In my opinion, before you start really preparing for Step 1

If you are a second year medical student, there is one thing on your mind at this time of year: Step 1. Although scary, there are things that you can do to help calm your anxiety and get your best score.
Set a goal
In my opinion, before you start really preparing for Step 1, you should have two things clearly in mind: where you are with your score and where you want to be. To determine where you are, you need to take a practice test. You might be scared by this score, but that’s good encouragement to study.
So, before you start studying, set your goal. A passing score on Step 1 is 188. The national average is 221. The most competitive specialties have average scores of around 240. Probably the best resource for what you need to do to match into particular specialties can be found here, the NRMP’s report on “Charting Outcomes in the Match.” It goes into volunteer, research and other activities as well as Step 1 scores for matched applicants in different specialties. If you know what specialty you want, you’ll have a good target for your score.
If you’re not sure what you want to do, you’ll want to score as high as possible. I wasn’t too sure going into the test, so I set a goal of 245. That way I wouldn’t be kept out of any specialty based on my score. I needed to spend plenty of time studying, especially since my first practice test was a 208.
Start studying early
Looking back, I wish I would have been using the resources I used for my USMLE prep throughout first and second year. That way I would have been more familiar with the resources when it was time to really study. That said, it worked out ok without doing that, so don’t get too stressed out if you’re looking at your prep materials for the first time now.
Our school gave us about two months to really study for Step 1 (meaning we didn’t have any classes scheduled during that time). I would recommend starting relatively serious study starting in January of your second year and really serious study for 2-3 months before you take the test. That should give you enough time to get your best score.
Choose the right resources
Choosing the right resources will depend partly on your learning style, but there are a few that are must-haves.

  1. A question bank
    There’s always the debate about whether Kaplan or USMLE World is the better question bank. I used USMLE World and loved it.
    The thing that impressed me most about USMLE World was how similar the questions on the QBank were to those on the actual exam. When I came to the test, I felt as though I was just taking another set of questions from USMLE World.
    Also, the explanations of questions are great. They give detailed explanations of why the right answer is right and why the wrong answers are wrong. I learned five or six important concepts tested on Step 1 from one question and its explanation. This made the QBank a very efficient study tool.
    I purchased a 6 month subscription to the USMLE World QBank. In retrospect, I would have purchased a shorter subscription. I thought that I would have time to start doing questions before classes ended, but I didn’t. So, I would recommend buying the QBank for the amount of time you have committed solely to your USMLE review (probably 2-3 months). I also purchased two practice tests, but only ended up doing one of them. Our school also gave us a practice test.
    I spent a lot of time answering questions and reviewing them closer to my test, but only got through about half of the QBank. In my opinion, if you really study the answer explanations provided by USMLE world, you’ll be able to master the concepts covered by the USMLE exam without having to do all of the questions. That was my experience, anyway. Obviously, however, the more you do, the better prepared you will be for the exam.
    As far as how your QBank score correlates with your final score, UWorld questions tend to be a little harder than the actual test. I was scoring in the high 70s on my question blocks before I went into the test and ended up with at 257. My overall was about 60%, but my percentages were getting much higher on each question block the more questions I did.
  2. First Aid for the USMLE Step 1
    I don’t say this for very many things, but First Aid for the USMLE Step 1 is a must-have.
    First Aid is essentially a very condensed version of most of the things you’ll learn in your first and second year of medical school (at least the material that will be covered on the USMLE exam). The more familiar you are with First Aid, the better off you will be when you start using it for your formal USMLE prep. If you use this book during your curriculum, you’ll be able to have a summary of the things you’ve learned, as well as seeing what might not have been covered by your school that is covered on Step 1.
    One tip I have is to not spend a ton of time on the biochemistry section of First Aid. Understand the key steps that have to do with certain diseases (e.g. what does lead poisoning or B12 deficiency affect), but don’t try to memorize full pathways that don’t have specific clinical relevance. I spent a lot of time on this and saw very few questions on the test. My classmates had the same experience.
  3. Rapid Review Pathology by Goljan
    This book is similar to First Aid in that the material is condensed into bullet points. However, it has more information about the “why” of diseases than First Aid. It gives great explanations about pathophysiology and this material is stressed heavily on Step 1.
    These are the only resources that I used for my Step 1 prep. As you can probably tell, I study more on my own. Also, I learn best from practice questions. If this is not your style, then this strategy is probably not a good fit for you. If you work better in groups, do that.
    My study strategy and schedule
    Month 1-2. Monday to Friday I would read a new section in First Aid USMLE and the corresponding section in Goljan’s book. I would read new material in the morning (around 6-8am), new material in the afternoon (1-3pm) and review the material from the day at night (7-9pm). Those hours might go a little longer on some days. The night review would sometimes include QBank questions on the related topics. On Saturday I would review the things that I had studied in the previous days. This would include questions about the topics. Sunday was a day off!
    In the middle of this I also took the USMLE World practice test and got a 220. This was encouraging since it was better than before, but lower than my goal of 245. So, I had to keep working.
    I would also take breaks at times during my studies to go play basketball, run, or watch TV. I study a lot better when I take breaks between. You might be different.
    My main goal in these months was to finish going through First Aid and Goljan twice by two weeks before my test date.
    Month 3. This is where I started doing more questions. I had finished most of First Aid and Goljan. Usually I did two sets of questions per day with the same schedule as above.
    Test day. I scheduled my test day for the middle of June, a couple of weeks before rotations started on July 1st. Looking back I wish I would have done it a week earlier. That last week probably had little effect on my score but took a week away from vacation that I would have loved to have before starting my third year of medical school. So, my advice to you would be to take it at the beginning of June.
    On test day, make sure you bring snacks and food. It’s a very, very long test. I would also recommend taking all of your breaks. I would run around the building, do push-ups or jump up and down to keep my body and mind refreshed. I’m sure I looked like an idiot, but it worked for me!
    So, with all of this, I was able to surpass my target score of 245, with a 257 which made me very happy. Again, this is what worked for me and may not work as well for you. But, USMLE World, First Aid and Goljan Pathology are top notch resources no matter your study preferences. Good luck!
    Michael Frazier is a medical student and founder of Medical School Insider.
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• Jake • 6 months ago
Very informational post. As a third year now almost a year out from step 1, I certainly agree with almost everything mentioned in this post. I too am a question-bank learner, so maybe that’s why I’d agree with this more than others. In fact, I’d say 75-80% of my daily study time was devoted to QBanks (World, it’s absolutely the best; I still use it for 3rd yr)
However, I would say that starting in January might be a bit much. In full disclosure, I studied for 5.5 wks, and as many of my classmates and myself have told our underclassmen, you hit a knowledge/question accuracy plateau around 4 weeks. At 4 weeks there’s an equilibrium between the rate at which facts exit and are stored in your gray matter.
mata_o_diabo, I think step 1 is such a monumental trek, that it’s hard to forget both the journey and the end result.