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Take Step 1 After 3rd Year: The Ultimate Guide

The argument on whether to take the Step 1 test before or after 3rd year in medical school has been a topic of debate. The data suggests that students generally perform better on Step 1 after clerkships, but there are pros and cons to both approaches. 

Proponents of taking Step 1 after 3rd year argue that scores on average go up, students can focus on exploring all their options in clerkships without being limited by their Step 1 score, and they have more time to study. Those who advocate for taking Step 1 before clerkships argue that you need to know your score to schedule fourth-year electives and apply to residency, and that you might forget pre-clinical knowledge by taking the test after a year of 3rd year. 

Additionally, it is suggested that taking Step 1 could improve shelf exam and clinical performances. Students might also prefer to take a break after clerkships to avoid burnout. The available data should be interpreted with caution, as it does not account for changes in curriculum, increases in Step 1 averages over time, and individual differences in response to change. A randomized, controlled study is unlikely to be performed.


Pros of taking Step 1 after clerkships

  • On average, there is an increase in Step 1 scores

Numerous educational institutions that have implemented this adjustment support it as explained earlier, and it is logical. Undertaking a twelve-month apprenticeship, taking shelf exams, and comprehending both medical practices and exam preparation can solely enhance one's abilities.

  • You have the opportunity to concentrate on clerkships and examine all of your possibilities without any restrictions

before being limited by your Step 1 score if you take it after third year. Additionally, Step 1 scores, on average, tend to go up after clerkships. However, there are potential drawbacks, such as not knowing what specialty to apply for without knowing your Step 1 score and forgetting pre-clinical knowledge. It is also unclear whether taking Step 1 after third year may negatively affect shelf exam scores and clinical performances. Ultimately, the decision of when to take Step 1 should be based on individual considerations and preferences.

  • It is highly likely that you have additional time to dedicate towards studying

After finishing third-year, there is less restriction on your time. However, taking Step 1 after third-year may make it difficult to schedule fourth-year electives or decide on residency options without knowing your Step 1 score. While the data suggests an increase in Step 1 scores after completing clerkships, this should be taken with a grain of salt as it does not account for factors such as curriculum changes and individual responses. 

Additionally, forgetting pre-clinical knowledge and potential burnout after clerkships are potential drawbacks to taking Step 1 after third-year.

Cons of taking Step 1 after 3rd year

The information must be viewed with caution

Based on the factual data presented, it is important to consider the limitations of the study and not solely rely on the results. Additionally, there are both pros and cons to taking Step 1 after 3rd year, including better scores, increased time to study, and the ability to freely explore specialties, versus potential difficulties with scheduling fourth year electives, forgetting pre-clinical knowledge, and burnout after clerkships. Ultimately, the decision to take Step 1 before or after 3rd year should be carefully weighed and consider individual circumstances and priorities.


You are not aware of the options available to you until you receive your score for Step 1

Without knowledge of your Step 1 score and what options it opens up or closes off, scheduling fourth year electives and deciding which ones to apply for can be a challenge. Therefore, discovering your score early on can help you make informed decisions about residency. 

You forget all the knowledge from first and second year

There is a concern that taking Step 1 after completing 3rd year may lead to forgetting much of the pre-clinical knowledge from the first two years of medical school. This is because clinical knowledge and application differ from pre-clinical knowledge, and after a year of only clerkships, students may need to re-learn much of their pre-clinical knowledge from scratch.


Your scores on the shelf exam and clinical tasks may be negatively impacted

Despite the absence of available data, there is justification to believe that taking Step 1 could potentially enhance your proficiency in shelf exams and clinical practice, facilitating the integration of knowledge acquired during your initial two years in medical school. 


After completing clerkships, you desire a period of rest

Experiencing extreme exhaustion during clerkship is a genuine concern, and facing the Step 1 exam (potentially the most significant test throughout medical school) after completing clerkships (considered the most challenging year) is not eagerly anticipated by anyone. 

Opting out of taking the Step 1 exam as a way of rewarding yourself for completing clerkships could be an excellent choice to make for your well-being in medical school.

Conclusion of taking step 1 after 3rd year

Based on the data, it appears that students generally perform better on Step 1 after completing their clerkships, which provides them with additional knowledge and test preparation. Taking Step 1 after third year also allows students to freely explore their options without being limited by their score and provides extra study time. 

However, there are concerns that waiting to take Step 1 may affect fourth year elective scheduling, result in forgetting pre-clinical knowledge, and cause burnout after completing clerkships. Ultimately, the decision of when to take Step 1 should be based on individual preferences and circumstances.

Frequently asked questions about taking step 1 after 3rd year

How long does it take for Step 1 scores to turn around?

When can I expect to receive my marks? Typically, your Step 1 scores along with your USMLE Step 2CK and USMLE Step 3 scores will be accessible within 2-4 weeks from the day of your examination. Usually, you can anticipate receiving your Step 1 score on the Wednesday occurring between three to four weeks after the exam date. Nonetheless, it is possible for score releases to be postponed.

What are the requirements for registration for USMLE Step 1?

On the day of your exam, it is imperative that you bring your scheduling permit and a valid government-issued identification that contains both your photograph and signature, such as a driver's license or passport. Additionally, the name on your identification must match exactly with the name you registered under for the exam.

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