For future physicians, the USMLE Step 1 Board Exam is arguably the most important exam you will ever take. I’ll share with you the strategies that will maximize your score.
The USMLE Step 1 consists of 7 blocks, each lasting 60 minutes and consisting of up to 40 questions each. This 8-hour marathon is high stakes, but fear not. With the right plan and approach, you will be prepared to crush it.
This article is focused on the dedicated study period, which generally varies between 4 and 8 weeks. The take home message of this video is that you need to create a schedule and do your best to stick with it. Assuming you have a sound study plan, the deciding factor on whether or not you’ll walk away with a score you’re happy with is having the discipline to stick with it.
Scheduling Your Exam
A quick word on scheduling your test. I had a 6 week dedicated period and I took my test 4 and a half weeks in. I used the remaining 10 days to go on a cruise. When scheduling your test, it’s important to keep three things in consideration. First, more time is not always better. With time, your knowledge and test score will start plateauing, and at a certain point start dropping as you burn out. Secondly, you want to have a break before starting the grueling journey that is third year. Lastly, do not push your test back for the reason of not feeling prepared. You will never feel fully prepared, and pushing your test back for this reason will likely do more harm than good.
01 | RESOURCES
First, decide on your resources. The UFAP protocol should be your core. This consists of UWorld, First Aid, and Pathoma. I also used Goljan’s Audio Lectures for pathology and Sketchy Micro, which I personally found tremendously helpful for microbiology. If you are also a visual learner like me, I highly recommend it. Now, pick your resources carefully. You do NOT want to have too many resources during your dedicated study period. You will quickly get overwhelmed and not be able to get through all of them. NBME practice exams will come into use as well but are not primary study resources.
02 | SCHEDULE
Creating a plan of attack for yourself is KEY. I made my schedule in Excel (downloadable above). This is what worked for me, and it’s fine for you to use it as a base template, but it is important that you personalize this for your own strengths and weaknesses. For example, if your cardiology is weak, make sure to spend more time on cards. If you struggle with finishing tests on time, then make sure you do plenty of timed practice blocks to improve your pacing, and so on.
My days and weeks were highly structured and this may not work for everyone. I personally preferred this because it removed thinking from the equation. Everything was laid out and I just had to follow it to achieve a killer Step 1 score.
The first step in creating the study plan was laying out my daily schedule. Each day, studying was divided into three 4-hour blocks of morning, afternoon, and evening. I took 5-10 minute breaks once per hour during each of these sessions. I woke up every day at 6AM, as this was the time I would wake up for the actual test day. At 7AM, I walked to school and listened to the Goljan audio lectures at approximately 1.5x speed. The morning study block started at 7:30, which was always a UWorld block of 46 questions. I would then review the block thoroughly until 11:30. Lunch was 11:30 to 12PM, and 12PM marked the beginning of the afternoon study block. This block ended at 4PM, and I got a quick 30-45 minute workout in until 5PM. I did evening blocks at home, and they were broken up with dinner, as my mental endurance was waning later in the day. The first half of the evening block was 5-7PM, dinner was 7-7:30PM, and the second half was 7:30-9:30PM. I was in bed and asleep by 10.
I followed this daily structure from Sunday through Friday. Every Friday evening block was for fun and relaxation, meaning Fridays after 5PM I did not work. Every Saturday morning until lunch time was reserved for groceries and laundry, but I got back to studying immediately after lunch.
Now that my daily schedule was determined, I went back and prioritized my study materials to organize my weekly studying. I recommend going through First Aid twice and UWorld at least once, preferrably also going through all of your incorrects a second time around. I determined how many pages each First Aid section was to help me estimate how many blocks to allocate to each system. Next, fill in with supplemental study materials as needed. I had already gone through Pathoma twice before my study period, so I only occasionally referenced it. I watched Sketchy Micro videos either during my study blocks where I had assigned micro OR during lunch breaks, since I found the videos entertaining to watch. I had an Anki deck but rarely used it during the dedicated study period, as it was more useful earlier in second year when I was still seeing material for the first time. I felt the application of that knowledge with UWorld questions and review of First Aid was a better use of my limited time.
The reason I started my morning blocks with UWorld is because I needed to get used to test taking first thing in the morning, and I also felt like my mind was freshest at that point. I tracked how many questions I completed each day, the percentage correct, and the number of questions remaining. This was important for me, as it was encouraging to see my percentage answered correct slowly rise as well as the number of questions left unanswered slowly drop. At the beginning, I focused my blocks on the systems I was studying. If I was studying microbiology in First Aid, then maybe I would do a block of 20 questions with pure micro, and a another block of mixed questions. A couple weeks into my dedicated period, however, I exclusively did mixed with all topics, as this was representative of the actual test.
Regarding practice tests, I recommend you take one towards the beginning of your dedicated period for self-assessment purposes, and the rest of them towards the end. These practice tests will help you get used to the USMLE question style, hone your endurance, and master your pacing. Make sure you take the practice tests mimicking the real environment, which means wearing earplugs, timing yourself closely, and sticking to the time limits on breaks. More on breaks in a litte bit. I took my first practice test, which was an NBME test, within the first two weeks. I then took four additional practice tests in the two and a half weeks before my test. I do not recommend taking a practice test within the preceding 48-72 hours of your test, as you want to be fresh for the real deal. And yes, you should absolutely review your practice tests and see why you got questions wrong.
03 | TEST DAY
Come test day, relax, you got this. Be sure to check out the Test Day strategies video well in advance of your test day and begin practicing those principles now.
I would also add that you should go in with a plan of how you will allocate break time. If you skip the 15-minute tutorial at the beginning, you will get 60 minutes total. Some students like to skip their first break and do two blocks back to back. I do NOT recommend this. Your attention span is not limitless. I recommend taking a break between every block, even if it is short. My break time was organized as 5 minutes, 5 minutes, 10 minutes, 20 minutes, 10 minutes, 10 minutes. Shorter breaks at the beginning since my mind was less fatigued, one longer 20 minute break for lunch, and 10 minute breaks at the end since my mind would be more fatigued.
I go over how to spend your break time and other test day considerations in my Test Day strategies article.
04 | CONCLUSION
I cannot guarantee a certain score or outcome, but if you deliberately create a thoughtful schedule and stick to it, you will maximize your score come test day.
A word of caution though… You will fall behind! I had a beautifully laid out, highly ambitious study plan, and within the first two weeks, I was already falling behind. THAT’S OK! Readjust your schedule and keep at it. There’s nothing wrong with shifting things around. Be realistic with what you can accomplish during each block, but also don’t beat yourself up if you fail to achieve it. Readjust and keep moving forward.
Thank you for watching and best of luck with your Step 1 exam. If you want to take your Step 1 Score to the next level, visit our Tutoring page to learn more.