Step 1 scores are key to getting your foot in the door.

USMLE Step 1 scores are becoming more and more important in the application process as competition for spots in desirable specialties and prestigious institutions reaches all time highs. A large reason for this is the fact that medical schools have been increasing their class sizes year by year, without a compensatory increase in residency training positions available for them upon graduation.

The result? Medical students are applying to more residency programs on average than ever before. When there are a few hundred applicants for a program that only accepts a handful of people, the easiest way for them to slim down the pool to a manageable size is by setting cutoffs by board scores. With so much randomness and luck that goes into the matching process, board scores are one of the few parts of your application that you have full control over. That’s why it is important for you to do the best you possibly can.

Where do I start?

Starting is quite intimidating when you begin to realize the insane amount of knowledge you will have to learn and retain by the time your test comes around.

Here are some tips and strategies to help you through your journey. Now remember, the Internet is full of self-proclaimed gurus that promise to guarantee your success, and some will even try to make you pay for it! Don’t fall for it. The reality is, everyone is different and everyone’s strategy will be different. However, here are some general tips, in no particular order, that I felt were essential for me to score within the top 8th percentile on my Step 1.

Start preparing early (give yourself 4-5 months).

Studying for Step 1 is a marathon, not a sprint. Pick out a preferred review guide/flashcard set early for every subject (Physiology, Neuroscience, Pathology, Microbiology, Pharmacology, etc) and begin reading through all of them. This will take you a long time, so you do not want to feel pressured to do this later on in your studying. As your doomsday date approaches, you will naturally want to limit the number of books you want to study from, so the earlier you get through the larger review books, the better.

Don’t skip out on class.

We all know that the curriculum set up for many medical students in their second year, which is primarily clinically oriented, is not what you’ll be tested in Step 1. This is really just perfect, when all you care about is making sure you do well on your boards. But unfortunately, you still need to do well in your classes. So, why do I recommend not skipping class?

You need to be efficient with your time, and it can be quite easy to decide that you’ll skip that awful 7AM lecture and just watch it at home. The next thing you know, you sleep in, get distracted, and now you find yourself always playing catchup.

By ensuring you experience the lectures as they occur, you won’t have to worry about trying to keep up with them anymore. Once classes are out of the way, you can spend the rest of your day completely focused on what is most important – crushing your boards.

Do questions, questions, and more questions.

Doing as many questions before your test date is easily the number one piece advice I can give. Seeing the content you will be tested on in as many forms as possible will help you prepare for the random and broad nature of the test. Additionally, doing lots of questions will help build up your test taking stamina. Being mentally focused for the entirety of the 8 hours of hell that is the USMLE is something you need train for, as if you’re preparing for half or full marathon race.

Here is my advice regarding question banks:

Sign up for Kaplan or BoardVitals PLUS UWorld (2 total)

Do UWorld second. These are known to be the highest quality questions out there, and you don’t want to “waste” them when you are not ready. If you haven’t gotten through the basic material yet, the 2-3 level deep UWorld questions will run circles around you. You will make the most of these questions when you’re partially prepared.

These are known to be the highest quality questions out there, and you don’t want to “waste” them when you are not ready. If you haven’t gotten through the basic material yet, the 2-3 level deep UWorld questions will run circles around you. You will make the most of these questions when you’re partially prepared. Initially, do questions by organ system and un-timed to get your feet wet. Once you get to the 1-2 month mark, you should be doing all your questions mixed, and in timed blocks of 40 (like the actual test). Becoming comfortable with the random nature of the question sets, as well as the pace you will need to have will greatly increase your confidence on test day.

Once you get to the 1-2 month mark, you should be doing all your questions mixed, and in timed blocks of 40 (like the actual test). Becoming comfortable with the random nature of the question sets, as well as the pace you will need to have will greatly increase your confidence on test day. Don’t do UWorld twice, unless you’re trying to reinforce the questions you got wrong. In my opinion, doing the whole qbank again essentially means you are cheating yourself because you may have some memory of what the right answers were.

In my opinion, doing the whole qbank again essentially means you are cheating yourself because you may have some memory of what the right answers were. Give yourself ample time to go over your questions. Answering the questions is only half the work, the other half is going through the explanations, and looking up/adding the content to your First Aid (more on First Aid later).

Answering the questions is only half the work, the other half is going through the explanations, and looking up/adding the content to your First Aid (more on First Aid later). Overall, don’t be discouraged. You will be getting lots of 30-40% on your question sets. It’s ok!

Mnemonics are your best friend.

I unfortunately was not blessed like some others in my class to have a superhuman photographic ability to regurgitate facts. For me, mnemonics were really important. It was a way for me to hack my memory. So, I made them for everything. I created them from friends, family, classmates, politics, anything recent in the news, foods, songs, you name it. Some were so embarrassing, I dared not share them with anyone! However, you will be surprised how many of these facts will stick in your head, even years after taking the exam.

Audio lectures (particularly Goljan) are essential for on the go studying.

Audio lectures are great way to give your brain and eyes rest from all the reading and question taking. They are especially useful when you feel like your brain has given up on reading, but you still want to get some learning in before the day is over. The Goljan lectures are legendary, and are a must. Not only does he guide your thinking appropriately, but he’s got a great sense of humor while doing it. The best times to pop these on are when you are driving, while you are doing chores or cooking up some dinner, or while you work out. You’ll be surprised how much more time of learning you can squeeze into the day without having to sit at a desk.

First Aid will become your most coveted sacred book.

Use First Aid in conjunction with every question set you do. Go to the section to look up answers to the questions you got wrong. Many times, you’ll notice the answer was already in there but your brain didn’t prioritize it. If not, add a tidbit about what you missed or forgot. After months of doing this, your book will be brimming with extra details from every question you ever did. Once you hit your last month, you will want to cover very broad topics in short time frames. That’s when all you will be doing is studying out of First Aid, over and over again.

Complete an official NBME practice self assessment (2-4 weeks prior to test date).

This is important in seeing where you stand and to see what your particular strengths and weaknesses are. Be careful not to do this too close to your exam date – it may effect your confidence on test day in a negative way if you don’t do as well as you expected. Or if you do too well, you may become overconfident and ease up on your daily routine. Fear is a very strong motivator, so use it to your advantage. From my experience, I took my NBME at the 1-month to test day mark. This gave me an idea of what I needed to focus more on in the coming month. But just to give you an idea of what is possible, my final score jumped up 30 points after 1 month of organized, 10-hour per day studying sessions.

Create a weekly and daily schedule.

It is very important that you come up with a routine for yourself as your test approaches. Estimate how long it will take to cover each subject, and plan out your last 6 weeks to make sure you have time to cover everything accordingly. Create a daily schedule for yourself during any time your school gives you off to study. Everyone is different, but I personally enjoyed sleeping in and taking the mornings off to make breakfast, run errands, and work out. My daily schedule for the last month was as follows:

10AM – 1PM: Reading/Audio

1PM – 2PM: Lunch Break

2PM – 6PM: Reading/Audio

6PM – 7PM: Dinner Break

7PM – 9PM: 2 sets of 40 questions (60 min each)

9PM – 10PM: Review answers to questions

10PM+: Brainless leisure time (Netflix, video games, etc)

Make sure you schedule time in your last week to review crammable topics.

There are certain topics that do not want to live in your memory too long. Do yourself a favor and save some of these to cram within the last days of studying. Subjects like biochemistry, or memorizing all those pediatric development stages will be important to review right before your test. However, do not disregard these topics just because of how infrequent they may appear on your exam – they are usually straightforward, memory recall questions that you can pick up easy points on.

Stay active, and take mental vacations when needed for your sanity.

Working out is a great way to blow off some steam, and prevent the body aches you may get from sitting in a chair or staring at a computer screen all day. Setting aside even just 15 minutes for a nice brisk walk or run will give you a reason to go outside and get some fresh air and Vitamin D.

Additionally, there will be days where your brain will not allow you to accomplish what your heart desires. Don’t fight it. If you’re not making the progress you want, or are getting so frustrated that you’re ready to call it quits, those are clear signs to take a break. Take the day off and do something fun. Hang out with some friends, or see family. Make an impromptu trip for 1-2 days. Do anything and everything not related to medicine. Once your mind is refreshed, the next day you will be back at the wheel and ready to keep pushing forward.

Avoid people that add unnecessary stress to your life.

This is obviously very individualized, but it cannot be overstated. Studying for USMLE Step 1 will take lots of willpower, discipline, and perseverance. You will become emotionally labile as you hit roadblocks in your progress, question your career choice, and wonder what the meaning of your life is. It’s totally normal and expected. But the last thing you need are other people dumping their drama or anxiety into your life unnecessarily. Do not let them do this. Do your best to avoid them, or put certain relationships on hold for a while until you are ready to resume a normal social life.

I hope this advice is helpful for you as you navigate through this stressful right-of-passage toward doctorhood. And remember, no matter what happens on exam day, you can at least take pride in the fact that you gave it your all.

Happy studying!