The United States Medical Licensing Exam: Step 1

A Guide for Preparation

Here is a reason to read the long guide below, my statistics:

UWorld Self-Assessment 1 (6 weeks away): 252

NBME 7 (5 weeks away): 245

School’s CBSSA (4 weeks out): 259

NBME 13 (3 weeks away): 271

UWorld Custom* (2 weeks away): 260

UWorld Self-Assessment 2 (1 week away): 262

Actual USMLE Step 1: 257

*UWorld Custom = 7 random, timed blocks of 46 questions from UWorld, all unused questions in under exam conditions. Averaged the percent across all blocks (range was in the very high-70s to the mid-80s). Score converted using the Conversion Chart found via this link: http://usmle-score-correlation.blogspot.com/

About Me: I go a to school in the Northeast US and I did one of those 7-year combined BA/MD programs. I worked very diligently throughout my M1 and M2 years and learned, not just memorized. I pay lots of money to go to school so I make it worth every penny. I wasn’t getting perfect scores on my M1/M2 exams - I typically scored, on average, in the 80-85% range on my school exams while the class average was typically in the mid-to-high 70s. However, when it came to understanding mechanisms, I made it my top priority. I also worked with a close friend who followed the same strategy for our entire medical school curriculum. We didn’t necessarily study together but we often “pimped” and grilled each other repeatedly to ensure that we were both at the top of our game.

Medical Year 1: Honestly, M1 courses are probably the most important part. People will often tell you that Step 1 is all about Pathology, Pathophysiology, and Pharmacology; however, if you don’t have the foundation from Year 1, you will NOT be able to fully grasp and LEARN the Year 2 material. This is what separates the men/women from the boys/girls. Here are a few pointers for major M1 courses:

1)     Biochemistry – Simple. Get your hands on the Lippincott’s Biochemistry book. It’s golden. Use it alongside your class notes or whatever and read it to learn it. The key is to do the Lippincott online questions (included with the book). These really are great to test your knowledge. And don’t just memorize – learn. You will truly thank yourself the moment you walk out of your Step 1 exam if you do this properly.

2)     Anatomy – Spend a lot of time in lab. Grab a Netter’s or whatever atlas makes you intellectually orgasm and get started. Spend time in lab. Use your class notes / dissection guide and just dive in…literally. Spend time in lab. You won’t learn the brachial plexus by just looking at it. Spend time in lab. You won’t learn the circumflex arteries in the peri-femoral head/neck area by just looking. Spend time in lab. Feel them. Spend time in lab. Get your hands dirty. Oh and spend time in lab. Use a structured attack plan: learn the skeletal structure, then the muscles, then go after the blood supply/drainage and finally top it off with the nerves. The cherry on top is the lymphatics, surface features and clinical pearls. Then review & repeat.

3)     Physiology – Pathways. Arrows. Lines. And stuff. Costanzo is excellent for everything, except cardiology – get Guyton for that (about 150 pages total in Guyton). During your M2 year, use BRS Physiology to review + First Aid.

4)     Histology – Just go to class, pay attention. There are a ton of excellent books out there – for this topic; it’s really dependent on your style. Also, learn the basics of Histology really well (common tissue appearances, some common structures, etc) because this will help you rape the hell out of Pathology during your M2 year.

5)     Biostatistics / Epidemiology – This depends on your background. If you’re a math person, you don’t need much help here and you’ll pick it up with time. If you hate math, grab a biostatistics review book (the High-Yield series is supposed to be decent). Other than that – as with anything math related topic, do a TON of practice problems. It may all seem like a jumble in the beginning, but eventually it becomes cake. I, personally, used to HATE biostatistics with a profound poetic passion but after a few months of research work and a ton of problems, it became my strongest subject on the UWorld QBank (literally got only 3 wrong in the entire Biostatistics portion of the QBank).

6)     Neuroscience – Blumenfield + Purves + Haines. I’m a big neuroscience fan. I live and breathe neuroscience. Especially Neuroanatomy. So I went I little more in depth here. For the average medical student, a good anatomy atlas plus Blumenfield along with class notes will be more than enough.

7)     Microbiology – Two point strategy: Lippincott’s MicroCards + Microbiology Made Ridiculously Simple (MMRS). Use MMRS along with your class in M1 then proceed to use the Lippincott MicroCards during M2.

8)     Immunology – Two point strategy: First read How the Immune System Works (it’ll take 2-3 days to kill the whole book) – this will lay the foundation. Then grab the Lange series Microbiology review book, flip to the 115 or so pages on Immunology and go to town on them. That will literally teach you everything you need to know, even without class notes.

Medical Year 2: This year is entirely about one thing: Step 1. I don’t care if you want to be a NeuroPlasticsInnerEar4WeekYearOld Fetus Surgeon or if you simply want to open a rural family clinic out in the middle of North Dakota – you MUST score high on this exam. No excuses. People say that a 230 or so is fine for most residencies and a 240 is golden. I expect a 250 or above from you. You ARE capable of doing this, don’t let anything or anyone (including yourself) tell you otherwise. The key is Questions. Do more and more questions. Shoot for a crazy high score and earn it – that way, you’ll be in a great position.

                  Get These Books / Resources:

1)     Goljan Rapid Review Pathology

2)     Lange PharmCards

3)     First Aid (newest edition)

4)     USMLE World QBank

5)     Lippincott MicroCards

Approach: I’m not going to plan out your M2 year the way I laid out M1. Instead I’m going to give you a single word: consolidation. You’ll have a ton of resources you need to narrow it all down to just a chosen few. In your dedicated study time, you don’t want to be flipping through 20, or 10, or even more than 5 different books. Keep it simple yet complicated. Keep it excessive yet efficient. Take all of your pathology resources and write all the extra information into the Goljan book. Get your hands on the Goljan audio lectures, listen to them in the gym, car, or wherever. Just listen and read. Your official soundtrack of your M2 year = Goljan. No radios, no Jay-Z, no Miley Cyrus – just Dr. Edward Motherfucking Goljan. For pharmacology, use whatever major book you want or simply your class notes and get it all onto those flash cards – write it in. For Microbiology, learn those MicroCards inside out. For everything else: First Aid. But just don’t memorize – understand. Read between the lines. Meanwhile, as you consolidate everything into Goljan, do the same for First Aid – write everything into it as well. This should be done throughout the year – yes, it’s crazy but VERY possible to manage. If you do this, I promise that you will have a very functional and efficient dedicated study period. Also, you’ll rape the actual exam so hard, the NBME will send you a letter demanding that when you rape them for Step 2, please use the KY.

Questions: UWorld is the closest thing to the real exam. In fact, it’s actually more difficult than the real thing – that’s good news. Do UWorld at whatever pace you want. Just get it done. Review both wrong and right answers. Use it as a learning tool, like another textbook and annotate things into First Aid from it. Use its “notes” feature. I started first with Kaplan QBank at the beginning of M2, and then by January, I started UWorld. I split Kaplan with buddy of mine and thus finished about 60% of it while my buddy did the rest. UWorld - I finished 100%.

Dedicated Study Time:

Registering – Go to the NBME website, follow the directions and set it up as you like. They’ll charge you a few hundred bucks. That’s fine. You’ll get more than your invested money back when you’re an attending physician in your dream medical field at your dream medical institution / hospital.

Books / Resources – Take all of the consolidated material from M2 (see above). Go through them as many times as possible over whatever amount of time you have. Remember, focus on your weaknesses.

Calendar / Agenda – First thing before any studying begins is to make a calendar. This is all dependent on your style of studying. I can post my calendar as a sample (see below). Otherwise, shoot me a PM or email and I’ll be more than happy to help you start making a calendar. No matter what, Day 1 of studying = First Practice Exam. This will tell you where you stand and tell you your weaknesses. Your weaknesses are the holes in your armor - fix them before battle. If your helmet has a massive hole in it, why the hell would you reinforce your perfectly protective chest plate? Take as many practice exams as you think you’ll need. I took 1 per week on the exact day of the week as my actual exam. My exam was on a Wednesday – so during my 6-week study period, I took one full exam each Wednesday during that time. I matched the timing down to the second and even packed snacks as my meals. Literally just like the exam – including bathroom breaks. Practice exams are usually only 4 blocks of 46-50 questions. The real exam is 7 blocks of 46 questions. That means, after you complete a practice test, do 3 more sets of 46, random, timed. That’ll put you in shape for the real thing. I did this for my last 4 practice tests and when I got to the actual exam, I had no issues with timing or fatigue. It was exactly as I thought it would be.

The Actual Exam – There’s no need to detail my actual test. You’ll get a random set of 322 questions from a pool of some massive number of questions. Bottom line is: you go in and show it who Daddy is. Take breaks, don’t be a hero and power through blocks. Get up, walk, drink water, eat and stuff. At this point it should be simply like another practice test. No different. When you’re done, walk out, throw on your sunglasses (even if it’s 8 PM at night), roll down the windows, and drive away blasting your favorite song.