Stress in medical school is a reality. Still, some anxiety producing parts of the experience stand out more than others.
Medical students at the Keck School of Medicine of the University of Southern California (USC) rated preparing for the United States Medical Licensing Examination (USMLE) Step 1 exam as the No. 1 stressor they encounter across all four years of medical school. It even registered as the top stressor for first-year medical students, even though it is usually taken during the second year of medical school.
Chantal Young, PhD, USC’s director of medical student wellness, presented research on medical student stressors at a recent thematic meeting held by the AMA Accelerating Change in Medical Education Consortium. She offered a few tips to students pondering how to maintain personal wellness during USMLE Step 1 prep.
Your Step 1 score is a key measure that residency programs will use to evaluate you as a candidate, but it’s hardly the only one. Knowing that, students are going to have to make their own choices about how much time and energy they put into their studying.
“You have to ask yourself, on a very personal level, how much is this worth to me?” Young said. “How much am I willing to sacrifice? For a lot of our students, the initial answer is everything. But you really need to think about it. Are you willing to drop your physical and mental health, your sense of self, and all the other obligations in your life to maximize your score?
“It’s all about perspective. The students who have more perspective from the beginning—and maybe that’s because they took time off before medical school and had other experiences outside of school that have been important to them, so they know that this exam is not the end of the world—or maybe that’s because they’ve had significant clinical experience and they know they can excel in that arena even if they don’t get a 250 on Step 1—those are the people who are sometimes more able to take the exam in stride.”
Some people are great test-takers. Some aren’t. Test-taking ability doesn’t mean you’ll be a great physician. Knowing where you naturally fall on the continuum can mean you will stay healthier during your exam prep, however.
“Everyone has a natural limit for how high their score can be without destroying their well-being to score higher,” Young said. “If I think my score on Step 1 might be on the low side, I would know that going in. I can still try really hard and put maximum effort in, but unless I start having sleepless nights and not eating well and never seeing my friends and family, I can accept that I have a natural ceiling and simply do my best inside that reality. Accepting your limitations is important and mature, and doesn’t mean you’re giving up, but being realistic.”
Every day at medical school can be pressure-packed, and the USMLE is a high-stakes exam.
“It’s a stressful event,” Young said. “Your score does matter. It also doesn’t matter, not as much as students think. There’s a recent line of thinking in the field that we have to stop relying so much on this score, and residencies are intentionally looking at a lot of other factors.
“Don’t blame yourself for feeling stressed. Students should know that it’s not their fault that it’s so high pressure. We have put pressure artificially on a test that was designed to be pass-fail and given it a score. The system did that, not the students. Unfortunately, the students are the ones who suffer. Thankfully there is currently a discussion at the national level about how to handle these issues with Step 1 moving forward.”
USC has taken actions to almost force students not to think about the exam.
“Students have initiated Step 1-free zones at our school, where you are not allowed to talk about it and the first person who does talk about it, pays a dollar,” she said.
“Taking full days in the middle of dedicated studying, if not two full days, of rest is very important. Sometimes you need to wake up in the morning and know you’re not touching it today. Your brain needs to rest and recover just like your body does if you are preparing for an incredibly difficult athletic event.”