Detailed USMLE Step 1 Guide by Dan Levi
I will break this down to:
1.1. timetable
1.2 how to take the most of the sources
1.3 sources
1.4 question banks and how to use them
1.5 NBMEs and how to use them + Uworld assessment tools
- notions/ how to ace to exam (from my point of view)
- personal perspective
- a proposition for an algorithm for step 1
I will elaborate as much as I can because when I prepared for step 1, I always found that people
wrote in very short their experience, and I couldn’t really understand what the thing that really
gave them their score was. Please feel free to jump and take whatever you want from this small
guide for step 1.
I wrote this with a lot of haste, so please feel free to ask questions, and if you see that I didn’t
make myself clear enough, I will re-write some parts. I started writing about this thinking that I will
just jot down some points and notions here and there, and suddenly I found myself writing about
a big part of my life .
1.1 Timetable
I did step 1 during my 4th year of med school and started using the American material at the first
year already, though I ONLY STARTED PREPARING PROPERLY FOR STEP 1 AT THE BEGINNING OF
MY FOURTH YEAR.
I gave step 1 half of the summer between my 3rd and 4th year, the entirety of my fourth year
(skipping all the lectures that I could and the labs which I could) and the entire summer of the
fourth year.
at my dedicated time (2.5 months in the summer) I studied 8-12 hours a day(sometimes more
when needed), with 1-2 days off/week
1.2 How to Take the Most of the Sources
I am not a great believer in hard-working, but in smart working. I tried never to read the same
resource twice if I don’t have to. Instead, I used ANKI flashcards, and from every resource which I
didn’t know the idea/ concept I made a card, and then before the test, I had about 4000 cards
which I repeated. It was a lifesaver, as it enabled me to review in 4 days ALL of my WEAK spots,
again and again, and again; because what you know…you know, it doesn’t matter if you grind it,
for step 1 you need to work efficiently, not with brute force.
1.3 Sources
If a specific subject is not written, it means I only encountered it at First aid / the Q banks and
didn’t have a specific tool to study it
First aid for the USMLE
What you need to understand, that EVERY single word in this book is testable, even if a number
is written near a DNA picture, this has a chance to be in your exam
This is only the summary of all summaries that exist, if you do not TRULY understand and can
manipulate the material behind those words…then yes you can get 220, even 230, but not above it
for sure
All the basic science notions=Dr Najeeb
*watched him during the first years of my med school not in the 4th year
*can only say, that this guy is all father of medicine, he was the one I owe my first 3 years of
medicine to, a walking legend on earth which teach up to an unbelievable high-yet simple to
understand level.
*I still remember 1-2 questions on the test day which I could solve easily because I remember Dr.
Najeeb accent telling me the answer
Pathology= Pathoma(audio ONLY)+goljan (book and audio)
*Pathoma is good for the start, but after reaching the 210 level he wasn’t useful, to be honest, he
is amazingly good, and he can definitely help you pass the exam EASILY, but not score high
*Goljan is amazing, I recommend this book to all med students, I used Goljan as my “bread and
butter” and robbins as a reference, Goljan teaches you more than the theory, he teaches you to
think properly, and prepares you to the upper years when you do rotations, I don’t think that
there is any book that exists which can see eye to eye with Goljan rapid review 4th edition, simply
amazing and to the point.
Biostatistics=
Uworld special Qbank for biostat
BRS- only the questions
A lot of youtube
*My weakest subject (and score percent at test day)
*I basically took every question that I saw on biostat, and put it into my Anki flashcards so that I
could repeat them before the test day a few times, it was a nightmare, but one that paid off Genetics-
-Bioethics and BS=
-100 cases by Conrad Fischer (Won’t recommend)
Biochemistry=
An extremely LOW YIELD subject, me and the people who took the test with me had max two
questions from the entire chapter on test day, but…understanding biochem gives you an edge
over the questions, as you can manipulate the material much much much better if you truly
understand it.
Kaplan videos (Raymond=a blessing on earth)
Goljan biochem book – as a source for clarification
Lippincott- as a source of clarification
Pharma=
Kaplan videos (Raymond)
Najeeb does an AMAZING job on pharma’s basics, truly a profound piece of work
-Microbio=
*Sketchymicro- as a recap, not as a proper studying tool
Anki Anki Anki, because I was doing step 1 during my studies, I always needed to find a way to
study in classes, if I would read a book I would simply fall asleep, so I got myself a tablet, installed
Anki, downloaded/made flashcards and did them basically everywhere I could for my weakest
subjects
1.4 Question Banks and how to use Them
I used RX, UWORLD, KAPLAN, GOLJAN Q banks
Goljan- didn’t give me to much, I was and am basically in love with the way the dude speaks and
explain stuff, so I enjoyed every single question, but I won’t say it gave me to much, maybe 1-2
concepts got more clear, then again it’s very short (350 questions ?)
Rx- very good to study this during the year, in fact, it’s a MUST for a good score, it solidifies and
DISCOVERS HOLES in your understanding of first aid (our one and only resource).
Kaplan- a super bad question bank, I would not recommend it unless you TRULY are bad in a
subject and you must have more questions for practice, and even then I would recommend doing
this Q banks “subject wise” and not mixing the subjects, so you won’t waste precious time on
subjects that you already know
UWORLD- The one and only, an amazing question bank, I read every single word in this Q bank,
and sometimes even twice, I solved 1-2 blocks per day, and when I did it I was on “fire mode”, no
phone, no distractions…like the real deal, this question bank is exactly like the real test (though
easier when you get used to the style, and predictable)
took my by average 4 hours to check each 40 question block
1.5 NBMEs and how to use them + Uworld
assessment tools
NBMEs, I recommend to use them ONLY after you finished studying everything already.
They are precise in their predictability, but the style of the questions is VERY different from the
real thing, thus I recommend to do them once per week near the end, and thus be able to “aim
yourself” towards your weak points, I did all of the online NBMEs and the off-line till 7(from up to
down, so new ones to old ones, didn’t do 6)
-Uworld assessment tool, those are basically 2 “demi exams” in the length of 4 hours I think,
composed of 4 blocks, and you can stop after every block.
I highly recommend to take the first assessment tool and break it into two times (2 blocks each
time) and do it in the following way
Do an NBME (5 hours)>break >do two blocks of the first (and much easier) assessment tool (with a
break between them). This gives you a “feeling” of the real exam and prepares you really really
good for the test day. The fact that you know the material doesn’t mean you can juggle it at LIGHT
speed for 7 hours in a row my friends…this is important to remember.
Here are my NBME scores –
Take – Test Dates – Timings – Scores
1 – 03/03/2017 – Standard – 380
2 – 04/21/2017 – Standard – 430
3 – 09/06/2017 – Standard – 590
4 – 09/13/2017 – Standard – 620
5 – 09/15/2017 – Standard – 590
6 – 09/22/2017 – Standard – 600
2.So to my personal notions (as bullet
points)
I tried to do some yoga every morning and practiced mindfulness. The yoga kept me flexible even
though I sat all the day, and gave me the ability to stay “in the zone” even if I would sit for 7 hours.
This is also applicable to mindfulness as practicing mindfulness is a “gym to the brain.” Of course,
you don’t have to agree with me on this one, or even like it, but if you have any affinity to those
practices, I highly suggest to take them as part of your routine during step 1 studying. Sport sport sport, I can’t emphasize strongly enough on how much it helped me to go to the gym
3/4 times/week…it gave my mind the air it needed and my body the ability to sustain such long
hours of studying, I truly don’t think I would even reach 240 without being consistent with sports.
Support support support
My personal key to succeeding in the exam was my AMAZING, NON-REPLACEABLE study buddies.
We read entire chapters together (normally- 1.5 days per chapter at the beginning of our
dedicated time till we covered all First aid), discussed concepts and questions. They helped me
stay at the top of my game, they took me by the hands and lifted me when I was down, and they
helped me to flare up and sustain my motivation for studying good, and not only for the score,
but to be a good-hard working doctor. I learned from working with them, at least as much if not
more than working for step 1.
I suggest to everyone who takes step 1 to find study buddies. In fact, before I met them, I already
studied for step 1 for 2-3 months and decided to aim for 220. As studying alone was just too hard
for me. Medicine is not a solo field, we work in teams and groups, and in my opinion Step 1 can be
the same.
I had and demanded A LOT of support from my amazing parents and girlfriend, and from all of
my best friends.
3. Personal Perspective
If you don’t need the score for your specialty, or if you do it just for yourself like me (I will probably
not go to the US), then I don’t suggest aiming for a score above 230…up to 230 it’s for being a
good doctor. Everything above it is just playing their rat game. I don’t believe a score above 230
contributes to your ability as a good doctor; it’s just those bits and pieces of memorization of
details that you would never use. When I look back at the road I took for step 1, I am happy I did it,
but I am not complete with it. I sacrificed a lot of my life for this, yes it was only one year, but in
that one year I wasn’t completely myself, and I pushed myself more than I believe I should have.
Yes, I am happy for the score, and for the opportunities that it brings me, but as a person who
most likely won’t go to the US, I think it was a waste of time. The score doesn’t make you a good
doctor, it’s the path to the score, and at a certain point you finish the path, and you just play the
game to win extra points here and there. I know a lot of people will disagree on this point with me,
though keep in mind, this is my opinion, and it’s okay if we don’t see eye to eye.
4. A proposition for a scheme during
step 1 studies
- Do Pathoma (Audio only, the book is redundant in my opinion)
- Do Goljan (audio included)
- Memorise every detail in first aid
4.Do Rx for that specific chapter you just covered in 1+2+3
5.Refer yourself to extra resources / a second reading for the weak parts / weak subjects following
Rx
you will see yourself according to your percentage and so one in what you are good and bad
6.Produce Ankis from your mistakes (Not a lot, as they will become useless as you advance to
Uworld, only the essential)
- Do Uworld
Produce Ankis to ALL the notions that you are bad at, as this Q banks is on point
Final words:
Remember that at test day, 60%-75% of the questions will be new questions (At least for me), stuff
that you never saw before in that way or thought about them in the specific angle of the question.
Don’t be afraid. Uworld prepares you exactly for this. Trust your preparation, and focus on making
the best that you can from Uworld while doing the blocks.
Good luck everyone, I wish you all the best for the test, and for your life, huge hugs to all of you
and be the best that you can be, nothing more, nothing less=)