Studying For the USMLE Step 1 Exam

The USMLE Step exams are important.  Even though they weren’t designed for this, many residency programs use these scores (especially Step 1) to decide who to interview for the NRMP match.  By far and away the best way to decrease the stress associated with this exam is to be prepared when you take it.

The best way to study for Step 1 is to start the process early.  As soon as you can (now, if you are in the first year!) look at examples of Step 1 questions.  This will give you an idea what to expect and will guide you in how to organize your studying.  The strategy for Step 2 will be similar.   Do this systematically – keep notes on your computer or in a notebook, or use the 3×5 card technique to make cards to organize and review later.  Whatever system you choose to use, be consistent.  You really can’t “cram” for the Step exams – it has to be a review.

In addition to developing a systematic approach to preparing for Step 1, it’s a good idea to spend dedicated time reviewing for the exam.  If your schedule allows, taking a full month or two to prepare for this exam is probably a good idea.  If it doesn’t, spread it out over more time, but devote the same amount of time.

The following recommendations are from two 4th year students on how to review for Step 1.   Use specific ideas that fit you, leave the ones that don’t.  There are many ways to succeed and not all of these recommendations will apply to you.

  • First week: Read quickly through First Aid cover-to-cover
    • This reminds your brain of everything you’ve ever studied and gives you the book’s lay-out
    • Read complicated or new information out loud
    • By reading out loud or skimming/reading quickly, it should take  about 6 days
  • Second week: Start UWorld as arranged in First AID
    • 46 “randomized” questions per set (2 methods of organization below)
      • Choose the organ system on the right hand side of the menu screen but not any subset groupings;
      • Alternatively, do biochem, behavioral science, and micro questions separately (everything for which there is a section in FA)
        • Then move onto organ system and the associated anatomy/physiology/ path/pathophys
  • Don’t worry about time at first, but ultimately you should be well under an hour/block
    • Practice good test-taking strategies
    • Read the last line of the question, skim the answer choices, read the full question for necessary buzzwords/data
    • No phone/gmail/chatting etc. during this time (it’s your “exam” time)
  • Take a 10 min break after answering all 46 questions
    • Do all the activities you put off – check your texts/email, go to the bathroom, read ESPN/NPR per preference, etc.
  • Review the answers from the 46 q block
    • Keep the 45-50 min “ON” study time (no distractions! No phone/email!) & 10-15 min “OFF” (see above)
  • Look up anything you don’t know / can’t explain to yourself
    • Make sure you really understand the explanation, but don’t get bogged down
    • Annotate any crucial information into First AID, using First AID as your primary textbook & notebook
  • Repeat above cycle until you have completed all q blocks for that organ system
  • Review associated First AID chapter (cardio, GI, etc)
    • Go over your freshly annotated chapter by yourself or with a study partner
      • “I sat down with my BFF and we took turns explaining each page & our annotations, covering details the other might have missed and adding mnemonics/stories.”
      • Review related annotations from other sections (micro/biochem/BS, etc)
      • Optional: listen to the related Goljan section while driving/exercising/etc
  • Repeat: Q-Block –> Review –> Annotate –> Q-block…etc… until you have completed all organ systems
  • Arrange some question blocks by topic (biochem/micro/etc)
    • You will already have completed all of these questions, but it is easier to review the First AID chapters for biochem/micro/BS if you take a couple question blocks to focus your mind
    • If you are consistently performing poorly on a non-organ based section, you can always interrupt your “organ based learning” and focus on your weak area for a couple of days using the above format (qs, review, annotate)
    • Identify weak areas based on score data & personal comfort
      • Retake question blocks, answers & related First AID chapter
  • If you have time during the last 2 weeks, as you go through First AID and your annotations in FA, write down everything you don’t know (don’t get stressed out if you end up writing a lot of stuff down…I think I had 1-2 pages handwritten front and back per section at this point). Then study only your notes and stop looking at First AID. The rationale behind this is that you don’t want to spend too much time rereading the stuff that you are 100% sure you know at a time when you should be focusing on what you don’t know. Note: you may need to start this while you’re still going through UWorld questions, but I think it’s worth your time.
  • Last Week:
    • Review First AID from start to finish with emphasis on weaker areas
    • Continue with random blocks of questions or NBME purchase exams to keep in “practice question shape”
  • Last couple days
    • 2-3 days before:  review behavioral sciences, write down any formulas for memorization, cram “regurg” factoids/formulas/graphs, cram the things in your notes that you still don’t know
    • Day before: NOTHING
      •  Hang out, relax, distract yourself, go to a movie…
      • You’re not going to change your score for the better by studying/stressing now (but it might make you fatigued the next day)
      • Pack your bag with all your documents, directions, First AID, notes for the next day (& lots of food) so you don’t have to worry in the morning
      • Try to sleep (you’ll be nervous but do your best!)



  • There are many opinions on how to best use practice exams.  The timing of them is as much an emotional consideration as a fact-based or practice based benefit.  Here’s one way to organize the practice exams that has worked for some students:
  • 2-3 Weeks into studying: Free NBME practice exam
    • Get a sense if you are on track, this score will underestimate you’re final score
      • If close to your goal, the score can be reassuring that you should keep doing what you’re doing
      • If significantly lower, the score can be motivation to pick up the pace/cut out distractions


  • 1 week before the exam: 2x 4 block UWorld practice exams
    • I took all 8 blocks back-to-back to simulate the exam experience (timing of breaks, fatigue, etc)
    • Do NOT review the answers on the same day, in fact, you should probably take most of the next day off to recover
    • Use the results as a comfort that you are on track (my actual score was 1 pt off my practice exams —- and despite fatigue & feeling like my second block of 4 was worse, I actually got identical scores throughout)
    • Look at the stats and focus on any weaker areas (my weakest areas became my strongest by the actual exam)


  • Last week: fee based NBME Exams
    • I paid for NBME 7, which tells you your estimated score, your percentile in each area, and reproduces the questions you answered incorrectly (but does not give you the correct answer) – again, within 1-2 pts of my final score
    • I worked through many of the exams (some easier, some harder than the my step) during the last week as a way to practice the random mix of qs….I found it helpful
    • Some of the questions on the NBME practice exams were on my REAL Step exam


BALANCE!   You’re job is study and do well on this exam —- but it can be very stressful, even just on a subconscious level.  For most people it works better to really structure your time.

Keep work hours:  go to a library/coffee shop/school on a regular schedule

  • 8 am – 5 pm (5/7/8 pm…whatever you decide)
  • Taken an hour off for lunch & hang out with friends
  • Go home & be DONE until the next day (get good food & sleep!)
  • Keep a life
    • Partner, work-outs, family, etc. should be in your life every day
    • Take at least one day off a week at the beginning



  • First AID & UWorld: you must use & love these, everything else is just bonus
  • Others (Wiki, BRS, textbooks, Goljan, etc.)
    • Resources other than FA and Uworld will not help your score significantly.
    • Use them to explain specific questions or concepts from UWORLD or FA that you don’t understand or can’t remember
    • Use them if for some reason you have a ton of extra time and already know FA and Uworld like the back of your hand
    • If you choose to use external resources, BRS physiology and the first part of Goljan Rapid Review Path (through the neoplasia chapter) might be worth your while, but seriously don’t worry if you don’t have time to get to them.


Traci Fraser and Natalie Gwilliam, Class of 2012, Baylor College of Medicine