Philadelphia University + Thomas Jefferson University

Alpha Omega Alpha Honor Society
Guide to USMLE Step 1


Introduction

SO, you are approaching the end of your second year at Jefferson, which was quite possibly the most grueling part of your medical education. Having gone through about a thousand pages of Path and countless lectures of FCM, you are so ready for a major break from the books, right? Well there’s still one hurdle to cross before you reach the promised land of clinical medicine: Step I of the USMLE, or "the boards." Although this examination can seem pretty intimidating, a logical and well thought out approach to studying helps most Jefferson students pass on their first try. So first and foremost, do not panic!

This guide is meant to provide a framework and some simple suggestions for studying for Step 1. Remember, these are just suggestions and no one approach to studying is right for everyone. The key to success is to think about the topics and issues that need to be covered, make a realistic study plan, and then do your best.

To organize this guide, we’ve separated it into 4 major sections. The first answers some commonly asked questions about the boards. The second section deals with scheduling your study time wisely and efficiently. Finally, the third section discusses the review books that are available within each major subject.    

In addition to this guide, be sure to visit these Web sites for official information:

National Board of Medical Examiners: The United States Medical Licensing Examination

USMLE.org

To register/apply for USMLE exams (and later check scores)

For more information about Step I

Commonly Asked Questions

How important is the score on Step 1?

Residency programs do look at your USMLE scores as part of their evaluation of resident candidates. It is however just one aspect of your application, which will also include your clinical evaluations, letters of recommendation, basic science grades, and Dean’s Letter. The more competitive the specialty (i.e., Neurosurgery, ENT, Radiology, Dermatology), the more likely the scores will be used to screen students for interviews. If you are leaning towards a particular field(s), ask residents or attendings about the relative importance of Step 1. Overall, just keep in mind that while your score does matter, it is only one of many criteria that will help determine your success in matching at the residency of your choice, so keep things in perspective.

If you are very interested in specialty-specific Step 1 scores, you can check out Charting Outcomes in the Match for U.S. Allopathic Seniors. Do NOT let it freak you out.

When should I start studying?

The truth is that you started studying for Step I the first day of medical school, since this exam is basically a cumulative exam of the first two years. It might be a good idea to slowly start incorporating Step 1 studying into your FCM studying, mainly by using First Aid (more on that later). In terms of focused studying for the boards, however, most students find that five-six weeks of 10-12 hours of dedicated studying per day is sufficient.

What topics are more/less emphasized on the boards?

This question is very important, as it will determine how much time you should spend reviewing each subject. Among first year classes, the most heavily emphasized subject is Physiology. There are also a fair number of questions in Neuroanatomy/Neurophysiology, Biochemistry and Behavioral Sciences (including statistics!), so spend a decent amount of time on these subjects as well (see scheduling section below for more detail). Anatomy, Histology, and Embryology are considerably less emphasized in Step 1, so spend less time studying them but please, please, please do yourself a favor and do not ignore any subject altogether.

As for second year courses, spend the most time with Pathology, Microbiology, and Pharmacology. Pathology is probably the most important single subject, since it ties in all of the other topics; don't be daunted, though, because the preparation you have received in going through FCM and Pathology in the second year has provided you with a strong foundation when it comes time for Step 1 prep. By devoting the appropriate time and energy and utilizing the right resources, conquering all of these subjects will be well within your reach. Also, don't forget the basics of Biostatistics, as sensitivity and specificity and positive and negative predictive values are favorites for the USMLE and are easy points.

What topics are more/less emphasized on the boards?

This question is very important, as it will determine how much time you should spend reviewing each subject. Among first year classes, the most heavily emphasized subject is Physiology. There are also a fair number of questions in Neuroanatomy/Neurophysiology, Biochemistry and Behavioral Sciences, so spend a decent amount of time on these subjects as well (see scheduling section below for more detail). Anatomy, Histology, and Embryology are considerably less emphasized in Step 1, so spend less time studying them but please, please, please do yourself a favor and do not ignore any subject altogether.

As for second year courses, spend the most time with Pathology, Microbiology, and Pharmacology. Pathology is probably the most important single subject, since it ties in all of the other topics; don't be daunted, though, because the preparation you have received in going through FCM and Pathology in the second year has provided you with a strong foundation when it comes time for Step 1 prep. By devoting the appropriate time and energy and utilizing the right resources, conquering all of these subjects will be well within your reach. Also, don't forget the basics of Biostatistics, as sensitivity and specificity and positive and negative predictive values are favorites for the USMLE and are easy points!

How important are sample questions and practice exams?

Students widely agree that doing questions is the single most important aspect of your Step 1 preparation. Generally speaking, doing practice questions and exams has been helpful to many students for several reasons: it directs your emphasis towards certain topics, identifies your strengths and weaknesses, and gets you in the right frame-of-mind for taking this exam. Additionally, it gets you accustomed to taking a computerized exam, with most Qbanks having identical formats to the Step 1 exam. Most students aim to do 50-100 questions each day.

What practice questions do you recommend?

USMLEWorld (UWorld) is the favorite question bank for students here at Sidney Kimmel and around the world. It does a great job simulating the format of the actual Step 1 examination. This is something that is well-worth the price and is fundamental to your studying. USMLEWorld offers >2400 questions with detailed answers, diagrams, charts, and helpful mnemonics to drive home key points. You should aim to get through USMLEWorld entirely throughout your dedicated study time. Make a schedule and see how many questions you need to do each day to accomplish this. Most students start UWorld during the dedicated study period, but some  students found it helpful to start using it during FCM. Some students attempt to get through USMLEWorld twice before test day (note: if you purchase a subscription for >6 months, you can reset your account and start from scratch with the questions). Some students annotate the key points into First Aid or a separate notebook, while others make them into Anki cards or take notes in the USMLEWorld note-taking section. See what works for you, but make sure you read all the answers (even if you got the question correct) as you can learn a lot from them!! You can mark questions on the software so you can revisit them prior to test day. Try doing questions on the random, timed mode, especially as test day approaches. As a disclaimer, the questions are often more difficult than the actual USMLE Step 1, so do not be discouraged if you are not scoring as highly as you wish to on your practice tests (especially if you attempt them during FCM). With the proper preparation, you'll find your question bank scores and confidence peaking as you near test day.

USMLE-Rx is a relatively new question bank created by the authors of First Aid for Step 1. We would like to stress that this is NOT a substitute for using USMLEWorld during the dedicated study period. The class of 2018 found USMLEWorld (not USMLE-Rx) to be more helpful with questions that were more realistic to test day in terms of difficulty. The students who did use USMLE-Rx used it to study for FCM (in order to save USMLEWorld for the dedicated study time). There are often discounts offered throughout the year, so look for one of them before you buy it.

There are other question banks out there, but we recommend sticking with USMLEWorld during the dedicated study period in May-June. If you want, feel free to use USMLEWorld or USMLE-Rx throughout the year when studying for FCM.

What self-assessments do you recommend?

USMLE World offers two self-assessment exams and the NBME has numerous “Comprehensive Basic Science Self-Assessments” for purchase. The class of 2018 reported using on average two to four of these assessments. Some people have found that the USMLEWorld self-assessments overestimate your score, while the NBME ones underestimate your score, but this differs from person to person. However, everyone can agree that these practice tests are helpful for assessing your progress as you study. Some students liked taking two self-assessments back to back to imitate sitting for a full-length exam to provide reassurance that you do have the stamina to rock the exam.

Just a disclaimer, the USMLE World self-assessments provide answers with full explanations for all of the questions. There are two purchasing options for the NBME: with and without extended feedback. The regular version just gives you a score - you won’t see any of the questions again. The extended feedback option (costs an extra $10 or so) shows you the questions you got wrong, but it does not provide you with the correct answers. The extended feedback option is helpful, but you will have to spend some time on google or consulting with friends to find the actual answers.

The official USMLE website offers a free computerized practice test. We recommend at least doing this for the tutorial, so you can save time on test day (the tutorial is identical).

Are there any review courses?

Keep in mind that there are also review courses (DIT, Kaplan, Becker’s) that can help you organize your studying if you are willing to spend the time and money. If you feel you may benefit from a review course, talk to upper years or your dean for recommendations.

DIT (Doctors in Training) offers a series of high-yield videos that basically follow along with the content in First Aid. There is an accompanying study guide with multiple choice questions to help review the material. These questions are NOT a substitute for UWorld. If you study best by listening to lectures, rather than just reading a book all day, this may be something to consider. Some students find DIT helps keep them on track. However, in the past, there have been many mixed reviews (and it has a hefty price tag), so make sure to ask someone who has taken it to see what they really thought about it.

Should I use Anki?    

Many students have found Anki helpful for studying throughout the first and second year courses. On survey of the class of 2018, some students continued to use Anki during the dedicated study period. Throughout the year, they used Kealan’s class deck, their own cards, or Brosencephalon. However, during the dedicated study period, many students found there was not enough time for such long decks. Instead, Anki was most helpful for memorizing high yield facts from First Aid (the rapid review section at the end of the book) or for addressing key points they were likely to forget from missed questions on UWorld. As is true for other resources, see what works for you and feel free to reach out to upper years to see what worked for them.    

What is the testing day like?

There is no denying the fact that the testing day is long. Just be sure to remind yourself that it used to be two days!! You can do it!

There are seven one-hour blocks of 40 (or fewer) questions, and you are allotted eight hours to complete the test. The total number of questions will not exceed 280. You have 45 minutes of break time automatically allocated to you (read on for more information).

In addition to the exam blocks, your test experience begins with a 15 minute computer tutorial. However, this is identical to the one online, so it is best to skip it on test day (check that the headphones work, then move on ASAP), and take those 15 minutes as break time. If you do this, you begin with 1 hour of break time, which you are able to take between sections at any point during the day. Also, if you happen to finish an exam block early, the remaining time will be added to your break time.

Some people complete a couple of sections at a time and then take a prolonged break, while others choose to take a five minute break at the end of each section. You can always access a screen on the computer which tells you your total time remaining (for your current section and for the test day) as well as how many sections you have left. So, time management is not a major issue as long as you pay attention. 

What is it like to take a computerized exam?

Your medical school computerized exams have been preparing you for this 8-hour computerized exam. You can download a practice test on usmle.org to preview the exam format, so you feel more comfortable as you approach the test. USMLEWorld is also pretty similar to the real deal.

You will be given a dry erase board to jot down any notes during the exam.

There are easy ways to review unanswered questions or to mark a question that you want to return to, and you should familiarize yourself with these beforehand by using usmle.org practice test.

As Step 1 is computerized, you are likely to have a handful of heart and breath sounds to interpret. You may also have a video demonstrating a specific physical exam finding.

If you would like, it is possible to schedule a practice exam at the Prometric center to familiarize yourself with the exam format. It costs less than $100 to schedule this exam, and many students find it very helpful to take the practice test a week or two before your actual exam.

The Right Resources

As you embark on your studies for the USMLE Step 1, choosing the appropriate study materials is crucial to your success. There are tons of review books and sample test question books available for your preparation but money and time are two factors you must consider. Many of these review books cost over $25 and take a significant amount of time to go through. Do not overwhelm yourself by using too many resources.

Here are some recommendations for books that may maximize your study success. Do not stick to one series of review books because you like the format - in every series, there are good books and bad books, and the best strategy is to use the best books from each series as appropriate. First Aid has a list of various resources in the end of it if you’re interested.

Keep in mind, you can’t choose the "wrong" book for a subject. Pick what works for you, and don’t have second thoughts about your choices. These books are published because they are good and wouldn’t have stuck around for so long if they weren’t. When you do choose a book for a subject, stick to it.

We have broken this guide into categories: general books, book series, anatomy, behavioral science, biochemistry, physiology, microbiology/immunology, pharmacology, pathology, and practice questions.

Items marked with an asterisk (*) are considered essential resources.

General

*First Aid for the USMLE 1 by Le and Bushnan. Published by McGraw-Hill Medical
We have listed only one reference in this section because this is the single best comprehensive reference for the Step 1. First Aid should be your best friend. Many students found it helpful to refer to First Aid during FCM, and some even chose to take notes directly into their First Aid throughout second year. Some also annotate UWorld into their First Aid. You should make sure to get through First Aid in its entirety during your dedicated four to six week study period. If you have time, many students have found it helpful to review First Aid a second (or third) time in the week leading up to the exam.

What is so great about First Aid?
The book is separated into three sections: the guide to efficient exam preparation, a database of high-yield facts, and a database of basic science review books. First Aid will answer all your picky questions about the exam (# of questions, time per question, scoring, etc.). The high-yield section is very handy and is a great review of all the topics. Reading this section over for the second or third time days before the exam will definitely score you some points. While no one book works for everybody, this book consistently receives the best reviews from students who have taken the boards. Strong sections: Micro, Pharm and Behavioral Sciences. The sections pertaining to some of the lower-yield subjects (anatomy/embryo/histo) cover a huge chunk of the important and testable items that may show up on the exam, so it is certainly worth your while to know them well. As you add important facts in the margins as you study the subjects during the final few days, First Aid becomes the only thing you need to read during the final few days. Bottom line: this book should become your best friend; however, it is not recommended as a stand-alone reference.

Step-Up to the USMLE Step 1 by Mehta. Published by Lippincott Williams and Wilkins.
It does the high-yield approach by organ system, rather than the by-discipline approach of First Aid. Good organization, but has too many errors. Good as a supplement if you like the style, but few students use this.

Online Series

Doctors in Training
See the “review courses” section of commonly asked questions    

Sketchymedical.com 
Many students absolutely swear by this visual video-mnemonic series for infectious disease and pharmacology. The class of 2018 found sketchymedical to be the best way to memorize “bugs and drugs.” Although some of the videos are a bit lengthy (especially the pharm ones), they present the material in such a unique way that you will be sure to remember nit-picky high-yield details (even when you’re a third year). It is very helpful to incorporate this into your IID/FCM studying, so you can review the videos more efficiently during the dedicated study period. 

Picmonic.com
Before sketchymedical, this was the go-to site for visual mnemonics. However, based on survey of the class of 2018, sketchy seems to have replaced it. Picmonic covers many topics in First Aid, including microbio, pharm, pathology, anatomy, etc. Some students find it helpful for memorizing topics that sketchymedical does not cover like those random biochemical and genetic disorders you swear you’ve never learned before.    

Pathoma
Many students use Pathoma throughout second year, so you probably already know that Dr. Sattar rocks. He covers high-yield pathology information for all of the organ systems in relatively short videos. During the dedicated study period, some students choose to rewatch all the videos on double speed, while others pick and choose videos in areas they’d like to refresh to complement First Aid. You can also just read the Pathoma textbook if you find that faster than going through the videos. The nephrotic/nephritic syndrome videos are a must watch as Dr. Sattar will help you keep them straight for test day.   

Boards and Beyond
This is a newer resource, but some students claim it is like the “Pathoma of Physiology.” There are over 300 videos on various topics, ranging from pharmacology to biostats to nephrology. We recommend talking to upper years who used this for more information on how to use it.

Goljan Audio
Prior to Pathoma, this was a popular resource for pathology. You can likely get a copy of the audio files online or from an upper year. Some people casually listen to it at the gym, while making dinner, or on the way to the library (although we do recommend having some time to yourself without any studying). Pathoma is probably easier to get through and has more updated information.

Book Series

Board Review Series (BRS), published by Lippincott Williams and Wilkins
Subjects available are Biochemistry, Pharmacology, Microbiology, Gross, Histology and Cell Biology, Embryology, Neuroanatomy, Behavioral Science, Pathology, and Physiology. All books have a similar outline format, many charts, sample USMLE-style questions with annotated answers, and a comprehensive exam. These are not textbooks; they are intended for review.

Appleton-Lange Series
Included in this series are an excellent review book for microbiology and immunology (Levinson and Jawetz) and a pharmacology review book that is the companion to your text (Katzung and Trevor). The formats vary. Both the microbiology and pharmacology books have excellent cases and sample questions.

NMS, published by Lippincott Williams and Wilkins
Same publisher as Board Review Series, but these are textbooks, not board review books. There is much more information and detail, with a "dense" format that makes them rather formidable.

Ridiculously Simple
The series has Anatomy, Neuroanatomy, Biochemistry, Pharmacology, Microbiology, and Physiology. Minimalist approach as the name suggests with silly, but helpful, mnemonics. The only "must" in the series is *Clinical Microbiology Made Ridiculously Simple.

Lippincott's Illustrated Reviews
There are three books in this series, Biochemistry, Pharmacology, and Microbiology. Biochemistry is popular as a textbook; it is well-written and well-illustrated, but long for board review. Pharmacology also is excellent to use as a text, but long for a step 1 review book.

High Yield Series, published by Williams and Wilkins

This series includes Gross, Neuroanatomy, Biostatistics, Embryology, Behavioral Science, Immunology, Histology, Biochemistry, Cell and Molecular Biology, and Pathology. The most popular books in the series are *High Yield Neuroanatomy, High Yield Embryology, High Yield Gross Anatomy, and High Yield Behavioral Science. These books distill the content to an irreducible minimum. No indices, no questions.

Rapid Review Series, published by Mosby
This series includes Pathology and Biochemistry. Many students use the Pathology book as their gold standard for studying the subject. It also includes helpful images for students. The Biochemistry book is known for containing excellent diagrams that are clinically relevant. Both have very comprehensive review questions.

Anatomy

After spending so much time studying anatomy during first year it is kind of disappointing to find out that anatomy is not really a big topic tested in Step 1. You can use this to your advantage by spending more time on other topics. Stay away from Chung and Moore. First, understand that all of anatomy is 1/7th of boards. At a minimum, you will use the anatomy sections of First Aid for the USMLE Step I. Many students contend that First Aid is sufficient by itself and additional review books are unnecessary. For those of you who would like an text, we recommend the following books by subsection of anatomy:

  1. Gross: First Aid alone or in combination with High Yield Gross Anatomy. BRS Gross is much too long for board review.
  2. Cell Biology/Histology: BRS - read the first 4 chapters on cell biology if you have time; a book to borrow or share. The practice questions will hit on most of the topics tested in this category.
  3. Neuroanatomy: First choice is *High Yield Neuroanatomy. You must have a neuroanatomy review book in addition to First Aid. BRS Neuroanatomy is much too long for board review. We strongly suggest you review your neuroanatomy before Dr. Brainard's review session: it is a great session but don't worry if it scares you; it scared all of us. There are a fair amount of neuroanatomy questions.
  4. Embryology: First Aid alone again is sufficient, and High Yield Embryology can just be used as a reference.

Bottom Line Minimum for Anatomy: Anatomy sections of First Aid for the USMLE Step 1, High Yield Neuroanatomy, and if you prefer, the first four chapters of BRS Histology and Cell Biology and, as a reference, High Yield Gross and High Yield Embryology.

Behavioral Sciences/Biostats

BRS and High Yield are by the same author. Last chapters in either book have epidemiology and biostatistics that are essential for USMLE. Make sure you have a decent understanding of the main topics in biostats. Both books are decent, though BRS is a lot thicker. Some students have noted that the questions in BRS are helpful. Many students also read through the packet you received from Dr. Mago during FCM, finding it a great review of pertinent topics.

Know the First Aid chapter!!
High-Yield Behavioral Science by Fadem
*BRS Behavioral Science Review by Fadem

Biochemistry

Biochemistry is a topic that is easily forgotten by the time the boards roll around. Going back over all the major metabolic pathways will take time. Many students solely use First Aid to study this subject because many other review books are very dense. First Aid reviews the high-yield molecular, cellular and metabolic pathways that are commonly tested on the boards. There is also a relatively comprehensive list of genetic diseases in First Aid. If you are able to review and memorize the common pathways and diseases, you probably do not need to use another review source. If you do choose to use another book, choose between Lippincott's, BRS, and Rapid Review. If you used one of these books during first-year Biochemistry, that's your ideal choice for board review. If not, then it's strictly your preference - dense outline of BRS vs. bigger pages and pictures of Lippincott's and Rapid Review. High Yield Biochemistry has a concise, no-fat approach. We recommend it only for those with a very strong background in biochemistry. The NBME (National Board of Medical Examiners) always like to ask something about several of the metabolic pathways, esp. glycolysis, citric acid cycle, oxidative phosphorylation, fatty acid oxidation, glycogenolysis, and gluconeogenesis.

*Biochemistry by BRS, by Marks
Lippincott’s Illustrated Reviews: Biochemistry by Champe
Rapid Review Biochemistry, by Pelley and Goljan

Physiology

BRS Physiology is a must read book for the USMLE 1. Costanzo does an excellent job summarizing a topic that is high-yield on the boards. You will do well on this subject if you review physiology with the FCM portion of your second year courses; this is essential for doing well in the courses and on USMLE. If you have a firm understanding of everything in the book you will definitely score solid points on the exam. The book is reader-friendly and has great clinical correlations that briefly go over FCM topics. By May, you should have been through a review of physiology at least once. Know this book COLD!    
*Physiology by BRS, Costanzo

Microbiology/Immunology

Microbiology is incredibly high yield for Step 1 so it is to your advantage to have a decent understanding of all the bugs and weapons in the body used to fight them. It is important to choose a reference that has brief and concise descriptions of all the microbes so you don't waste your valuable time. Sketchymedical has wonderfully illustrated videos to help you score big points on test day. Clinical Microbiology Made Ridiculously Simple is another resource for board review in microbiology; it can be a long read for step 1 review, but it's well worth it. For immunology, many students said First Aid was enough if you have a strong background in the topic. For those looking for a resource, get Medical Microbiology and Immunology--Examination and Board Review (Levinson and Jawetz) or High-Yield Immunology. High-Yield Immunology is a fairly quick read and covers most of the high points for the exam. Levinson and Jawetz has a great section called "Brief Summaries of Medically Relevant Organisms" and a must-read 70-page section on immunology. Many students also opt to get micro flashcards as a quick review.    

Medical Microbiology & Immunology: Examination and Board Review by Levinson
*Clinical Microbiology Made Ridiculously Simple by Gladwin
High-Yield Immunology by Johnson

Pharmacology

In recent years, most students have been moving away from Pharmacology text books and have been using First Aid alone or with pharm cards. The pharmacology on Step 1 is very straightforward and focused on drug class, MOA and the major side effects. If you want a reference book, the same said above with micro/immuno applies to pharm. You want a reference that doesn't waste your time but gets to the point as this topic is high-yield on the USMLE step 1. Tables, outlines and index cards are very helpful in studying for pharm. Lippincott’s Pharmacology has excellent illustrations and tables that are worth looking at. The book is cross-referenced to its brother, Lippincott’s Biochemistry. Johannsen’s Pharm Cards are index cards highlighting the major drug/drug classes that are very useful. The index cards have great diagrams and charts. We recommend you use the pictures and tables in Lippincott’s with Pharm Cards. If you liked sketchymedical for IID, they also have great videos for pharmacology.  If you are looking for good pharm questions, Katzung authors a board review book that has tons of them in the back. The text is good, but is too detailed and takes time to read. If you have been using the companion all year and are familiar with it, stick to it, it will be easy to go through what you've seen before. But again, most students rely heavily on First Aid and you must know the section in First Aid COLD!
*Lippincott's Illustrated Reviews Pharmacology by Harvey
Pharm Cards: A Review for Medical Students by Johannsen
Pharmacology: Examination and Board Review by Katzung

Pathology

This subject represents the foundation of your medical knowledge, and not surprisingly, the foundation of this exam. Pathoma is the best resource for pathology (video + book). If you want additional review books, BRS Pathology and Rapid Review by Goljan are popular. Buy one early and use it along with every course in second year. Pathoma emphasizes the most high-yield points and Dr. Sattar’s voice and drawings will quickly be engrained in your mind. The BRS path book does an outstanding job of taking the vast subject matter in pathology and presenting it in an easy-to-read outline format that highlights "key points" (there are literally small keys in the margins next to important tidbits of information). It follows a very similar outline to Rubin’s pathology and includes pictures from Rubin’s Pathology that you are exposed to throughout the year during FCM. Rapid Review is a much longer review book, but students feel it is more comprehensive and contains many more useful images and review questions. We recommend that students start Rapid Review prior to Step I studying since it takes longer to complete. Do the study questions in the source you choose if you have time, otherwise you are better served saving your time for your question bank. Although it is also important to be familiar with the slides and pathology photos presented in First Aid; you will see few slides on test day. Above all, be confident that your preparation in taking FCM and Pathology this year has provided you with a good foundation for preparing for this exam.
*BRS Pathology by Schneider
*Rapid Review Pathology by Goljan

Top 10 Things to Do

You’ve already learned all you need to know for the boards. You’ve worked hard this year. The summer is coming and you’re almost ready to move into your third year clinical rotations. It’s time to take a deep breath and begin to review the concepts you’ve learned over the past two years. You’ll find this process really helps to solidify the body of knowledge you’ve worked so hard to accrue. Now is the time to pull it all together and refresh your memory. You’ll do great!!

First, no single method of test preparation is perfect. Your approach should include a number of modalities, such as Q-bank, high-yield sources such as First Aid, and subject-specific review texts. The following is a suggested approach to preparing for the USMLE Step I. Ultimately, you know how you learn best. You know which approaches have worked best for you during medical College to date. That’s why the first part of this guide is the schedule. Design it for you, based on your learning strengths. Then, stick to it.

1. Make a schedule – Set reasonable goals and stick to the schedule.

Most people study for approximately 4-6 weeks. In general, 4 weeks is sufficient to prepare for Step I, but if you choose to study for five or six weeks, just increase the study time listed below for each subject proportionally. Below you will see a sample schedule to prepare by studying in a subject based manner. Many students prefer a systems based approach.

Sample Schedule

FCM Final Exam

Take a Break!

 

May 11

May 12-13

Subject Number of Days Schedule
Biochem 3 May 14 – May 16
Physiology 4 May 17 – May 20
Pathology 4 May 21 – May 24
Take a day off! 1 May 25
Micro/Immuno 4 May 26 – May 29
Behavioral Sciences 1 May 30
Anatomy/Histology 1 May 31
Neuro 1 May 31
Pharmacology 3 June 2 – June 5
Take a day off!
1 June 6
Half-Length Practice Exam 1 June 7 & 10
Overall Review Period (First Aid) 5 June 8 – 12
Boards   June 13
Total Time
4 weeks
May 14 – June 13

Note: the "Overall Review Period" is a time to reread First Aid (cover to cover), take practice questions and review the high yield section at the end of First Aid. The night before the exam, you should review the “released items” available from the USMLE website.

2. Take care of yourself – Schedule time for yourself!

Sleep at least eight hours per night.
Exercise at least one half-hour daily – work it into your schedule and stick to it!!
Eat well with well-balanced meals and snacks of fresh vegetables and fruits.
If you need it, take a full day off one week prior to the exam – No studying allowed!

Sample Daily Schedule

7:00 am
Wake up, have breakfast, take a shower, get some sunlight.
8:00 am to Noon
Read from your review books.
Noon to 1:00 pm Eat a healthy lunch with friends, get outdoors.
1:00 pm to 6:00 pm Read from your review books.
6:00 pm to 7:30 pm Exercise and eat a healthy dinner.
7:30 pm to 11:00 pm Complete practice questions and review the answers.
11:00 pm You did a great job today; get a good night’s sleep.

3. Buy a primary, high-yield review book
First Aid for the USMLE Step IRecommended

4. Schedule the boards

5. Subscribe to the question bank of your choice – AND USE IT!!

  • USMLEWorld is the most commonly used by Jefferson students.
  • USMLEasyLite, available for free as part of JEFFLINE, has over 500 practice questions and answers for Step 1.
  • During your 4-6 week study period, try to do 50-100 questions each night. At the start, you will not be able to do many more than 50 per night, but try to do more as you progress. Take a single 48-question test, then spend the remaining time reviewing the questions you missed. Remember to review the questions you got correct as well!

    Don’t worry about your question bank scores! The important part of the question banks is the practice. Many people with top Step I scores performed poorly on their questions. These are a high-yield test prep tool, but do not use them to track your progress. If you’re getting 30’s to 50’s at the beginning, don’t worry!

6. Choose your subject review books.

  • If you used a particular review book during a class, continue with that book.
  • Otherwise, choose your subject books (keep in mind you may not need a book for every subject):
    • Anatomy, Physiology, Pathology, Biochemistry, Pharmacology, Histology, Microbiology, Immunology, Neuroanatomy, Behavioral Sciences/Biostats, Embryology

      Look for the latest edition of each book, but don’t worry if you’re studying from an outdated edition – the information in these texts doesn’t change much from year to year. Be on the lookout for the HAH Review Book Sales--these typically occur 1-2x per year and are a great way to get cheap books and feedback from upper years.

      Anatomy – First Aid +/- High Yield (Dudek)
      Physiology – BRS (Costanzo)
      Pathology – BRS (Schneider and Szanto) or Rapid Review (Goljan)
      Biochem – First Aid +/- Lippincott (Champe) or or Rapid Review
      Pharmacology – First Aid +/- Lippincott (Champe)
      Cell Biology/Histology – BRS, first 4 chapters only (Gartner et al.)
      Microbiology – Ridiculously Simple
      Immunology – First Aid +/- High Yield or Medical Microbiology/Immunology: Examination and Board Review by Levinson
      Neuroanatomy – First Aid +/- High Yield (Fix)
      Behavioral Science & Biostatistics – First Aid and BRS (Fadem) or High Yield (Fadem)
      Embryology – First Aid +/- High Yield (Dudek)

      Some notes on your daily review:
      Plan to read the books cover-to-cover within the time allotted on your schedule.
      Determine how many pages you plan to read and how much time is available.
      Then, calculate how many pages you must cover in each hour to keep on schedule.
      Use a highlighter if you feel like it, but try not to take notes as you simply do not have time to do this for every subject. This is your time to review the material - to think briefly about each subject, then move on. You won’t remember everything you read - that’s okay!! Focus on covering the material allotted for each day. And if you don’t finish the pages you allotted for the day; that’s okay too!

      At the end of the day, move on. If you don’t get to your page mark, you will make up for it on your "catch up" days.

7. Choose a good study place that you can go to each day:

A classroom on campus where you can expect few interruptions
The TJU library – does the presence of half your classmates make you feel stressed or supported?
Think about this when making your decision.
Consider staying with family or friends out of town
Consider a local library for your study space
A library at another medical College?
Can you focus while staying in a cabin on a beach?
If so, consider a vacation during boards study time
A local coffee shop?

8. Download the "Released Items" from USMLE:

150 practice questions released from USMLE.
If you are a Kaplan subscriber, you may download the released items and corresponding explanations from the Kaplan Q Bank website.
Review these the night before the exam – some of the actual test questions may look very familiar!

9. Taking the test:

Know the test works: refer to First Aid or the NBME website for detailed instructions.
Items to bring:

  • Scheduling permit
  • ID - passport, driver’s license
  • Bottle of water
  • Snacks – 2 energy bars
  • Lunch – don’t forget cookies!
  • A sweater – the air conditioning might be on overdrive.
  • Advil – for sudden headaches from staring at the poor-quality computer screens

10. Plan something fun to do after you finish so you have something to look forward to.

Systems Based Schedule

What is the Systems Based Approach?

Another approach to studying for the boards is to use the systems based study method. If you use this method it means that you will basically follow the template of how you learned the material in the first two years, which is also the way the material is arranged in First Aid. The big difference between the two study methods is that using the systems based approach you will study physiology, pathology, and pharmacology by system (i.e. cardiovascular, gastrointestinal, endocrine, etc.). All other subjects like anatomy and biochemistry are studied separately just like everyone using the subject based study method.

Why do people choose this approach?

One reason some people like the systems approach is because it is very similar to how you studied during FCM (which is the bulk of your boards knowledge). Also, pharmacology can be dense and tedious when you study only pharmacology for 3 days. However, divided throughout the systems, pharmacology is less tedious and is only studied within a context (the context of that system).

If you want to study for 4 weeks, you can still use the systems approach. This approach can also be easily adapted to any schedule between 4-6 weeks long because you can just adjust how many days you spend on each system, thus physiology, pathology, and pharmacology, which are very high yield subjects for the boards.

So how do you determine your schedule?

Let’s start with the subjects not studied as part of a system. Just follow the same model as students using the subject based approach.

Biochem 3
Micro/Immuno 4
Behavioral Sciences 1
Anatomy/Histology 1
Neuro 1
Half-Length Practice Exam 1
Days off or Half days off 2 or 4
Overall Review Period (First Aid) 5

Then divide the rest of your time amongst the individual systems. You will study each system for 1-2 days depending on how many days you have left to study and how much time you want for each subject. However, remember just like biochemistry, systems like dermatology and hematology/oncology could be studied for several days and you won’t know everything. So remember you shouldn’t "favor" your weak subjects, focus on your strengths. So if you only have time to study a couple systems for 2 days, focus on cardiovascular, gastrointestinal, and pulmonology, NOT dermatology or musculoskeletal, for example. Therefore, plan on studying each system for 1 day and add extra half days or a second day to some subjects, as your study schedule permits.

Cardiovascular 1 (or more)
Nephrology 1
Endocrine 1
Reproductive 1
Dermatology/Musculoskeletal 1
Pulmonary 1 (or more)
Hematology/Oncology 1
Gastrointestinal 1 (or more)
Neurology 1

Other tips for this approach

You may want to consider starting each system by reading the relevant First Aid section. This will help you quickly refresh and will focus you in on the major concepts to focus on when reading your other resources (such as BRS physiology and Rapid Review Pathology or BRS pathology). If you have extra time at the end of the system, consider rereading the First Aid section with your added notes.

Also, plan to study the systems first and save the other subjects for last. Subjects like microbiology and biochemistry should be studied towards the end because they are more memorization heavy. The earlier they are studied the more likely you are to completely forget things you already studied. The systems however, are more fresh in your mind from FCM and are often more conceptual, so you are more likely to retain this knowledge if studied early on.

What are some common questions about this approach?

First, since anatomy is actually divided by system, many people wonder how to approach studying for anatomy. Go ahead and read through the anatomy when you read that system’s section in First Aid. This should only take you about 10 minutes - don’t spend more than 15 minutes. You will still have one day to study anatomy, and at that time you will review the anatomy in each section.

Also, in First Aid there is just one section that has all the neuroanatomy as well as the clinical neurology. This is a large section so spend one day studying the neuroanatomy (just like everyone else) and one day studying neurology as a system (the pathology and pharmacology.) So in essence you will spend 2 days studying this section as a whole in First Aid.

Finally, there are also short sections in First Aid for Pathology and Pharmacology that we haven’t mentioned studying yet. These sections have some very high yield concepts and should be reviewed. However, they are also very short. Either work these two sections into your schedule somewhere spending about a half-day for both sections or just plan to review them on a day or two when you have finished your material a little bit earlier than planned. Although reviewing these sections will not take long, there are some important points that are purely memorization (specific genes, carcinogens, antidotes, autonomic drugs, etc.), so think of what will work best for you to make sure you know this material by the end of your boards studying (flashcards, quick reviews of the material, outlines, etc.).

Sample Step 1 Study Schedules

Below please find links to a few sample study schedules that have been used by students in the past. These documents are PDFs. Feel free to use these as guides to make your own, but remember to make your schedule personal -- include your personal obligations, any time you will need to relax, etc.

Subject Based 1
Subject Based 2
Systems Based 1 - 4 weeks
Systems Based 2 - 5 weeks
Systems Based 3 - 5 weeks
Systems Based 4 - 5.5 weeks
Systems Based 5 - 5.5 weeks

A Final Word about Step 1

There is no magic bullet for success on the USMLE Step 1. Successful preparation boils down to three things.

  1. Work hard and learn well in your M-II courses.
    Students report that material tested on the USMLE exam was learned in class, not crammed at the end. Keep up, go to class, and stay mentally and physically healthy. A good M-II year is your best insurance policy for USMLE.
  2. Use board review books along with your classes.
    For most subjects, this means faithfully reviewing physiology and previewing pathology and pharmacology. For microbiology, neurology, and behavioral science, use their respective review books.
  3. Be strategic in your Step 1 preparation.
    For the intense USMLE study period in May/June, select standard board review materials that are well-regarded, make a reasonable schedule based on your goals, and stick to it.

We hope this guide will be helpful as you make your first step of three to freedom!

Be Focused!
Be Confident!
Be Smart!
Don't Worry!