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How to Study for Step 1: Tips for USMLE Success

7 min read / Medical School


On the road to earning your Doctor of Medicine (MD) degree, there are various checkpoints during which your knowledge and skills will be tested. The United States Medical Licensing Examination (USMLE) is one that all US physicians will need to pass to obtain licensure. The exam is delivered in three phases, with the USMLE Step 1 and Step 2 before you apply for residency, and the USMLE Step 3 in the first year or two of your residency. Satisfactory performance on the first steps can have a sizable impact on your eventual residency placement.  

With so much riding on your test performance, it’s important that you adequately prepare. That’s why we rounded up some expert advice to help you learn how to study for the Step 1. Consider these five tips for USMLE success. 

5 Tips for USMLE Step 1 preparation 

As you work through your first couple years of med school, you’ll hear a lot about this exam. The information can seem somewhat overwhelming, so we boiled it down to five basic elements you’ll want to consider as you begin studying for Step 1. 

SGU student studying outside with a beautiful ocean view

1. Understand the importance of the Step 1

It’s no secret that the process of becoming a doctor is chock full of exams. But medical students will often hear their instructors talk about the USMLE Step 1 and Step 2 as the most important set of exams they’ll ever take.   

The National Residency Matching Program (NRMP) recently conducted its 2021 Program Director Survey, which indicated that USMLE scores are among the top criteria residency directors consider when reviewing applications.  

“Your Step 1 performance is going to determine if you get interviewed for the specialty that you want to pursue,” explains Dr. John Madden, emergency physician, associate dean of students and director of the Office of Career Guidance and Student Development at St. George’s University (SGU) School of Medicine.   

The USMLE Step 1 assesses whether you understand and can apply important science concepts that are basic to the practice of medicine. There is special emphasis placed on the principles and mechanisms underlying health, disease, and modes of therapy. Passing this exam on your first attempt is critically important because it demonstrates a medical student’s mastery of basic science knowledge and their ability to solve problems through the application of those principles. 

The eight-hour exam is comprised of multiple-choice questions. As of January 2022, a change to the passing standard for the USMLE Step 1 was enacted, shifting to a pass/fail scoring system. Out of 300 possible points, a passing score is currently a 196 or higher. The USMLE Step 2 exam remains a numerical score and it is generally felt that residency program directors will highlight this score during their application review. 

2. Start studying when you start medical school 

When it comes to USMLE preparation, it’s not the kind of test you want to cram for at the last minute. Considering the expansive ground this phase of the exam covers, studying for the Step 1 can take a considerable amount of time.  

Students typically take the USMLE Step 1 at the end of their second year of medical school, but it’s smart to start preparing early. “What I try to drive home is that you need to start studying essentially on the first day of medical school,” Dr. Madden emphasizes, “and even during the summer and winter breaks.”  

The Step 1 will be testing you on the material you’re expected to learn during those first couple of years of medical school, so keeping your USMLE Step 1 preparation top of mind as you work through those courses can be to your benefit. Emergency physician Dr. Chirag Shah explains: “Studying USMLE materials while taking the core classes provides another context to help master the material and prepare for the test months before the actual study process begins.” 

Specific resources will vary based on the student support services offered at your medical school, but some schools give students access to USMLE study materials. For example, SGU offers its students multiple leading USMLE prep question banks, some of which are built into the course curriculum. Utilizing these can help students determine which concepts they’ve grasped and which may need extra attention. 

A trio of SGU students doing class work on a white board.

3. Use the right resources for your learning style

As you work through your USMLE Step 1 preparation, you’ll find all sorts of recommendations for the books you should be reading, the study schedules you should adhere to, and more. But the truth is, there isn’t a one-size-fits-all method that will work for everyone.  

Because each student’s learning style is different, you’ll first need to understand how you best absorb new material. Dr. Madden says, for example, that some students run into academic trouble when they assume they study best on their own.  

There are multiple different study guides and other resources you can review on your own, but if you find that you work better with some guidance or in the company of others, he suggests forming a peer study group. You could even join a live review course, which Dr. Madden notes are offered by multiple different vendors across the web. 

4. Stay on track as you prepare for the USMLE Step 1 

Sticking to a regimented study schedule won’t matter much if you’re not absorbing the material. So, how can you know if you’re keeping pace? The most effective way to do this is to keep tabs on your grades and class rank.  

Because the USMLE Step 1 covers the material you’re learning in your first couple years of medical school, your academic performance will be a direct indicator of your grasp of the material as a whole. If you find you’re having academic issues at any point, you’ll want to take action sooner rather than later.  

As your exam date nears, be smart about how you spend your time. Too many distractions could derail you from focusing on any final preparations. “One should train for it like a triathlon, minimizing social activities in the days leading up to the test,” Dr. Shah suggests.  

A pair of SGU students referencing a textbook during a laboratory session.

5. Take advantage of USMLE practice exams 

One of the most effective USMLE preparation tips is to complete practice exams. This is the best way to simulate what the real process will be like. Many med students and instructors recommend taking the practice exams offered by the National Board of Medical Examiners (NBME), as they’re built to the same specifications as the USMLE tests.  

It is helpful to note, however, that your score on a practice exam may be somewhat inflated. “When students take the practice NBME exams for Step 1, I generally recommend subtracting 15 to 20 points from the scores that they’re getting in the comfort of their home or apartment,” Dr. Madden says. He explains that it’s common for students to score lower on the actual test day because of nerves or other factors. 

Prepare yourself for residency 

With so much riding on your USMLE success, it makes sense to be apprehensive as the first portion of the exam series approaches. But now that you’re armed with some expert advice, you have a better understanding of how to study for the Step 1.  

Satisfactory USMLE scores can have a big impact on your eventual residency placement, but there is a lot more that goes into it as well. Get a better understanding of the road to residency by reviewing our article “7 Important Residency Application Milestones Medical Students Need to Know.” 

*This article was originally published in 2018. It has since been updated to include information relevant to 2022. 



March 22, 2022