How to Prepare for the USMLE Step 1 Exam

As you close out your second year of medical school, there’s no doubt there’s one thing on your mind – Step 1 of the USMLE exams. Sponsored by the NBME, the USMLE Step 1 is generally the final exam that you need to take in order to enter into clinical medicine.

It’s critical you score well on this exam because it is more than likely the residency you would like to get into heavily weighs USMLE scores during the interview process. In the most recent survey published by the National Resident Matching Program (NRMP), 94 percent of all program directors interviewed (n = 1,793) identified USMLE Step 1 as the number one selection criteria for selecting applicants for interview.

While your acceptance into a residency will also depend on clinical evaluations, letters of recommendation, basic science grades and a Dean’s letter, your score on the Step 1 exam has the most influence.

The USMLE Step 1 exam is a culmination of all of the topics you have covered in your first two years of medical school. Remember when you were young and your parents told you to go to school so you’d get a better job? They weren’t kidding. Regularly attending class and absorbing the key principles for your board is exam is the foundation for success.

Knowing the USMLE Step 1 Exam Content

The first thing you will want to do when preparing for any medical licensure exam is get to know the contents of the exam by familiarizing yourself with the exam’s blueprint (when available). The USMLE Step 1 blueprint can be found here.

The exam covers various content areas such as:

• Anatomy
• Behavioral sciences
• Biochemistry
• Microbiology
• Pathology
• Pharmacology
• Physiology
• Interdisciplinary topics, such as nutrition, genetics, and aging

Pathology is perhaps the most important content area to study as it ties into a wide array of other topics.

Furthermore, the multiple-choice questions are classified into two dimensions: system and process. On the exam, 25-35 percent of the system questions are on general principles, while the majority (65-75 percent) are on individual organ systems.

The process dimension is a bit more complex. Psychosocial, cultural, occupational, and environmental considerations account for 10-20 percent of the dimension, principles of therapeutics covers 15-25 percent, 20-30 percent of material is on normal structure and function, and 40-50 percent is on abnormal processes.

Studying for the USMLE Exam

There are plenty of ways you can study for the USMLE Step 1 exam, but it’s important you pick the strategies that will maximize your time, as well as learning capacity and recall.

As we mentioned before, the foundation for success on the USMLE Step 1 exam is to attend class and absorb as much relevant information as possible. From there, you want to supplement your learning and challenge yourself.

This can be done through books, learning guides, online courses, in-person courses, flashcards, etc. However, we believe the best way to prepare for any medical licensure exam is by using Q-banks.

Practice questions for the USMLE Step 1 will help you develop a higher order of thinking, as well as activate the ‘testing effect’. The ‘testing effect’ is a well-documented phenomenon occurring during the course of testing, which has been shown to produce greater gains in meaningful learning than other methods of studying such as watching videos, listening to lectures, and re-reading notes. Multiple studies have demonstrated that students who practice testing outperform those who prepare in other ways.

You’ll want to start taking practice questions about six months before your exam date. During the first two months of this period you should aim to take about 25 questions in a single sitting, three times per week.

As each month passes, you should ramp up this effort so you are taking between 50-100 per day in the weeks leading up to the exam. You should view these final weeks before the exam as a high-intensity workout for your brain. It will be grueling, challenging and most likely exhausting. That’s why it’s so critical you get enough rest, eat right and find time to exercise the rest of your body. You need energy left in the tank for exam day.

Taking the USMLE Step 1

If you haven’t already, you’ll need to apply for the USMLE Step 1.

Be prepared for a very long day. The computerized exam is broken into seven blocks of 48 questions in which you are given a maximum of eight hours to complete. There is a 15-minute tutorial at the beginning of the exam that we recommend skipping to give yourself more time to take breaks between blocks. We suggest you download the tutorial and view in advance before your exam date.

Once you’ve taken the exam, prepare to still be anxious as results for the exam are generally posted online within three to four weeks of your test date.

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