Preparing for Board Exams

A guide for disabled, neurodiverse, and chronically ill trainees

���������Editors: Anika Makol��Writers: Lily Upp���March 2025

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Table of Contents

• Formal Accommodations…………………………………………………….…pg 3-6
• Your Health………………………………………………………………………...…pg 7-23
• Optimizing and maintaining your health…………………..pg 7
• Mental Wellbeing.…………………………………………………….pg 8-13
• Chronic pain and physical disability………………………....pg 14-15
• Migraine, concussion, traumatic brain injury……………pg 16-21 
• ADHD and learning disabilities…………………………………pg 22-23
• Study Environment……………………………………………………………….pg 24-33
• Study space………………………………………………………………pg 25-27
• Seating…………………………………………………………………….pg 28
• Desk………………………………………………………………………..pg 29
• Fidgets…………………………………………………………………….pg 30
• Foot rests…………………………………………………………….....pg 31
• Miscellaneous………………………………………………………….pg 32
• “Body doubling” or supervised studying………………….pg 33
• Study Strategies……………………………………………………………………pg 34-52
• Making a study schedule…………………………………………pg 35-41
• Structured vs. unstructured schedule………………….....pg 42-43
• Studying by time versus task……………………………….....pg 44-45
• Choosing resources………………………………………….........pg 46
• Motivation and boredom…………………………………………pg 47-48
• Thought traps to avoid…………………………………………….pg 49-51
• Avoiding burnout…………………………………………………….pg 52
• Additional resources…………………………………………………………….pg 53-54

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Standardized exams can be a daunting and taxing part of medical education. This guide is intended to provide suggestions to medical students—including those with disabilities, neurodiversity, and chronic illnesses—for studying for medical licensing exams such as USMLE Step 1 and 2, and COMLEX Level 1 and 2. We hope that the advice and perspectives offered here will ease your preparation for these exams and help you approach test day with confidence.

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While the process can be challenging, it’s important to recognize that completing these exams is a significant milestone in your medical journey. The dedication and effort you put into preparing for them deserve to be acknowledged and celebrated, regardless of the outcome. Each step taken in this process is a testament to your resilience and commitment to the profession.

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This guide is not meant to be a study guide, study schedule, or a how-to on applying for exam accommodations. For more information on these topics, please refer to the sections “Formal Accommodations” and “Additional Resources.”

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This guide was adapted from “An Inclusive Guide to Studying for Step 1” by Emory’s DMSA, and we wish to acknowledge and thank those authors for sharing their content. Additional ideas and information were contributed by students around the country—we are grateful to those who volunteered their personal experiences to improve this guide.

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The purpose of this guide is not to explain the process for requesting formal accommodations on standardized exams. However, we will briefly note that requests for accommodations must be approved BEFORE requesting a scheduling permit, so we suggest starting the process as early as possible before each exam, ideally about one year ahead of the time you anticipate taking the exam.

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Medical Equipment

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Many items do not require approval. Some exceptions include:

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• Hearing aids with Bluetooth capabilities, even if that function can be turned off
• Some questions include audio

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• Medical equipment with alerts that cannot be silenced completely, including vibrations

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• Medications (prescription and over-the-counter) in packaging or a container
• Most are allowed in the test room if removed from all packaging
• Medications are always allowed in your locker, which is accessible during breaks

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Studying for a tough exam can be very stressful and may worsen existing mental health issues. Whether or not you have a history of mental illness, it's important to plan ahead to protect your mental health and know what to do if you start struggling.

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Make time for your usual healthy habits.

Whether you are a morning gym-goer, have date night every Saturday, or like to watch an episode of TV each evening, DO NOT stop! Build these things into your schedule so that you don't miss them.

Maintain balance.

Plan something to look forward to each day or week. It could be something small, like a favorite snack or watching a movie, but being intentional will help keep your motivation up and ensure you are taking time for yourself.

Continue medications.

Plan ahead to make sure your prescriptions/ refills are in order, especially if you'll be going out of town to study.

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Manage your perspective: 

• Create a mantra, write grounding notes to yourself, or have loved ones write reassuring notes ahead of time to open during a particularly hard moment.
• Remember, Step 1/Level 1 is pass/fail.
• These exams are just one small element of your journey in medical school and an even smaller part of your career in medicine. Remind yourself of why you are doing this and that it is not worth sacrificing your health.

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Chronic illnesses are worsened by stress. Studying for standardized exams can also disrupt your normal schedule and demand longer stretches of sitting at a desk and repetitive motions (e.g. using a laptop or writing implements) which is taxing to the body. Consider a preventative check in with your provider (PM&R doctor, physical or occupational therapist) who can offer suggestions for tools that help with positioning, adjust meds or add therapies to prevent pain flares.

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If you have migraines or headaches now, they are likely to be aggravated by studying and staring at screens for long periods and by heightened stress.

Here are some examples of experiences individuals have had while preparing for their exams:

"I'm nervous about my ability to study enough hours each day. Currently I can only get about 1.5-2 hours of study done most days before the migraine begins to take over. In a rare migraine free day, I can only get about 4 hours of focused work done (down from 6-7 hours of focused work pre-chronic migraines)”

"Reading triggers headaches as a result of my brain injury, so doing long blocks of questions was very challenging. I was thankful to discover my Mac already has text-to-speech software and subsequently got a license to Natural Reader through my university's disability office for further accommodations."

"I got access to an e-Reader through student disability services."

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If you use adjunctive therapies (e.g. peppermint oil, blue light glasses) bring these as well and confirm ahead of test day whether your item will be allowed in the testing room.

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Your Health: Migraine, Concussion, and Traumatic Brain Injury

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Screen-Free Study Alternatives:

Ways to reduce screen time while studying

1. Use Printed Materials:
• Print out slides or study materials for easier reading.
• Obtain hard copies of key resources, such as First Aid and Sketchy or Pathoma workbooks.
2. Get Creative:
• Draw diagrams or illustrations on paper to reinforce learning.

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Your Health: Migraine, Concussion, and Traumatic Brain Injury

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Screen-Free Study Alternatives:

3. Explore Audio Learning:

• Listen to educational podcasts.
• Use voice memos to record yourself explaining difficult concepts.
• Partner with a study buddy to discuss topics aloud while they verify with a text or screen.

4. Listen to Text:

• Convert written materials into audio by listening to text being read out loud.

5. Consider an E-Reader:

• Contact your school’s disability services office for a free e-reader if available.

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Your Health: Migraine, Concussion, and Traumatic Brain Injury

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If you have any condition that impacts focus and study habits, it’s important to tailor your study plan to your strengths and needs. Here are some strategies to consider:

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Your Health: ADHD and Learning Disabilities

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Your Health: ADHD and Learning Disabilities

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If you have any condition that impacts focus and study habits, it’s important to tailor your study plan to your strengths and needs. Here are some strategies to consider:

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Your study environment is in your control. Take advantage of this, and optimize the space for you!

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Start by making a thoughtful assessment of how and where you normally study:

• What works and what doesn’t?
• Do you have support for your posture?
• Do you have materials that can adapt to your needs?

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The following ideas are meant to help you assess your ergonomics and study materials and discover what works best for you.

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Optimizing Your Study Environment:

Studying outside the home, such as in a library or coffee shop, can improve focus and prevent burnout. If that is not possible, try these tips to create a productive study space at home:

1. Establish a Dedicated Study Area:

• Use a space solely for studying. Avoid doing other activities (e.g., online shopping or social media) here to help your brain associate it with "study mode."

2. Minimize Distractions:

• Choose a quiet spot away from distractions like hobby materials, chatty roommates, TV, or snacks.

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Optimizing Your Study Environment:

3. Use Good Lighting:

• Use bright lighting, ideally natural light.
• Adjust the lighting based on the time of day to maintain an alert and focused atmosphere.

4. Avoid Comfort Zones:

• Stay away from your bedroom, favorite napping couch, or other cozy areas that might tempt you to relax instead of study.

5. Stay Prepared:

• Keep all necessary materials within reach to avoid disrupting your focus with trips to grab supplies.

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Study Environment: Study Space

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Optimizing Your Study Environment:

6. Prioritize Comfort and Wakefulness:

• Create an ergonomic setup that supports your posture and keeps you awake (e.g., a supportive chair, a desk at the right height).

7. Mimic Your Favorite Study Space:

• If you love studying in a coffee shop but can't go, recreate the atmosphere at home.
• Play coffee shop background noises or music on YouTube and place aromatic coffee grounds nearby to evoke the scent.
• If you enjoy working in a library due to the quiet company of others, invite a friend over to study quietly together (see "Body Doubling").

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Study Environment: Study Space

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These suggestions may not be possible in your living environment. Do your best with what you have!

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These suggestions may not be possible in your living environment. Do your best with what you have!

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For attention and preventing skin picking or other body-focused repetitive behaviors (BFRBs)

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Your feet need to be supported fully. This is important for attention, no dangling feet or tiptoes.

*doubles as fidget

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At home

• Invite a friend or classmate over and study next to each other
• Facetime a friend or family member

In public

• Go to a library, coffee shop, or other public space. Note that some public environments may also bring more distractions.

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Most schools provide a dedicated study period to help students focus on preparing for exams like Step 1 or Step 2. However, some students choose to study alongside other duties such as classes or rotations.

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Below, we provide tips based on feedback from students in various programs. Remember, these are suggestions and may not work for everyone.

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If you’re struggling with creating a study plan, reach out to your school’s administration or advisor for guidance. They may also be able to offer flexibility in the curriculum or your study period to accommodate your specific needs.

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Common Concerns

Step 1:

"I've been worried that I should be studying during the preclinical curriculum (not just during the dedicated time), but I have a hard time multitasking. All my doctor's appointments also make it difficult for me to find time for Step 1 studying. I'm worried that 4-8 weeks won't be long enough to study for the exam."

Step 2:

"Make sure to understand preclinical and clinical topics well while you are in the relevant block/clerkship. Do a lot of practice questions during preclinical years and clerkships."

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Strategies: When To Start

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Why Some Students Start Early:

• To take the exam at the beginning of the dedicated study period and use the remaining time for other priorities (e.g., vacation, surgery).
• To break studying into smaller, more manageable chunks over a longer period.
• To prepare for multiple exams back-to-back (e.g., Step 1 and Step 2).

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Strategies: When To Start

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Strategies for Early Studying:

If you decide to begin studying early, consider the following approaches:

1. Integrate New Concepts:
• When learning new topics or starting a clinical block, dedicate time to deeply understand those concepts.
• Maintain knowledge by reviewing briefly (e.g., a few UWorld questions or Anki cards) on these topics regularly. This provides daily or weekly reinforcement without detracting from new material.
2. Time Management:
• Use weekdays to study ongoing class material and reserve weekends for exam-focused review.
3. Low-Demand Schedules:
• Plan your study start date during a low-demand clinical rotation or lighter class period to maximize focus.
4. Preparing for Multiple Exams:
• If tackling multiple exams, schedule a short break (even a few days) between tests to recuperate.
• Use this downtime to do light review or shift focus to the content of the next exam.

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Strategies: When To Start

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Step 1: Reflect on Your Study Habits

Take time to critically examine your past study habits. Understanding what has worked and what hasn’t is key to designing a personalized and effective study plan. Avoid relying solely on generic advice from Reddit or friends, as your learning style and needs are unique. Consider the following questions:

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• Focus and Breaks: How many hours per day can you meaningfully focus? How often do you need breaks to recharge?
• Study Environment: Where do you study best? At home, in a library, or another specific setting?
• Learning Tools: What materials help you retain information? Videos, practice questions, note-taking, flashcards, drawing, reading? Decide how much time you want to allocate to each.
• Distractions: What else competes for your attention during study sessions? How can you address these distractions and maintain balance?
• Non-Negotiables: What other priorities in your life (e.g., exercise, naps, outdoor time, family, hobbies) must be incorporated into your schedule?

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Experiment new strategies but also feel free to stick with what you know works!

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Strategies: Study Plan

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Step 2: Develop a Flexible Study Schedule

Use the insights from your self-reflection to create a structured yet flexible study schedule. Tailor it to your timing, environment, and personal needs to set yourself up for success. Here’s how:

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• Plan Study Blocks: Schedule study periods based on your peak focus times and incorporate regular breaks to avoid burnout.
• Diversify Study Methods: Allocate time for different learning tools that suit you best, such as practice questions, videos, or flashcards. One effective strategy is to create dedicated question blocks for subjects you need to improve in. For example, if hematology-oncology is a challenging topic, you can create a block of 25 heme-onc questions on UWorld to focus on that area.
• Balance Competing Priorities: Incorporate time for essential non-study activities like exercise, meals, relaxation, and socializing.
• Build in Flexibility: Include catch-up days in your schedule. These are not rest days but are designated for reviewing missed material or adapting to unexpected interruptions. Use these days to assess and recalibrate your study plan.

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Strategies: Study Plan

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Step 2: Develop a Flexible Study Schedule

Use the insights from your self-reflection to create a structured yet flexible study schedule. Tailor it to your timing, environment, and personal needs to set yourself up for success. Here’s how:

• Include Mock Exam Days: These are especially useful for managing test anxiety and adapting to the testing environment. Simulate test day by:
• Taking a practice exam under timed conditions with any necessary accommodations.
• Mimicking the testing environment (e.g., traveling to the test center, using a similar computer setup, wearing devices like earplugs).
• Practicing test-day routines, such as managing breaks, checking in and out, and consuming planned snacks or meals.
• Test out snacks/lunch options that benefit your mind and body the most. You can get accommodations to incorporate these snacks if your chronic illness is associated with food needs.

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Strategies: Study Plan

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Step 3: Stay on Track

To maintain motivation and stick to your schedule:

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• Set Hard Deadlines: If you’re driven by urgency, plan a trip or event immediately after your test date. This creates a fixed timeline and reduces the temptation to postpone.
• Prioritize Rest Days: Ensure your schedule includes dedicated rest days to recharge and prevent burnout.
• Be Adaptable: Recognize that no schedule is perfect. There will always be material left uncovered, and that’s okay! The goal is to focus on meaningful progress rather than perfection.
• Avoid Pitfalls: Be mindful of common distractions and thought traps that could derail your progress. Keep your goals and schedule realistic and achievable.

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By aligning your study plan with your personal habits, needs, and priorities, you’ll set yourself up for a productive and balanced preparation period. Remember, flexibility is key, and it’s okay to tweak your plan as you go!

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Structured Schedule

• A structured schedule outlines specific tasks and deadlines.
• Best for people motivated by checking off lists, those who know their strengths and weaknesses, or those who find unstructured time overwhelming.

Example for one day:

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Unstructured Schedule

• An unstructured schedule provides general guidance on materials and focus areas without specific tasks.
• Ideal for those who prefer flexibility, task-based study, or are unsure where to allocate their time.

Example submitted by a student:

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Like structured and unstructured schedules, it is worth considering whether you will study by time or by task. Either approach can be combined with either type of schedule.

Studying by Time

• Studying by time means you end your study day after a certain predetermined amount of time, no matter how many questions or tasks you have completed. For example, "I will focus for 6 hours then be done for the day, no matter how many tasks I complete.”
• This approach may be helpful for those who experience predictable periods of fatigue, who are prone to burnout, or who are overwhelmed by long checklists of tasks.
• It may also be motivating for those who procrastinate since you know you only have to focus for the designated time, and when that time is over you will no longer be able to study.

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Studying by Task

• Studying by task means that you complete a predetermined set of activities no matter how long it takes. For example, "I will complete 40 practice questions, 3 videos, and 100 flashcards, no matter how long it takes.“
• This approach may be helpful for those who have difficulty setting boundaries between study and personal time, who are motivated by checklists, or who prefer to study in small increments throughout the day or the week.
• By aligning your study plan with your personal habits, needs, and priorities, you’ll set yourself up for a productive and balanced preparation period. Remember, flexibility is key, and it’s okay to tweak your plan as you go!

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Don't just follow what others are using—choose study tools that fit your learning style. If you're not an auditory learner, it's fine to skip things like Pathoma or Divine podcasts. The best resource is the one that works for you.

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If you’re struggling with motivation, consider the INCUP approach. Start with something that falls in 1 or more INCUP categories:

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When motivation is low, doing anything is better than doing nothing. Use these strategies to jumpstart your study session:

• Passive Learning: Can’t focus on reading? Start with videos instead.
• Multitasking: Combine Anki with leisure (e.g., watch TV while reviewing cards)
• Podcasts: Listen to podcasts while cooking, exercising, or getting ready for the day.
• Creative Study: Draw diagrams or illustrations to understand anatomy or processes.

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Recognizing and avoiding thought traps can improve productivity and prevent burnout.

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Recognizing and avoiding thought traps can improve productivity and prevent burnout.

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Recognizing and avoiding thought traps can improve productivity and prevent burnout.

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Burnout is a common challenge for students, particularly during intensive study periods. Recognizing and addressing it early can help maintain productivity and well-being.

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