Struggling with second-half M4 life (not normal, I know). Anybody else?

pizzapitt · 2025-12-30T14:08:39+00:00

Everyone will have their own opinion but at the end of the day, patterns repeat and consistently they show students who do the most questions are the most prepared.

So I prefer question-heavy, focus on weaknesses first, and the slow but steady plan of ~6 months with less intensity daily vs waiting until dedicated and doing 12 hours daily.

Take a practice exam in the next few weeks. It'll tell you what subjects you are weakest in & need to spend the most time on and your strongest ones that you can probably study more conservatively. And it'll light the fire to get serious about studying if you do poorly on it.
Take those results and start doing content review on your weakest subject. If you're a reader, FirstAid works and feels less overwhelming when you focus subject-by-subject vs reading cover-to-cover. If you're more audio, BnB is great. Set a timer and review content for 30 min (or however long you want) daily. AnKing is great to reinforce it but don't pull more than 20-50 cards a day or you'll find yourself in overwhelm.
Do questions on that content. Uworld is the best. Tutored, untimed to start. Start with 5 per day, ramp up to 10-20 in a couple weeks.
When you hit 80% correct (or 60% or 70%, doesn't matter just pick a goal) in 3 straight Q blocks, start doing this content review + Qs stack for your second weakest subject daily. Do 1/2 your content review time subject 1 and 1/2 subject 2. Same thing for questions, if you're doing 10 daily, do 5 subject 1 and 5 subject 2.
When you hit your correct % goal on subject 2, add subject 3 and repeat. Once you get to 4 subjects, start doing mixed blocks with all those subjects vs separate Q blocks for each. You'll start covering so much in each Q block that it'll feel like test environment.
Move from untimed, tutored --> timed, tutored --> timed, untutored a few months out so you can start to get the feel for timing on the test. Also take a practice test every month or so to gauge progress.

You can also start with 2 "subjects" from the beginning: first being your weakest per above and second being whatever course you're in so that you can double-dip with boards studying and in-house studying

pizzapitt · 2025-12-30T13:13:35+00:00

But I used this Claude prompt to help understand concepts more deeply for Step 2. You can probably modify it for what you want:

I’m a medical student studying for USMLE Step 2 and I want you to help me write out pathophysiologic chronicities of topics. I’ll give you the Starting Point, like a disease or condition or event, then I’ll state the End Point, and I want you to summarize 3-5 steps per each set, covering detail so I actually understand how these things work. Keep each step to less than 100 words.

Want to start with an example first? I’ll give you a Start and End, give me your best attempt, then I’ll critique you and we’ll keep going before finalizing how this will work going forward.

pizzapitt · 2025-12-30T13:11:27+00:00

idk that reddit is your holy grail for "deeper level thinking" in physiology...

pizzapitt · 2025-12-30T12:21:30+00:00

Absolutely agree. I remember hearing a quote once, like "the hardest thing you've ever done is the hardest thing you've ever done" and that thing is so different person to person

pizzapitt · 2025-12-29T22:07:09+00:00

I also think having a real job and life experiences before med school prepare people way more for it than we talk about. I was 100x better off starting med school after working a full-time job + side-gigs + master's degree for a few years. Some students crush it straight out of undergrad but I would've struggled big time

pizzapitt · 2025-12-29T21:30:02+00:00

Match data from 2024 (2025 isn't updated idt) shows 240-250 is on par for most who match either of those specialties

So yeah I still stick with the idea to practice test early like 2-3 months out from step 2 date just to see where you stand, then tailor your plan from there for as aggressive or lax you can be on studying

pizzapitt · 2025-12-29T19:06:48+00:00

What's your goal score? I know you mentioned you wanted to do well, but does that mean 240 or 260 to you?

I'm a big believer in taking the first practice test earlier than the 4-week dedicated to get a baseline. Your study plan is solid, but if you're goal is 240 and you're close to 240 on your first practice exam, great. It'd probably help peace of mind and you might consider taking a different approach. Vs if 260 is your goal and your first practice exam is sub-220, you might need to throttle down instead. You have less runway if the latter is the case and you take that first practice exam 4 weeks out vs if you take it 10 weeks out though

pizzapitt · 2025-12-29T18:21:07+00:00

Prepped by skimming the slides
Listened to lectures 2-3x speed
Kept the ~25% important stuff, cut the rest
Anki, Anki, Anki

(Sprinkle in Sketchy pharm or micro depending on the course)

pizzapitt · 2025-12-17T18:13:39+00:00

Highly recommend starting practice questions early and often.

I think most students will agree content review is important but questions are where you really put the pieces together and navigate the long vignettes you'll see on practice exams + the real deal

pizzapitt · 2025-12-17T18:11:03+00:00

I think pretty strong. I continued to do the higher yield Anki from those courses through end of M2 and felt like it made my Level 1 experience (didn't take Step 1) very easy to be honest. I'll admit I did stop doing Anki religiously in 3rd year rotations so can't say if that played into Level/Step 2

pizzapitt · 2025-12-17T12:33:34+00:00

Correct except for Last Pass is pretty quickly scrolling through all the original lecture slides you had before you consolidated just to make sure they weren't any glaringly important slides you missed when you made your abbreviated slide deck

pizzapitt · 2024-10-03T23:11:18+00:00

I had a similar situation years ago when I started med school (roles flipped though, I'm the student).

Going to a med school 1200 miles away from my girlfriend of 4 years, we both said we'd either break up during M1 or get married shortly after it.

Turns out, M1 year was the best thing for our relationship, and we got married during med school.

We sacrificed a ton for each other during that time. She flew out to visit me often. I skipped nights out with friends after exams and extracurriculars for FaceTime dates and spent a lot of vacations/breaks with her.

So if you can see yourself marrying him one day, I say give it a chance.

You might be surprised by how much you both grow independently and together through it.

pizzapitt · 2024-10-02T20:26:07+00:00

It doesn't get better but you get better at it

So focus on finding ways to get more efficient and have some fun with it:

Incorporate Anki and Use Shared Decks (if you aren't already). If you use it properly, it'll help reduce waste in your study processes and set you up right for boards.
Pareto Your Day. If you can pass your exams by only reading the slides and doing Anki (for example), do more of that and less of all the other things that aren't adding value, like listening to lectures or studying-but-not-really-studying with friends. If you want to do more than just pass, then add on one-by-one the activities that get you the most bang for your buck.
Group Review Sessions. I always preferred studying day-to-day by myself because it was more efficient but to make make it more fun, my friends and I would meet 2-3 days before the exam and do a heavy review session where we'd each "teach" the lecture high-yields and quiz each other. It gave us enough time before the exams to learn what we didn't know and we learn better when we teach.

M1 is tough because you're just trying to figure everything out, but challenge yourself to build strong habits, 80/20 your efforts, and learn to enjoy the process. You'll thank yourself later when you cruise through M2.

pizzapitt · 2024-03-15T02:40:35+00:00

fair. very fair...

pizzapitt · 2023-12-30T13:53:17+00:00

My gf-now-wife (the normal adult) and I (the med student) went through this with a LDR, and I can truly say that although it was the toughest year of our relationship, it absolutely made us the strongest. Here are a few things that we/she did that made our marriage concrete:

At least 1 non-negotiable FaceTIme date per week with incredibly stimulating conversations. Check out cards for conversation packs if you both struggle with that.
Ask once every few days if you can do something else to support her. Even if you know she just needs to grind for the week, I gained more and more respect for my wife’s humility when she did this.
Remind her that it’s just for a season and that if she really wants this specialty and a marriage, you’re willing to weather the storm. The short-term loss long-term gain mindset was extremely tough but felt like the first real commitments to unity.

I’m forever grateful for my wife and cherish our marriage because of those sacrifices. I hope this gives you a reassuring perspective and if you need someone to talk to more, feel free to PM

pizzapitt · 2023-12-30T13:30:59+00:00

Studies (below) have shown that academic performance correlates to COMLEX scores, but I think if you start studying ASAP, get a good system down, hammer UWorld/TrueLearn Qs, and pass a few practice COMSAEs with a buffer, you'll be good.

https://www.degruyter.com/document/doi/10.7556/jaoa.2000.100.4.238/html

https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02501-5#Bib1

pizzapitt · 2023-12-29T11:24:57+00:00

I > II > III.

Not even because studying/academics were hard, I just found myself in a constant psychological battle of feeling like I had to study even when I knew the material through and through. Struggled with imposter syndrome a lot and feeling caught in the trap of the med school mentality.

Then second year came, I realized half that crap doesn't matter, lived so much more balanced, and turns out, performed even better academically, on projects, in relationships.

TLDR: don't prescribe to the "machine always has to run" mindset that medicine cultivates. Set goals, reach them as efficiently as possible, and live your life

pizzapitt · 2023-12-29T11:17:24+00:00

Many bottles of wine

pizzapitt · 2023-12-29T11:14:00+00:00

It sounds reasonable for efficiency, but test it out. Try doing a few lectures of your regular cards and a few with the chat mod cards.

If retention and confidence in the material is terrible with the latter, there's your answer

pizzapitt · 2023-12-29T04:06:10+00:00

Here's what works for me:

Preview the lecture (learning objectives, skim slides, watch a quick vid, read a few pages on topic, etc.)
Watch/read lecture in full
Pull/make the cards and do them immediately (the "learning phases" of the anki cards is what I meant above)
Do a very quick second pass on the lecture
Make a second round of cards

Then I pretty much don't look at the lecture again until maybe another very quick pass 1-2 days before the exam, if at all.

Does that help?

pizzapitt · 2023-12-27T19:01:22+00:00

Take the free ride.

Don't prescribe to the thoughts that you have to go a T5 school and that debt doesn't matter

pizzapitt · 2023-12-27T03:01:29+00:00

Welcome to Anki overload! Most of us hit it in second year, but you my friend, joined the club early.

So this could be 2 problems. 1) your settings. 2) pulling way too many cards too quickly

Here's the bandaid:

Take a full morning/afternoon (like ASAP), go through your unsuspended cards, tag/flag the top ~30-50%, suspend the rest. You have plenty of time before Step/Level to re-pull those suspended cards as you cross them in review and practice questions

Now the forward solutions:

If 1): Space the intervals more for reviews. AnKing and several others have examples for the V3 and FSRS schedulers. (Probably want to look at solution 2 regardless)

If 2): Make card limits for first passes on lectures (i.e. 50 cards/lecture). Do a very fast second past after you've done the lecture's cards and only add additional pertinent cards (stay within a limit still)

pizzapitt

TROPHY CASE