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How to Manage USMLE Step 1 Test Anxiety

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How to Manage USMLE Step 1 Test Anxiety with Ease


Like Bill Murray in Groundhog Day, medical students can feel stuck in a repetitive loop. Between learning new content, spending long hours studying, and anxiously taking exams, many students feel stuck in a perpetual cycle of anxiety and find themselves constantly worrying about the next exam. Even though Step 1 went pass/fail to ease the stress, plenty of students still feel the pressure.


Being the first of many standardized tests that you will have to take in your career, it is very common for students to experience high levels of anxiety surrounding the first of the USMLE exams. However, the problem is, that when you are stressed, you have less emotional and mental capacity to dedicate to the real task: passing the exam. If you are a student experiencing test anxiety, there are ways to break this cycle of stress! Here are a few scientifically proven ways to help you manage test anxiety:



Take Care of Yourself


We all know the importance and value of a consistent schedule. This includes regular bedtimes, good nutrition, and sufficient exercise. While at 10PM you may be inclined to do another UWorld set because you are behind in your schedule or you just feel really motivated—resist the temptation. A number of studies have shown that a reduction in total sleep time or specific sleep stages can dramatically inhibit a person’s ability to consolidate recently formed memories (1-3). Researchers find the most critical period of sleep for memory consolidation is the one immediately following a lesson (4). So, if you want to make your 12-hour study day worthwhile, make sure you get adequate sleep to retain all that hard-earned Step 1 knowledge. 



Be Realistic About Your USMLE Step 1 Study Schedule


Uncertainty breeds stress. Developing a clear daily and long-term USMLE Step 1 schedule can help address this uncertainty. Making a realistic study schedule requires preparation, forethought, and honesty. Everyone learns differently, so it is important you are realistic and honest with yourself about how to pass.


While some students prefer dedicating a minimum of two hours a day for flashcards, others cannot fathom spending more than 15 minutes on this task. Creating a daily schedule with covered topics each day is critical. Within topics, you should also outline for yourself how much time you realistically plan to spend using each study resource. For example, if you’re the person who absolutely can’t get through a 2-hour flashcard block every day, make a study schedule that allocates that time to something else that you know you can accomplish like doing UWorld questions or going through First Aid for the USMLE Step 1. Additionally, you should factor flexible time into your schedule, which will allow you to catch up on material that you fell a little bit short on. This provides reassurance you will stay on schedule.



Don’t Force It


There will be days when tests are tough or focus is fleeting. Practice self-awareness and stop forcing the process. This could involve a one-hour nap break during your test or taking the rest of the day off to relax. Occasional breaks to listen to your body and take an afternoon off serve multiple purposes. It offers respite from perceived stress, tackles overwhelming feelings, and prevents ineffective learning struggles.


If you often feel anxious or struggle to concentrate during USMLE Step 1 preparation, it’s wise to reevaluate your study schedule to ensure you’re not setting unrealistic expectations for yourself. If however you check your study schedule and there are no problems, you may want to consider a Step 1 study buddy or private tutor to help encourage you and get your test anxiety levels under control.



Learn to Relax


Embracing Mindfulness


I recognize that the idea of “relaxing” can seem radical, particularly in medical school and Step 1 preparation. But trust that mindfulness has been shown to significantly reduce stress. It is endorsed by eminent CEOs and businesses like Bill Gates, Oprah Winfrey, and Google.


Mindfulness is defined as focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings. Mindfulness can take many forms—from 2-3 deep breaths with 5 second inhales and exhales to full hour-long silent meditation. Either way, this break in routine offers a chance to gain perspective on our limited control over everything. If you don’t know where to start, you are not alone. Luckily, there are countless companies dedicated to enabling mindfulness, including Aura, Breethe, Calm and Headspace. In fact, some residency programs have recognized the value of mindfulness and have begun to provide free subscriptions to some of these apps.


Establishing a Mindful Routine


Make a habit of practicing mindfulness to ease USMLE Step 1 test anxiety. Spending 15-20 minutes each day when you wake up and/or before bed acknowledging and breathing through your stressed feelings and being in the moment can help set you up for success by making peace with your anxiety.


Employing these simple techniques will help you manage USMLE Step 1 test anxiety. However, it is important to remember that while excessive worrying is negatively associated with exam performance, a moderate amount of stress is an adaptive physiological response. Everyone experiences Step 1 anxiety, but it is up to you to manage it in a healthy way and not let it negatively impact your exam performance. If you have already employed the tips in this article and still feel overwhelmingly anxious about Step 1, get in touch with us and we would be happy to connect you with one of our tutors who specialize in helping Step 1 students get their test anxiety under control.


  1. Walker MP, et al. Sleep-dependent Motor Memory Plasticity in the Human Brain. Neuroscience. 2005; 133(4): 911-7.
  2. Stickgold R, Walker MP. Memory Consolidation and Reconsolidation: What is the Role of Sleep? Trends Neurosci. 2005 Aug; 28(8): 408-15.
  3. Ellenbogen JM, et al. The Role of Sleep in Declarative Memory Consolidation: Passive, Permissive, Active or None? Curr Opin Neurobiol. 2006 Dec; 16(6): 716-22.
  4. Walker MP, Stickgold R. Sleep-dependent Learning and Memory Consolidation. Neuron. 2004 Sep 30; 44(1): 121-33.


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