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Studying for Step 1: A trek

In this Stanford Medicine Unplugged post, second-year medical student Orly Farber discusses her plans for preparing for the Step 1 exam.

A couple weeks ago, I called up my family and non-med-school friends: "For the next couple months, pretend like I'm backpacking in the Himalayas," I said. Pretend, I stressed, because, in reality, I don't even intend to leave Palo Alto much in the coming months. 

I've now entered one of the most-dreaded phases of med school: preparing for the first licensing exam, Step 1. During this time -- which can last as long as a few months -- most students spend their waking hours trying to cement everything we learned in the first two years of medical school.

Studying for the test takes discipline. My friends and I recently compared our self-directed daily schedules -- some of us list out general goals and to-dos, while others fill each waking hour of the day. If you so much as Google "Step 1 schedule," you'll unearth blogs and forums filled with contradictory tips and tricks, a variety of schedule types, and unverified score estimators. Each post oozes with the uncertainty and anxiety that this test provokes. Scoring well opens up residency's doors for future training, and can influence which specialties are available to which students.

One week into my dedicated study period, I'm still figuring out my own plan -- juggling how to learn efficiently and thoroughly, while also carving out time for self-care. I block out time for flashcards, practice questions, and content review. But I also schedule in doing laundry, exercising, and cooking meals. I'm genuinely worried that, as the weeks go on, I might begin to neglect these basic activities. But above that concern, I'm most afraid of neglecting to care for the people I love.

For the next couple months, I know that I have to do the hard and disciplined thing -- prioritize my own education and wellness so that I can take what is, unfortunately, a significant test. Like all med students, I want to do well -- in part, because I want to be a good clinician. But I also want to do well on this test because I've worked hard in school and want my efforts validated.

That's why I asked my friends and family to act as though I'm on another continent. I'll take care of them when I'm a doctor, I thought. But in doing so, I have never felt quite as selfish, and I've never felt the irony of such selfishness more acutely. In building up to career of caring for patients, I'm already limiting my care for those closest to me. Isn't this intense inward focus -- not only on learning, but on immersing myself in my studies for performance-sake -- a form of self-absorption?

I'm not okay with that. I want to do what I need to do to succeed, but I still want to call home, support my med student friends, and spend relaxed time with the all of the other people in my life.

One of my classmates was recently advised to make all of her "emotional decisions" now because she'd need to be hyper-focused while studying for the exam in the coming weeks. While I'm not sure that's a realistic take on emotions, I'm trying to follow the advice -- I too am making my emotional decisions now.

As I shift my schedule around, adding more cardiology review and less pulmonology, incorporating more practice exams, I will also commit more time to my loved ones than I had originally allotted. I'll call while browsing the aisles of the grocery store, make time to go for short walks between practice tests, and remind myself that they always come first. I'll care for them now. At least to the best of my ability.

This is my new schedule, spelled out in a post that reveals that, just like the students I've encountered on medical forums, I'm scared. I'm afraid of failure, afraid of underperformance, afraid of a test I've been warned about since day one of school. But it's just a test -- a serious one, I'm taking it to become a doctor after all, but I refuse, within reasonable limits, to put my life on hold until that happens.

I might vanish to the Himalayas for a few days at a time, but I plan to come back to base camp on the weekends, to catch up with my loved ones and to catch my breath, before beginning the next week's ascent.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Orly Farber is a second-year medical student from Washington D.C. She graduated from UChicago in 2015 and spent the following two years in an allergy lab at the National Institutes of Health. While Orly's heart remains in Chicago, her body is thrilled to be in the Bay Area! She loves running, hiking, rock climbing, baking bread, and tending to her plants -- fully embracing the West Coast lifestyle.

Photo by Yash Raut

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