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A Student’s Experience with USMLE Step 1
What is Step 1 and why is it important?
It is a 350 question 1-day 8 hour long exam. It is divided into 7 hour-long blocks of 50
questions. There is also 1 hour of total allotted break time. However, break can seem
shorter during the exam because you need to check in and out each time you leave the
room. Step 1 is entirely on a computer that keeps track of time for you. You can use
your break time any way you choose, and the break timer keeps track. You can’t pause
in the middle of a block. First Aid for USMLE has a great explanation of the exam. If
you want to become a doctor (and that’s why you’re here!), it is one of many exams you
must pass to become a licensed practicing physician in the U.S. Residency directors also
use your Step 1 score as a screening tool for residency selection
How should I study?
The info below is only one student’s view on how to study for Step 1. There is no one
right way to study for Step 1. Everyone will have a difficult style, strategy, and plan.
Decide what score you are aiming for: pass, average, very high, or somewhere in
between. This can determine your study plan. Talk to people and find a way that works
best for you. The biggest mistakes I think are:
• Not starting soon enough
• Using too many resources
• Using books during the study period that you have never seen before
• Adopting a study strategy that isn’t a good fit with your leaning style. (i.e. you
are a visual learner but use books without pictures)
The “study period” for Step 1 is not the 3-4 weeks allotted at the end of year 2. It is
during the entire 1st and 2nd years, with particular emphasis on year 2. It’s a mistake to
think that if you didn’t learn something well the first time, that you can learn it well
during the study period. Studying well for your classes will prepare you for Step 1 and
beyond, and preparing for Step 1 can supplement your coursework. I never viewed them
as separate. Both were complementary.
Know Yourself. I personally am a horrible memorizer. I have to see/hear/write
something several times using many different resources before I understand and retain. I
started thinking about Step 1 at the beginning of the 2nd year and set small but realistic
goals for myself. I am a procrastinator. I can’t sit down and read Lippincott’s in one
weekend. I needed to break it up in manageable chunks, such as reading a chapter a
week to make sure I stay motivated and on track.
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Studying with others vs. by yourself. I had a study partner while studying for Step 1. It
helped me stay motivated because we had the same study styles and I knew someone
would be waiting for me if I didn’t get up and around. It was also great having someone
to chat with during study breaks. We would read a few pages at a time and then quiz
each other verbally on the material until we both learned it. I also studied with the same
partner throughout the first two years and it worked well for us. A lot of people studied
for Step 1 by themselves and this worked great for them too. Do what is best for you.
Where to begin?
First, I started reading discussions boards on Studentdoctor.net and see what other
people said about their study plans and books they used. I hated to see when people had
this huge list of books. It was too overwhelming. I poked around Amazon.com and read
the reviews on First Aid, BRS Phys, BRS Phys. I came across a Listmania! List by alias
“steveo” entitled “Rock the USMLE Step 1 Using Only 5 Books”. That was intriguing to
me, so I emailed him and he sent me a document he wrote entited : “A Student’s
Perspective On How To Study For Step I”, which I have attached to the end of this
document. I found his notes very helpful.
What about Kaplan Q-bank?
A tool most people use is Q-bank by Kaplan. It is a 2100+ question database with
sample test questions and answer explanations that are excellent for knowledge
assessment. It is organized by topic (i.e. physiology, microbiology, pathology) and organ
system (cardiology, neuro, renal), etc. It allows you to create 50-question exams based
on those parameters and also on questions that you have missed or not done yet, e.g an
exam of missed questions of respiratory microbiology. You can also take the blocks in
timed or tutor mode. Timed mode simulates a real exam. Tutor mode lets you review the
answers as you go and is good for learning. Read the answer explanations. The Kaplan
folks came and talked to us at the beginning of the year, and offered 9-month subscription
to 2nd years at a discount. My manageable goal was to do the organ system relevant
questions during the school year as we were covering them in our classes. So after
finishing the Cardiology section in Circulation course, I did the 250-some Cardiology
questions and read the answers and took notes on what I had missed.
Other practice questions
The other tool that was very useful was the NBME practice exams. Available on
nbme.org > “Self-Assessment Services” >”NBME Interactive Website for Self-
Assessment Services”. Create an account, and then choose “Comprehensive Basic
Science Self-Assessment (CBSSA)”. There are 4 forms, each costing $45. Each of the 4
forms has four 50-questions block, so 200 questions per form, 800 questions total. You
can choose Standard-Paced (1 hour for each 50-question block, 4 hours per form) or SelfPage
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Paced (4 hours for each 50 question block, 16 hours per form). Solutions are not
provided. If you choose the Self-paced version, you can answer the question block in an
hour, and then have 3 hours to look up the answers on the web. You can’t review the
exam once submitted, and you must submit it to get a score. It gives you a score that can
reasonably predict your Step 1 score. The questions are different than Kaplan and very
much worth doing. Since this costs money, it may be worthwhile to do them during the
study period. For more info:
What could I do during the year?
Remember this is only one students perspective. There are many different ways to study.
Ask around what worked for other people and figure out what would work best for you.
Here was sort of my plan:
Prior to study period, beginning September:
• Used comprehensive review books to supplement studying for classes, i.e. mostly
First Aid, BRS Path, BRS Phys, Lange and Lippincott Flashcards, and also Step-
Up, Hi-Yield, and took notes in them. Goal of getting through the content-related
chapters in these books while studying the subjects in class.
• Did the content-relevant Q-bank as I studied the topics during the class (I had
completed about 75% by the time the study period began)
• Used High-Yields as needed to supplement course work.
• Listened to Goljan lectures during commute to and from school
• Read Clinical Micro Made Simple in January/February
• Took the practice assessment offered at OHSU. Realized how little Biochemistry
• Read Lippincott’s Biochemistry starting around March, only ½ to 1 chapter per
• Read the “Immunology” section of Lange Medical Microbiology and Immunology
• Started reading Lippincott’s Pharmacology
Starting around beginning of May
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• Started going through First-Aid in detail with study partner. Went over each page
methodically and tried to memorize as much as possible. Created a study
schedule, using First-Aid chapters as a guide
During Study Period
• Finished going through First Aid. Memorized as much as possible. Made sure I
understood as much as possible. Finished a section at a time using First-Aid as a
anchor and then supplemented
• Used other review books and class text books as necessary to further explain
things I didn’t understand in first aid
• Finished Qbank
• Went through High-Yield Embryo, a good aid for embryology and reviewing
organ system anatomy and pathology.
• Memorized the virus table in Clinical Micro Ridiculously Simple.
• Did the 4 NBME forms, 1 per week (200 questions per week)
• Did the Kaplan full-length practice exam
• Did 150 Released questions from NBME and reviewed answers (Free)
To get an estimate of how much time this took me (remember, I am a slow memorizer).
Qbank: For me, 2100 questions / 25 questions/hour (including reading answers) = 84
hours, or roughly 100 hours total to go through Qbank, (I completed 75% of this
High-Yield Embryo: 10 hours
First Aid: It took me roughly about 150 hours going through it in tremendous detail
NBME: 4 forms * 4 blocks/form * 4 hours/block = 64 hours
TOTAL: 325+ hours for Qbank, First Aid, HY, and NBME. Studying 60
hours/week = 5 ½ weeks
Other, not included in above, as were done throughout the year before May:
Goljan Lectures 40 hours
Clinical Micro Made Ridiculously Simple 20 hours
Lippincott’s Biochemistry 30 hours
Lippincott’s Pharmacology 30 hours
(only finished 1/3 of this, 30hours
an estimate for the whole book)
BRS Path 20 hours
Lange Medical Microbiology and Immunology (Levinson) 10 hours
(Immunology section only)
ADDITIONAL TIME TOTAL: 150 hours
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Starting early helps. To get through the 150 hours, studying 1 hour per day is about 22
weeks, or 5 to 6 months. I tried to be creative and find less monotonous way to study. I
put the Goljan lectures on my iPod and listened to then on my commute to and from
school (40 minutes total) and then would try to read for ½ hour before I went to bed. I
made small goals, and only tried to read ½ to 1 chapter per night, so I would finish a book
in about 6 weeks. I would only do questions blocks of 25 question or so at a time. I
retained more and it was easier to stay focused.
Our study period was 5 weeks long. If you want to take a vacation, like many of us did,
and I highly recommend, that leaves about 4 weeks, which was how long I studied. So
that required me to study before the study period started. I probably ended up studying
60 hours/week for 3 ½ weeks during the studying period and then took a ½ week to
review and relax. You may take more of less time. Figure out how much time you will
need and plan accordingly.
Yes, Step 1 is important. But your health, well-being, happiness, and family cannot be
neglected. No score or amount of studying is worth it if you lose the things in your life
that are most important to you. Remember to get enough sleep, eat well, exercise, spend
time with your friends and family, and continue to pursue outside activities and interests
that are important to you.
This book lists reflects where my weaknesses were. For example, I know biochemistry,
microbiology, and immunology were weak for me, so I studied that more. Books that I
• First Aid
• BRS Path
• Lippincott’s Biochemistry
o Read after Circulation and Metabolism
• Goljan’s Pathology Audio lectures (available on ebay)
o 40 hours of Pathology lectures. Very funny and entertaining! I put these
on my iPod and listened to them on my commute to and from school.
• Lange Pathology Flashcards
o Used these throughout the school year. Very helpful for classes.
• Clinical Microbiology made Ridiculously Simple.
o Re-read this around mid-year. Made a lot more sense after Circulation
• Hi-Yield - I used an assortment of these, specifically High-Yield Embryo. Good,
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• Medical Microbiology & Immunology, Warren Levinson
Flashcards (The ** are the ones I used the most, but all are pretty good)
**Lange Pathology Flashcards, Barron, Lee
Lange Pharmacology Flashcards, Baron
Lange Microbiology and Infectious Disease Flashcards, Bos, Somers
**Microcards, Harpavat, Nissim
**Pharmcards, Johannsen, Sabatine
Some Useful Websites:
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A Student’s Perspective On How To Study For Step I
Basically, take my advice for what it is worth...I did well on Step I but I could probably take that
test again ten times and not get the same score. If you study hard and know the material, you will
probably break 240, but the difference between 240 and 265 is luck.
That being said, preparing for this exam is not a six week endeavor (well it is if your only goal is to
pass) and it should technically start at the beginning of second year. That doesn’t mean you
should be putting in time studying for any of the first year subjects during second year, rather you
need to learn the second material really well and in a clinical context so that you aren’t learning
any new information or associating a disease with its symptoms for the first time when the six
weeks of hell rolls around. 70-80% of the material on this exam is from the second year, so this
is where your money is. I believe the single biggest reason I did well was because when boards
study time came around, I didn’t even have to look at the two biggest subjects the exam (Micro &
Path) because I already knew them cold (don’t get me wrong I still looked at these subjects, I just
wasn’t relearning material or learning material for the first time…it was all just reinforcing the
material I already knew). The reason I feel I was able to do this was because I used very good
resources to study during the second year that approached these subjects from a clinical
perspective. This way when it came time for boards I was (1) using resources that I already knew
were good and (2) I had been using these resources the whole year so I was already familiar with
them (ie they were already full of my own notes and highlighting). Hopefully this makes sense but
you wouldn’t believe how many people start purchasing new books right before studying for
boards and then spend half of their time learning how to use the book and/or making your own
notes in the margin. All boards studying is supposed to be review, and I wouldn’t even bother
using a book that you haven’t already read at least once if you are in the hardcore boards study
Finally, this exam is not like other standardized exams that you’ve taken up to this point (SAT or
MCAT) because your score is not predetermined before you walk in the door. There are a lot of
people in my class much smarter than I, and I did better than all of them on this exam. This is a
knowledge-based exam and there really aren’t any tricks…if you know the information well, you
will do well (as opposed to the MCAT where you could study your ass off and still come in at an 8
on the verbal). Resources are listed in the order of how useful I felt they were in preparing for
Step I. Remember, this is all just my take on how things are; each person needs to find out what
works for them. Good luck.
Class of 2007
First Aid for the USMLE Step I
The absolute best book for Step I. Get it early and use it w/ your second year courses. Every
line printed in this book (even the ones that seem like random facts) is high yield. It is updated
every year to reflect the changes on the exam; 2006 version to be released in December. There
is a reason this book is universally used by all med students…it’s that good. This is the only book
I used for Pharm, Biochem, Embryo, Anatomy, Neuro, and Behavioral Science/Biostats.
Basically 90% of the questions you could or will be asked on these subjects are in this book;
there are additional books out there that are more thorough and probably contain the extra 10%
of material not in First Aid, but in my opinion it would be much more beneficial to know First Aid
inside and out than to know 70% of First Aid and use an additional book on the same subject.
Probably the biggest reason why everyone uses First Aid and not everyone does well on this
exam is that the key to using this book is UNDERSTANDING (and not just memorizing) the facts
in it. It will have facts like “an associated finding in patient’s with Conn’s syndrome is a
concurrent metabolic alkalosis.” And sure you can memorize this little fact but boards doesn’t
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want to know the what (ie metabolic alkalosis finding) they want to know the why (aldosterone
stimulates a proton pump in the collecting ducts to pump hydrogen ions from the plasma into the
urine, so excess aldosterone results in more acidic urine and more alkalotic plasma).
Also, someone gave me the 2004 version of First Aid put to notecards on MS Word documents,
so if you want the docs let me know; I found them pretty useful.
Goljan Lecture Series For The USMLE Step I
Five days of multidisciplinary lecture with most emphasis on pathology. Unbelievable how much
Dr. Goljan knows about Step I and how right on he is. Worth listening to at least two to three
times…just hard to find the time unless you want to listen to path lectures while at the gym or
while driving (which would probably accelerate the course to insanity rather than bump up your
score). I have these lectures on mp3, so drop me an email and I’ll make you a copy. These
lectures are very valuable.
Best resource out there for microbiology for both Step I and the second year course. Very high
recall value (the information sticks with you) especially if you use the clinical scenarios written on
the front of every card. Everything you could want or be expected to know about the bugs and
their respective diseases is on these cards. Don’t get these for Step I if you haven’t been using
them all year, it would be a waste of your time…they need to be bought in the beginning of
second year and used with the course. The flow charts on the front of each section alone make
these cards high yield enough to buy (by the way, you should memorize and commit these flow
charts to memory when you study the respective bugs….it is unbelievable how much time this will
save you when you starts studying and how many attending you will impress third year when a
sputum gram stain shows gram positive rods and the attending asks you which bugs it could be
and you rattle off 10 species like it was nothing).
ISBN # 0781722004
Pathology Flash Cards
Everyone raves about BRS Path but these cards are where I felt the money was for path. Every
card has a clinical scenario on the front and all the major pathology on the back (etiology and
epidemiology, gross and micro pathology, clinical manifestations, treatment, and extra random
facts about the disease). My step one exam had very few obscure diseases/syndromes and I
would say 95% of the path questions I was asked were covered on these cards. Very good
resource but only if bought in the beginning of second year, otherwise they would take too much
time to use. These cards are fairly new so they haven’t gotten the publicity that BRS Path has yet
but eventually they will be considered a necessity for all taking path.
Everyone knows about this book and everyone uses it for good reason. Clear, concise, and all
the info you need for path. More comprehensive than the path cards (but path cards have higher
yield/recall value). Questions and comprehensive exam are also very good.
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BRS Physiology is the gold standard for studying phys. This is the only first year subject really
tested in depth on Step I; good to know it cold. The way the questions on physio are asked on
Step I is in the context of diseases; for example, they would give a scenario of a person who has
a small cell carcinoma of the lung and is experiencing signs and symptoms of hyponatremia
(headache, dizziness, altered mental status, ect.) and at the end of the scenario they may or may
not tell you that this person was diagnosed with SIADH (if they don’t you are supposed to assume
since the scenario is classic). Then, they’ll ask something about renal phys and fluid shifting
between compartments (serum osmolality would be decreased and both the ICF and ECF
expanded) or how hyponatremia causes cerebral edema (water movement from ECF into cells of
the brain causing swelling). It is very rare to have a physio question that doesn’t ask about the
pathophysiology of disease, so while it’s important to know the normal, most of the questions will
be on how deviations from normal physiology manifest as signs and symptoms of a disease.
Other Stuff You Can Buy If You Have The Cash And/Or
Micro & Immuno Review
Good book but too much writing and so you should probably only use it to study for the
immunology section of your microbiology course. Otherwise, this book is most useful for the
assload of questions it has on each subject (virology, immunology, ect.). I did use this book for
boards but only to study immunology and I only reread the sections on hypersensitivity reactions
and immune deficiencies (which covers over 80% of all the immuno questions they’ll ask on
USMLE Step I Secrets
The way the boards are written is that they write a case scenario and then write five or six
questions that could be asked about the case (anything from what is the diagnosis to what is the
mechanism of virulence of the bug that causes this disease to what drug would you give to treat
this disease); you and the person next to you might get the same case scenario but be asked
totally different questions about that case. This book is set up just like that; there is a case
followed by six or seven questions on the case and their answers. It is most useful because you
can see how they could ask multidiscipline questions on the same case (so it helps you see how
they could ask pharm, phys, biochem, and path questions on the same case). This book is
divided into systems and so its perfect for boards studying.
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Much better than the Underground Clinical Vignettes series (which if you use the UCVs you’ll find
out just how much they suck within the first day). These books give ‘classic’ presentations for
diseases and bugs causing disease which is what they expect you to know on Step I. Also,
unlike the UCVs the answers are not printed on the same page as the case so you can actually
think about the case and come up with a diagnosis rather than having it given to you. The
behavioral science book in this series was especially useful. Dr. Brochert is the king of USMLE
exams; his books for step II and step III are to these exams what First Aid is to the step I exam
(he doesn’t have a step I book out, so these are as close as it comes).