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Tips for the Step 1 Exam

Advice on studying from a fellow student By James Wu

IN THE BEGINNING of my second year of medical school, I searched for the best method to prepare for the U.S. Medical Licensing Exam Step 1. I read study guides, questioned third- and fourth-year students, researched forums, and began studying early. Having read that the Step 1 score was among the top criteria competitive residency programs use to narrow their pool of applicants, I made it a goal to give the exam my best effort. Now that I’m in my third year, I’ve completed the exam and acquired a feel for the types of questions asked. This article passes on some valuable “do’s” and “don’ts” I collected along the way.


Concentrate on high-yield knowledge and concepts. Try to understand, especially, the ways in which the knowledge and concepts are connected. To test your understanding, see if you can comfortably explain the main points of a disease process to a friend; be sure you always know the diagnosis, pathophysiology, and management of a disease.

Know that the USMLE is designed so that it is difficult to answer questions by simply regurgitating medical knowledge. The purpose of the exam is to assess “whether you understand and can apply important concepts in the sciences that are basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy.”

Study First Aid and be sure you thoroughly understand the concepts. By a conservative estimate, First Aid contains between 80% to 90% of the knowledge base tested by Step 1. The bulk of questions asked will be found in core sections in First Aid.

Use USMLE World. UWorld helps illustrate the significance of the high-yield facts and the circumstances in which they are important to consider. UWorld questions closely mimic the setup of the actual exam in that a single question may require you to simultaneously diagnose, understand the pathophysiology, and decide on a treatment.

Read the explanation for every answer stem when reading question banks, even the wrong ones. It’s easy to answer a question correctly by chance and equally easy to eliminate answers for the wrong reasons.

Resist the urge to move quickly through UWorld because you may unknowingly rob yourself of the chance to learn high-yield concepts. Once you’ve mastered First Aid and UWorld, use your time effectively by trying other question banks such as Kaplan Qbank to help identify gaps in your knowledge and to target those weaknesses.

Try to develop test-taking habits that are beneficial when working on practice problems. Spend some time early in your study schedule considering which strategies work for you. Simple strategies such as reading the last line of the question before reading the question stem can help save valuable time.

Do not

Emphasize rote memorization or measure your learning by the quantity of material you’ve studied.

Be a perfectionist and try to read every book or watch every video within your allotted study time. It is impossible to learn everything that could potentially be tested and trying to do so only diverts your focus from more effective ways of studying.

Leave a single question on the exam unanswered. This is an absolute rule. If answering a question seems to take an abnormally long time, guess an answer, mark the question, and come back to it at a later time.

Second-guess yourself on questions that seem suspiciously simple or straightforward. There will likely be plenty of these questions on the exam. Overthinking a question requires both time and mental stamina, both of which will be a limited resource on exam day.

Spend more than two or three minutes on a difficult question. A large portion of the exam is straightforward and can be answered quickly and easily. Answering these questions will improve your overall exam score far more than spending extra time on difficult questions. The goal is to obtain the highest possible score, which is accomplished more effectively by budgeting your time appropriately.

Find a study partner if it helps you stay motivated. Try to maintain a reasonable study schedule with time allotted for breaks. Preparing for the exam can feel overwhelming, but you are not alone in your struggle! In the words of Henry Ford, “Obstacles are those frightful things you see when you take your eyes off the goal.”

James Wu is co-chairman of the CMS Student District and a third-year student attending the Chicago Medical School at Rosalind Franklin University of Medicine and Science. He scored in the 90th percentile on the USMLE.

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