The Basics

Step 1 is often referred to as the single most important test of medical school since it is used as a tool to screen applicants for residency programs. It's both intimidating and perplexing how two years of preclinical knowledge is condensed into a single 280-question multiple choice test, but that's how it is. Step 1 will move towards a Pass/Fail grading system in the future, but it will still remain important to master the content of this exam since third year shelf exams & Step 2 largely build off this foundation.

Studying for Step 1 is often a source of anxiety for medical students since it's seen as such a monumental, high stakes exam. The purpose of this article is to distill some of my experience with the hope that it can help others be less stressed & better prepared for this exam in the future.

Should You Trust Me?

Ultimately I ended up scoring a 250 (82nd percentile) on Step 1. I post this not to boast, but to offer some evidence behind my musings in this article. Historically I have been an above average test-taker but I also have a very strong work ethic. I firmly believe that success on this exam is dictated by how much work you put in up front & the goal score you set for yourself. Yes, test taking skill is a part of this process, but it's no coincidence that the person with a goal of 260 will probably score higher than someone with a goal of 220.

How to Prepare

I personally believe in putting in the work early on to avoid cramming. I'm sure there are lots of examples of students who did all their Step studying in a dedicated period & blew my score out of the water, but as with most things in life, early preparation is key. I accomplished this by using Anki, a spaced repetition flashcard app, as a tool to continually review old concepts & keep frameworks in my head fresh throughout the year. It is definitely a time investment, but also makes reviewing a breeze since you never have to think about what to study for the day. I recommend checking out the medical school anki subreddit if you're unsure of how to use or implement Anki.

My school was also Pass/Fail in the preclinical years which allowed me to largely focus on studying boards-specific resources & then skimming class lectures to fill in the small holes in knowledge. Learning for Step happens in three phases: knowledge acquisition & understanding, review, and application. Here's how I used these concepts to approach most of my studying during the preclinical years:

1. Watch Boards & Beyond videos for the relevant class system

2. Annotate First Aid by hand as I watched Boards & Beyond videos

3. Do the relevant Anki cards for this subject & expand on cards as needed (I used the USMLE Rx deck, but more on this later)

4. Review school lectures & do any practice questions given by the school

5. UWorld questions for this subject (started during summer after M1)

6. Take school test

7. Keep up with Anki card reviews

8. Rinse & repeat

I liked using Anki here since the study system only gets better with time. Cards with wrong answers are automatically reviewed more often & easy cards get pushed into the future. This makes your studying more high yield since you're forced to focus on your weaknesses.

Doing this process continually allowed me to come into dedicated with a very solid knowledge base. This allowed me to have a relatively stress-free dedicated period where I focused on test taking skills & weak areas rather than trying to relearn our whole curriculum in a few weeks.

Study Resources

I believe in keeping things simple so I focused on using just a few key study resources for Step preparation.

UWorld

This is far & away the most important study resource you'll use. The question bank teaches you both how to assess what a question is asking & how to apply your knowledge. I ended up going through UWorld thoroughly once, and then repeated all my incorrects. For each question I'd make a personal Anki card or two on new concepts I had learned.

I'd recommend starting off on tutor mode so that you can get immediate feedback on your thought process while the question is still fresh. Closer to your exam date start doing UWorld on timed, random to better simulate test conditions and timing.

If you're looking into doing more questions I'd recommend looking into AMBOSS. They're newer to the US market and some of their questions are overly tricky, but question banks are hands down the most effective way to learn. I've been using AMBOSS some for 3rd year shelves and it's been a helpful resource secondary to UWorld.

Note: I found that my 1st pass UWorld percentile (77% correct; 83rd percentile) was on the mark predicting my Step 1 score. You'll hear over & over that it's a learning resource, but I believe that your performance on it also shows your test taking skills. There's an art to taking standardized exams, and being able to decipher the strategy of the test writer is undoubtedly just as important as the content itself.

Anki

Question banks are the gold standard, but Anki enables repetition to solidify concepts & information in your brain. I used the USMLE Rx Flash Facts deck, but I don't know if I'd use it again. It helped really pound First Aid into my head, but sometimes the application of these concepts was lacking.

I'd recommend using both a pre-made deck as well as some of your own personal cards. Making your own cards takes time but that's half of the learning process right there. Check in on Reddit to see the popular decks but I know Zanki & AnKing are well known these days (get these decks on the sidebar of medical school anki). Try a few different decks early on to see what type of card style fits best with your learning style.

Also, don't get too wrapped up in Anki. At the end of the day it's just a tool, and having good test taking skills and a firm grasp of general concepts beats minutiae any day. I'd very much recommend keeping up with your reviews but taking a day off each week with the Postpone Cards add-on. Keep your sanity to stay productive.

First Aid (affiliate link)

Very useful for annotating with comments from lecture or Boards & Beyond. Treat it as an outline of things to know. I didn't open the book much outside of annotation since my Anki deck had First Aid images throughout.

Sketchy

Sketches work incredibly well for most people. I used Sketchy Micro with the Zanki Sketchy deck & still remember the information well. Watch cartoons & get super solid at microbio? It's a no brainer.

Podcasts (Goljan or Divine Interventions)

I listened to Goljan's lectures from the early 2000's and they are great for connecting the dots & getting a greater understanding of the material. Recently I've been listening to Divine's podcast and would also highly recommend them. Some veer more into the Step 2 world but all are very focused & relevant to board exams.

Pathoma

I didn't use Pathoma as much as I thought I would, but it gives you a great general framework with which to think about pathology. As with any resource I'd test it out to see if it works well for you.

NBME Exams & Uworld Self Assessments

These are both good resources to get a rough gauge of your abilities & to track some progress. They also give you experience with endurance and timing for test taking. I'd recommend taking one full length exam each week to develop these skills. The NBME scores are notoriously inaccurate, but there are many score predictors online which can help give a rough prediction of where you stand. UWSA2 seems to be one of the most predictive practice tests so I'd save this for a few days before your test. It really helps your performance if you can walk into the testing center knowing what you're capable of.

Everything Else

My biggest piece of advice is to take care of yourself throughout this process. This should really apply to all of medical school, but Step 1 seems to be especially stressful for people. You will unquestionably perform better if you're getting enough sleep, exercising regularly, eating well, and taking study breaks. Skipping any of these core needs to knock out more practice questions will only hurt you later on!

Make sure not to get too wrapped up in the weekly scores. I wrote about this back in 2016 when I took my MCAT and it rings true here as well. Sometimes it feels as if your weekly self worth is based on the practice test score you get each week. Don't fall into that trap. There will be ups and downs, but know that if you're putting in the right work your score will go up.

Practice Test Scores

Final Thoughts

Step 1 is truly a beast of a test, but if you come in with a plan and put in the work you’ll do well. It’s important to keep in mind that it’s impossible to know everything that may be covered on this test, so take time to develop your testing intuition and feel comfortable going with your best guess. Even though Step 1 will be going Pass/Fail soon it’s wise to take this study time to truly consolidate your knowledge as the same themes will pop up over and over throughout clinicals.

Most of all, believe in yourself! We’ve all made it this far for a reason, and you have the skills to succeed! Good luck!

Questions or Comments?

Have you taken Step 1 recently? Have any questions or thoughts to share? Post them below in the comments and I’ll do my best to address them and add that material to the article.