How to Study for Step 1: Tips for USMLE Success


Getting into medical school took years of diligent studying to meeting medical school prerequisites, a robust resume of extracurricular activities, and a smart approach to the application process. In short, it took a lot of hard work. Your tendency to put your nose to the grindstone will continue to prove useful going forward.

Now that you’re a medical student, you’re going to face a lot of challenges. Your classes will be even more difficult than the ones you took during your undergrad. You’ll also have to pass rigorous exams to obtain your medical license, and the process starts relatively soon. Most medical students take the first important test, the United States Medical Licensing Examination (USMLE) Step 1, at the end of their second year.

This exam is critically important—you need a passing score to eventually become a practicing physician. Furthermore, a strong score is a key element in securing a postgraduate residency position. Program directors actually rank USMLE Step 1 scores as the most important criteria they evaluate when considering applicants.

There’s clearly a lot riding on your test performance. So naturally, you’re devising your plan for how to study for Step 1. While every student is a little different, there are some general strategies experts recommend. Find out how to start gearing up for this all-important test.

5 Tips to consider when studying for USMLE Step 1

These pointers are general enough that they can be helpful for all medical students. Once you’re aware of these basics, you can figure out a more specific plan tailored to your needs.

1. Understand the significance of the Step 1

You might hear instructors say Step 1 is the most important exam you’ll ever take. Though it sounds like an exaggeration, your performance on this test really does set the stage for your future in medicine. Residency program directors heavily scrutinize scores.

"Your Step 1 score is going to determine if you get interviewed for the specialty that you want to pursue."

“Your Step 1 score is going to determine if you get interviewed for the specialty that you want to pursue,” explains Dr. John Madden, Emergency Physician and Director of the Office of Career Guidance and Student Development at St. George’s University (SGU) School of Medicine. He adds that some programs simply don’t extend interview offers to applicants who fall below a certain threshold.

2. Start studying when you start school

If you’re used to reviewing material at the last minute before an exam, you’re going to need to change your mindset. Studying for Step 1 should take a considerable amount of time. It’s a lengthy, eight-hour test that covers a vast amount of material. You should 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 during the summer and winter breaks.”

That doesn’t mean you should eliminate time dedicated solely to studying for the USMLE Step 1. Many students like to set aside eight or more weeks for their final review. But you’re more likely to understand the important concepts with a two-pronged approach.

"Studying USMLE materials while taking the core classes provides another context to help master the material."

“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,” Dr. Shah explains.

3. Use the right resources for your learning style

You’ll find all sorts of recommendations for the right books, study schedules, and more. But there isn’t a one-size-fits-all solution that will work for everyone. Every student’s learning style is slightly different. You may need to find resources that can help you understand how you best absorb material. Dr. Madden says some students run into academic trouble when they assume they study best on their own.

“Then we usually recommend a live review course by one of the many vendors out there that offer them,” Dr. Madden explains.

Many physicians and current medical students also mention the importance of forming a peer study group to prepare for Step 1. While that might work in some cases, it could also backfire.

“You can't join a group of students that learn differently than you,” Dr. Madden warns. “They may slow you down or go too fast.”

"You can't join a group of students that learn differently than you."

Regardless of how you do it, testing yourself is always going to be a good strategy. Many students swear by Step 1-specific question banks. These resources often include thousands of prompts on relevant medical topics.

“Doing lots of questions through books or interactive question banks will help solidify the material and identify weak points,” Dr. Shah offers.

4. Stay on track

Sticking to a study schedule won’t matter much if you’re not absorbing the material. So, how do you know if you’re keeping pace? Your grades and class rank should give you a sense of where you stand. If you’re having academic issues, take action sooner rather than later.

“You need to switch the way you're preparing for the most important exam you'll ever take,” Dr. Madden warns.

As you get closer to the exam, be smart about how you spend your time. You don’t want to derail yourself by having too many distractions. It’s certainly important to take study breaks, but be careful about making too many commitments that will pull you away from final preparations.

"One should train for it like a triathlon."

“One should train for it like a triathlon, including minimizing social activities in the days leading up to the test,” Dr. Shah says.

5. Take practice exams

Completing practice tests is a must for every student, because it’s the best way to simulate what the real event will be like. Many students and instructors recommend taking the practice exams from the National Board of Medical Examiners (NBME). They’re built to the same specifications as the USMLE tests. That said, know your score on a practice exam is going to be a bit 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 adds that students typically don’t do quite as well on the actual test day due to nerves. Keeping this in mind can help you know where you stand going into the big day.

Get ready for residency

It’s normal to have nerves for an exam that has so much influence on your eventual residency placement. Even if you still have some butterflies, you can see passing the first portion of the USMLE series is achievable with the right preparation. Hopefully, these tips have given you a better understanding of how to study for Step 1 going forward.

Of course, a strong Step 1 performance is just one part of what it takes to secure a postgraduate training position. You’ll also need to put your best foot forward on interviews and demonstrate good clinical skills during rotations. It also helps to have a thorough understanding of how residency matching works.

There’s a lot that goes into applying for and securing a postgraduate position. Familiarize yourself with the entire operation by reading our article, “The Match: Explaining the Application Process and Your Residency Results.”

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