USMLE® Step 1 Preparation: Complete guide with timeline and planner tool

​Dr. Vartika Kesarwani
All India Institute of Medical Science (AIIMS)
This detailed blog gives you step by step guidance on all you need to prepare for Step 1, along with our free planner tool which you can access at https://planner.usmlesarthi.com/

​PREPARING FOR THE USMLE STEP 1

How is the USMLE exam structured?
USMLE Step 1 is a computer-based, one-day, eight-hour long examination. It consists of seven one-hour question blocks (40 questions/block) and includes one hour of break time. The one-hour break time can be utilized all at once split into 5-10 minutes break time after each question block. 

What subjects are covered in USMLE Step1?

​Subjects covered in the USMLE Step 1 include:
  1. Biochemistry
  2. Anatomy
  3. Physiology
  4. Microbiology and Immunology
  5. Pathology
  6. Pharmacology
  7. Bio-statistics and Epidemiology
  8. Medical Ethics
  9. Behavioral Science
  10. Genetics and Aging
When should I start preparing?

​USMLE Step 1 tests the basic science subjects covered in the first two years of medical school for most International Medical Graduates (IMGs). It is best to take the test immediately/as soon as possible after completion of second year when concepts are still fresh in the mind. But what if you could not take the exam in medical school? What if you decided to pursue USMLE after you graduated? Don’t worry! It’s never too late to begin! Students who start late or have lost touch with basic sciences, may need to supplement their preparation with additional resources like textbooks or video lectures to clarify concepts, but it will never pull you back from scoring well. It is a disadvantage only when you think it is! 
How long does it take to prepare for USMLE Step 1?

​Time required to prepare for Step 1 varies from one student to another and is influenced by many factors like:
  • Time since graduation
  • Command over the basic sciences
  • Time dedicated to study every day
  • Individual reading style 
For IMGs who have just completed second year of medical school, 4-6 weeks of dedicated preparation time will be enough. However, for those who start late, 4-6 months of dedicated preparation will allow them to do well on the exam. Any shorter will probably not be enough and any longer may not significantly improve performance. 
What are the resources available for USMLE Step 1?

​USMLE Step 1 is one of the most important examinations that you will take during your medical career. Step 1 scores not only determine the kind of residency spot you secure, it will also support your application for fellowship post residency. Hence, there are multitude of resources available to help students prepare for Step 1. Given below is an account of the most popular core resources used by the students:
First Aid for the USMLE Step 1: Also referred to as the ‘BIBLE’ for Step 1, it is one of the most popular resource among students. First Aid is a comprehensive review book, best used as a core resource to guide the preparation. It can be used as the only study resource for students who have a good command over the basic science subjects. But for most students, it is advisable to supplement this with an additional resource to develop an understanding of concepts and scientific principles. First Aid will tell you what you need to study, the additional resource will help you master that. Note that every edition of First Aid may have some mistakes. Do not forget to refer to the Errata section of the First Aid (available online on https://firstaidteam.com/updates-and-corrections/).

​UWorld for the USMLE Step 1: If I had to pick the most essential resource for Step 1, this would be it! Understand that USMLE Step 1 is a test of both knowledge and application. While some questions will test basic facts and definitions, most questions in the exam will be based on application of concepts and scientific principles. The core and additional resources will help you gather information and UWorld will teach you the application of those concepts. A student who has achieved mastery over UWorld, will undoubtedly score well on the exam. The objective is to solve and review EVERY question in UWorld, understand and memorize the learning objective of EACH question, learn to EXCLUDE the wrong answer choices, learn to pick the BEST response and to develop speed (one question in 60-65 seconds).
 
NBME (National Board of Medical Examiners) Assessments: NBME examinations can be used as assessment and learning tools. Most of the concepts tested on the NBME exam will be covered in UWorld question bank, but it is not uncommon to find new questions/concepts in each NBME exam. As of today, there are 6 practice exams available under the Comprehensive Basic Science Self-Assessment (CBSSA) tab on the NBME website. Each exam costs $60 and can be purchased through the official website. It is advisable to solve and review ALL NBMEs online. NBME is scored on the same scale as USMLE and the score report incudes feedback on strength and weaknesses. The predictive value of NBME assessment varies from one form to another. Although there is no data regarding this on the official website, there are some sites which can help compare. Note that unlike UWorld and UWSA, NBME only provides information on the correct response to a question and not the explanation. The objective is to estimate readiness for the actual test, get a feedback on performance, identify weaknesses and to asses test taking skills.
 
UWSAs (UWorld Self Assessments): Like NBMEs, UWSAs should also be used both as a learning tool and an assessment tool to estimate readiness for the actual exam. As of today, there are two practice exams available on the UWorld website. They can be purchased along with the UWorld Qbank or separately through the official website.  It is advisable to solve and review BOTH UWSAs online. At the end of each assessment, a three-digit score which is equivalent to actual exam score and a feedback on performance, identifying areas of strength and weaknesses is provided. The predictive value varies for both assessments. There is no official data supporting this, but some information can be found on reddit or other social media threads . UWSAs will provide explanation for each correct and incorrect response. The objective is to use these assessments to estimate readiness for the actual exam, get a feedback on performance, identify weaknesses and asses test taking skills. ​
Additional resources

​While First Aid, UWorld, NBMEs and UWSAs are the most popular core resources, most students will need additional books or videos to supplement their preparation. Due to the vast majority of resources available, it is impossible to cover all of them in detail. Below is a list of the resources that I found useful during my preparation: 

 

SUBJECT

RECOMMENDED RESOURCE

Biochemistry and Genetics

Kaplan video lectures + Kaplan lecture notes

Microbiology and Immunology

Kaplan video lectures + Kaplan lecture notes + Dr. Najeeb lectures for Immunology

Embryology

Kaplan Video lectures by + Kaplan lecture notes

Anatomy

High Yield Gross Anatomy+ High Yield Neuroanatomy

Physiology

BRS (Board Review Series) Physiology

Pathology

Pathoma book by Dr. Sattar + Pathoma video lectures by Dr. Sattar

Pharmacology

Kaplan video lectures

Behavioural Sciences

BRS (Board Review Series) Behavioural Sciences + Kaplan video lectures

Biostatistics and Epidemiology

Kaplan video lectures + Kaplan lecture notes

Medical Ethics

100 cases in medical ethics by Dr. Conrad Fischer

 

Other Additional resources:

QUESTION BANKS

REVIEW BOOKS

VIDEOS

MNEMONICS/FLASHCARDS

Kaplan Qbank for USMLE Step 1

First Aid for the Basic Sciences: General Principles

Kaplan video lectures

Anki

USMLE Rx

First Aid Cases for the USMLE Step 1

Boards and Beyond

Memorang

AMBOSS

First Aid for the Basic Sciences: Organ Systems

Doctors in Training

First Aid Step 1 Flash Facts (USMLE Rx)

BoardVitals

Step-Up to USMLE Step 1 2015

KISSPrep

 

Pastest

Kaplan USMLE Step 1 Lecture Notes 2018

SketchyMedical (Microbiology and Pharmacology)

 

 

Crush Step 1: The Ultimate Step 1 Review

Dr. Najeeb lectures

 

 

USMLE Step 1 Made Ridiculously Simple

Lecturio

 

 

 

Picmonic

 

 

How many resources should be used?

​The key to scoring well lies in using a ‘FINITE’ number of resources and ‘MASTERING’ them rather than juggling with too many and not knowing them well. It is advisable to use one core resource (First Aid for the USMLE Step 1) and one additional resource for concept clarification (optional) in addition to question banks, flashcards (optional) and mnemonics (optional). 
How to select resources?

​Every resource has its strengths and weaknesses. Remember that there are no ‘BEST’ resources, only ‘BEST’ students! Selection of study resource depends on individual learning style and baseline knowledge of the subject. One way to figure this out is to study the same topic from few different resources in the beginning of your preparation and compare them all. Stick to the one that works best for you for the rest of the preparation phase. The time and effort spent during this phase will determine your command over the subject and the time required for revision. 
How to make a study schedule?
 
Most students preparing for the USMLE use the same resources. Then what causes the variation in scores? Why do some people perform better than others? The result can be influenced by many variables like baseline knowledge, learning style etc., but one of the most important modifiable factors contributing to this variation is a well-planned study schedule. Below are a few tip and tricks that may you help you succeed.  The scheduling and planning best practices have been implemented in the free planner tool which you can access and start using at https://planner.usmlesarthi.com/
So there they are

  • Don’t overlearn: Although time required to read varies among students, 5-8 hours of dedicated study every day is ideal for most students. Less than this may not be enough and more than this may cause burn out. The above tool allows you to set your dedicated hours by day of the week and take a day off every week as well.
 
  • Take breaks: Studying for long hours in a single stretch decreases efficiency and reduces retention. It has been proven that he attention span for an average human is 40-45 minutes and hence it is advisable to take a short 10-minute break after every 45-60 minutes of study time. It is also advisable to take one day off every week for relaxation and recreational activities. This will break the monotony and reenergize you for the following week.
 
  • Study the same topic in different ways: Use flashcards, ‘Feynman technique’, mnemonics, books, videos etc to study the same topic. This will not only spark interest but also help in developing a better understanding of the topic.
 
  • Teach: The best way to test the understanding of a topic and improve retention is to teach it to someone else. If you can teach it, you know it! That’s the reason that in the planner tool, it is proposed you do UWorld timed tests every day.
 
  • Revise: The key to success on any exam is revision! No matter how well you study a topic the first time, without revision, it cannot be retained. Allocate 60-90 minutes to revision every day in the study schedule. One of the techniques that I found useful during my preparation was the ‘Spaced Revision Technique’. It is based on the ‘Forgetting Curve’ and provides time interval between study sessions for long term retention of information.
 
  • Divide your Step 1 preparation in two phases (depending on individual requirements):
 

Preparatory phase
​
  • This should make about 3/4th (75%) of the total preparation time.
  • Goal: To learn the facts and master the concepts and its application related to each topic/subject. Think about the different ways a fact/concept can be tested as a question.
  • Resources: First Aid for the USMLE Step 1 + Additional resources + UWorld
  • Use First Aid to guide the preparation. Don’t just read, understand and master it! By the end of this phase, the student must have competed one pass of First Aid.
  • Use additional resources to understand the concepts/scientific principles.
  • Take necessary notes from the additional resources in First Aid book/notebook. The idea is to have a comprehensive ‘GO TO’ resource for revision rather than juggling with different books.  The planner tool also allows you to take notes for each topic- Try it! https://planner.usmlesarthi.com/
  • Use UWorld (or any other question bank) to learn the application of knowledge and develop test taking skills (time required to solve each question and choosing the best response). Solve and review UWorld every day from the first day of preparation! At the end of this phase, the student should have completed one pass of UWorld.
  • Maintain a UWorld Journal. Take notes of the necessary concepts/facts from the question bank again you can use the tool to take notes. This will be your resource for a quick revision before the exam.
  • Tracking progress: Observe a gradual improvement in Uworld scores.
 ​

Revision phase
  • This should make up about 1/4th (25%) of the total preparation time.
  • Goal: To revisit all the facts and concepts learnt in the preparation phase and to develop test-taking skills.
  • Resources: First Aid + Notes from additional resources + UWorld + UWorld Journal + NBME Assessments + UWSAs
  • Complete the second pass of UWorld. Solve and review 80-100 questions every day. Practice solving one question block (40 questions) in 45-50 minutes so as to leave enough time for review of responses on the actual test.
  • Revise the UWorld Journal.
  • Complete second pass of First Aid and revise the notes taken from additional resources.
  • Take and review NBME at the beginning of the preparation to identify areas of weakness and determine readiness for the exam. Revise and improvise based on the feedback received.
  • Take and review subsequent NBMEs and UWSAs every week along with revision to monitor progress.  It is advisable to take all assessments online.
  • Take two, four-hour assessments online in a row to simulate the actual eight-hour Step1 exam. Solve question blocks and take breaks as you would on the day of the exam. This should be done at least once during the revision phase.
  • Tracking progress: Observe gradual improvement in assessment scores every week. Observe improvement in the areas of weakness identified by the assessments.
When should I take the test?

Understand that USMLE Step 1 tests both facts and application of concepts. While concepts, once understood may be retained for a long time, facts are volatile and need to be revisited frequently. Hence, it is advisable to take the test as soon as the assessment scores (NBMEs and UWSAs) fall within 10-point range of your target score. Remember that you will never feel 100% prepared, trust your assessments!