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What To Do Before The Step 1 Exam: Prepping The Mind And The Body

You’ve allcomputer-3-smaller heard it before – a student freaks out before the Step 1 exam because he did not get a good night sleep and vomits all over the bathroom just before walking into the test center. During the exam, because he’s nauseated and dehydrated, he couldn’t focus and starts to lose confidence. He feels like he’s getting too many questions wrong, so he starts to panic and because he panics, he misses more questions – so began the downward spiral.

Now get ready for the punch line: IT’S ALL IN YOUR HEAD!

No matter how prepared you are, game day performance makes a difference. Here’s how you can ensure you bring out the best performance in you and have a razor-sharp mind to cut through any anxiety. Do NOT wait until the day before the Step 1 exam. Your mind and body need at least 1 week to adjust. Research has shown that the body is not adept at sudden changes, which is why people taper medications, physical training, and mental conditioning. If you’re reading this, you’ve probably been intensely studying for the past few weeks. No worries!

Here’s how to taper:

1. Fine tune your circadian rhythm:

• The suprachiasmatic nucleus in the hypothalamus controls your circadian rhythm, which are the physical and mental changes in your body that follow an approximately 24-hour cycle. Circadian rhythms can influence sleep-wake cycles, hormone release, and many other important bodily functions. All of these can potentially influence your game day performance, and they take a few days to fine tune. So don’t wait until the night before to switch.

• If your Step 1 exam starts at 7 am, but you normally wake up at 10 am because you are a night owl, then start waking up an hour earlier every day and go to bed an hour earlier every day until you can wake up at 6 am and be focused by 7 am.

• It is extremely important that you get at least 7 hours of sleep each night the week before your exam so you are fully recharged.

2. Taper your studying:

• Ask any marathon trainer if you should run a marathon the week before the event, they would tell you that you are crazy. Training is about being ready, not being done.

• If you study 14 hours a day for the past few weeks, then taper down to 10 hours a day for two days and then finally down to 8 hours a day, which is approximately the length of the exam.

• Substitute the other 6 hours with light exercise, fun activities, good food, and sleep.

• Do not try to over cram because it will only increase your anxiety level.

3. Watch your caffeine intake (or any other meds that you’ve been taking to help you focus)

medstudentcoffee• Research reviews have convincing evidence that caffeine-withdrawal syndrome produces common symptoms that include headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability, and fogginess/not clearheaded. You want none of these.

• You can either taper your caffeine intake or maintain, but DO NOT drastically change your caffeine intake because you will likely experience withdrawal.

• If you normally have two cups of coffee a day during your studying, then taper to one and a half or one cup of coffee the day before, and on exam day you may have 1 or 2 cups of coffee.

• Do not increase your caffeine intake the week before the exam because it builds up a tolerance and makes the withdrawal even greater.

• Do not have coffee past 4 pm so you can sleep well every night.

4. Plan out your test day:

• This is a great way to feel confident and mentally ready.

• Know where you’re going on test day, where to park, where to put your bags, how long it takes to get there, and how hot or cold the room is (so you know what to wear).

• Know what to eat. We recommend complex carbs to start with because it provides longer lasting energy, bananas, and oranges because they have lots of electrolytes and are convenient to carry, then finish strong with a snack bar that gives you a sugar boost to get you across the finish line.

• Know what you’ll do during exam break time:

   – Food, see above

   – Bathroom break (use the bathroom even if you don’t feel it at the moment, trust me, it can hit you suddenly during the exam)

   – Walk around to get the blood flowing and remember to breathe and hydrate.

• Being prepared will reduce your anxiety level.

Now for the day before the Step 1 Exam:

1. Take the day off from studying! 

• Taking a day off allows your brain to recharge, and it needs it!

• Research has shown that studying the day before the exam can actually hurt you because you crowd your short-term memory with last minute information which can interfere with long-term memory retrieval or bias your decision making. For example, if you studied diabetes the day before, your mind will naturally want to think that every question on the exam might be related to diabetes, when in fact, they are not. For more information check out interference theory.

2. Wake up early

• Waking up early prevents you from breaking your circadian rhythm

• It will help ensure that you’re tired at night and can get restful and restorative sleep

3. LIGHT exercise in the morning

• Emphasis is on LIGHT because you do not want to perform rigorous exercise and get a buildup of lactic acid

• Key is to increase heart rate with aerobic exercise, but don’t go overboard and run a marathon

• Walking, light jog, cycling, or hiking are all GREAT options

• Exercise releases endorphins which will help you feel happy and more confident

• You will sleep better at night

4. NO naps

• Naps can interfere with your circadian rhythm and throw your sleep schedule off, so fight the urge

5. Plan what you will do after the exam

• Know how you will reward yourself because you deserve it

• This will help you relax and feel motivated

6. Open space

• You’ve probably been staring at your book or computer screen for weeks

• Give your eyes a break and find an open space where you can enjoy the view

• Whether you take a small trip to the nearest mountain, beach, park, or the top of a building, take an hour and just peacefully observe the open space

• This is not only good for your eyes, but it also helps your mind relax

7. Don’t watch a movie that’s too intense or makes you reminisce too much afterwards

• You don’t want the visuals of crashing cars or dying soldiers in your head on the day of the exam

• A “mindless” movie is ok

8. Watch this video and get fired up for success

Remember that you’ve already laid the bricks. You just have to visualize success and believe in yourself. You got this!

  1. NIH. Circadian Rhythm Fact Sheet. http://www.nigms.nih.gov/education/facetsheet_CircadianRhythms.htm

  2. Juliano et al. “A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features.” Psychopharmacology (Berl). 2004 Oct; 176(1):1-29 Epub 2004 Sept 21.

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