What I Wish I Knew Before Taking USMLE Step 1


Step 1 is the first test out of three in the United States Medical Licensing Examination (USMLE). It is a one-day examination with seven 60-minute blocks that are composed of up to 40 questions, taking a total of eight hours. At a cursory review, it is like any other standardized examination, but mention that to a medical student and they will shudder.

Unofficially, people have claimed USMLE Step 1 is the most difficult and important of the 3-part USMLE series. And, speaking from personal experience, Step 1 was one of the hardest things I had to do. But now that I have successfully gone through the process and had some time to reflect, I want to offer what I wish I knew before taking Step 1.

  • It’s not how hard you study, but how smart you study.
  • Caring too much about what other people are doing can make Step 1 way more stressful than it has to be.
  • The knowledge you gain from USMLE Step 1 is actually helpful in the clinic.
  • In the end, USMLE Step 1 is just one test.

Below I’ll expand on each of these lessons. I hope that you will learn from my experiences as you prepare for your Step 1 examination.


1 | Study Smarter, Not Harder

In the beginning, my approach to Step 1 was pure repetition. If I got through UWorld, Sketchy, First Aid, Firecracker, and Goljan audio as many times as possible, I thought I would get a stellar score and succeed.

I was hoping to passively absorb the information. However, with this approach, my NBME tests kept projecting a score much lower than my goal. I was confused at first. I got a first and almost second pass through all of these resources. How could I be doing so poorly?!

I reevaluated my studying approach and realized that brute memorization was good for my short-term memory; however, it is impossible to stuff the amount of information that is testable for USMLE Step 1 into your short-term memory.

So, what is the solution? I needed to study smarter. Studying how a system works and why a system works will bode much better on the test than pure memorization. Even though Step 1 will ask several memorization-based questions, I was surprised by the number of critical thinking questions there were. USMLE Step 1 is really a test designed to get you to start thinking like a doctor, and you cannot learn that passively by memorization alone.


2 | Caring About What Other People are Doing Will Make it More Stressful

Caring about everything that everyone around you is doing will make the whole process of Step 1 preparation way more stressful.

Everyone advised me not to listen to other people, but some things are easier said than done. In the beginning, I opted for more solo studying strategy, but after a couple of months, I found that isolating. Instead, I started a group chat with my friends where we would discuss questions we missed. I really do think group studying is valuable. However, I wish I did not worry so much about what other people did or were doing.

For example, several of my friends and a number of blogs mentioned Anki decks and how they were amazing. I wasted unnecessary time trying to work with Anki, incorporating it into my study time with little success. Also, when people would share their study schedules and habits on social media, it always brought me anxiety.

I am going to pass on the same advice that I did not listen to: everyone has their own individual way of studying. Do not feel pressured to do anything just because your friends or other people online are.


3 | USMLE Step 1 Knowledge Will Help You in the Clinic

Although some medical schools have started making changes regarding taking USMLE Step 1 after clinical rotations, my medical school still followed a more traditional format where we took Step 1 before our clinical rotations.

Without the experience of our clinical rotations, it was difficult for me to contextualize all the studying I was doing every day. Sometimes I wondered if I actually had to learn certain facts to treat patients.

However, I wish I had known how important the knowledge you learn for Step 1 is during clinical rotations and Shelf exams. I started my pediatrics rotation right after finishing Step 1, and I was surprised by how many times facts from Step 1 came up.

I wish I had known this before because knowing that your studying is valuable for much more than a test can be really motivating.

How to Study When You Don’t Feel Like It – 4 Steps


USMLE Step 1 is Only One Test

There is a lot of pressure surrounding Step 1, and it can be overwhelming. However, it is just a test, and what truly matters is passing. Remember that USMLE Step 1 is only one part of your application; residency interviews are holistic evaluations.

This test should not define you. Working hard and trying your best is what really matters. At our medical school, we had deans and professors who were amazing physicians, and they reiterated that Step 1 is just a comma in your journey, not a period. There is so much more for your medical training after Step 1.

I wish I had kept this perspective, especially in times that were extremely stressful and overwhelming.


Customized Step 1 Tutoring

If your USMLE Step 1 practice test scores aren’t where you want them to be, don’t leave it up to chance. Med School Insiders offers premium tutoring for Step 1, in addition to other medical school courses and exams. Our tutors excelled on the test themselves, utilizing the tried-and-true Med School Insiders methodology. That means a customized approach, and ultimately, a significantly better score for you.

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This Post Has One Comment

  1. Binh

    Do you think it is ok to take STEP 1 after starting rotations? My rotation start in June, but I don’t feel ready to take STEP1 yet, and I know it isn’t the end of the world if I don’t do too well, but at the same time, I’m not close to making a decent score.. So I’m very worry about taking it and stuck with a score that will not be good enough for the field I want to go into. It’s not ideal to study during rotations, but is it possible/ok, or should I just dive in and take it?

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