How I Studied for USMLE Step 1

As one of the biggest exams you will take during your training, Step 1 requires dedicated preparation to be successful. Although it may not feel like it, you begin your prep the day you begin medical school and in many ways well beforehand. If you ask 100 people for advice about studying for this exam, you will get 100 different responses because studying for this exam is so individualized. What worked for someone else may not work for you and in the same way, what worked for me may not work for you. I highly encourage everyone sitting for this test to speak to as many people as you can so you can put together a plan that will help you do as well as you can. So with that, here’s exactly what I did and I hope this helps provide some insight and encouragement – it is no doubt a challenging exam but very much doable with hard work and dedication! Wishing you all the best with your prep and beyond and feel free to reach out if you do have any additional questions!

*PLEASE NOTE* - All prep materials mentioned in this post are resources I used during my exam prep. I do not receive any promotions or commission from any of the services mentioned here and have no affiliation with these companies.

About the Exam

Structure of the test

• 7 blocks, 40 questions per block, 60 minutes per block

• 280 questions total

• Total Exam Time – 8 hours (including time for breaks)

• Each block has randomized questions from all subjects tested and is different from the MCAT which has separate sections based on content

For more detailed information about the test and content covered, visit https://www.usmle.org/step-1/#overview.

Prep during Pre-clinical years

The best thing you can do to prep for Step 1 during your pre-clinical years is learn the material well the first time around as you cover content for your classes. During M1, I primarily used the notes provided by my program to study for block exams. When we began covering Pathology in M2, I started incorporating the resources I used to prep for boards into my studying for each block. This included the Boards and Beyond video series, First Aid, Pathoma, and Sketchy Micro/Pharm. Especially while watching the Boards and Beyond videos, I would annotate notes into First Aid to clarify challenging concepts and also annotated my Pathoma book while following along the videos. Some of my classmates used flashcard modalities like Anki throughout the year and found it helpful to learn with spaced repetition (I personally did not use this myself and can’t speak to this). Some students also purchased a question bank other than UWorld early on in the year for additional practice. Of course, the more practice you can get, the better, but I did not use anything other than UWorld and NBME Practice Exams and found that to be more than sufficient. I began using UWorld about 4 months out from my exam date while finishing up the last few blocks of M2. Although I didn’t get through too many questions (maybe 200 max), I wanted to save the resource for when I began my dedicated study period since this is the BEST practice question resource for the exam.

Quick note about starting prep early – Your preclinical years are not only a time to learn but also a time to continue exploring your interests both in and outside of medicine. Yes this test is extremely important, but don’t concern yourself with trying to do too much too early. The bulk of my prep was in the 6-7 weeks leading up to the test. Taking time to do the things you enjoy during M1 and M2 year is something that is very important to making the most of your medical school experience. You will have plenty of time to prep for the exam when the time comes.

Dedicated Study Period

At my school, we have a total of 8 weeks after our last exam of M2 year before orientation week begins for our third year of school – a period of time we collectively call “dedicated”. There are no clinical duties and no academic commitments during this time. This is time protected for students to focus on one thing – studying for Step 1. Many of us aim for 5-7 weeks of prep, sit for the exam, and try to plan for some time off afterwards before beginning the next academic year.

In the weeks leading up to dedicated, I worked on coming up with a daily schedule I would follow for every day leading up to the exam. Our school has a Cognitive Skills Department who was very helpful in guiding us how to create our schedules and I encourage everyone to take advantage of these resources if available at your program too. You can also sit down with your peers and professors who may also be able to help you create a study schedule. To do this, we counted the number of days in our dedicated study period, allocated how many days I needed to review each subject covered on the exam, scheduled full days dedicated to taking and reviewing practice exams, and scheduled half days on Sundays for breaks. After that, I created an hourly breakdown of tasks for each day to help me meet my daily study goals and this also helped to provide each day with some structure.

The day before beginning dedicated I took the day completely off to relax and clear my mind before starting exam prep for the next several weeks. I spent the day with my family on the beach and this was really something that helped put me at ease before beginning.

During the first week of dedicated, I tried my best to stick to the study schedule I had created for myself in the weeks prior. With every day, you’ll slowly start to figure out if there are certain things you prefer scheduling for the morning or evening and can modify your daily tasks as needed. I kept to using the same resources I used to prep for my classes throughout the year including First Aid, Pathoma, Boards & Beyond, and Sketchy Micro/Pharm. I also aimed to complete about 80-120 UWorld Practice Questions every day and annotated key points in First Aid. Personally, I liked completing practice questions in one chunk towards the middle of the day and reviewed them all together afterwards. This also helped to build stamina to complete several question blocks with a 5-10 minute break in between each. Throughout the weeks, I made studying pharmacology and microbiology longitudinal goals so I could space out reviewing them throughout dedicated.

Typical Study Day

Below is what most of my study days looked like from the time I woke up to the time I went to bed. Although my schedule did change a bit as I neared my test date to accommodate more time to review topics I was weaker on, most of my days still followed a similar structure.

7:30am-8:00am – Wake Up/Coffee/Breakfast

8:00am-10:45am – Content Review from First Aid/Pathoma and supplement with Boards & Beyond videos when needed

11:00-1:00pm – 80 UWorld Practice Questions (on days I completed more than 80 questions, I would complete the rest right after lunch)

Lunch

1:30pm-7:30pm – Review UWorld Questions (If I needed more time to review the questions I completed, I would do them after dinner. If my review was complete, then I continued on to another block of content review)

Dinner

8:00pm-10:00pm – Content Review

10:00pm-11:30pm – Sketchy Pharm/Micro

Note: Yes this is a very rigorous schedule, but there really is no substitute for quality time spent studying in preparation for this exam. There were many days where I did not complete everything I wanted to do and had topics that carried forward to the next few days. Just remind yourself that you are trying your best with the time you have and do the best you can to prioritize reviewing your weaker topics if you feel you’re running behind.

The Day Before the Test

The BEST thing you can do for yourself before test day is relax. So many people told me to do just this and I wish I had taken more time that day away from the books to gather my thoughts before taking the exam. If I were do it again, I would have used half the day to brush up on challenging details and pharmacology and the other half to fit in a workout, set aside my materials for test day, and head to bed early that night. While setting aside your materials for the exam, make sure to review your test center’s policies, pack snacks/lunch, and most importantly confirm the exam start time which may be different based on if you’re taking the test on a weekday or weekend. Lastly, just remember that you are more ready than feel and the more you can get yourself to feel calm before the exam, the less you will stress about test day.

Game Day

The morning of the exam, I did one last check to make sure I had my ID and testing permit in the bag I was taking to the testing center and it was off to the test. Test day is LONG so make sure you bring enough snacks, water, and coffee to keep you fueled throughout the day. I used up all my allotted break time to give myself a break in between sections. Even if you don’t feel like leaving your desk, just taking a break and sitting for a few minutes before starting the next section can be helpful in mentally prepping yourself for the next block. There will always be questions you won’t know how to answer. Just try your best to narrow down the choices, choose your best answer, and keep moving forward. You can always flag or mark the questions and come back at the end of the section to review them if time permits. Most importantly, try your best to not think about them after completing that section.

Leaving my desk at the end of the exam, I didn’t know what to think. I honestly felt as if my preparation for the exam paid off in some ways, but in many ways might not have. I felt confused, worried, anxious, and left with a feeling that this didn’t go the way I had hoped. Just know that you are not alone in how you feel walking out of that test. But now, you can finally say YOU’RE DONE!! You sat through an 8 hour exam, gave it your all, and it’s time to head home and celebrate!!

The Weeks after the Exam

Score reports are usually released about 3 weeks after the exam. Go on vacation, spend time with family and loved ones, do the things that were on hold these last several weeks while you were studying, get together with your classmates and decompress, and reflect with one another. Enjoy the time you have post-exam. It’s a time for you to celebrate and relax after the marathon you have just been through.

A Word on Physical and Mental Well-being

To anyone studying for Step 1 or any standardized exam, my biggest advice to you is get yourself in a good headspace well before test day.

I started off board prep strong and feeling good about the weeks ahead. I had everything planned out day by day and followed it to the hour as best as I could but ended up cutting down on other aspects of my life that helped keep me grounded like exercise and sleep. There was too much that needed to be done and the days were just flying by. The stress built up but I pushed through as test day continued to get closer. And at Week 5, everything came to a stop as exhaustion and built up emotions hit me. There was no way I could continue like this if I was going to take this test in another 2 weeks, and so the next few days I focused on one thing - rebuilding myself. In those days, I made myself a promise to just do my best without ignoring my well-being.

I shifted my focus from stressing about knowing everything for this exam to using this study period as an opportunity to solidify my knowledge for when we become directly involved in patient care as 3rd year medical students at the end of the month. I can’t thank my friends and family enough for all their support during this period of time. Talk to your loved ones and peers if you ever feel down because no one should go through such a stressful time alone and remember to check in on your friends who are also studying for the exam.

Remember, you’ve done your best, believe in yourself, and give it your all. And above all else, listen to your body when it tells you to slow down.