The USMLE Step 1 is the first licensing exam in the US to become a physician. It consists of all the pre-clinical years in an eight hours exam. Seven Blocks of sixty minutes. Forty-five minutes of break total.
Overall Timeline and Dates
Five months CBSE/Semester 5 Review, Two months Step 1
For context, my school had a Semester 5 “Review” Semester for Comprehensive Basic Science Examination (CBSE), the exit exam to take USMLE Step 1.
I took the USMLE STEP 1 on February 12, 2021, when it still had a score. It is currently a pass/fail system.
Don’t Make the Same Mistakes I Made
My biggest mistake when studying for the CBSE and USMLE was switching resources and letting the exam stress get to me. I had to remind myself daily I was capable of this exam and to stick to the BEST resources and learn from them.
I started studying for the USMLE Step 1/CBSE, aiming to do 80 UWORLD Questions Random Tutored Mode daily. I was not doing well on UWORLD and continued. I would review the topics I got wrong/struggled with in more detail in the evenings with supplementary youtube, Boards & Beyond, or First Aid.
My weekly NBME practice exams were not passing and not moving too much. I also needed to grasp the system as a whole, so I had to make changes.
Game Changer for CBSE
I started every day with my weakness, pharmacology & physiology. I watched Sketchy Pharm and integrated it with the physiology I was learning for that day. Combining the two disciplines helped me understand how the body functions and how the medication fixes the problem. I consistently completed my ZANKI Pharmacology Review deck to continue seeing any old systems I had finished.
I then moved on to a section of Boards and Beyond, annotating my First Aid Step 1, and if there was a section I knew was my weakness or that First Aid didn’t cover in as much detail (physiology & anatomy), I would draw it out in a notebook.
I completed my questions in the afternoon after gaining knowledge all morning. I completed my first pass of UWORLD, TUTOR mode, and SYSTEM based. I started aiming to do 20 questions a day, gradually increasing to 40 questions a day, and then 100 questions a day. Slowly, the questions became easier to answer and understand, and I could get through more in a day. I would annotate my First Aid Step 1 for any of my incorrect or the questions I guessed. My averages slowly started to get better during this time.
For Biochem/Genetics, I watched DIRTY MEDICINE, drawing out the pathways and integrating them with their diseases and the enzymes. I unlocked some ANKI cards for it based on my UWORLD incorrect, but Biochem was a topic that had to be drawn out multiple times.
I watched HyGuru 100 Concepts in Gross Anatomy to solidify the highest yield of anatomy and musculoskeletal injuries. I also watched Dirty Medicine Upper Limb and Lower Limb videos.
I watched PATHOMA at 2x speed in the evenings since I had already annotated Pathoma during my pre-clinical years.
I was already strong in Microbiology throughout Medical School, but I would watch Sketchy Micro in the evenings when I was getting more tired and continued doing my LOLNOTACOP anki deck.
BUGS and DRUGS every day = micro and pharm.
If I was driving, walking, or doing chores, I would listen to GOLJAN podcasts. He was excellent at explaining the pathophysiology in simple terms, and it felt conversational.
I completed an NBME each week (my exam was scheduled for a Friday, so each Friday would be NBME/EXAM day), one week apart, reviewing my incorrect writing into a notebook and making ANKI cards for it. I stimulated test day each week I did it. Eating similar snacks, timing my bathroom breaks, and creating the mindset of test day.
I also spent a few days doing the extra section on UWORLD STEP 1 for Biostats and Ethics, the Boards & Beyond videos, Randy Neil videos and again, DIRTY MEDICINE.
Once I finished all the systems for Boards & Beyond and the CBSE was approaching the last 2 weeks, I began doing Random Timed mode to simulate test day. CBSE was 5 hours consisting of 4 blocks of 50 questions.
STEP 1
After passing the CBSE, I had approximately 6-8 weeks until Step 1.
I then did my incorrect UWORLD, reset my UWORLD, and then did them Random, TIMED Mode, 80-200 questions PER DAY every day until Step 1. I created a section in my notebook for my second pass of UWORLD INCORRECTS identifying my last months of weaknesses.
I continued to do my ZANKI Pharmacology, LOLNOTACOP Microbiology, and ZANKI for Systems/Anatomy/Physiology/Pathology. I watched videos or listened to any podcasts I needed a refresher on based on my weaknesses.
I was fortunate enough to have a resident willing to do 20-40 questions a day with me during my last 6-8 weeks for Step 1, which was very helpful in reinforcing high-yield material and little techniques to test taking.
Final Week Before Step 1
The final week is mindset week. Positive thinking and telling yourself you can do it. I rewatched Pathoma Chapters 1-3, focused on the Biostats, and read my First Aid Rapid Review. I continued to do questions daily just to stimulate test days.
Step 1 Results
(Keep in mind this was in 2021, before the pass/fail system)
I am commonly asked which practice exam was closest to my exam, and they were all relatively close, but my UWSIM 2 was the closest to my Step 1 Score.
Things I Would Do Differently In Pre-Clinicals
If I could go back in time, I would have started ANKI on the first day of Medical School and really spent the time learning how to utilize it to its full potential. I also would have aimed to keep up with my decks throughout pre-clinical so that by the time I came to “Semester 5,” it would all be a review and not learning some cards from the beginning.
I also wish I had started UWORLD since the beginning. During pre-clinical, I was using USMLE-RX and AMBOSS towards 2nd year. However, I definitely would have benefitted beginning from Day 1. Questions and topics on UWORLD are separate from any other study resources.
Lastly, I should have stuck to First Aid Step 1, Boards & Beyond, Sketchy Micro/Pharm, Pathoma, and UWORLD questions. Utilizing and knowing fewer resources really well is better than spreading yourself thin with all resources.
As someone who encountered Divine Intervention during Step 2 studying, I definitely would have benefitted from listening to his podcasts while walking or driving during Step 1 studying.
Overall Training For Step 1
Studying for the USMLE Step 1 is similar to training for a marathon or game day. Not only is it getting the knowledge, confidence, and ability to answer the questions, it’s training your body to only eat and drink on a schedule because you only don’t have access to it during the exam except for the little break times. The weeks before Step 1 is getting your body accustomed to sitting all day without moving too much for exam day.
Step 1 requires focus, dedication, and hard work. You have to tell yourself you can do it every single day. Go into the exam confident you have done everything possible and that you are ready for the exam. Clear any negativity surrounding you, and keep going. Focus on your weaknesses and improve from them. Try to understand the gaps you have.
Look at a small goal/task daily and stay calm by the bigger goal of step 1. The small tasks will lead to big goals. Keep a positive mindset. Learn to be friendly and gracious to yourself. Tell yourself you can do it and are doing your best daily. Perseverance will get you through the studying and the day of the exam. Keep pushing forward.
Don’t let the exam get to you or let it be more significant than it is in your head; it’s just a day of testing the knowledge you have confidently studied and prepared for.
If I can do it, YOU CAN DO IT. Don’t give up, you GOT THIS.
My Personal Resources
I have attached the EXCEL Sheet Checklist I used for Step 1 to keep track of everything. DATES become essential to ensure you have spaced repetition and consistently reviewed the material. Create your schedule based on your weaknesses.