How to Use Osmosis During Your Dedicated Step 1 Study Period

Welcome to today's webinar. This is Proven Study Strategies for Step One, or how to use Osmosis during your dedicated Step One period. I decided to approach it from the angle of Step One in general, and then I will plug in how Osmosis can help as we go. Hi, I am Mike Klug. I am a DO and a psychiatry resident in my fourth year of training. I have several years of experience working in test prep in different capacities. I have worked on the MCAT and test prep, and I have also worked for USMLE and COMLEX prep companies. I have been with Osmosis for a number of years at this point and do not intend to stop being with Osmosis when I finish training this year. I used Osmosis in med school. I am very biased. I think we are wonderful, but that is fine. The focus of today's session is advice toward USMLE Step One in general. I am going to cover specific barriers and pitfalls and leave time for questions. This is broken down into some learning objectives. If you have been to one of my webinars before, there is a little crossover, but much of it is referential material. In other words, you can review the slides after the presentation to brush up on what I talk about. That is how I do webinars. We will start by talking about Step One in general because it is in a transitional stage. You are not the first class to go through the pass fail transition, but you are also not several years into it. It is still a relatively new change. With the pass fail transition, there is a misconception that since it is pass fail, students only need to do the bare minimum compared to when it was scored. The reality is that the exam content and difficulty did not change. There are conspiracy theories among people who work in test prep that it became harder when it switched to pass fail. I did some digging and could not find evidence that that occurred. However, the pass and fail rates were different the first year it changed. There were actually more fails that year than the year before when it was scored. You are still taking the same exam that graded previous students. Keep that in mind. A developing idea, so take it with a grain of salt, is that residency directors are looking at Step Two scores more heavily. In psychiatry, I know we are. I am sure in surgical specialties it is probably happening as well, but this is still developing. A pass on Step One is really just the prerequisite to have your application opened. That sounds scary, but we will help make sure you can meet that prerequisite during this webinar. The goal of Step One is to study and master the material for Step Two, not just scrape by with a pass. Everything on Step One serves as the foundation for Step Two. If you do a good job studying for Step One, studying for Step Two is much easier. The USMLE does not publish a specific percentage anymore, but the passing standard is roughly equivalent to what was a 196 on the old three digit scale. Historically, that is about 60 to 65 percent of the questions correct. Some questions on Step One, Step Two, and Step Three are test questions that do not count toward your score. They are used to see if the USMLE wants to include them in future exams. So it is 60 to 65 percent of the scored questions correct. For preparation purposes, you should not aim for 60 percent. You should probably aim for about 70 percent on practice exams like the NBME, Osmosis practice questions, or UWorld to account for test day anxiety and variance. The safe zone is probably getting about 65 percent correct on practice question blocks to pass by the old standard. Step One is not a trivia exam. You will rarely be asked something like what is the diagnosis. The exam often uses a two step logic process. First, you read a clinical vignette and identify the diagnosis. For example, a patient comes in with a swollen toe. If it were a trivia exam, you would say it is gout. But Step One takes it further and may ask about the pharmacodynamic target of the medication that treats that diagnosis. It is called two step because you have to know it is gout to answer the question, and you also have to know that treatment targets microtubules. Medical school can sometimes emphasize rote memorization instead of deep understanding. Step One requires you to understand pathology and biochemistry along with diseases. If you learn it that way, it makes being a doctor and a resident much easier because medicine relies on understanding foundational knowledge when diagnosing and treating patients. In the three digit score era, students chased extra points by trying to get very hard questions correct using high volume recall, speed, and test optimization. Since it went pass fail in 2022, they have prioritized core mechanisms and common presentations. They are emphasizing integration and application, why you do something in medicine or what is next in treatment, over memorization alone. They are also adding competency content, including ethics, legal questions, patient safety, communication, biostatistics, epidemiology, and research ethics. Make sure you cover those topics because every year that percentage seems to increase. Behavioral health and neuroscience make up about 10 to 14 percent of the exam. Communication and interpersonal skills can be almost 10 percent of the exam depending on the form. Covering communication and interpersonal skills can account for a significant portion of what you need to pass. Pathology is still about 45 to 55 percent, and physiology about 30 to 40 percent. Microbiology, gross anatomy, behavioral science, and genetics also make up a substantial portion. I use what I call the toolbox approach to studying. It is difficult to use resources effectively if you do not clearly identify them. Make a list of essentials, things that have worked for you and resources considered gold standards, such as UWorld, First Aid, Pathoma, and Sketchy. Think of it like a toolbox. If everything is labeled, it is easier to know when to use each tool instead of digging through a mess. For example, if you do well rewriting notes and reviewing lectures, you might list your tablet, stylus, favorite pen, legal pad, organizer, and accommodations paperwork as tools you already have, and then identify what you need. Board prep has a high cost of entry. UWorld, Sketchy, and Pathoma can exceed one thousand dollars on top of tuition. Subscription fatigue is real, and new resources constantly appear. Switching resources midstream is often procrastination. Just because a classmate swears by a resource does not mean it fits your learning style. Try before you buy. Most reputable resources offer trial periods. Osmosis offers a free trial so you can see if the style works for you before committing. If you have been given accommodations for school or test taking, file them with your school early. Even if you have not used them before, graduate school is sometimes when those needs arise. The USMLE takes a long time to approve accommodations and requires specific documentation, so handle that early. Think of studying as two broad categories, exposure to new material and review. Reviewing should always be part of your study plan. One of the biggest mistakes students make is learning new material more than reviewing. Reviewing helps consolidate, retain, and integrate information into conceptual thinking. Early on, you might spend 60 percent of your time on new material and 40 percent reviewing. As the exam approaches, shift toward 90 percent review and 10 percent new material. Content acquisition builds your foundation. Videos can introduce new topics and create visual memory hooks. Do not transcribe everything. Engage actively and annotate. Use textbooks as references during dedicated time. Look up specific topics you missed in practice questions instead of reading them like novels. Practice questions are the highest yield study method because they allow you to learn new information and review simultaneously. If you get a question wrong, you learn something new while reinforcing related material. Spaced repetition, such as flashcards or rewriting notes at intervals, is also effective. In person lectures are valuable. Online lectures are a close second. If you learn well by listening, consider recording lectures if permitted and replaying them later at increased speed. Briefly review new content before bed. Reviewing at the end of the day improves retention. Rewriting notes before bed can be meditative and reinforces content. Reviewing should be active and mentally tiring. If it does not feel tiring, it is probably passive. Prioritize content you are less comfortable with. Do the hardest review first. Explain concepts out loud to ensure you understand them. Rewriting notes by hand is supported by research because handwriting reinforces memory. When rewriting, only rewrite what you do not remember. Over multiple passes, you will create a concise study sheet of weak areas. Anki is spaced repetition software that is evidence based and effective for review. It is not designed to teach new material. Pre made decks can be helpful but sometimes contain too much information per card. Making your own cards can be more efficient. Studying with someone else, even quietly, can improve productivity. Scheduling breaks ensures you rest without guilt. Movement during study, walking, treadmill desks, sports, can improve focus and productivity. Nutrition matters. Consistent, simple foods work best. A cup of blueberries daily has been shown in some studies to improve memory. Frozen blueberries are convenient and affordable. During exam week, maintain your routines. Do not try new foods or habits. After a few weeks of dedicated study, take practice exams and spend the next day reviewing them thoroughly. Research does not support cramming. Spaced repetition is more effective. Sleep is essential. Keep consistent sleep and caffeine routines. After the exam, avoid immediately checking answers. Give yourself time to decompress and plan something enjoyable for the evening. Education in healthcare can feel broad and unfocused. Use spare time to network and explore niche interests. Professional organizations often offer discounted student memberships. Identifying a mentor can help. Maintain hobbies and friendships outside medicine to reduce stress and avoid isolation. For attending today's webinar, we are offering 15 percent off Osmosis with the QR code. We also have a free trial available. Now I will move to questions. The content says as of 2022 because that is when the pass fail transition occurred. If the QR code is expired, we will update it. We do not provide official USMLE retired questions, but we write questions in the style of the USMLE. Regarding the study schedule tool determining the order of systems, I am not certain about customization options. I can bring that up with the team. For retaking the exam, review your test taking strategies first. Look at patterns in how you change answers. Then focus on weak systems identified from your previous attempt. Dedicated study time is usually about four to eight weeks, depending on the student and curriculum. If you lose focus taking notes during class, consider recording lectures and reviewing them later. If you feel anxious while studying, determine whether the anxiety signals a content gap or an issue with study methods. Schedule regular breaks and consider therapy if needed. If your practice scores are not gradually improving, adjust your plan or seek help. If you are thinking about asking for help, you probably should. To balance class material and board prep, use class material for depth and Step One resources for high yield reinforcement. If you are studying hard but not reviewing enough, increase your review time and focus on rewriting weak areas rather than everything. Thank you for attending and for your thoughtful questions.