I’ve gotten a few requests for a USMLE step 1 study guide, so I’ve put together a little guide for all of you medical students out there. Hope this is helpful to some of you who are getting ready to buckle down and start studying for the exam!
What is Step 1?
Step 1 is the first in a series of exams that you need to take in medical school to graduate and also to apply into residencies. Though there is step 1, step 2 CK and step 2 CS, step 1 is undoubtedly the most important exam. In fact, I haven’t even submitted my step 2 CK or CS scores to my residency, and I’m already halfway through my PGY-2 year. Step 1, however, is what most residency programs look at to standardize your academic potential against medical students from all other schools across the country. From the USMLE website:
“Step 1 is a one-day examination. The testing day includes 308 multiple-choice items divided into 7 blocks of 44 items; 60 minutes are allotted for completion of each block of test items. On the test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.”
The following topics are tested:
- behavioral sciences,
- interdisciplinary topics, such as nutrition, genetics, and aging.
When should I take Step 1?
It seems to differ by school, so I would say check with your classmates and your school registrar about when is the standard prep period and test taking time. At Stanford, we got six weeks off between April to June to study for the test and take Step 1 before starting clerkships on July 1st. Other schools including NYU have students take Step 1 after their third year of clerkships.
How should I study for Step 1?
This is the big question. It really depends on how much time you have, and I suggest sitting down and making a schedule to map out what topics you want to study on which day. Since I had 6 weeks, I made a weekly schedule of which topics I wanted to do per day; for example, biochemistry on day 1, immunology on days 2-5, microbiology on days 6 and 8, etc. I built in a one day break per week every Sunday, which helped me relax and refocus my efforts for the upcoming week. I left the last week blank to take practice tests that then highlighted which topics I still needed to review further.
A typical day’s schedule looked like this:
9:00 AM: Breakfast
9:00 – 11:00: Go over a few rapid review books and old lectures and notes on the topics assigned for the day
11:00 – 12 or 12:30: Do a section of USMLE World questions
1:00 – 3:00: Go over the questions I missed, read through the explanations of all the answer choices, and annotate my First Aid with any new or missing information
3:00 – 5:00: Listen to Goljan tapes, look up anything I don’t understand and annotate my First Aid, do another section of questions if my brain could handle it
6:00 Gym time / dinner / relax in the evening
I also recommend the use of Anki, which is a free downloadable flashcard creating program. It is a smart flashcard program in the sense that you can “choose” how easy, moderate, or hard each flashcard is for you, and depending on the difficulty level, it will show them to you within 1 minute, 10 minutes, or 4 days. The next time the card is shown, the time intervals will broaden to longer, such as 4 days, 7 days, or 10 days. Each time you mark it as “hard” aka the lowest interval for review, it’ll review the card more often for you. I like it because it tends to force you to review the cards that are hardest while still pulling in new info (I put mine on a setting of 10 new cards a day, 30 old cards). This is a great method for studying dermatology, which is mostly straight memorization and pattern recognition. I recommend using Anki for memorization-heavy fields such as immunology or genetic diseases. It is a hefty time investment in the beginning because you have to make the flashcards, but it pays off when you’re studying in a smart way in the future. You can also split the work with friends since you can share decks of flashcards.
Now for the books I used (also, more recs on my preclinical year books and clinical books here):
First Aid for the USMLE Step 1 2016 (First Aid USMLE) remains to my knowledge the holy grail of first aid board review. I’ve written about it before, and I’m writing about it again because it is just that good. I still to this day remember where certain pieces of information were located. A pro tip for the prepared ones: Buy this book during 1st or 2nd year and start annotating it as you study. This way, you’ll have all your useful information in ONE place, making this book the only one you really need as you study for boards!
Goljan Pathophysiology Audio Files: I found Dr. Goljan’s lectures entertaining and some things he said still stick out in my mind (“Broad based buds – BLASTO!”). He is a pathology professor at an osteopathic medical school in Oklahoma, and apparently he enjoys recreational arm wrestling, according to his Wikipedia page. He did a whole series of board prep lectures on a variety of topics, peppered with his interesting and snarky humor which sometimes helped me remember things. I don’t have access to these files anymore but ask around your medical school.
Question banks: I think the USMLEWorld Q bank is still the best one out there because its difficulty level is the closest to the real thing. I tried Kaplan, USMLEWorld, and USMLE-Rx (I won this qbank at an APAMSA conference actually!), and out of the three, USMLE World was by far the hardest but the closest to the actual test difficulty. I really appreciated taking the practice tests on USMLE World as well, because then you can become familiar with the format and the computer program you’ll use for the test. Pro tip: Buy USMLE World for Step 2 to study for shelf exams during your clerkship years!
What should I bring to the Step 1 exam?
Since it’s a long test, I recommend you wear something comfortable without a lot of pockets (test centers like Prometric make you turn your pockets inside out each time you go out and check back into the exam room). Bring a drink or two, snacks for your breaktime, and lunch. Other optional items include a hair tie (I sometimes put my hair up when I want to concentrate…likely placebo), Advil just in case, a pad or tampon just in case, and a light hoodie or jacket in case you get cold inside the testing room. The testing center will provide you scratch paper, a marker, and noise canceling headphones.
The day before your exam, just relax. I always use the last day before a big exam to clear my head, do some enjoyable activities such as spending time with my friends/family or shopping. I also planned a Vegas trip with some of my best friends from college the weekend after the test. It helped a lot to have something to look forward to after the test.
Good luck! If you have any questions or comments, leave them below.