Outlined below is the study strategy that I used to prepare for LEVEL & STEP 1 medical board exams. I have used an Anki-focused approach with the AnKing deck on AnkiHub since the beginning of medical school, which significantly affected the decisions I made for myself regarding boards prep. I committed myself to using Anki since Day 1 for the explicit purpose of having an easier dedicated study period. Even if you didn’t use Anki like I did, I believe there are still many useful and relevant tips included below.

Pre-Dedicated Study Period

As I mentioned before, Anki was my primary study tool throughout pre-clinicals. As I progressed through each course I would unsuspend relevant cards from the AnKing deck and continue to review them even upon completion of the course. You can read more about my study strategy for more details.

I wanted to take boards as early as possible and calculated that I had only 23 days of true dedicated study time before I was scheduled to take both exams. I scheduled LEVEL 1 and STEP 1 to be taken consecutively, on May 31 and June 1, respectively. I don’t necessarily recommend doing this, as it requires a certain amount of stamina and endurance, but my wife was pregnant with our first child and I needed to get these exams over with so that I could start getting the nursery ready. Otherwise, I would've separated them by 1 or 2 days.

To prepare for dedicated I watched the AnKing's Step 1 video and used a “lazy” and “stress-free” schedule and study strategy posted by a u/mikel_buble on Reddit that resonated with me. I used these resources as a launching pad and modified them to my needs, described in more detail below. 

Dedicated Study Period

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My goal was to effectively study as little as possible, maintain high-quality self care, and pass both exams with relatively low stress. 

Q-Bank > Content Review

I believe that many students, understandably, are so worried that they don’t remember enough that they feel compelled to watch countless hours of Boards & Beyond, Sketchy, Pathoma, etc. to try to fill their gaps in knowledge before they start doing practice questions. However, in my opinion, these exams don’t necessarily require that you know everything in order to pass. I like to think of the exams like this: boards prep is 40% staying calm, 40% medical knowledge, 20% strategy and confidence. Therefore, I believe it’s better to go straight into doing 40-question blocks and self assessments (SAs) since many questions can be answered correctly — even if you don’t know why — with a cool head and proper test-taking strategy.

Daily Problem List

I followed u/mikel_buble’s advice:

During my review of the UW blocks, any topics that I was obviously weak in, forgot everything about, or otherwise couldn't be solved with a simple fast Anki card, got added to the "daily problem list." For example, if I got a question wrong on treatment of CML and realized I know nothing about leukemias, I would add "Pathoma video 6.3 Chronic Leukemia" and also "Sketchy pharm Antineoplastics 3.1 Imatinib" to the problem list. After reviewing my blocks, I would clear out my problem list to zero each day.

This helped reinforce concepts that I was weak in while also saving me a tremendous amount of time.

Suspend Anki  

If, like me, you have been using the AnKing deck since M1, then you likely have >15,000 cards unsuspended. During pre-clinicals I averaged approximately 450 cards daily. This would take me about 90 minutes to complete. I didn’t want to spend 90 minutes every morning during dedicated reviewing Anki cards.

Therefore, I decided to suspend virtually all cards EXCEPT those related to Sketchy micro and pharm, OMM, and select cards based on personally difficult concepts. I used this AnKing video as a guide to help me suspend cards. 

After suspending several thousand cards, I was averaging <150 cards daily, which I could complete in < 30 minutes. This was much more manageable. In addition to continuing with these reviews, I would unsuspend and/or forget cards for missed questions and for my daily problem list (see below).

Dedicated Schedule & Performance

The table below includes my schedule of when I took my self assessments (SAs) along with my performance. I used the AnKing and other posts on Reddit to determine the order in which I took the SAs based on how well they translate to STEP and LEVEL 1. 

Date

Source

Score

Notes

Feb 14, 2023

AMBOSS Self-Assessment

215

~22 %ile

April 12, 2023

Rx Self Assessment

227

~37 %ile

April 24, 2023

PRE-CLINICAL ENDS (37 days to Level 1 / 38 days to Step 1)

April 30, 2023

COMSAE 112

568

(~66 %ile)

May 8, 2023

TRUE DEDICATED BEGINS (23 days to Level 1 / 24 days to Step 1)

May 8, 2023

NBME 29

73%

Predicted 246 on Step 1 (According to YouSMLE)

May 15, 2023

NBME 30

73%

Predicted 247 on Step 1 (According to YouSMLE)

May 18, 2023

UWSA 1

66%

Predicted 232 on Step 1 (According to UWorld report)

May 22, 2023

NBME 31

73%

Prediction unavailable

May 24, 2023

COMSAE 107

598 

(~76 %ile)

May 25, 2023

COMSAE 111

586

(~66 %ile)

May 26, 2023

UWSA 2

69%

Predicted 230 on Step 1 (According to UWorld report)

May 29, 2023

NBME Free 120

78%


May 31, 2023

LEVEL 1

PASS


June 1, 2023

STEP 1

PASS


I began dedicated doing 4 days of studying question blocks, 1 day completing a SA under test conditions, 1 day reviewing the SA, and 1 day off (only Anki). Over time, I progressively increased the number of SAs I completed each week to 2-3.

At the start of dedicated I wanted to complete one pass of the UWorld Q-Bank before my exam. I divided the total number of UWorld questions available by the number of days I had to study and determined how many questions I needed to review each day. However, after I took my 4th SA (NBME 29) I was confident that I would pass both exams, so I decided I didn't need to do a full pass of the material.

By the end of dedicated, I had completed 40% of AMBOSS’ Q-Bank at 59% correct, and 58% of UWorld at 67% correct. I include this information only because I want to emphasize that (1) it’s not critical to complete the entire Q-Bank in order to pass; and (2) Q-Banks are a learning tool, not a diagnostic tool — don't get hung up on the % correct.

Daily Schedule

Below is the daily schedule by u/mikel_buble compared to what I ultimately did for myself, outlined in the Activity (Reddit) column and Activity (JFS) column, respectively.

Daily Schedule

Time

Activity (Reddit)

Activity (JFS)

5:00 AM


Wake up, walk dog

6:00 AM


Make coffee, pray/meditate, relax

7:00 AM


Anki

8:00 AM

Wake Up, Coffee, Anki 

Breakfast

9:00 AM

UW Block #1

UW Block #1

10:00 AM

UW Block #2

UW Block #2

11:00 AM

UW Block #3

Review UW Block #1

12:00 PM

Lunch break

Review UW Block #2

1:00 PM

Review UW Block #1

Gym

2:00 PM

Review UW Block #2

Lunch Break

3:00 PM

Review UW Block #3

Begin Daily Problem List

4:00 PM

Break* / Gym

Other Misc. Tasks

5:00 PM

Begin Daily Problem List

Stop

6:00 PM

Content Review


7:00 PM



8:00 PM

Stop & Relax

Sleep

9:00 PM

Sleep by 10 PM


Biohacks for Test Day

Lastly, I used this Dirty Medicine video to prepare for test day itself. Here’s the gist:

  • The day before the exam, wake up early at 5 am and workout. You’re going to be anxious the night before. This will help you sleep.
  • Pack your bag the night before with water and a snack high in fat and protein (e.g. mixed nuts, protein bars, etc.). Your brain is like a Ferrari — it needs quality fuel to function at its max capacity. Avoid eating sugary foods. NO BIG LUNCH!
  • Decrease your caffeine intake. Only drink one-half cup of coffee on the morning of the exam. You don’t want to have to rely on coffee during the exam and then have to pee while in the middle of a block. 
  • On exam day, eat a healthy breakfast high in complex carbs and protein, like oatmeal and eggs. You will feel satiated for a long time and won’t feel hungry for quite a while.
  • On test day, get to the testing center 30 minutes early. It’s better safe than sorry. Spend the extra time stretching and getting your mind right. 

I began integrating these biohacks from the start of dedicated so my body got used to it prior to test day. I was in great condition during dedicated and I think this is what enabled me to take both exams consecutively without significant fatigue.

Use A Mantra

Lastly, one small trick that helped me considerably is that I created a mantra for myself that I would repeat before I started each block, even during dedicated. Before starting the timer, I would pause, close my eyes, take a deep breath, and say something to the effect of, “I was made for this. Move quickly, and stay calm. If you’re unsure, go with your gut, flag it, and look at it later. Please, God, help me do well.” This took all of 10-15 seconds before each block and I believe it helped prevent me from making silly mistakes.

As I mentioned before, I believe the exam is 40% staying calm, 40% medical knowledge, 20% strategy and confidence. This biohacks section, in addition to maintaining quality mental and physical health, is 60% of the exam.