How to Stay Mentally Strong During USMLE Step 1 Preparation

The gears in your brain are turning at high speed. Make connections. Memorize. Apply. Memorize more. Differentiate. Eliminate choices. You sit at your desk the minute you open your eyes every morning, until the moment you happily surrender to your bed. You can’t figure out where your gluteus maximus begins and the legs of the chair end. Perhaps 40% of that seated time you are brain dead, with your thoughts mindlessly wandering. Your body is waiting for the caffeine surge to kick in and work its magic, and the entire time you’re thinking:

Beat the US National Average. Breaks are for the weak. Maybe if I study an extra half hour, I can push my score up another point. What if I don’t get a 230? Will I not match? Just beat the US National Average. What do I do if I don’t match? How disappointed will my family be? How disappointed will I be? Should I be using more resources? Different resources? Beat the US National Average. What do the forums say? My NBME wasn’t what I wanted it to be. I think I’m stupid. I peaked too early. I’ll never match. Why did I choose medicine again?

These are just a few of the thoughts that run through a medical student’s anxious mind when preparing for the USMLE Step 1 exam. Writing the first of three USMLE Step exams to becoming a licensed American medical professional is an arduous task. It can seem ominous, looming in front of you, waiting to decide your fate. The number you receive on the exam is such a powerful number for students. We peg our hopes and dreams on a good number leading to multiple open doors, and we are determined to think that any number below our expectations will only lead to failure.

One of the biggest challenges during the preparation for the Step 1 is staying positive and mentally strong. It sounds easy, “Yes! Stay positive!” but the anxiety, the fear of the unknown, and the expectations we place on ourselves have the power to put us in a downward spiral. Following are a few tips and pointers students should keep in mind that may help them with their fears and anxiety.

1. You are not your score.

Coming from a Caribbean medical school, we are misleadingly caught up in the notion that our scores decide our fates. Being an IMG (International Medical Graduate) is disadvantageous, so you need all the right cards for your application; a good Step score is considered a straight flush. However, this is not entirely true. A good score is a good score. It’s good. It may even be great! But at the end of the day, it’s a score. Your residency application depends on more than just your Step 1 score, although it is a major contributing factor. However, your attitude and your drive to continually better yourself after Step and prove yourself in clinicals and subsequent exams is what will truly be the deciding factor. There are individuals who have matched on their first attempt with a score of just 198 while being an IMG, and others with a score of 244 who took 2 rounds to match. Ultimately, it is hard to know exactly what a program is looking for. Just remember that there are a wide variety of versatile programs that are looking for all sorts of students and are interested in various qualities. The score is powerful, but you are much more powerful than your score.

2. Task oriented vs. Ego oriented.

In sports, the concept of goal orientation is heavily stressed. In order to deliver, you have to have a set of goals in place that you work towards daily to better yourself. These goals can be further classified into task-oriented and ego-oriented.

 Task oriented individuals are intrinsically motivated. They strive to do their best, giving their maximal effort. They enjoy the task at hand. A student studying for Step who is task oriented is also likely to find more happiness. Remember, Step is about mastering the skill of being tested and knowing the information to the best of your abilities.

Ego oriented individuals are focused on being better than others, having the best and right resources, and tend to focus on luck. They are extrinsically motivated. What this means in a Step setting is that these individuals compare themselves to other students and base their happiness, success, and self-validation on doing better than their peers. Success isn’t measured so much as being the best they can be, but more so as NOT being the worst.  

It is easy to get caught up in the ego trap while studying and constantly mulling over scores of different individuals and where it led them in life. It is advisable that you let go of this mentality and focus on yourself. Try to be the best doctor YOU can be, not just better than the next man or woman.

3. Repetition. Repetition.

As med students, we already know that it is important to study something, and then study it again, and then again, and maybe another 50 times before it sinks in and becomes a part of your very being. However, we tend to neglect this principle when it comes to our own mental health and positivity.

While studying, I found listening to one of the many brilliant inspirational YouTube videos to be incredibly uplifting. Motivational videos rarely tell you anything you don’t know, but sometimes, being reminded in a more dramatic fashion with some great background music helps revive these messages in our minds, and lets us tackle our goals with more veracity. Find a positive activity, whether it is listening to YouTube videos, reviewing a list of all the reasons why you are where you are and where you want to go, or even meditating. Find what works for you and then do it every day.

4. Fans to keep cool.

As monstrous as Step 1 seems to those writing it, it becomes a tad bit less monstrous if you surround yourself with people who care about you and cheer you on – your fans. Having a support group, whether it is family, friends, or partners is paramount. Support systems can act as a foundation for your ideas and help craft specific solutions to improve a difficult situation. The American Psychological Association states that speaking and listening to others regularly can help you put your own problems in perspective. An additional medical benefit of having these support systems in place, as stated by John Hopkins Center to Eliminate Cardiovascular Health Disparities, is that stress and anxiety have a tendency to hike up blood pressure and increase heart rates. Having reliable family or friends around to talk to and rely on can decrease these rates among people.  

5. Life after Step 1?

This is an easy pointer to forget. The day I wrote Step 1, I half expected to walk out of the exam and see the heavens part, with confetti falling on me and family and friends congratulating me for writing this 8-hour exam. Instead, I ended up waiting 15 minutes outside my testing center at a Tim Hortons, watching a pair of old timers play chess while sipping on hearty vegetable soup. It was somewhere at this point and subsequent encounters where it truly occurred to me that Step 1 and similar examinations are not my life. I remember talking to peers and stating how I felt 2 years of my life culminated on this one day. I had to prove two years worth of education by obtaining the highest score possible. After writing the Step, though, I found this outlook quite silly. Besides your ability to take a test, this exam doesn’t “prove” your worth. Difficult, mentally exhausting examinations are a part of the medical profession. However, they are just passing events that we must deal with graciously. Take it for what it is – an exam – and remember, you have so much more yet to see, so many hurdles yet to cross, and so many rewarding experiences yet to go through.

While being mentally strong and positive throughout this process is difficult, there are many tools at your disposal to help you through it, whether it be family and friends, YouTube videos, or the knowledge that you will be okay.

References

Johnson, B. (n.d.). Psychotherapy: Understanding group therapy. Retrieved June 28, 2016, from http://www.apa.org/helpcenter/group-therapy.aspx

John Hopkins Center to Eliminate Cardiovascular Health Disparities. (n.d.). Family and Social Support. Retrieved June 28, 2016, from http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-to-eliminate-cardiovascular-health-disparities/about/influences_on_health/family_social_support.html