{"id":3984,"date":"2022-05-29T15:41:00","date_gmt":"2022-05-29T15:41:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3984"},"modified":"2026-06-01T16:31:23","modified_gmt":"2026-06-02T00:31:23","slug":"at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety","title":{"rendered":"At Least Humor Is a Mature Defense Mechanism: An Unqualified Guide to USMLE\u00ae Step 1 Anxiety"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\/#Tip_1_Take_At_Least_a_Half-day_Off_Weekly_and_an_Hour_Off_Daily\" >Tip #1: Take At Least a Half-day Off Weekly and an Hour Off Daily<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\/#Tip_2_Learn_to_Meditate_But_Do_It_Your_Way\" >Tip #2: Learn to Meditate (But Do It Your Way)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\/#Tip_3_Wear_Your_Emotions_on_Your_Sleeve\" >Tip #3: Wear Your Emotions on Your Sleeve<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\/#Tip_4_Be_a_Good_Friend_to_Yourself_and_Go_See_a_Therapist\" >Tip #4: Be a Good Friend to Yourself (and Go See a Therapist)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\/#About_the_Author\" >About the Author<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today on the Osmosis blog, former Osmosis Health Leaders Initiative  member Kayla Hicks shares a humorous account of how she dealt with board exam stress leading up to her USMLE Step 1 exam.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Studying for Step 1. You\u2019ve been at it for weeks, using every medical education tool imaginable, and their words are swirling ceaselessly and unintelligibly in your brain: <em><a href=\"https:\/\/www.osmosis.org\/learn\/Naegleria_fowleri_(Primary_amebic_meningoencephalitis)\" target=\"_blank\" rel=\"noreferrer noopener\">Naegleria<\/a><\/em>, <em><a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Hypopituitarism\" target=\"_blank\" rel=\"noreferrer noopener\">Pseudotumor<\/a><\/em>, <em><a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Adult_brain_tumors\" target=\"_blank\" rel=\"noreferrer noopener\">Glioblastoma<\/a><\/em>, <em><a href=\"https:\/\/www.osmosis.org\/learn\/Clinical_Reasoning:_Rheumatoid_arthritis\" target=\"_blank\" rel=\"noreferrer noopener\">Etanercept<\/a><\/em>, <em><a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Cardiomyopathies\" target=\"_blank\" rel=\"noreferrer noopener\">Takotsubo<\/a><\/em>, <a href=\"https:\/\/www.osmosis.org\/learn\/Metachromatic_leukodystrophy\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Metachromatic<\/em>\u00a0l<em>eukodystrophy<\/em><\/a>, <em><a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Parathyroid_disorders_and_calcium_imbalance\" target=\"_blank\" rel=\"noreferrer noopener\">Pseudopseudohypoparathyroidism<\/a><\/em>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You\u2019ve put in the work, you tell yourself\u2014steeling for the moment when you push submit on your practice test. You feel the butterflies in your stomach\u2014or is that\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Gastric_cancer\" target=\"_blank\" rel=\"noreferrer noopener\">gastric cancer<\/a>? Let me check\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Clinical_Reasoning:_Thrombophilia\" target=\"_blank\" rel=\"noreferrer noopener\">Virchow\u2019s node<\/a>\u00a0real quick. You finally push &#8220;Submit,&#8221; and it\u2019s not what you expected. You spiral and crumple to the floor. Instead of garbled medical jargon, you hear your own voice in your head:\u00a0<em>Why? Why me? Failure. Failure. You\u2019re not good enough, not smart enough. Failure, failure, failure<\/em>. Your heart pounds in your chest like a kick drum. (<em>Or is that\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Hypertrophic_cardiomyopathy\" target=\"_blank\" rel=\"noreferrer noopener\">hypertrophic cardiomyopathy<\/a>? I DID have chest pain that one time!<\/em>) As much as you\u2019ve scratched and clawed to keep your head above water, the\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Clinical_Reasoning:_Anxiety_disorders\" target=\"_blank\" rel=\"noreferrer noopener\">anxiety<\/a>\u00a0is creeping in and sinking your ship. You\u2019ve never felt more vulnerable or more alone. But as clich\u00e9 as it sounds, you are not alone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Likely, anxiety has plagued everyone who decided to step on the long, winding, bumpy road that is medical school. It is an understatement to say that this situation is taxing emotionally, mentally, and physically. For many, it will be the first time such a massive load of responsibility has been placed on our shoulders. Suddenly, we are the experts, if only in our parents\u2019 eyes. We are entrusted with much more than many of us have ever undertaken. In seemingly one day, we have gone from skittering, quivering schoolchildren to healers. It\u2019s enough to bring anyone to their knees. Couple those looming feelings with the acutely crushing, suffocating beast that is studying for Step 1, and you get a veritable perfect storm of anxiety. I\u2019ve been that person. I collapsed to the floor and sobbed, as it was all just too much, as my own words swam in my head\u2014<em>not good enough, not smart enough, I\u2019m going to fail, not good enough, not smart enough, failure failure failure\u2014<\/em>until the words ran together like the tears streaming down my face.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I hit my lowest low studying for Step 1, but I learned a lot. I learned about Naegleria, Takusubo, and Glioblastoma, but I also learned about myself. I came out a different person than who I was when I went in. It was a trial by fire, plagued by struggle and culminating in every student\u2019s nightmare\u2014my test being canceled not once but twice by the testing center. Through it all, I emerged from that testing center three whole days after my scheduled test date, a grizzled but gratified&nbsp;<a href=\"https:\/\/www.osmosis.org\/blog\/2019\/12\/03\/how-to-manage-excessive-exam-anxiety\" target=\"_blank\" rel=\"noreferrer noopener\">survivor of Step 1 anxiety<\/a>. Having gone through so many challenges, I learned a lot about dealing with my anxiety. Here\u2019s what you should know.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"467\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-student-having-nightmares-about-usmle.png\" alt=\"Osmosis illustration of a person lying awake in bed with a distressed expression, while a thought bubble above their head contains medical images and terms. The graphic conveys anxiety and intrusive thoughts about taking the USMLE Step 1 exam.\" class=\"wp-image-3988\" style=\"aspect-ratio:1.4989460300465085;width:550px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-student-having-nightmares-about-usmle.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-student-having-nightmares-about-usmle.png?resize=300,200 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Tip_1_Take_At_Least_a_Half-day_Off_Weekly_and_an_Hour_Off_Daily\"><\/span>Tip #1: Take At Least a Half-day Off Weekly and an Hour Off Daily<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">I know the inclination that plagues every medical student \u2014 we didn\u2019t get here because we tend to idle, and we\u2019re definitely not going to start right before the biggest test of our lives. I can\u2019t overstate the importance of taking this time for yourself during a period when simultaneously nothing and everything is about you. Talk to your mom, sit outside and get sunburnt, and do some underwater basket-weaving. Whatever it takes for you to not study, then get back to it the next day, fresh.\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Tip_2_Learn_to_Meditate_But_Do_It_Your_Way\"><\/span>Tip #2: Learn to Meditate (But Do It Your Way)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">I was skeptical, too. There is something about meditation that has always felt a little too new age for me. In the depths of my anxiety, however, I was willing to do anything it took to pull me out of that spiral. At one point, I had 6 meditation apps downloaded. I did positive affirmations, journaling, and followed guided meditations 3 times per day, but it wasn\u2019t working. If nothing else, I was MORE anxious. I realized that I was trying to shove myself into a &#8220;Meditation Mold,&#8221; opting for a one-size-fits-all solution instead of searching for the solutions that would work best for me. I am constantly in my head, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/blog\/2019\/10\/31\/mindfulness-in-medicine\" target=\"_blank\" rel=\"noreferrer noopener\">meditation just allowed me to live there more deeply for a few minutes at a time<\/a>. To get the most gain out of meditation without getting trapped in my head, I developed my own method of meditation that worked for me\u2014a combination of&nbsp;<a href=\"https:\/\/www.osmosis.org\/blog\/2019\/04\/30\/breathing-practices-to-calm-the-mind-before-a-test\" target=\"_blank\" rel=\"noreferrer noopener\">deep yoga breathing<\/a>&nbsp;and prayer. Always do what works for you.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Tip_3_Wear_Your_Emotions_on_Your_Sleeve\"><\/span>Tip #3: Wear Your Emotions on Your Sleeve<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">For me, the second-most concerning aspect of Step 1, aside from the&nbsp;<a href=\"https:\/\/www.osmosis.org\/blog\/2019\/05\/03\/overcoming-failure-in-medical-school\" target=\"_blank\" rel=\"noreferrer noopener\">looming fear of failure<\/a>, was the thought of everyone discovering that I was a failure. My&nbsp;<a href=\"https:\/\/www.osmosis.org\/blog\/2020\/05\/18\/overcoming-impostor-syndrome-in-medical-school\" target=\"_blank\" rel=\"noreferrer noopener\">impostor syndrome creeped out like a specter<\/a>, saying to me, \u201cYou\u2019ve hidden it this long, but they\u2019re all about to find out.\u201d Living that way is isolating and just leads to a spiral. You may feel that your classmates are beautiful, model geniuses who will cure the world of all famine and disease, but I promise that everyone has had that moment where they sobbed in their car, or the floor, or Walgreens (totally not based on a true story).&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Furthermore, a source of distress that is especially prevalent with future medical professionals is that if we admit our fear and anxiety, especially as it relates to testing, we&#8217;ll be labeled as \u201cdamaged\u201d or \u201cfragile.\u201d This is not the case. To the credit of my medical school, my classmates, my family, and my fianc\u00e9, when I arrived at their respective thresholds bawling, they circled the wagons and dragged me back to my feet. Do not suffer in silence\u2014admitting that you are afraid allows you to take back your power. &nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image alignright size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"467\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/student-with-her-support-network.png\" alt=\"Illustration of three people standing outdoors together, smiling and laughing during a friendly conversation. One person places a hand on another\u2019s shoulder, conveying social connection, support, and positive interpersonal relationships.\" class=\"wp-image-3986\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/student-with-her-support-network.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/student-with-her-support-network.png?resize=300,200 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Tip_4_Be_a_Good_Friend_to_Yourself_and_Go_See_a_Therapist\"><\/span>Tip #4: Be a Good Friend to Yourself (and Go See a Therapist)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">I saved the best, and arguably the most important, for last. One of the best decisions I\u2019ve made regarding preparation for Step 1 was&nbsp;reserving an hour every week to meet with a therapist. When I was being dragged down the whirlpool of my anxiety, the waves washing over my head and threatening to drown me, the initial two hours I spent sniffling and explaining to my therapist how I was feeling was a lifebuoy. In the weeks that I met with her, I felt able to love learning and myself again. It always helps to have someone to vent to, who won\u2019t pass judgment or offer practical solutions, because let\u2019s face it\u2014there comes a time for everyone where we just want someone to pat our shoulder and say, \u201cI\u2019m sorry, that sucks.\u201d&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">More importantly, my therapist called me out on the destructive behaviors that were contributing to my anxiety. One of the most important and influential things that she ever said to me came after I said, \u201cI just feel stupid, like I don\u2019t have the capacity to do this.\u201d She looked me in the eye and said, \u201cWhat if your very best friend said that to you? How would you feel?\u201d I began to realize that I was arguably the worst friend to myself. We all have friends, family, and mentors, but the one voice we hear in our heads day in and day out is our own. Be a good friend to yourself, and if all else fails, pat yourself on the shoulder and say, \u201cI\u2019m sorry, that sucks.\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"About_the_Author\"><\/span><strong>About the Author<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"margin: 0px;padding: 0px\"><strong>Kayla Hicks<\/strong> is a first-generation medical student from Kentucky and a former member of the <a href=\"https:\/\/www.osmosis.org\/community\">Osmosis Health Leadership Initiative<\/a>.<\/span> She will be starting her third year at\u00a0Case Western Reserve University School of Medicine. Her specialty is undecided, but she is interested in pediatric general surgery, pediatric otolaryngology, and maternal-fetal medicine. Kayla enjoys cooking, dogs, medical history, true crime podcasts, and Broadway musicals.\u00a0<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png?w=700\" alt=\"\" class=\"wp-image-3507\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong><em>Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of clinicians and caregivers love learning with us.<\/em><\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Today on the Osmosis blog, former Osmosis Health Leaders Initiative member Kayla Hicks shares a humorous account of how she dealt with board exam stress leading up to her USMLE Step 1 exam. Studying for Step 1. You\u2019ve been at it for weeks, using every medical education tool imaginable, and their words are swirling ceaselessly [&hellip;]<\/p>\n","protected":false},"author":224,"featured_media":3985,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,22,35,44],"tags":[],"class_list":["post-3984","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-health-and-wellness","category-osmosis-health-leadership-initiative-ohli","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>At Least Humor Is a Mature Defense Mechanism: An Unqualified Guide to USMLE\u00ae Step 1 Anxiety - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"At Least Humor Is a Mature Defense Mechanism: An Unqualified Guide to USMLE\u00ae Step 1 Anxiety - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Today on the Osmosis blog, former Osmosis Health Leaders Initiative member Kayla Hicks shares a humorous account of how she dealt with board exam stress leading up to her USMLE Step 1 exam. Studying for Step 1. You\u2019ve been at it for weeks, using every medical education tool imaginable, and their words are swirling ceaselessly [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/at-least-humor-is-a-mature-defense-mechanism-an-unqualified-guide-to-usmle-step-1-anxiety\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-05-29T15:41:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-06-02T00:31:23+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/unqualified-guide-to-usmle-step-one-anxiety.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Kayla B. 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