Crush Step 1 With: Margot Cullen

Step 1 is a monster. There’s nothing like it. It could easily be said that no test requires more study, has more influence, demands more hours of preparation or creates more anxiety disorders. That being the case, there is great deal of resources and information dedicated to helping medical students learn what they need to in order to do well on it.

With all the information that’s out there and available, however, it can be difficult to determine what’s valuable, and how to apply it to yourself and your own studies in order to be effective. Bearing that in mind, we thought that it would be a good idea to talk to students who have done exceptionally well on Step 1 and simply ask them how they did it. What better source of information could there be on Step 1 and how to succeed than those who have actually done it?  Seems legit, right? We think so. This series in our blog, Crush Step 1 With:, highlights students from all over who have achieved higher than a 245 on Step 1, and helps break down how they were able to do it. Straight from the horse’s mouth, as they say. The reality is that there is no magic bullet for Step 1 because everybody is unique, but through this series we hope to be able to help you find that something that works for you. Enjoy!


Where are you from and what school did you go to?

I’m originally from Green Bay Wisconsin, and I attend Duke University School of Medicine.


What residency are you planning on going into?

I actually matched into ophthalmology, so I’m really excited about that!


When did you start to get serious about Step 1 preparation?

I feel like there are a couple of different approaches. I am not one who spent time studying during my first year at all. I had friends that started early with flashcards and different things, but that was way too stressful for me. We have a little bit of a different curriculum at Duke; our first year is basic science and our second year is our clinical rotations and we take Step 1 after our clinical rotations, during out third year, which is research. I ended up taking Step in January of my third year. I started doing a little bit of studying toward the end of that November, just to start getting into test-taking mode, but I didn’t get intense until my dedicated study period. During third year, we do 10-12 months of research and we are given a guaranteed 4 weeks of study time for Step 1. I took my 4 weeks following Christmas break, so I had somewhere around 5 weeks for my dedicated study time.


How did you juggle coursework with Step 1 studying?

I personally didn’t. I kept all my Step 1 studying contained to my dedicated study time.


How did you do in your coursework compared to how you did on Step 1?

I passed all my courses, but I struggled a lot with physiology and pharmacology. I’m a very visual learner and there weren’t any good visual resources at the time to help solidify those areas for me. Ultimately, the clinical experience that we got during out second year helped me a lot with physiology and I was much more confident going in to Step 1 because of that, but pharmacology has always been a weakness.


What resources did you use for your Step 1 prep?

DIT, which was great for reviewing. We tend to use Costanzo for physiology. I did UWorld and went through First Aid and I also read and reviewed Pathoma. I made it through all of UWorld. I actually paired it with DIT and my First Aid reading by organ system. I would watch a section in DIT, read the associated section in First Aid, then pound through a bunch of UWorld questions. I always saved a few questions in each organ system for a review toward the end of my studying to make sure that I had retained everything that I needed to. I also tried to do one NBME per week to track my progress. It was very reinforcing for me to see improvements in areas that I had been studying.

One of my friends gave me some great advice and that was that you can expect a variation of about a 10-point decrease between your NBME’s and your actual Step 1 score. With that I mind, I made sure that my NBME’s were at least ten points higher than my target score, and when I took Step 1 my score actually ended up being eight points lower than my last NBME which I took two days before my exam.


What advice would you personally give to a student starting medical school about preparing for Step 1?

I would recommend that you spend the time necessary to determine what your learning style is and then make sure that you employ that in your studying. It’s totally worth it to go through this exercise so that you don’t waste time on study methods that don’t work for you. When talking about studying for Step 1, time is precious! The most important thing that I did during my first three months of med school was to figure out what style of studying worked for me. You really need to know yourself as a learner.

I’m the kind of person who believes that the primary goal in med school is to maintain happiness and a healthy work/life balance, and the secondary goal is to do as well as humanly possible, haha! For me personally, I knew that if I focused on Step during first year, I would be miserable. That being said, I knew what I needed to do and I did it. Ultimately, you need to really take the time to figure out what works for you and what you need to do, then do it no matter what.

When you do commit to studying for Step 1, remove all distractors and commit completely to it while you’re doing it. It’s hard to do, but it’s incredibly important.

Focus hard during your study time, but don’t kill yourself! During my Step 1 study, I studied Monday through Friday, reviewed on Saturdays and took Sundays off in order to level out a little bit. I occasionally used Sundays to catch up on certain things if I felt like I needed to, but it was important to have that little bit of time to give life some meaning!


High-Yield Questions:

What are you watching on Netflix?

I’m currently re-watching House with a critical eye, which has been interesting! I also just finished the latest season of Sherlock.


What is your favorite restaurant?

That’s a hard question! Basically anywhere with good homemade pasta and good wine. I love Italian food!


If you hadn’t gone into medicine, what would you have done?

I would definitely say teaching. I love teaching. I love education. I am actually very interested in getting involved in graduate and undergraduate medical education.


Thanks, Margot! Good luck moving forward!

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