How to Study for the USMLE Step 1

I’ve spent the majority of my “adult” life as a standardized test taker. As a resident physician, my skills are still developing. But as a student, as an aficionado of the multiple choice question, I’ve already reached (and probably lost) my peak abilities.

I am asked frequently about my thoughts on the Step exams, especially the USMLE Step 1. It is after all the single most important determining factor in what specialty a medical student can reasonably hope to enter and probably the easiest and most-used exclusion criteria used by program directors everywhere (with the likely addition of graduating year and US Allopathic schooling). I can hear your thoughts. They ask, how should I prepare? My answer is simple:

USMLE World.

Theoretically, any good question bank should do. In practice, UW is the best.

More so than First Aid, more so than Goljan, and absolutely more so than Doctors in Training, I believe the USMLE World question bank is far and away the most critical component of Step preparation (with a solid helping of Wikipedia). Here is why:

When you learn a fact in a book, you can congratulate yourself on adding a virtual index card into the Rolodex of your brain. However, you have not indexed this fact in a retrievable way. It isn’t necessary usable in a test-taking context. This is one of two reasons why many people who know things still do poorly on tests. They can talk about it, but they can’t apply it. You may know the right buzzwords but never seen them described in an exam question. When you do questions, you both learn facts and learn them in context. You learn them in a question format, instead of learning them in a paragraph and then struggling to integrate and apply it to a question. Your time is valuable, wouldn’t you rather kill two birds with one stone?

UW questions have extensive explanations and are essentially a textbook page unto themselves. You can learn what you need to know from UW. The only downside to UW is that is not “organized” like a book for those students without sufficient background in need of a stronger foundation (this is what a quick read-through of First Aid as fast as possible at the very beginning of your study process will give you: a reminder of what you’ve learned, a horrifying glimpse of how much you do not know). This can be is a strength for two reasons: 1) it’s [slightly] less boring 2) the USMLE is not divided into sections. You never know on what topic the next question will be. 3) Patchy random exposure to topics isn’t exactly “spaced repetition,” but it does work along those lines.

So read through First Aid in a week or less. Just get through it. Bring up all the hidden junk you memorized long ago, then go straight to questions. Questions, questions, questions. Use books only to memorize tables and diagrams or flesh out your knowledge when you find yourself stumped by concepts or totally out of your element. Many students spread themselves thin trying to get through multiple sources at the expense of not doing enough questions—this is a mistake. Focus and depth trump breadth, end stop. Go through UW and mark/flag all the questions you get wrong and all the questions you guess on. Then do the marked ones a second time. Unless you have a significant problem finishing exams on time, I believe in “tutor” mode: this mode allows you to learn the correct answer and read the explanation immediately after each question. The goal is here is to learn first (and simulate the test second). If you do NBME practice tests closer to test day, those will obviously be done in timed mode. Ultimately, this is a matter of preference.

UW also goes to the trouble of explaining not only why the right answer is right but also why the wrong answers are wrong. This is crucial. This means you learn how to answer similar questions correctly again as well as when the wrong choices would be correct. Several related facts in one caffeine-riddled swoop. These explanations are on the whole excellent. These exams no longer include the classic buzzwords found in review books; they describe those buzzwords and key phrases. UW employs this nuance well.

The second major reason people struggle with MCQ tests is the inability to “get in the head” of the question writer. There are individuals who seem to test better than they should. You could ask them to explain why they choose the correct answer and they typically cannot explain themselves. Or, if they know why, it often is not entirely based on their book-knowledge. They’re able to narrow it down to those same two choices as the next guy, but they pick the right one more regularly. These people are natural test-takers. Step 1 is a MCQ test, but its style is not identical to that of the SAT or MCAT. You need to do Step questions to know how to do Step questions. It’s like any other skill. Hone it.

Because you wouldn’t learn to play guitar by practicing the flute, would you? Sure, the flute is a musical instrument: your dexterity would improve, your knowledge of tempo, rhythm, and music itself would develop. But if you picked up a guitar, you would still suck. Don’t spend 10 hours a day for six weeks learning the flute, then pick up a guitar and hammer on a few chords for a week and call yourself a guitarist. Just play the damn guitar. Skip the middle man.

Here is my compilation of free USMLE questions, which can be helpful before you’re ready to shell out for a definitive resource. Here are some things to keep in mind while studying. And some more thoughts about how I read Step questions.


  1. Ben thank you so much for this site!
    You cannot understand what a huge help you are to all of us in probably the most important test of our life…

    My question is, I am an IMG and I am aiming for Neurosurgery, which means I need no less than 99.
    Do you think usmle world (as many times as i can) and first aid can be enough?
    Yesterday I did the 143 questions in real time that nbme offers you together with downloading he FREDV2 software and I got 60% with no substantial reading (just a read through of the Biochemistry section in First Aid). I still have 5 months ahead of me for the test. Do you think I can get such a high score?

  2. You’re very welcome.

    The first thing to do is forget all about the two-digit score, as it is never used in the US by programs (and even the relationship between these scores has shifted, making it all the more confusing).

    Use this calculator to correlate your UW qbank percentage with your USMLE score. It’s actually relatively accurate. Below a 220 is a non-starter. The average matched applicant has a 239. Above a 240 is a solid score for US grad. Usually 230 and above is sufficient to match so long as the rest of the application is concordant. I can’t say how much more stringent it becomes as an IMG. There were 196 NSG spots this past year, of which 18 total came from IMG (which is an increase from the previous year, which I imagine is a trend that will continue)

    For neurosurgery (as well as most competitive fields), being an IMG is a massive disadvantage, and many programs may essentially rule you out out of hand regardless of your score (they can filter applicants by score, US allopathic school, and graduation year to narrow down their pool). If this remains your passion, you will have to apply broadly and have a back up plan no matter what. Read Charting Outcomes 2011 for some ideas of the odds.

    As far as the score, it’s my belief that for most people, 6-8 weeks and a lot UW will get you the score you’re capable of. If you’ve gone through UW twice and you have plenty of time left, it’s at that point that I’d consider buying Kaplan or reading additional sources to supplement areas where you continue to have a disadvantage. For most of my peers, after this amount of work, your sanity is hanging on by a thread and additional time/energy have low returns.

    • I really appreciate your advice.i am final year IMG and will be doing usmle step 2 soon.i am planning to start studying step 1 around a week after my step 2 exam.I will take two months fr step 1 question is two months enough?is uworld twice sufficient or should I study first aid too?

  3. Thank you very much Ben! It’s the most insight I had in months!

    One more question, I have done no research yet (I have just graduated) but I have publications and presented in world conferences etc. If I don’t get allocated in Neurosurgery from the first time, do you think it would be better to find a research program or choose a General Surgery program to do my intern year and gain some more clinical experience?

  4. Good question. My impression is that many programs, especially those that are less competitive, are not super research-focused. Many do worry about visa status and US clinical experience. My gut instinct would be that coming over here to work would be preferable.

    But solid research in that field resulting in publications etc would also be time well spent; the problem is that research is never guaranteed to be time well spent.

  5. So true. Thanks again for everything Ben! I can’t even begin to tell you what a huge help you’ve been to all of us!

  6. The only videos I have any familiarity with are the Doctors in Training (DIT) videos, for which I do not think they are worth the money if one is dedicated to studying. I think minute per minute, videos aren’t usually the best use of one’s time. The exception is if you’re the type to become distracted easily; I had many peers who found the videos helpful to keep themselves honest. The DIT series, for example, mirrors the First Aid book exactly, so watching the videos essentially replaces/augments this task.

  7. This is awesome!!! Could one get away with only using UWorld??? Or would it be advisable to supplement it with also another Qbank such as kaplan??

  8. I would use UW until you have gone through it at least once, marking all questions you got wrong or guessed on, and then do all marked questions a second time. Doing it twice is also fine. You can keep doing marked questions until you get them all right.

    If at that point you have exhausted UW and have significantly more time, then feel free to buy another qbank. I think UW is superior to Kaplan, and I think it’s better to know one qbank backwards and forwards than to use two to a lesser extent.

  9. hey there Ben,

    I’m aiming for primary care, and I’m wondering if first aid and uworld is sufficient enough for atleast a 230???

    I’m planning on reading first aid 7 times and do uworld 4 times with very good notes :)

    what do you think?

  10. That combination will not limit your score. I believe time spent doing questions is the most important modifiable scoring factor. How “smart” you are (at taking tests) is the non-modifiable factor. If you’ve truly exhausted and memorized UW, you could consider reading a chapter or two of another book in your areas of weakness. I doubt many people truly have time for that with a normal 1-2 month preparation.

    On a related note, 230 is an excellent score for family medicine and pediatrics and still very good for internal medicine. Always shoot for the stars, but just to be clear that one can get fantastic training with scores significantly lower than that, especially in primary care.

  11. Hey there Ben,

    thank you so much for answering my question.
    So here’s what’s going on right now in my studies. I’m one subject away form finishing first aid, I have to get through stupid microbiology. I’m almost finish with uworld, i just have a couple more to do :). I will be taking my NBME in about 2 more weeks. If I completed all the uworld and first aid, should I review first aid in two weeks then take the NBME or should I just do uworld all over again in two weeks then take my NBME. I know that two weeks is not enough time to do both uworld and first aid all over again. This NBME means alot to me because it will let me know if I’m ready to take the exam or not. I really want to take this exam around august so I can start clinicals in septemeber.

    let me know what you think :)

    PS: so far this would be my third time reading thru first aid and my second time doing uworld. Even all this time, I still feel like there are too much material and it’s so overwhelming.

  12. If it were me, I would do UWorld again with a focus on questions missed previously. Also, as you get closer to a test date, I think it’s prudent to focus on the single best answer for each question (and not all the wrong choices). As you go through a large number of questions quickly, you want to reinforce the correct relationships and not be distracted by the distractors. During the test, this lack of focus can cause you to second guess that very important gut feeling and over-think questions.

  13. greetings Ben

    thank you so much for your advice. I can see you have great emphasis on uworld. I find it practically impossible to memorize first aid. Even after the third read, I still forget things, hopefully doing uworld again will further reinforce things.
    I will keep you updated on my NBME

    thanx for everything :)

  14. I agree with how you feel about First Aid.

    It’s very difficult to efficiently glean new material from review books of that length and density once read. With the exception of the high-yield charts scattered throughout, I personally find trying to re-read resources like that mind-numbing.

  15. I don’t believe so, no. A good qbank is essential. First Aid usage is universal. What books you use outside of those to supplement are a more individual choice. Kaplan, Goljan, etc are all fine. The most important thing about all of these books is that none of them is a replacement for doing questions.

  16. Greeting Ben white,
    I have done a diagnostic exam, and finally passed. I’m not so thrill about the score, but it’s a good start. I will be taking the exam on november 30th. Based on my diagnostic exam, I’m a couple points away from my desire score. As of right now I’m finishing my last read of first aid, and will have about a month to do uworld all over again. How should I do uworld this time in order to get the best of it. I’m really hoping for one more improvement to get to my dream score.

    I heard people scoring over 250 with just mastering everything in uworld. But I want to know how they do it??

    Can you tell me how you approach uworld to get the most out of it?

    thank you so much

  17. If you haven’t already, you might get some utility out of my discussion on how to approach USMLE questions.

    In addition to the logistic preferences I describe above, there are a few things to keep in mind (other than just time and repetition):

    1. Every question is a chance to learn an important fact, even ones you get right. The wrong answers can matter just as much as the right ones.
    2. When a question seems very difficult, go back and read the stem at length. Each part is included to convey something. The question writers are always talking to you, it’s your job to decipher the code.
    3. Guessing correctly is good on test day, but it’s not sufficient when studying.
    4. The “take home message” component at the very end of the explanation is the bare essential fact to know. It’s tempting to breeze by it after reading a long chunk of text, but this little summary seals the most salient point home.
    5. Finally, pattern recognition and simple recall are extremely important. It’s possible to discern the thrust of question very quickly if you’ve done enough similar questions. Understanding medicine is great (and preferable, especially for physiology), but you don’t always have to understand a question to get it right. You have to associate.
  18. Hi Ben, thanks for the info, very helpful. I need your advise though as to how to help improve my score along with what you have already said. I took my first nbme today and received a 190(149 triple). Very discouraging and i need a new approach to studying since my exam is in two months. I did world once already but my average was a 35% untimed. I seem to know a little of everything and not solid in any one subject. I feel if i decide to redo every subject one at a time again, i will forget what i already learned. I don’t know what to do now please advise.

  19. Two months is still a long time to prepare. Personally, I think it’s best to do UW questions randomly and not by subject. After all, the test is a jumbled together. Variety can be a little bit frustrating but is very helpful to keep things fresh. When you find yourself totally lost by a question, that’s a good time to take a step back from UW and utilize another resource to re-teach yourself the specific material.

    An important distinction to make for yourself is why you get questions wrong. If you can’t make a diagnosis from the stem, then you need to especially focus on the pattern recognition that leads you to guess correctly (e.g. left upper quadrant pain, African-American child, low H/H = sick cell anemia with splenic sequestration). These often long questions can be distilled down to the key points.

    However, if you often know the diagnosis but can’t answer the second- or third-order questions, then it’s time to focus on learning the key facts associated with every diagnosis. Biochemistry boils down to knowing the enzyme deficiency for each disease. Microbiology requires that you know not just the pathogen, but also its magical unique ways to cause disease and what drugs you can use to treat it, etc. So on and so forth. A lot of facts in textbooks aren’t easily testable, but the ones in UW tend to hit the highlights (and many are over-the-top hard, so don’t be discouraged).

    This is a clinical test. Everything is framed as a patient encounter, so frame your thinking accordingly when you approach each question:

    Chest pain – what big things live in the chest? – heart, lungs, esophagus, aorta – what about the history helps me narrow down the organ? – then, what things help me figure/tease out the diagnosis?

    Presentations on the USMLE are almost always classic and idealized.

    Lastly, the more common or well-studied the disease, the more detail you must know. For example, that means that you can’t avoid deep understanding of the physiology of acid/base/renal, heart/circulation, and lungs.

  20. Hey Ben! This is fantastic, and I can’t thank you enough for all this info. I’m writing my Step 1 later in November, and I’ve just started studying for it. Do you think I’ll be able to make it? Do you have any tips for how I can fast forward my prep, yet do it efficiently?

  21. That’s plenty of time (and don’t forget it’s a marathon and not a sprint). It’s very easy to burnout during Step review, especially after around 4 weeks of dedicated all-day study time. If your background is poor, you may find a greater proportion of reading (pathoma, FA, Goljan, or other basic science books) to be helpful early on. That said, often doing questions helps identify the areas for which you need the most secondary reading, so don’t be afraid to do questions, get them painfully wrong, and use them as a springboard for further review.

    I found that the Robbin’s question book is a great resource to get through a lot of relatively short questions to quickly get a handle on Pathology. Highly recommended as an early lever into dedicated board review. Otherwise, the other relevant posts on the site might also be helpful to read as you get started (listed here).

  22. Thanks so much for this, Ben! I can’t express how much I appreciate what you’ve written.

    I’m a dual US and Australian citizen studying medicine in Australia. But our medical schools don’t provide us with a strong foundation in the basic sciences (much more focussed on clinical sciences here). I reckon I have a s*** foundation in basic sciences to be perfectly honest.

    I’ve been reading through First Aid but as others have said it reads like a list of random trivia to me. I’ll start with Pathoma (which I have heard helps people with a poor foundation like me), then try First Aid again, hopefully with a better foundation. Then I’ll focus the majority of my studying on UW per your recommendation. I’m not planning to sit the Step 1 exam until early next year (Jan/Feb), but I’m in hospital 40 hours per week (though I’ll have a month entirely off for summer holiday in December, which is when our summer is). Do you reckon this is a good plan to do well on the USMLE Step 1?

    Cheers, mate!


  23. Or do you reckon even with a poor basic sciences foundation like the one I have, I can move directly to UW alone (bypassing FA entirely, as I honestly didn’t like FA very much, but perhaps I have to simply trudge through it)?



  24. With a poor background in the basic sciences and a desire to do a greater degree of primary learning through UW, you’ll have to give yourself a lot of time with the qbank. If you can get through it once now and then reset and redo from scratch during your month off, that would likely put you in good shape. You may find that FA is somewhat more readable after doing some Pathoma and UW. The are certain portions (a few tables, microbio, etc), that FA does a nice job of distilling into a memorizable format.

    I found that when learning Pathology, the Robbins and Cotran Review of Pathology question book was a rapid fire way to learn the testable points in a body-system oriented manner. I would actually use this book (with Wikipedia) at the beginning of a module. I would always start each chapter totally lost, getting all of the questions wrong, and then eventually improve as I went through them. Since UW is such a big resource, you may find the Robbins question book to be a nice test-oriented introduction. I’ve heard good things about Pathoma as well, but it didn’t exist when I was a student and I don’t know much about it. I imagine it was meant for more longitudinal study but that using certain sections would definitely help fill in gaps as needed.

  25. Thanks for your very helpful response, Ben! :) If I can summarise your good advice, to make sure I understand you correctly, is it basically — establish some sort of a foundation (however creaky) in the basic sciences such as by using FA and/or Pathoma and/or the Robbins and Cotran Review of Pathology (maybe spending a week or thereabouts to do this), and then spending the rest of the time going through and deeply understanding UW inside and out? Would this be about correct?

    Also, I don’t suppose you might know if residencies in the States will filter me out because I’m a foreign graduate (despite having dual US and Australian citizenship)? I’m hoping for a residency in either internal medicine or anaesthetics. But these might be too competitive for me?



  26. Yes, that’s basically what I would do. Expect to get a lot of UW questions wrong—take your time on it. If you find it too frustrating or are totally lost, take a step back and read systematically on the topic du jour.

    Some upper crust type places might screen you out but most won’t out-of-hand. As a US-born IMG, you’re better off than a true FMG, as you speak English natively and have no visa issues (the latter often being the more important). There are tons of IM spots, and they get filled by people of all types (IM is truly an “average” residency in that there is the whole spectrum from extremely competitive to very noncompetitive programs). As an IMG, as long as you have reasonable stats and are flexible, it should be very possible to come stateside.

    I won’t pretend to know too much about anesthesia, except to say that you should make sure to apply to some “lower-tier” university and community programs when the time comes, in addition to the places of your dreams, in order to keep your chances as high as possible. It’s a bit of crapshoot, even as an AMG, so you’ll have to apply broadly regardless. Your school would probably have a better idea of its students’ track records over the years.

  27. Hi ben..
    Im doing my final year would be of great help if you could tell me how can i go about studying for usmle, how should i apply aaply and all the procedures
    Thank you

  28. Hey ben..
    Can you please tel me when do i have to apply for usmle like which month… i am totally unaware

  29. Hi Ben,

    Sorry mate, a couple of things came up, and I didn’t have a chance to respond. But I simply wanted to say a deep thank you for your wonderfully helpful and considered advice! Not only for me but (as is obvious) to so many others. I hope you receive much well deserved thanks from everyone else as well. Thanks again, Ben, I truly appreciate all you’ve done and continue to do to help us aspiring ‘almost’ doctors, and I hope you all the best! :)



  30. Do you mind if I ask how you approached all of the questions? Did you take notes or did you read everything and make sure to redo the ones you had trouble with? Any help is greatly appreciated.

  31. For me, the latter. I have never been a note-taker. This is largely in part because it always hurt my hand to write for long periods but also because taking notes is time-consuming and I’ve never had the patience for it.

    When I do questions, I read the explanations in detail; I treat UW like a textbook with nearly 100% clinical/usefulness correlation. I mark all questions that I guess on or get wrong (guessing correctly is better than being wrong, but it’s not good enough when going through for the first time). When I finish, I go through the marked ones again.

  32. Hi Ben,

    I have a question for you. I take my USMLE step 1 in about 3 months. My technique so far has been to master the material in UWORLD using index cards. I find that the content I have learned through UWORLD I know cold. I’m trying to read First Aid and Pathoma, but I’m finding it too dull. I love studying UWORLD and would love to make that my only source. I’m confident with the amount of time I have that I can master the UWORLD content. So I guess what I’m asking, if I completely turn a blind eye to all other resources aside from UWORLD, do you think I would be making a big mistake? I’d really appreciate your opinion. Thanks


  33. The UW-only approach is much more common for Step 2 CK than for Step 1. Part of that is probably because people have a pretty structured foundation from third year due to the shelf exams. The other part I think is because UW alone works pretty well, and many people realize how important questions are for success. I think due to the nature of most med school curriculums, students overestimate the importance of book learning. So while that’s an uncommon approach, I actually think it would work fine. I would say there are times when you need to supplement (e.g. when you do a biochem question and really don’t remember enough of what’s going on), but otherwise I think it’s possible for a lot of people to max out their potential via a qbank, using other resources PRN to get a better handle on specific topics. There are some good tables/charts in FA that are worth memorizing, but it can rapidly devolve into death by bullet point.

    3 months is a long time for studying. Depending on how much time you have, how your note card system works, how long you spend on the explanations, and to what extent you supplement with Wikipedia or textbooks, it’s possible you may actually exhaust UW. If you find that you literally have memorized the whole qbank, it’s at that point that it might be worth looking at an additional question source. I personally think the red robbins qbook is an excellent question source for high yield path and thought it was a great foundational question source (particularly before UW).

    The short answer is, I didn’t care much for FA. I read it but it bored me to tears, and I frequently lost focus so it took me forever. I like questions, and doing questions is a task with built in sections, breaks, checks and balances, and intrinsic goals. That made all the difference for me. For Step 2 CK, I switched to UW-only with zero regrets. The time and energy spent is more important than the number of resources you use to spend it (ranted about here.)

  34. Hi Ben
    I feel so blessed when I got your site. I am an IMG & I got 145 on UWSA 2. My exam is within 5 months. I have finished UW once. I used it as a learning tool, not to judge my knowledge. What is the Best approach for me right now you suggest? I am aiming for pediatrics & I can spend max 6 hours a day.

    Thanks so much.

  35. Look back at your UW percentages and see where you are weak. With 5 months, you have some time to read (at least portions of) some books, so shore up your foundations. You may find the robbins qbook as another nice rapid fire way to figure out where you are weak in path (and in many ways, path is almost everything). FA can take a long time, particulalry if you plan on reading additional resources to flesh out its terse format. I’d start that next soon so you can do it slowly, acknowledging that you’ll be doing a fair bit of additional reading. Once you’re back down to two (or three) months, I’d reset UW from scratch and use it as I describe above.

  36. Thx you so much for the reply Ben. You reply faster and more thoughtfully than my school’s advisor lol Really appreciate it. Cheers!

  37. Hello Ben!
    I just came across your site and it’s just what I need! I’m currently preparing for STEP 1 and I have about 3 months to prepare. I understand that questions are the best method of approach. However, I don’t feel like I have a very strong foundation in basic sciences and with just a few months to study, I’m not sure how to balance my review of basic sciences with questions. I’ve been told that for every subject tested I should have one book that I can look back to for reference. Also, the importance of First Aid has been stressed. Do I have enough time and should I place more emphasis on doing questions than reading review books? So far I’ve been attempting to do both and would like to know how I can be more efficient.

  38. Personally I’d devote a minimum of four (but preferably) six weeks for dedicated questions (using books PRN when understanding a question depends on more reading). That would give you six weeks to shore up your foundation with books. The easiest way would be to read FA, using other resources PRN to flesh out FA (which can be pretty terse). Because pathology is a huge overaching component for the exam, I would spend more time with path than most other review sources (e.g. Goljan, Pathoma). Since I like questions, I found that using the Robbins question book (linked to a couple of comments above) was a good way to quickly orient my path studying for rapid review. If you have lots of books already, then feel free to use them when appropriate, but I very much doubt most people really use a book for every subject to a significant extent. For example, the relevent portions of physio are extremely important but widely summarized throughout many resources and online.

    Some people can read books and intuitively understand how to apply their knowledge to questions. Other people are better served by seeing what knowledge is needed to answer specific questions and then memorizing that instead. I think the second approach is very effective and orients your learning. The major downside is that it’s a disorganized approach, which really bothers some students. To me, that’s one major reason that a quick read-through of FA to wrap your head around the “complete” subject matter is helpful as a foundational step.

  39. I do find that I learn how to integrate the material with questions and remember the information better. Thanks for the reply and advice!

  40. Hey Ben,

    I feel like this article makes a lot of sense. I take step I in two months and have been focusing strictly on UWorld. I have a copy of FA but I believe we both have a similar view on it. Because of how FA is written, it really doesn’t help me to retain anything that I read from it (minus some of the catchy mnemonics).

    In contrast, UWorld is written in syntax with very helpful information and diagrams. So, I took some advice from another source on the web and started keeping a UWorld journal which has all of the necessary information that I needed to know in order to correctly answer the questions I got wrong. I’ve written it in a quiz format so that I can test myself instead of just passively reading. I’m attempting to review this journal every week, but it takes me forever to get through, mainly because by the the time a week has passed, a lot of the information I have already forgotten and need to re-read the explanations from UWorld.

    I’ll end the long preface and get to my questions. When you did uworld and read the explanations, did you do anything to ensure that you didn’t forget the information that was in the explanation? Or, like you said, should I focus on a system during the week and then do the incorrect/marked question on the weekend? Knowing my memory, I feel like this would leave me vulnerable to forgetting if I go weeks without seeing the concepts I missed.



  41. Nope. I’ve long kept my personal writing/note-taking efforts to a minimum. 1) It hurts my hand 2) It takes forever 3) I find my own shorthand to be impenetrable and meaningless upon review 4) The other things I could be reading probably say it better.

    In many cases, I think a lot note-takers are leaving out part of the picture in the interest of brevity, so they only reinforce part of the picture. When you have an incomplete understanding of a topic (which is when you’re most likely to take notes), you’re more likely to take bad notes.

    I personally would just do the questions. In order to avoid the issue you describe, I always just did random blocks instead of system sections. It’s more disjointed, but it helps prevent long stretches of similar questions, boredom (as much as possible), and better simulates the random nature of the exam. I think over time, even when forgetting things in between, the questions and topics gradually reinforce themselves (sort of a built-in “spaced repetition”). By the time I took Step 3, I remembered the majority of the material from Step 2 with nominal review. The longer you reinforce things the deeper embedded they become.

  42. Hi Ben,

    I’m so glad I found this post. I feel like I’ve kind of floundered through half of my designated study time for Step 1 using Pathoma and FA. Unfortunately, now I realizing I’m only getting return from doing questions. That being said, I have about 2.5 weeks left until the exam. Would you suggest modifying anything at this point? Or basically just power through?

    Thanks in advance!

  43. If UWorld is essentially a textbook, is it possible to use only UWorld and nothing else to study for Step 1 and do well (if I keep going over UWorld multiple times for two or two and a half months until I learn it all to the best of my ability)?

  44. I admit it’s because my school is pass/fail so I have been lazy which is my own fault. But it’s time for me to get serious and I aim to put all my time and energy into Step 1. Hoping for 230 or higher.

  45. Yes, it’s possible. If your background is poor, you could consider doing your first pass by body system to get a better handle. I personally might consider starting with the Robbins question book since it’s a much faster read and will help you cover some ground first, but if those explanations are too terse then I wouldn’t feel obligated to continue with it. I know a lot of people who didn’t care for First Aid but very few who actually didn’t use it; I’d probably still keep a copy around for perusal and variety.

  46. Hi Ben,

    Thanks for the post; do you have any insight on when I should begin studying for the USMLE, I am about to start med school but internationally (Im a US citizen though) this fall. Should I begin First Aid now along with UW or during my basic science years? I’m aiming for PM&R and am hoping for 240+! Any advice will be very helpful!!

    Thank You!!

  47. Option 1: Just study for your classes until a few months before.
    Option 2: Just study for your classes for the the first year and then do the relevant UW/FA during each block of second year (assuming you have a traditional two year curriculum where you visit each system once per year)
    Option 3: Do FA & UW throughout

    I did Option 1. If I could go back, I’d personally probably do Option 2 (which is analogous to what I did for Step 2 CK). Depending on the makeup of your exams and your class schedule, it may be more or less feasible; doing well in your classes is important as well. Option 3 would work for the integrated 1.5 year curricula that are rapidly gaining popularity but maybe not as well otherwise. For example, my first year had a fair amount of mandatory class time and some pretty idiosyncratic tests, I’m not sure devoting the time to UW at that stage would have helped.

  48. Hi Ben,

    Thanks for all of the great insight, I just finished the kaplan 7 week review step 1 course 9( July 3rd)…and am plugging thru Kap q Bank random,
    do you think I should reread the Kaplan notes…or move on to Uworld.?
    Took STeo 1 6months ago and tanked it with a I need to pass
    Any advice would be appreciated

    Thanks again,

  49. Hi Dear colleague
    Really I want your help and kind advice,
    I’m old graduate ( graduated since 2001) from medical school,so I would like to move to USA and I’m specialist of radiology,although I know its impossible to get Radiology in USA ,as its very competitive ,my question shall I get any kind of residency if I passed all steps of USMLE in USA or its also impossible like radiology for old graduated doctors to get residency in any branch of medicine ????? your kind opinion
    especially the practical one

  50. There is an IMG alternate pathway offered by the American Board of Radiology (ABR) that you might see if you qualify for. This would be your best and least painful way to practice in this country. Matching into another field may be difficult for a variety of reasons; you’d need to take all of the Steps, yes, but you also have no clinical experience in other branches of medicine that most competing IMGs have.

  51. Hi Ben, I love your website and thank you very much for sharing your experience and tips with all of us. I wanted to know when you talk about “pattern recognition” are you referring for instance whenever a question ask about pernicious anemia, it seems to link with B12 on most questions right or is this rote memorization?

    Also, what is your advice to study for step 1 as a tactile/kinesthetic learner? Thanks again

    • I mean pattern recognition in the broad sense of memorizing key facts and presentations, as certain concepts and question presentations are common. By memorizing the most testable things, you cut down on extraneous less testable material. So it’d be like pernicious anemia 2/2 b12 deficiency 2/2 intrinsic factor insufficiency 2/2 parietal cell loss. Something like that. Even complex questions are usually secondary to a chain that is frequency repeated across multiple questions in the qbank. By recognizing and learning the handful of ways a concept is likely to be tested, you ready yourself for a novel question on test day.

      I thought about your learning styles question and came up mostly blank (my one idea is below). I think for better or worse, Step 1 preparation mostly hinges on doing questions, reading explanations, and trying to apply reasoning to more questions. For what it’s worth, despite a learner’s learning style preference, the data hasn’t shown different/better outcomes when using a learner’s preferred method, so the nature of the material shouldn’t be too discouraging. I suppose for isolated concepts that give you difficulty, one could develop a tactile analogy/mechanism (but not necessary for the whole process).

      My one thought for kinesthetic learning of this volume is that you could actually use physical places like your home or apartment to make memory places to walk through and explore for learning. This technique is commonly used by people who compete at the world memory championships, described well in the book Moonwalking with Einstein.

      As for broadening your learning modalities in general, you may find that occasionally reading outloud helps things stick. Or that you could type notes (and then even have them read aloud back to you by your computer). Or that visual aids / virtual memory places might help, such as those used by Sketchy Micro. Some of these techniques can be quite time consuming, so you’ll have to determine if they’re worth the investment.

  52. Thanks Ben! That is so true about Pernicious Anemia/B12/Intrinsic Factor. I have seem this particular question asked in that pattern format most of the time and that’s from doing lots of questions. The way I study now is creating hypo questions + answering questions too, but its a bit time consuming because I love to write (tactile/kinesthetic) its helpful somewhat. I will look into visual memory. Its just that you had mention in one of your post that its best to deeply understand renal/cardio/resp really well and I learn by doing questions for patho. Is Robbin’s the book you recommend?

    • Taking detailed notes or writing sample questions is definitely labor intensive, and it’s tough to make enough ground when the method is that involved. It may be better suited to the toughest concepts or in response to difficulty with a particular question. I think the red Robbins has questions that boil down to the key facts/patterns most quickly in both stem and answer. I really liked it.

  53. Or if you have any patho/physio books to recommend that have patient examples or sample exercises that will be great!

  54. Hey Ben,
    Thanks for the website.
    I am an American medical student; I sat for Step 1, and was unsuccessful.
    I prepared for 4 – 5 months primarily using first aid, pathoma and u world… Occasionally I used other resources, but I stuck with the above.

    I guess I don’t know what to do at this point. Do I just go through my same study strategy? I signed up for a Kaplan course, but I can already tell that the amount of details in that book/ style of presentation is too detailed.

    I”m concerned because I was going for neurosurgery, and I acquired a fellowship to pursue research, but now I feel real discouraged. What do you think I should do about my preparation?

    Right now, I could potentially have up to a year of time to study for it, but because of research, things are more difficult. It’s like taking classes in Medical school all over again (meaning don’t get full time to study).


    • Before focusing on what exactly do to next, you need to look back critically to see where things went wrong. If it helps, take a new practice test. There’s a root cause for the failure, and whatever it is tells you if you need to go back and spend time focusing on building up your foundational knowledge more with books (at least in certain subjects) versus going through a couple of qbanks at a leisurely pace. Take a look at how you were using UW and if you were maximizing the resource and your gains from doing questions. How you study and move forward is more important than what you study.

  55. Hi Ben,

    Thank you for taking the time to answer us.

    I am currently enrolled in a unique medical degree at St. George’s, University of London designed specifically for international students aiming for US residency. Interestingly, I will have to complete 3 years of pre-clinical medicine and 1 year of doing a research project in the UK, and then the plan is to go to the US for my last two clinical years. I am currently in second year and I am due to take the USMLE Step 1 at the end of year 3 or midway into year 4. My problem is that I’m in a UK medical school with it’s own syllabus that isn’t designed to prepare us for the USMLE.

    I still have about 2 years till I have to take it, and what I’m doing now to prepare is I’m expanding the material I have to learn for my own course with First Aid. So I would add bits and pieces of information from First Aid into my course notes if they weren’t covered there. Honestly, I’m not sure if this is effective or not. I feel like I have to expand on material in First Aid rather than expanding my notes with First Aid (if that makes sense?).

    What do you think? First Aid recommends many external resource books to cover the general principles and organ systems, should I use those to guide my studies? Do you have any recommended resources that I can use to understand the high yield material, not just mere quick review books? I feel like you’re a firm believer in using UW, but surely it’s too early as I haven’t even completed my basic pre-clinical science yet.

    Ultimately, I need to start preparing early and I really don’t know the best way how. I really need to do well as I am an IMG and I don’t have US/Canadian citizenship, I’m Indonesian.

    Help me please!



    • I’ll admit I know very little about the ways in which UK curricula differ from the US. I would have imagined that at its core, the basic material is probably more similar than different?

      I personally never got into the “annotate” First Aid approach. Partly because I think FA is a bit overrated, but mostly because I don’t like taking notes and a definitely don’t like reviewing my own (terribly imperfect) notes as a primary means of studying. In your circumstance, if you do like the idea but not the practice, you might consider buying the First Aid for the Basic Sciences (which include volumes for “General Principles” and “Organ Systems”), as these books retain the FA formula but contain more detail. FA by itself is definitely more of a detailed review outline than a primary study source.

      You don’t have to use UW this early. You need to have some foundation. I have some book recommendations for the basic sciences here. I do plan on discussing the answer to your question about long term self-study more in the future, so keep checking back.

  56. I know this is kind of late since you made this post a while back, but as someone who will be starting basic sciences soon (I entered a BS/MD program after high school where the first 2 years are fully undergraduate coursework before starting the official 4 years of med school), what can I do to better prepare for the type of questions on the USMLE Step 1 exam while I’m actually still learning things in classes? I’ve heard from upperclassmen that our school is REALLY bad when it comes to preparing students for Step 1 especially when it comes to our course exam questions which are mainly still rote memorization one sentence type questions, which I can probably do quite well on, but probably won’t be helpful in terms of knowing how it’s tested on Step 1, so I’m on my own there.

    1) Do you recommend any specific Qbanks (free or otherwise) or question books during courses specifically (besides USMLEWorld) to get used to how questions are asked?
    2) Or any subject specific resources for each of the subjects below helpful for the USMLE Step 1?

    I didn’t know if you knew any Qbanks or Question books that were more subject specific and didn’t require you to integrate with other basic science subjects just yet (since I haven’t had them), but are similar to the way the questions are on the exam.

    These are our courses which is still a traditional curriculum:
    MS-1 – Biochemistry, Developmental Anatomy, Gross Anatomy, Histology & Cell Biology, Immunology, Microbiology, Neuroscience, Physiology

    MS-2 – Epidemiology and Evidence Based Medicine, Genetics, Behavioral Science, Pathology, Pharmacology, Reproductive Biology

    If you could make a new post on this, I think it would be helpful to everyone starting medical school who wants to not just learn the material but learn it in the best way for how it’s going to be tested.

    • As far as I know you can still filter qbank questions by subject and body system, so you can definitely use one as a study adjunct as you go through your basic science years. Still a good bet. If you want to save UW for closer to your test, USMLERx is a reasonable alternative. For path during your MS2 year, I also highly recommend the Robbins question book. The Robbins book is also organized by body system (and is great for MS2 year in general). Utah has a nice big free pathology question bank.

      In general, I think a lot of schools seem to do a terrible job with medical education, and the whole thing can practically by done by correspondence. So don’t sweat your possible disadvantage. Your Step score will depend much more on your dedicated review than your school’s failings. I do plan to write on this more.

  57. Ben,

    Thank you for all the helpful comments. You put a lot of emphasis on doing questions but what I’m wondering is, how much time do you spend on each question that you get wrong?

    I’m planning on doing wrong questions over and over but like others mentioned I am worried that I’ll remember some answers just by remembering the answer instead of pattern recognition from test stem.

    Lastly, you mention that UW is a great resource to learn in a way that would most efficiently help us answer step 1 questions, but how similar/different is UW questions from step 1 questions?

    Thanks in advance.

    • It depends. I treat explanations like a review book page. Early on, I read them very carefully like studying a textbook. As you progress, it depends on why you get the question wrong. If you don’t know the material, then you got to go back and pour over it again. If you got it wrong due to a test taking reason, you might do a more focused review. If you have time, more is better, but at least always read the take home point. It’s also always worth reading why the answer you did choose was wrong! You’ll definitely spend more time on average reviewing the question than it takes to answer it.

      You can usually go through a resource at least 1.5x without remembering questions by rote. Some questions are/will feel like repeats (but that’s actually the point, you are recognizing the pattern!). If this is a concern, the easy solution is to buy a second qbank (USMLERx, BoardVitals (10% off with coupon code BW10), or Kaplan). UW is the best and has the best explanations, but the other vendors’ products are viable sources of questions when you need more volume.

      UW questions are mostly moderate/hard difficulty USMLE questions. As a result, they tend to be on the longer side and are more frequently second- and third-order questions. This is to say the real thing is a bit easier, and generally, if you can get it right on UW you can get it right on the real thing.

  58. Hi Doctor,I am IMG final year med student and will do usmle step 2ck soon.I will start step 1 prep after my step 2 2 months enough time to study?is uworld sufficient?

    • 2 months for a US student taking it at the end of their basic sciences is definitely enough. It’s probably plenty for you as well given that you’ve been studying for Step 2 and there is definitely overlap, but it would depend on how your basic science background is. If you have no background, UW by itself may be a bit tough. You’ll probably want to go through First Aid first since it’s probably been a long time since you’ve seen a lot of the material. If FA doesn’t make sense when you read it because you’ve never seen parts of the material before, you may end up needing more time.

      • Thankyou so much for your advice.during my prep fr usmle step 1 I will plan to use the textbook ‘usmle step 1 made ridiculously simple” since I find it more easier to grasp information frm this book.what is your suggestion about this book.Is it worth it and is the information in it sufficient fr step 1 prep?

      • Haven’t read it, but it’s a review book. How “enough” it is will depend on where you stand, but you can always do something different if you don’t have the background.

  59. I really appreciate your know doctor,the university I am studying doesnt train or prepare us fr the usmle.I am self studying for the steps because my dream is to do residency in usa.i usually browse through usmle forums on the Internet,that’s how I came across your website.i will try as much as I can to study well for step 1 with the hope of getting a good competitive score.i

  60. I just took my NBME and I got destroyed. I have about a month to study for step 1. I feel like NBME questions were easier but they were asked in a more tricky way. For step 1 specifically, is uworld better than usmle qmax? and also will doing questions/review and reading first aid allow me to answer all the questions? (some questions on nbme couldn’t be explained in first aid; ex. giving paroxetine for premature ejaculation). I am just getting paranoid because I only have a month left. In your opinion, what is the most time efficient method I can use to yield the highest score at this point?

    Thanks in advance,

    • I’d like to address your question more in detail later, but
      1) UW is the best
      2) It will be enough to answer the vast majority of questions and get a great score
      3) There is a difference between knowing everything and doing well. Often, trying to know everything reduces your chance of doing well, because not all facts are equally important or equally testable.
      4) You probably didn’t have to memorize that fact, you can extrapolate. SSRIs cause impotence (widely known and commonly tested) and thus would logically be a good guess for premature ejaculation. Extrapolating is great, it’s one of the rare situations that required critical application of your knowledge-base.
      4) There will be microdetails that cause you to get questions wrong on the real thing. It’s unavoidable and you can’t worry about them. It won’t matter if you’re doing well on the valid stuff.
      5) I would just do questions, as I’ve advocated. Again, doing questions isn’t about getting through them. It’s about taking your time and learning the material as it is likely to appear on test day. Read the explanations carefully. Go back to the question, see what parts of were supposed to lead you a certain direction. Understand the facets that make one answer best and why not the wrong answers are not just wrong, but also when they would be right.

  61. Hi doctor Ben ,
    First of all , thank you for your tips .I am an IMG graduate and now I am in the internship year . I am going to do step 1 after 4-5 months .my plan is to study pathoma , uworld (twice) with explanations and NBMEs . My goal is to get (230-235), is it possible with my plan ??!!
    Thanks in advance.

      • Thank you Dr for your rapid answer.So your advice is to go to pathoma and then directly to uworld and NBMEs without FA ?
        Is it important to do questions other than uworld(twice) + nbme ?
        Also , can I finish my plan (pathoma+uworld+nbmes) in 4 months ?.
        Thank you again Dr for your help

      • That’s not exactly my advice. My advice is written above and tailored to an average US student who has a strong/recent background in the basic sciences prior to a period of dedicated review. The exact books matter less than the fact that you don’t miss doing questions. NBMEs are all well and good, but it’s the explanations, especially early on, that are really important for your learning.

        You are unlikely to need more than UW as far as question banks go. Knowing one resource extremely well is better than knowing two only okay.

        Pathoma did not exist when I was a student, so I can’t speak in detail on it. From my impression, it is a good foundational book but is incomplete for Step 1. It would be most helpful early on to replace or supplement your basic science knowledge but probably not to replace FA, at least according to most people. To me, knowing UW by heart is more important than anything else.

        4 months full time is plenty.

  62. Dear Ben,
    I found your blog to be very informative and helpful. I like how you are realistic about limiting the number of resources used to study for Step 1, especially emphasizing how important UWorld is above all other resources. I have just started my dedicated study period which consists of 6 weeks for the COMLEX, and 8 weeks for the USMLE. My problem is that I take ABSOLUTELY FOREVER on just one UWorld block. Reviewing one block alone thoroughly has been taking me about 7-8 hours for the past few days, which is just ridiculously and embarrassingly slow. I’ve been wanting to use other resources like DIT for FA, Pathoma, and Sketchy for content review but there’s just been so little time since I’m not accomplishing my goal of 2 blocks per day of UWorld. How do you think I can speed my my UWorld process where I can at least halve the time I spend on one block? Cutting the time spent to even 3-4 hours for one block would be a miracle for me, which is still pretty slow.

    Thank you in advance for any advice you have.

    • Also, my background/knowledge base is weak since it has been hard to retain facts long-term. I understand you suggested just blasting through first aid quickly but even that I’m unsure how to approach since that’s a slow process for me too unfortunately.

    • UW may speed up over time, as content is repeated and becomes more familiar. I suppose you should look at where that time is going? For starters, how long as taking to do the question itself? Even on tutor mode, you should be doing the actual question at the normal test-day speed. There’s no point taking longer: you don’t have that luxury on test day, you need to be able to do it fast (and the real point is to see the correct answer and read the explanation).

      If you need to cut down on time further, try reading the initial paragraph explanation and the take-home fact and only read the wrong explanations for the options you choose incorrectly. You should attempt to get your eyes on the whole qbank and redo your incorrects if possible, so you’re going to have to be ruthless. You’re not going to have time for FA, Pathoma, AND Sketchy. You can do FA and maybe supplement on specific topics with the others when you find yourself lost, but you’ll have to be selective on that.

  63. Thanks for the speedy response. Today I spent 5 hours on 1 block of UW reading all the explanations, which is an improvement from yesterday but still horribly slow. And this is not including referencing to FA which I barely do due to time constraints. I obviously spend a lot of time on reviewing the questions I did incorrectly, but I find myself spending almost equal time on questions I got correct since there were always details on specific pathophys or mechanisms that I need brushing up on. I can try speedreading the ones I get correct more. I also do annotate a little bit in OneNote, though not in First Aid. And yes, timing on answering the questions themselves is an issue for me, so I will need to start being vigilant about that.

    For your suggestion on just reading the initial paragraph explanation and the educational objective for the correct ones, is UW comprehensive enough where they do test on the concepts in the wrong answers in other questions? UW is a lauded resource for a reason, and if it is truly comprehensive enough where most concepts will get tested on via a correct answer choice in some way, then I will take that into account of not drilling so hard on the wrong answer explanations too. I know ideally I shouldnt skip around with UW, but I do have to be strategic

    • I think UW explanations are good enough that referencing FA is not necessary for the majority of topics/questions.

      Ideally, you do spend nearly as much time on corrects as incorrects (at least at first) and do savor the explanations including the wrong answer choices. As you’ve noticed, there’s a lot of important testable content in each question that may have not been necessary to get *that* question correct but would be necessary for a different question.

      UW is comprehensive enough that you will see the vast majority (if not at all) of the high yield topics again as dedicated questions. Anything you’d literally not see again is of low enough yield that you overall score isn’t going to hinge on that (it’s more important to know the low-hanging fruit well than chase edge cases). Ideally, going over them as wrong choices will reinforce that knowledge when you see it again, and the repetition is of course helpful, so it’s better if you can. But if you look at your timing and literally won’t get through the question bank otherwise, I’d cut the corner so that you can make up the volume.

  64. Hi Ben,

    First off thanks for sharing all of your secrets about Step 1. I’ve read all of your posts and truly value all of your information. I’m at a tough point with my studies (roughly 3 weeks out). I’m not at my target NBMEs after taking 3 of them – still about 15-20 points away from my goal. I feel like my problem isn’t so much the content itself – I can spit back FA/Pathoma, etc. back and I know that this exam isn’t only about regurgitating information. I feel like the main reasons why I get questions wrong are A. I don’t always know what they’re looking for and B. The answer choices are tough to figure out. For example, they’d describe a clue cell on histology rather than give clue cell as an answer.

    Do you have any suggestions/approaches that I can use to improve this? I feel like if I could nail this down, I can boost my score up by 10 points.

    I know you’re quite busy but I truly do value your test taking abilities!

    • To point a), this is probably easiest achieved through more questions, especially with 3 weeks left to go. If you read anything in a book, read critically and ask “how could this appear in a question?” (which is the inverse), otherwise that fact may just get lost in the rolodex of your mind.

      B) You probably know the right associations but aren’t being tipped off by their descriptors. This is the problem with buzzwords. The real test rarely uses buzzwords or “classic” descriptors. They describe those terms. They’ll never say “currant jelly sputum,” but they will say “mucus tinged with blood.” This applies to histology (clue cells), physical exam findings, syndromic associations, etc. I’ve never thought about specifically isolating out buzzwords per se, but that’s what I’d recommend if doing questions doesn’t seem like enough. One option would be to go through First Aid quickly and scan each page for terms and make sure you actually know what they mean (e.g. cystic hygroma, blueberry muffin rash, what pulsus paradoxus actually is, etc). Wikipedia may actually be your best friend for rapid answers.

      • Thanks Ben. I’m at the point where I’ve exhausted most of my material (roughly 2.5 weeks out) and I’m scoring ~210, I want to get up to at least 225. What do you suggest I do? Just focus on weak content areas and go through Uworld again. This would be my 2.5 pass since I’m going over just my mistakes.

        I’m pretty frustrated to say the least and feel like I’m burning out. I don’t think reading through FA/Pathoma will be high yield at this point.

        Thanks again

      • I wouldn’t be able to read any books either at this point, so doing mistakes on UW would be my primary focus. Once you’ve done that (or if you feel like you recognize the UW questions too much and thus aren’t really “doing” them again or getting much out of it), you could supplement with a different qbank at this point. If you do, take your time and focus on the issues you’ve noticed. Don’t blaze through and miss the critical interpretation aspect trying to finish it before test day.

  65. Hello Ben
    Thank you for all the information you provide on your website. I am an IMG and felt very lost at the beginning of my study program for step 1. After going through your posts I fell more engaged and focused.
    Do you recommend any medical podcasts with an usmle approach? I Really enjoy listening to podcasts while commuting and I guess I could take advantage of such resource, if available. Thank you!

  66. Hello Ben,

    I really really need some help. I started studying for the Step 1 approximately 3 weeks ago (exactly August 1st). I took NBME 12 just to get an idea as to where I’m at and apparently, I didn’t learn anything from med school. My score was horrendous. So I figured I needed to re-study everything. I am studying with First Aid and have been doing 1-2 question sets of UWorld everyday. I decided to go with the per subject approach, but cumulatively. During my first week, I focused on Biochem (both First Aid and UWorld). My second week, I added Physiology so that means I took UWorld questions in both Biochem and Physio. I figured this would help me not forget what I studied the week before. Truth be told, my scores in UWorld has been improving and I was feeling good about that.

    When I hit the 3-week mark, I decided to gauge where I was at with another NBME assessment. And I scored worse than my first one. I feel incredibly discouraged right now. I am at a loss what to do. I’m at the point where I know I have to study, but I don’t feel like studying at the same time.

    Please tell me you have a suggestion how I can improve my score.

    • People put too much stock in the self-assessments, especially early on. Doing a self-assessment when you haven’t reviewed everything is sort of meaningless; every exam touches on different proportions and subsets of the material you need. I wouldn’t have done another self-assessment until I had finished all of UW once and finished FA, otherwise you’re just doing your psyche a disservice.

      It’d be like telling a patient to take an SSRI for depression and then them being disappointed when they don’t feel better in three days. So give yourself a chance and finish UW. I would also say that path, physio, and even microbio are probably the bigger bangs for your buck than biochem. I think it’s easy to sink a lot of time into biochem trying to memorize hard-to-retain minutia without it denting your score.

  67. Ben,

    I have a question for you. I believe it’s more of a self realization type of question however it doesn’t hurt to have an outsider perspective. When it comes to studying for the USMLE, I just despise making notes or annotations or flash cards (my general habit is to read and not do anything else). Is this something you recommend, or is some derivative of note taking a must? And how does this play out with UW vs. FA, since FA is not really the best read. Should I perhaps just do 2-3 blocks of UW per day and once completed maybe do FA along with marked questions? Any advice is greatly appreciated!

    • You don’t have to change your habits when it comes to Step 1. It’s a bigger test, but I’d argue that’s not necessarily a great time to completely reinvent yourself as a student.

      As a personal response, I never took notes in medical school. Passive reading and questions were my method. I did a single FA pass relatively quickly and for me felt that a second pass would be a total waste, though I occasionally reviewed specific pages. I felt a cover to cover review to start was relatively helpful to get a good view of all of the material in an organized way, which qbanks don’t exactly achieve. That said, with a strong background, I don’t know how critical that is. For Step 2, for example, after a year of solid studying via shelf exams, I went straight to questions and felt better for it.

  68. Hi Ben,
    I just found your site and am appreciative of the great information on here. I wanted to ask you for some advice about Step 1. I’m an M2 at a US medical school, and I have generally just barely passed my classes from first and second year (thank god for pure pass/fail schools). Thus, I don’t feel like I have a solid foundation in much of the material. I haven’t really been able to go through many step resources during the school year, but have gone through a few chapters of First Aid and maybe half of Pathoma. Our school recently made us take a practice NBME before we start studying hardcore, and my score on it was pretty poor at 49 (which would be between 145 and 150). I have started doing questions in Rx at the beginning of this year, and I start an 8 week dedicated Step 1 period on March 1st. I had initially planned to get through all of UWorld 1x during the 8 week dedicated period, but was wondering if I should start UWorld right now so that I could finish my first pass of UWorld by 5-6 weeks of the dedicated period and then go over my wrong/marked answers in the last 2-3 weeks? Or is it better to get through as much as I can of Rx right now and just start Uworld at the start of my dedicated period? I do feel like I don’t know a lot of the material that I should/should have known, we are currently in our last course of the M2 year. I had also ideally hoped to score around a 250. Do you think that this would still be possible? The school itself is pretty lenient and would be willing to give me a few more weeks off if the 8 weeks fell short. Please let me know your thoughts and any advice would be appreciated on how to proceed. Thanks!

    • I’d spend the next couple weeks trying to shore up that foundation (finish FA etc). 8 weeks is usually enough time to do UW thoroughly, though with a poor background and presumably low-performance on the first run it’ll probably take longer. See where you stand after four weeks and if you’re not on track to finish as you hoped then you can consider delaying.

  69. First of thank you so much for your advice. I absolutely love this site! I am 2nd Medical student here beginning to start studying. Still need to order books. From many resources and yours I have heard that First Aid as well as USMLE World are the best two. So how exactly would you recommend I start studying? Reading First Aid and then doing the equivalent questions in USMLE World?

    • I suppose the best answer could depend a bit on how long you have and your background, but I’m more of an advocate for reading FA in one go, then doing UW and referring back to FA sections for reinforcement.

  70. Hi Ben,your posts are really awesome…i need an advice on how to be focused for 30 days to give my STEP 1…
    here’s me story,please go through…
    i’ve been preparing for step 1 quite longtime almost 3 years
    Old Graduate:YOG:2011
    nbme 13-205(2015)
    nbme 17-218(2016)
    nbme 18-225(2017 march)
    (Gave all these nbmes,without a proper plan to know where i stand in this difficult journey)
    i’ve done everything multliple times kaplan ,uworld 3rd time 85% last month ,beckers q bank one time ,pathoma,goljan,el hussieny,FA 2014/2016…i like getting engaged in discussions about intresting concepts to my friends (ex:why dec in contractility in acidosis or why steriods are given along side with beta agonist in the long run for asthma and so on..),it really makes me happy knowing these and sharing with everyone.i din’t expect it(step 1 journey) coming this far.believe it’s because of inconsistency.
    i’m not good at solving questions(ex: reading DM type 1/2 as DI,out of 40 mistakes which i committed in NBME 18,20 where silly mistakes, don’t know how to reduce them),i’m not able to be focused while answering question.i’m tired thinking about these concepts and everything related to step 1.I want to overcome all these negative feelings and give my step 1 ASAP.i need 240+ Ben and i strongly believe i can achieve it if i’m focused for 30 days.

    Please help me Ben.
    Thank you.

    • You’re most likely to reduce the silly mistakes by doing questions day in and day out, being careful to create a steady habit of approaching and doing questions carefully the same way over long blocks of time. Build up some stamina, and no rushing or jumping to conclusions!

  71. Thanks a lot Ben for making out time to respond to my situation,i’ll definitely work according to your advice.

  72. Hey Ben,
    Did you use a particular resource to explain step1 NBME answers you got wrong (like the 2016 practice explanations you made – thanks for those)? I’m sure you’ve been asked this a million times in the comments, sorry about asking again.

    • No, and I did find that frustrating. They didn’t exist back then, though it seems like at least some are googlable now. For example, someone on the site testpirates has posted explanations for NBME 18.

  73. Hi Ben,
    Thank you for your advice on my previous post,it’s really helpful.Ben would like to what are the chances of getting into internal medicine residency being an old IMG (>5years).how much we need score on an AVERAGE in step 1/2 to be in safe zone compared to fresh graduates.

    • Check out the NRMP data for IMGs matching into IM. Last I checked the mean scores for Step 1 were in the 220s while for Step 2 CK in the 230s, but things may have changed since I last checked.

      Most likely you’re looking at community programs in undesirable places. Check out their websites. Look for places with lots of IMGs. And contact the PDs and ask for their advice as well.

  74. HI BEN
    first of all thanks for all the valuable information and advice its incredibly helpful.
    i am 3rd year medical student studying outside US and i wish to give STEP 1 later this year as the basic sciences are still fresh in my mind .
    my problem is recently USMLE have been including a lot of CT scans, MRIs, X RAYS we never had a course of radiology in my basic science and i suck at anatomy . would you pls give me any advice how to approach this imaging stuff as i always leave the question based on imaging as i am too underconfident about it .

    • I’m sorry I don’t have a USMLE-focused answer. Historically, the imaging has been very basic such that significant dedicated study hasn’t really been necessary. In many cases, the imaging isn’t even necessary to get the questions right. You might check out the free online sources on this post, particularly the Virginia intro course and Learning Radiology.

  75. thanks ben. i just wanted to ask that i struggle in anatomy but pretty good at pathology stuff so could you pls guide me if i should study further more from textbook for anatomy or just rely on FA and uworld .

    • A lot of anatomy isn’t the highest yield, the stuff that is you’ll find in FA and UW. I’d probably focus there.

  76. What a wonderful resource this blog has been. I do have a question to kind of put things in perspective. Since you have advocated the use of UW so heavily, and based on your personal experience with the exam, what score can we reasonably achieve if we use just UW as our main source (ie. No FA, No Pathoma etc.). While this is a very vague question and does defer from person to person, but assuming we know and understand every concept questioned in UW (ie. Main question stem and it’s explanation, excluding the wrong answer choices), what would be an attainable score with this scenario. I only have 4 weeks to prep for this exam, and do not like FA at all (It’s like memorizing a cheat sheet), so was hoping to hammer out 3 blocks daily and implement the flash card technique to memorize every concept questioned in the bank. If you could shed some light on this, it would be much appreciated.

    • The practical answer is that I think very few people need any other specific resource to maximize their personal score. The real answer is that few people only use UW, particularly the sort of hard-working, driven, dedicated folks who perform at the highest levels.

      That being said, I’m confident some students can get a 260+ essentially using UW alone for the typical 4-6 week dedicated review. The outcome has more to do with the student, background/starting point, and their preparation volume than any particular resource composition.

  77. Perfect, that reinforces my plan. It is often difficult to make up and implement your own plan along with a study schedule, when there is a sea of information regarding all the other sources and their questionable absolute necessity. Anyway, thank you for your feedback!

    • The way I like to think about this issue is that the test has changed very little over the years while the resources have multiplied at an incredible rate. For one, people performed well on Step 1 long before Pathoma or Sketchy or any other specific resource became commonly utilized. And, more importantly, it’s literally impossible for anyone to use all the “good” ones.

      I would argue it’s better to completely exhaust a high-quality resource than to skim bits and pieces from several. Supplementing an area of weakness is one thing, but it’s silly for anyone to assume that any company has a monopoly on this stuff.

      • I couldn’t agree with you more! But what is even more baffling is the general consensus amongst all the bright stars out there, that some resources are crucial for a good score. And I guess for a person like me, the more I read up on it on various forums, it just spiralled me straight into depression, having to accept the reality of going through resources which I know are quite the opposite of my learning style. It has been an absolute breath of fresh air to have some realistic outlook on this topic, and I’m sure this will benefit all your other readers as well, whom find themselves stuck on a similar impass.

  78. What a wonderful blog and this thread of advice is just eye opening! I’m facing a conundrum of my own, my exam is 2 months away, and I have opted to make UW my only source to study for it. I read on your Step 3 advice portion, about using the UW app on iOS. I am inclining to do the same for Step 1, since I can just do questions while sitting in a coffee shop or elsewhere on my iPhone/iPad (instead of the traditional hunched behind the computer screen for hours on end). My issue is this, I often go through the questions and know the concepts well (or make in app notes on and study the concepts I don’t know), and this leads me to think that it shouldn’t be this straight forward, perhaps I need to add another source due to fear of missing out on things. I mean I don’t make notes, have multiple books open, a laptop or a word document or anything. I just spend quality time with my iOS devices & keep it limited. Now is this a road with imminent failure in the end, or does this seem like a good track to be on in your opinion? I am not shooting for the stars or anything, but just around the national average is my goal.

    Appreciate your thoughts!

    • Mastering a single source should be fine for your goals. You will probably want to switch to an actual computer at some point later on to simulate the exam experience better (which also includes being bored at a computer).


Leave a Reply to Ben Cancel reply