By Ria Mulherkar, MD
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Preparing for the USMLE Step 1 is one of the most daunting academic endeavors. It’s the first medical board exam. It’s 240 questions and 8 hours long. And it tests your knowledge on… well, everything you’ve learned so far in medical school.
Now that the USMLE Step 1 is pass/fail, there’s a little less pressure going into the exam. Still, I would argue that all medical students should study for this test with just as much rigor. The knowledge tested on Step 1 is relevant to our future careers, no matter which specialty you pursue. As such, it’s important to learn the material well. It’s not just about acing the exam, it’s about building a foundation of knowledge on which you can build your future practice. And it’ll make preparing for future board exams much easier too!
There’s no secret formula to preparing for the USMLE Step 1. We all have different learning styles, and you know what works for you the best. Here, I will try to provide you with some tools to build your study strategy. I’m dividing the studying process into two sections: pre-dedicated and dedicated Step 1 studying time.
Section 1: Pre-dedicated (weeks to months before dedicated study time)
Step 1: Identify your resources
There are so many USMLE resources out there, and you cannot possibly utilize them all. Find the ones that work for you, and stick to them. I’d say, pick 2-3 core resources. These are the resources that you absolutely have to cover comprehensively. It’s okay if that’s all you can get through, but these resources are your priority. When I was studying for Step 1, my two core resources were First-Aid for USMLE Step 1 and UWorld Step 1 question bank. I told myself I had to cover these through and through, and everything else I did was a bonus. Identify your core resources, whatever those might be.
Consider all the other resources to be your ancillary resources. In my case, these were the USMLE-Rx review videos, the Kaplan question bank, and other resources like Pathoma, Sketchy, and the Goljan lectures. You can identify whatever works for you – whether it’s review videos like Boards and Beyond or Anki flashcards. Recognize that you are human and can only cover so much material in a given amount of time. Forgive yourself if you don’t make it through all of the ancillary resources. It’s okay if you use them intermittently, and it’s okay if you even drop them!
Step 2: Make a plan
Your schedule will depend on when you start studying for Step 1. I would personally recommend starting around 4-5 months prior to your Step 1 exam, and a couple months before your dedicated window opens. Of course, this is not possible for everyone, but regardless of when you start, it’s important to stay organized.
Most medical students are type A personalities and like to have a thoughtful plan of attack. My plan was to read and highlight the chapters of First-Aid one by one, based on organ system, and then do the corresponding UWorld practice questions in tutor mode. As I read the answer explanations, I would then go back to my First-Aid book and make annotations, adding in content from the UWorld question bank. The very first thing I did was write out all the chapters in First-Aid that I wanted to cover, one by one. I started with organ systems and I ended with more basic science topics like biochemistry and genetics. I didn’t have a daily or weekly schedule, but I actually had monthly benchmarks to track my progress.
Once again, whatever core resources you are using, whether it’s First-Aid and Uworld like me, or perhaps a Step 1 review course such as Boards and Beyond, map out the subjects you need to cover, and try to set some goals as to when you will complete them. Studying for Step 1 is definitely challenging while also juggling schoolwork and in-house exam prep. This is why I recommend setting weekly or monthly goals rather than daily goals.
Step 3: Execute your plan
It’s not enough to make a plan. You have to act on it! And you have to stick to it. As I said, this can be extremely challenging while juggling schoolwork and in-house exam prep. But you have to set aside time specifically for Step 1, however that fits into your schedule.
If my classes started at 8 or 9 AM, I would wake up at 6 AM and either read First-Aid or do UWorld questions. In the beginning, it would take me an entire hour just to go through five UWorld questions and read the answer explanations. Even if you feel like your progress is minimal, it’s okay! It’s important to get in the habit of studying and form a routine around Step 1 preparation early on, so that as you approach the exam, you start to build momentum. And of course, you may not be able to study for Step 1 every single day, and that’s okay! As long as you’re making some progress, it will pay off when dedicated study time rolls around.
Section 2: Dedicated (days to weeks before the exam)
Step 4: Practice Tests & Practice Questions
By the time dedicated Step 1 time comes around, you’ve hopefully built enough momentum from pre-dedicated studying to start gearing up for full Step 1 mode. Now what does that mean?
It means increased intensity. You may still have material to review, whether it’s chapters to read or videos to watch. That’s okay, and you should definitely set aside time for that. However, during dedicated time, it’s really important to start training for exam day. If you’re running a marathon, you train by taking practice runs. If you’re taking the USMLE Step 1, you train by taking practice tests.
Practice tests are not just about testing your knowledge. They are also about building up your stamina and training your mindset for exam day. Believe me, all of that is just as important as mastering the material. I took at least 1-2 practice tests per week. I used practice tests from NBME, UWorld, and Kaplan to get a few different flavors of what a practice test might look like. On practice test days, I would spend the mornings taking the practice test, and the afternoons and evenings reviewing my answers. I reviewed all my incorrect answers, as well as the questions I had marked as unsure. It’s really important when taking the practice tests to simulate test-taking conditions. I would find a quiet room, start the exam, and only allow yourself 5-10 minute breaks in between sections as you will have on exam day.
The days that you’re not taking practice tests are the days you can catch up on readings, videos, and other study materials. The most important thing, however, is to keep doing practice questions. Outside of practice tests, I always used to do my practice questions in tutor mode. I found it easier and more convenient to review the answers this way. I tried to do at least 100 practice questions a day in tutor mode. Part of the reason was to help build my stamina, and the other part was to help keep as many concepts as I could fresh in my mind.
Practice, practice, practice!
Step 5: Check your mindset
I don’t blame you if you’re feeling overwhelmed! I was overwhelmed on a regular basis during this entire process. It’s very natural to doubt your plan of attack, compare yourself to peers, and feel low if you don’t score as well as you want on practice tests. However, all that negativity is not going to help you.
This is where I remind you of why you’re taking the Step 1 in the first place. It’s so that you can master the material you need to learn in order to become an excellent future physician, no matter what specialty you pursue. It’s not about the score, it’s not about getting a question right or wrong, and it’s not about comparing yourself to peers. It’s about learning and understanding.
When I did practice questions and focused on my performance, I was very hard on myself and felt extremely burnt out. Somewhere along the way, I shifted my focus from getting a question right or wrong to actually understanding and being able to explain the material. I pretended every question I answered applied to an actual patient in my clinic, and if I was in doubt, I used what I knew to make educated guesses. Of course, I still missed questions. Of course, it still bothered me a little. But the change in focus dramatically improved my mindset. I was in a better mood, and I actually understood the material better.
Studying for Step 1 while maintaining a positive mindset is an iterative process. At the end of the day, you have to remember that no matter how important this exam is, you matter more. And you have to take care of yourself and your mental health. Try to do that by focusing on the learning, and try to make studying fun!
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Best of luck to anyone who is preparing to study for USMLE Step 1. Hopefully this post gives you an idea of how to approach things if you’re feeling intimidated. Remember, everyone is different and you have to find the methods that work best for you. If you have a solid plan of attach and a positive mindset, you are on track to succeed!
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