)
7 am – 6 pm: study in 45 minute intervals with 10 minute breaks, eating when I was hungry, taking a walk if I wanted one, taking a nap if I wanted one, etc
6 – 8 pm: yoga class, gym, run outside, dinner with friends (aka something other than studying)
8 – 10 pm: Anki cards on the couch, get ready for bed, drink some calming tea or make a fun dessert
10:30 pm: bed time!

Keep in mind that my “average day” was super fluid for me (as you can see from my description of 7 am – 6 pm). You probably noticed that I didn’t have a scheduled lunch break, nap time, etc. Some days I took several 30 minute breaks because my brain just couldn’t keep up, while other days I found myself skipping the 10 minute breaks my little timer was giving me! Some days I was already hungry by 11am, while other days I just wanted to snack all day. It all depended on how I felt. If my eyes were drooping or I found myself re-reading the same paragraph over and over again, I got up from my desk and took a 15 minute nap. I just listened to my body.

On the weekends, I would often take 2-3 hours in the middle of the day just to walk outside and review Anki cards – I loved doing this! It got me outside and in the sun, and I still got a ton of review in without feeling like I was studying nonstop.

While I was studying, my phone was on ‘Do Not Disturb.’ I only checked my text messages a few times a day, and I told my friends and family to call me if they truly needed me (I set my ‘Do Not Disturb’ settings to allow calls).

STAYING SANE

I signed up for a yoga class about a month before my dedicated board study time began, and consistently attended those classes throughout my studying. I can not emphasize enough how important it is to find a few things that make you happy and keep doing them, no matter how stressed you are or how little time you think you have. For those of you who asked me how to stay sane, this is how. Stay active, eat wholesome food, and get enough sleep.

Also, don’t be afraid to change what you’re doing, even if you’re already mid-way through your study plan. If something isn’t working for you, throw it out! The biggest mistake you can make is continuing to do something just because other people are doing it and it works for them.

Don’t be afraid to modify things in your life to make this time easier for you. I took full advantage of all the grocery stores that allow you to order online and then just drive up to the store to pick it up (Sams club, Tom Thumb, some Target stores, etc do this). I also did weird things like move my desk into the middle of my living room because that’s where I got the most natural light.

Lean on your support system. Joshua, my boyfriend, made my board study time so much easier than it could have been. I was open with him when I felt overwhelmed and he was always there to support me, whether it was picking up my groceries, making me dinner, bringing me coffee, or just letting me cry on his shoulder (quite literally). If you don’t let your friends and family know what you’re going through, they can’t help.

COMLEX

I took my USMLE Step 1 first and COMLEX Level 1 second, with 3 days in between (June 7th and 11th). I did not feel like I needed any additional time in between the two to study for COMLEX, as all I had to do was review some OMM stuff.

So many people told me to read the Savarese OMM textbook cover-to-cover during this time, but I tried that for about 30 minutes and hated it so I stopped. Instead, I just flipped to the chapters I knew I needed to review most and studied those selectively. I also did as many Truelearn practice questions as I could (click the link or use code NICOLETLIFE for $25 off!) I focused specifically on OMM and ethics questions, considering I had just spent 5 months studying all the other stuff that was on USMLE and just needed to add in those topics for COMLEX.

WHEW. Anyone else feel like that was a ton of information? I hope I didn’t overwhelm anyone. But I really wanted to be thorough and cover all the questions I got regarding USMLE Step 1 and COMELX Level 1 studying. Remember, do what works best for you.

Happy studying ❤

This post is not sponsored by any of the companies discussed above. Simply my personal experience and advice.