As a second year medical student, the USMLE Step 1 Boards is constantly on your mind and fall heavily on your shoulders throughout the year. How do you conquer a huge exam like this? You stand in front of it well prepared and boosting with confidence. Here, I'll share with you how to study hard but also smart using high yield resources.
First, let's talk briefly about the exam itself. In the US, most medical students take their step 1 boards at the end of second year (which generally marks the end of our full didactic year, although you're still taking exams during 3rd and 4th years).
Here's a summary of how it works at my medical school (every school has it's own unique schedule so this is just one example. You can use adjust your own study strategy based on the differences in your medical program):
The first year curriculum | includes basic sciences, anatomy, histology, biochemistry, microbiology, etc.
The second year curriculum | is focused on pathophysiology and the course is split up into systems. For example, the cardiology unit will quickly cover physiology, spend the majority of the time on pathology and highlight pharmacology as well as associated clinically relevant. | We end our second year curriculum in March
Preparing for boards | We have 7 weeks of reading time from March to May before we take step 1 boards. This time is dedicated to reviewing the first 2 years of medical school curriculum. Most students opt to take the step 1 exam between May 7-9th leaving you with approximately 1 week off post boards prior to starting mandatory 3rd year hospital rotations.
What does the USMLE stand for? United States Medical Licensing Exam. Having said that this exam is required for your medical licensing. You're required to pass and as the "step 1" implies, there are other steps. Three in total!
What is covered on the exam? (taken from the USMLE.org)
Step 1 includes test items in the following content areas:
anatomy,
behavioral sciences,
biochemistry,
microbiology,
pathology,
pharmacology,
physiology,
interdisciplinary topics, such as nutrition, genetics, and aging.
Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:
interpret graphic and tabular material,
identify gross and microscopic pathologic and normal specimens,
apply basic science knowledge to clinical problems.
Step 1 classifies test items along two dimensions: system and process, as shown in Step 1 Specifications.
System**
25%–35% General principles
65%–75% Individual organ systems
hematopoietic / lymphoreticular
nervous/special senses
skin/connective tissue
musculoskeletal
respiratory
cardiovascular
gastrointestinal
renal/urinary
reproductive
endocrine
immune
Process
20%–30% Normal structure and function
40%–50% Abnormal processes
15%–25% Principles of therapeutics
10%–20% Psychosocial, cultural, occupational, and environmental considerations
* Percentages are subject to change at any time. See the USMLE website for the most up-to-date information. ** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.
What's the structure of the exam? Step 1 is a one-day examination. It is divided into seven 60-minute blocks and administered in one 8-hour testing session The number of questions per block on a given examination form will vary, but will not exceed 40. There is a total of 280 questions.
So why is the USMLE Step 1 such a big deal? Well it basically determines what you can specialize in. The boards puts a score on your resume and if you're interested in a very competitive residency you'll need a higher score. Of course this is generally how it works but it is absolutely not a rule and if you have a low score it doesn't mean specializing in a competitive field is impossible. However, it does make it harder so your priority is to get the highest score possible to keep your options open.
So how do I study for this enormous exam? Studying for the USMLE Step 1 is not a small task. I have not taken Step 1 yet however, I have prepared for it before. During my third year of dental school I took the National Board of Medical Examiners Comprehensive Basic Science Exam. The NBME CBSE is a requirement if you want to apply to Oral & Maxillofacial Surgery residencies. In a nutshell, this exam is very similar to the USMLE but about half as long. You use all the same resources to prepare and now that I have to take the USMLE I feel a lot more comfortable with the resources available. I've found a good rhythm and I am sharing it with you.
Keep in mind that everyone has a different optimal way of studying. My method may not work for you and you should modify it to fit your needs. There are a TON of really good resources out there, some I use and some I did not like. I am highlighting the resources I have found the most useful personally (under no endorsement or collaborations, these are my own opinions). I've linked all of my resources below (including my favorite pens and highlighters for annotations)!
These are the high yield resources I use:
Medical school lecture notes
These are resources I've used here and there to review topics I am weak in:
Sketchy Medical (if you like a paper version there's also Clinical Microbiology Made Ridiculously Simple)
Shop the Post
How I use these resources:
Your medical school lectures are your primary source of learning which is why I listed it first. This is where you'll get the latest up to date details about topics covered on the exam. The other resources simply highlight the high yield points that are often tested on the exam. They are by no way a means to LEARN medical information but rather a review of things you've already mastered in great detail at one point.
You should use your resources alongside your lecture notes in the beginning of second year (generally when most medical schools will begin their pathology courses). By the end of the second year, you'll have become so familiar with your study resources it'll not only make you more efficient but also build memory.
The USMLE First Aid review book is the holy grail. It's just SO good. But it's by no means a comprehensive book. It's a review book with high yield bullets. And that's how it should be used. There's plenty of space you can use in the book to annotate with extra details you pick up from your lectures, uWorld, or Rapid Review of Pathology, etc.
If you purchase the uWorld Q bank for 180 days or more you have 1 reset for all of your questions (I recommend buying it for a year so you can use it all year). You should go through the questions at least 2, maybe 3 times if you're dedicated. These questions are a great way to get familiar with the way the USMLE is structured and how they like to ask questions. The answer explanation should be used to annotate your USMLE First Aid book to make it a bit more complete.
Dr. Goljian's Rapid Review of Pathology is A LOT of text. It's a bit dry but it's GREAT. It has a lot of extra details you may not find in First Aid or uWorld. This is not a book you should try to memorize from cover to cover but rather use to pick up a few extra details here and there to help you tackle some extra questions.
Pathoma should be used alongside your lectures to help you understand pathology. It can then be used during your study period before your boards just for a quick review. Dr. Sattar has a magical way of making pathology simple. It's not something you should dwell on or spend tons of time rereading because it's a bit too basic. But it's an excellent way to review pathology without becoming overwhelmed.
Hope you found this helpful! I've linked all of the resources above. I cover this and more in my YouTube video so much sure you watch it below (and subscribe to my YouTube Channel)!
Watch the YouTube
