USMLE Step 1 Advice
The United States Medical Licensing Examination (USMLE) Step 1 is a 280-question, 7-hour test that medical students take after they’ve completed the first 18-24 months of medical school. It used to be one of the most important tests you’d take during medical school because residency programs would review applicants first based on scores. For myself (Class of 2021) and the class behind me, this score will still be an important part of our residency applications. However, USMLE has recently announced that Step 1 will now be pass/fail. I personally think this will work in students’ favor in the long run, because Step 2 CK is much more clinically oriented.
Step 1 is still important of course, and there are endless study programs, countless resources, and lots of opinions out there about the best ways to prepare for this exam. I personally felt overwhelmed during every part of the process by the amount of resources available, and wondered if I was truly choosing what was best. I also lost my best friend, my white lab Holly, while I was studying, so my dedicated study period unexpectedly turned into a bad episode of depression and I had to change my schedule out of necessity. Here, I’ll offer my advice for studying for Step 1, focusing on what my original plans were before my personal loss. Some of the general advice will be the same as what I mentioned in my MCAT studying post, but I’ll go into more detail about resources I used and my schedule for Step 1 here.
I’ll start out by saying, my number one piece of advice is that your priority should be doing what works best for YOU, and it may not be the same as what others are doing. You won’t be able to take just one person’s experience and apply it directly to your plan, and to your learning style. I think the best thing to do is ask a handful of people, read or watch a handful of articles/videos about the topic, but don’t spend too much time collecting opinions because it can easily get overwhelming and counterproductive. I chose my resources based on my experience with what worked for me during the first 18 months of medical school, and I created my schedule based on a mix of my friend Erika’s youtube videos, and the advice of my academic success person at UNLV. Once I had committed to my resources and set up my schedule, I tried to limit my discussion with my peers about specifics of studying.
My Resources
First Aid:
This is a great resource that summarizes all of the topics that you need to cover during dedicated. I used it as an outline to help create my schedule, and would also have it open as I reviewed my U-World questions. I used a version that was 1-2 years old at the time because I had already become familiar with it during the first 18 months of school. If you’re worried about what’s wrong or missing in an old version compared to a new version, the first aid team always outlines the errata so you can check that out.
UWorld Question Bank:
A majority of my dedicated study time was spent on completing and then studying from these practice questions. I think a maximum of 80 questions per day would be an attainable number to do and have adequate time to review/learn from the questions. (I had to go up to 120 questions per day towards the end of my period, but that was just a result of my personal adversities and I don’t recommend doing that many.) I suggest doing random questions of all topics as soon as you feel comfortable since that will be the format of the test. I also used both of their practice forms as practice tests and they were more helpful than the NBME forms to study from since you see what questions you got wrong.
NBME Forms/Practice tests:
I planned on using 3 forms total (1 my school had us take before dedicated had begun, and 2 I planned to use as practice tests during dedicated.) But ended up only using 2. I couldn’t really tell if the NBME or UWorld tests resembled the real test better, my scores were similar on most of my practice tests and averaged within 10 points of my actual score.
Pathoma:
I did one pass of pathoma as I was learning the material during the first 18 months of school, and then another full pass during dedicated. My viewing of the videos during dedicated were often at higher speed than my initial viewing. I found Dr Sattar’s lectures to be very clear, concise, and memorable, and he definitely outlines “high yield” information very efficiently while still providing background pathophysiology.
Sketchy:
I watched all of the pharmacology and microbiology videos before my official dedicated time started, and took personal notes on the videos. I really loved all of the sketchy micro and pharm videos and still find them useful and memorable during clinical years.
I also watched some, not all, of the pathology videos during dedicated. I would watch pathology videos when I found myself getting multiple questions wrong on the same disease, or when I’d get to that page in first aid in my schedule and just knew I needed to get a better understanding. I personally really like the path videos that compare two similar diseases, all of the leukemia/lymphoma videos, the acid-base disturbance video, and most of the cancer videos.
Boards and Beyond: I used this resource much more heavily during the first 18 months of school as I was learning the information for the first time. During dedicated, I only used boards videos on a handful of topics I needed more background on. I liked the way these videos explained the physiology behind many of the equations found in first aid, and how it simplified biochemistry/microbiology. I personally preferred pathoma for pathology, but boards does cover some additional details and explains things in a different way that works better for some.
Creating My Schedule
Overall, I took 6 weeks for “dedicated study time”, only taking one ½ day off per week and studying about 8-15 (probably average of 12) hours per day. I also incorporated ½ day for catching up. During this time my plan was to do 2 passes of the information, using First-Aid as an outline/guide, and do 4 practice tests on the same day of the week that I would eventually take the real test. I tried to simulate my testing environment for the practice tests by taking them at the library, otherwise all of my studying was at home.
With some initial help from my UNLV academic success faculty, I used google sheets to create a schedule that broke down my pages of first aid, UWorld questions, and practice tests. In general, I found that getting through 30 pages of first aid and 80 UWorld questions would fill up my entire day of studying. Here is a picture of the beginning of my schedule/how I broke down my first pass of the information:
My ability to reach my goal of doing 80 UWorld questions per day would vary day-by-day, and I had to learn to be patient with myself. I would use my catch up days mostly doing practice questions.
At the end of my dedicated period, I took Erika’s advice and scheduled in 5-8 days of “cramming” time and the last 2 days were “catch up” days. I also saved biochemistry/molecular biology (for me it was the first few sections in First Aid) for this last week because I knew I struggled with that information, and it’s almost entirely memorization anyways. My “cramming” days included reviewing UWorld topics I had taken notes on, skimming quickly through First Aid pages, and maybe looking in the back of First Aid at those “quick review” type sections with a bunch of facts/syndromes/buzz words you should have memorized by the time test day arrives.
How I Studied from UWorld
My general approach: Reading the last sentence of the question stem, and skimming the answer choices will help set you up for focusing on the right information as you read the rest of the stem. I used the highlight function pretty heavily, and also the strike-out function for crossing out answer choices I knew were wrong right away. The highlights and strike-outs would help me know later if I was focusing on the right information/had the right thought process when I initially saw the question.
The thing that makes UWorld so valuable in addition to the questions themselves are the explanations that follow every question. I would definitely spend the most time reviewing questions that I got wrong, but I at least briefly reviewed all of the questions to be sure I also focused on questions that I might have gotten right by guessing.
I used Notability to take hand-written notes from the UWorld Descriptions, which I organized by body-system. UWorld also has a flashcard function, so making flashcards in their program of the facts that you get wrong or with their really useful tables/images is also a great idea.
Whenever I got a question wrong or felt it was a topic that I needed to learn more about, I’d find the page in my first-aid, and highlight or write in a specific color so I knew the item came up in U-world. This would help me as I did subsequent passes of that First-Aid page, and it also helped me review related topics as I went through questions.
What did a “pass” of First Aid look like for me?
Again, First Aid really acted as an outline for me as I went through the information. I would go line-by-line in First Aid, and supplement with my other resources and old notes when I got to information that I didn’t fully understand or recall. During my first pass of First Aid, I also watched the corresponding Pathoma videos as I reviewed each set of pathology (usually on 1.5-2x speed). Other things I would do as I went through the outlines in First Aid included:
- Watching 1-2 sketchy pathology videos on disease(s) I had trouble memorizing all the details/”buzz words”
- Watching 1-2 Boards and Beyond videos explaining the physiology of certain lists of equations we need to memorize
- Reviewing my study guides I created during the first 18 months of school
- Reviewing my notes from sketchy microbiology or pharmacology
- Reviewing my Pathoma notes and comparing it to the details listed in First Aid
Staying mentally and physically healthy during dedicated study time
If I’m being completely honest, after losing my Holly I did not take great care of my mental health, and it took me a long time to feel like myself again. My advice is to incorporate at least 30-60 minutes per day of exercise and/or time outside in the sun if possible. My original plan was to walk Holly every day, maybe twice for a couple of shorter walks, and also work in some 5-10 minute guided meditations/breathing exercises. Everyone is different, but whatever physical and mental activities help you feel grounded, make sure you lean on those skills during this time! Also schedule time with loved ones on your days off, as long as they bring you positive energy and support.
Take care of yourself, or as someone once told me “feed and water yourself” every day. If your practice test scores aren’t coming out the way you want, pause and reevaluate, and use any resources your school provides to help. Just remember, this test is important but it’s not absolutely everything and you’re still a whole person who will be a great doctor someday!
The last block(s) of medical school leading up to dedicated
At my school, the last two blocks of our preclinical time were Mind-Body-Behavior (Neurology and Psychology) and a Multi-system Disease block in which they tried to recap all of the body systems briefly. As these last few weeks passed, it became more and more difficult to stay focused on the information in class and not be thinking about the looming unknowns of Step 1 dedicated study time. My advice for these last few weeks is this: If you’re going through new material (for me it was neurology and psychology), focus on that first. Make good study guides for yourself and focus on the tasks at hand. I did this and found that during dedicated time, I didn’t have to spend much time at all reviewing neurology and psychology because it was still fresh in my mind. If your school has a block that’s meant to act as a review, definitely spend as much time as you can studying, but don’t burn yourself out either. I personally found it really helpful to re-watch all of the Sketchy Micro and Pharm videos during the weeks leading up to my dedicated study period, and if I could go back I would also watch a few Sketchy Pathology videos.
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Good luck, and I hope this was helpful. Feel free to reach out with any questions.