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For everyone preparing to write their first USMLE STEP examination, often the STEP 1 exam, the study period especially the dedicated period is one of the most challenging times in one’s life. This period is considered an evil dictator’s rule over many centuries. Honestly, it feels that way at times. One of the biggest reliefs with completion of the exam is getting done with the dreaded dedicated period. For those who have yet to complete the examination, the challenges they will face in this time will shock them and for some, it may put them off their game and entirely ruin their preparations. The last thing anyone wants is for your hard work for months to be ruined by a few very intense weeks closer to the exam. So, in today’s blog, we will shed some light on some of these challenges and how you can mitigate their effects to optimize your exam performance. As soon as you start studying the major issue you will notice is balancing all your needs and priorities. We all have different priorities on a day-to-day basis and month-to-month basis. Personally, a complete day for me consists of studying, doing anything that improves my professional acumen as a doctor, meditation, a workout, a little casual reading and being social with those I love (and feeding my social media addiction because why not). Intensifying any one of those may mean I will not have a complete day, and with studying for STEP 1 that is an inevitability. It’s important to realize that passing your exam is a priority. Depending on the demographic reading this, acing STEP 1 might be a matter of ‘life and death’ for you, so it is important to create a priority list of your needs and tackle your days as per that list. A priority list gives me a nice segue into the next issue, which is managing distractions. These are numerous depending on the kind of person that you are. In this day and age, it doesn’t help that these distractions are particularly enticing and addictive. Imagine having an app on your phone that curates’ videos only to your taste and values and is designed to keep you swiping up all the time (Tiktok I’m talking about you). That is only one example of a social media app and there could be more personal examples for you. What is important to do is to prioritize and also realize you are human. You might not perfectly resist these distractions every time but if it’s not excessive, in that it’s not keeping you from achieving your daily goals, it’s not too bad. In my time in med school, getting big outbursts in motivation closer to major examinations was an easy task and kept my grades good (Disclaimer, this only works if you stay on top of your studies for most of the year). For the dedicated study period for STEP 1, those bursts of motivation are detrimental to you. It’s much more important to stay disciplined and consistent over months as that will more readily translate to better grades in your practice tests and ultimately the final paper. It’s better to add 1% over many days than 20% every few days. Going by this analogy, having a big goal and breaking it down into small, manageable chunks that can be achieved daily will not only ensure you develop this consistency and discipline but also give you something to tick off from your to-do lists, which always gives a big serotonin boost at the end of the day. That brings us to the end of this first blog on challenges in the STEP 1 study period. We at USMLElite hope this has helped you be in the frame of mind to tackle these issues when they inevitably come up and ultimately improve your performance on practice tests and the exam itself. Best of luck with your preparations!

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Preparing for any of the step exams can feel overwhelming. USMLE Step 1 for one is daunting considering the vast amount of material you need to master and apply. Now that Step 1 is pass/fail, if has becoming increasingly important to figure out efficient studying techniques to cover the major concepts in a short precise manner without burning out. This is where active recall and spaced repetition come into play. These evidence based learning techniques have stood the test of time and have been applied by the individuals with the highest scores in all the Step exams. When applied correctly, these strategies are known to not only enhance memory retention but also improve recall speed, boost test performance and reduce anxiety symptoms associated with exam preparation. Let’s take a deep dive into the intricacies of how to effectively incorporate these strategies into your Step 1 preparation.

First things first, What exactly is Active Recall?

Active recall is a study technique that focuses on intentional retrieval of information from memory rather than passive review of study material. For instance, instead of reading First Aid or watching Sketchy videos on repeat, active recall forces you to remember facts actively, quite similar to exam day.

How to Use Active Recall for Step 1
1. Turn Notes into Questions•
Instead of writing long paragraphs you can easipy convert key concepts into questions to challenge yourself later on in your preparation. For example, instead of passively reading that “The most common cause of bacterial meningitis in adults is Streptococcus pneumoniae” Active Recall would involve converting the previous statement into “What is the mcommon cause of bacterial meningitis in adults?”• This forceful manner of retrieving information, will enable you recognize the answer quicker on test day. Think of it as a going to the gym but this time it’s your brain’s neurons lifting weights. The beauty is the brain is malleable and the more we apply Active Recall, the greater the number and strength of synaptic connections created.

2. Use Flashcards Effectively (Not Passively!)• Flashcards such as Anki are a life-saving resource for many students including myself while preparing for my Step exams. However, I quickly realised that using Anki should follow the question-answer format rather than containing paragraphs of text
Example:• Front: “What is the rate-limiting enzyme of glycolysis?”
Back: “Phosphofructokinase-1 (PFK-1).”

The ultimate goal is to test yourself frequently, not just skim through.

3. Cover and Recall Method•
Read a small section of USMLE step 1 such as First Aid, promptly close the book, and try to summarize the main points from memory. Later on, review First Aid and recheck the facts. Right away you can tell if the recalled key facts have been summarized correctly

4. Teach What You Learn• Most teachers become experts in their fields pretty quickly due to Active Recall. Frequently explaining concepts to a study partner, peers, other students or even out loud to yourself forces you to retrieve information. Moreover, identifying gaps in your understanding becomes easier.

What is Spaced Repetition?

Spaced repetition is a learning practice that entails reviewing of information at increasing intervals over time. Instead of cramming everything in one sitting, it’s more benefitial to revisit material just before you forget it. This is particularly important for strengthening long-term memory.

How to Use Spaced Repetition for Step 1
1. Leverage Anki’s Algorithm•
Anki deck is a flashcard app that automatically plans spaced reviews. It has an in built feature that intervals your reviews based on how well you remember each card. If you get a card wrong, you’ll see it sooner. On the flip side, if you get it right, it will appear later. This review format requires consistency. Stick to a daily review habit to avoid cards piling up and frustrations rising. What I love about Anki is that even 100-200 cards per day can make a huge difference.

2. Use the “Forgetting Curve” to Your Advantage.
Multiple research studies have shown that we forget upto 70% of new information within a week if we don’t review it. The secret is to review content at the following evidence backed intervals:

First review: 24 hours
Second review: After 3 day•
Third review: After 1 week•
Fourth review: After 1 month•

This study format ensures that knowledge is reinforced before forgetting.

For Anki, mix Spaced Repetition with Active Recall instead of passive review. Trying to recall the answer before flipping the card is an excellent strategy•
If you struggle to remember, you can write it down, say it out loud or create a mnemonic to help you internalize it.

Schedule Your Anki Deck Reviews•
Create a daily schedule that allows ypi to Integrate Anki reviews into your study session. Here is a sample schedule:

Morning: Review Anki flashcards from the previous two days.

Midday: Do 40-50 UWorld questions with active recall.

Evening: Summarize key concepts and test yourself/ have a study session with Violet and James

Combining Active Recall & Spaced Repetition for Step 1 Master•
If you get a question wrong on UWorld, don’t just read the explanation and leave at that—turn it into an Anki card.
Example: If you missed a question about Horners Syndome, create a card

Front: “Which structures can be compressed by a Pancoast tumor in a smoker?”•
Back: “Brachial plexus, sympathetic chain, recurrent laryngeal nerve, subclavian vessels.”•

Finally, First Aid is a Reference tool, Not a Primary Tool• Many students that by re-reading First Aid multiple times, they are able to commit those facts to memory but passive reading only helps recall marginally. Instead, quiz yourself on each page and test your knowledge• By pairing Active Recall with Practice Questions, you will reduce the amount of time you need for reviews. UWorld is an excellent tool for practice active recall in a clinical scenarios considering their vast catalog of questions. You can improve your clinical acumen by asking yourself:• “Why was my answer wrong?”• “What is the key concept being tested?”Such questions will enable you to spot diagnosis faster during your Step exams as well as your clinical practice in future.
• “Can I explain this to a friend?”

Final Thoughts

Passing USMLE Step 1 iis all about long-term retention. Short-term memorization can be applied sparingly for concepts and figures that require brute memorization. By applying active recall and spaced repetition, memory efficiency can be improved immensely. On the other hand, time spent on studies can be reduced drastically. Instead of unneccessary re-reading, you can allocate the time for reviewing UWorld questions for instance. In the long run, your confidence in tackling Step 1 questions will sky rocket. Don’t wait till tomorrow, start incorporating these strategies today. You’ll be amazed at how much more you retain by test day. Happy studying!