by / Wednesday, 07 September 2011 / Published in USMLE Advice

If you ask those who have successfully passed the USMLE Step 1 they usually all say the same thing:  First Aid + Question bank = Success.  The only problem is that for many of us, passing this exam takes much more than a review guide and aimlessly going through a question bank.

I have been getting more and more emails lately of students asking me for help, with a good majority asking me simply “How do I pass the USMLE Step 1?”… So I decided to lay it all out and share exactly how I approached the Step 1 back when I wrote it in 2007.

The first thing you have to do is be honest with yourself… Did you succeed in medical school relatively easily?  Did you get straight A’s because you had a solid grasp on the concepts and information, or did you get good grades because your professors went way too easy on you?  Or did you struggle to get good grades, did you struggle to get good grades but still have a decent grasp on the information you learned? – ultimately, you have to take an honest look at yourself and figure out where you’re starting from.

If you know you need to learn the basics and essentially move through everything from scratch again, give yourself ample time and don’t set yourself some unrealistic goal of writing in 4 weeks… if on the other hand you have a rock-solid grasp on the basics, know the details, and need nothing more than a review to refresh yourself thoroughly, then go ahead and set your date for a few weeks away and get down to business.

Ultimately, figuring out how much time you realistically need in order to achieve your desired score is the first step to passing the Step 1…. once you’ve figured this out, choose a goal and set a date.

At the risk of sounding too ‘Tony Robbins’, until you’ve visualized your goal and written it down, it is not really a goal.  Any student who approaches the Step 1 without a goal score in mind is at a serious disadvantage – so even if your goal is simply to pass the exam, decide on it, write it down, and visualize the ultimate goal of achieving that score.

So you’ve figured out how much time you need and you have decided on the score you want to achieve (and written it down)… now is the time to devise a solid plan of action and start putting it to work (putting your plan into action is imperative to your success)

Here are the steps to successfully passing the USMLE Step 1 exam (after all the above is completed)

#1 – Choose your study sources

If you need to seriously review all of the basics and need a lot of time, consider choosing the hardcore basics we use in medical school.  If you are weak in physiology dig out your old physiology textbook and tackle your weaknesses – and do this for all of your weak areas.

2 – Limit the sources of ‘review’ material you use

Review books are just that – review.  So many students walk around town with First Aid, Secrets, Crush, Boards & Wards, etc all at once… and lets be honest, we don’t use all of these to review at the same time.  So do this, choose a single ‘review’ book and ditch the rest.  At the end of the day, when you realize that you don’t actually learn from review books, but instead use them to remind yourself what is high-yield and what isn’t is the ultimate purpose of having one of these books.  The best students open their First Aid and see the high-yield nuggets, then from each high-yield piece of information that can elaborate and discuss each topic for several minutes… this is what we need to do to be successful on the Step 1.  You cannot simply know the superficial information from the review books, you need the reminder about what is important and you need to be able to go in-depth about these high-yield topics.

3 – Start doing practice questions now

Here’s the deal – practice questions are beneficial for USMLE prep for so many reasons, but the main ones are that they help us practice for the Step 1, they help us look at medical information from many different angles, and they help us sharper our overall understanding.

How we use question banks is often very wrong – and I see so many of my students wasting lots of time and money doing things the wrong way, so let’s set the record straight about what works best for the majority of students.

Here is how to best use a question bank:

Tip #1 – Choose only one qbank, you are going to go through it twice – the first time you will go through and learn, the second time you will go through and solidify your knowlege.

Tip #2 – Go through the qbank the first time in blocks of 45-50 in an times mode – this will best prepare you for doing questions in the time that the USMLE allows… perfect practice makes perfect!  After finishing each 45-50 question block, go back and see which you answered right and which you answered wrong.  Figure out what you got wrong and learn why you were wrong – then go and read about the big-picture concept that each question was trying to teach you.  When you use the questions this way, you don’t give yourself a falsely elevated score by reading things as you go and using that to answer questions along the way.  Sure, it may increase your scores per block, but the ultimate goal is to learn as you do questions, so don’t worry about beating the average in that qbank.

Tip #3 – The second time through the question bank, don’t just answer the questions from memory, instead explain to yourself out loud why the answer is what it is… doing it this way will ensure that you have a rock-solid grasp on the concepts they are asking you, instead of just pointlessly answering from memory.  Now, when you do this, what you are doing is actively figuring out what the question is asking and when you can figure out the correct answer before you even look at the options, then you will know that you are ready to sit and write the Step 1 exam.

That is how you properly use a question bank, and I should mention that you only need to use 1 qbank because they all test you on the same concepts… if you notice that you see the same concepts over and over again in UWorld, and when you see the same concepts over and over this should tell you that this is high-yield information that is absolutely ‘must know’.

#4 – Do an NBME exam

NBME exams are active USMLE questions, which is why you won’t get answers at the end.  You will however get a diagnostic page after you write the exam that shows you what you are likely to score on the real test, as well as an in-depth look at your strengths and weaknesses.

The key to using NBME’s to your advantage is to ensure that your ‘strengths’ are all closely together, meaning you are not all over the board when it comes to your strengths and weaknesses (see the picture below to see what I mean – on the left shows a badly distributed knowledge, while on the right we see a well-rounded knowledge base).  The reason why you want a well-rounded strength base is because if you have a very diverse range of strengths and weaknesses on your NBME, what would happen if they asked you more of your weak areas and less of your strong areas on the real Step 1???  What happens then is that you thought you were ready but were given a bunch of your weaknesses and ultimately you end up failing… but if you know that you are well-rounded all across the board, it won’t matter if your exam is richer in one discipline over another, you will still be able to score well because you are well-rounded.








#5 – Be prepared to work harder than you ever have before

The USMLE Step 1 exam is notoriously known as the hardest standardized test you can take… so with that said you can’t expect to do well working at half-capacity, so be prepared to work extremely hard and stick to your plan as closely as possible.  If you are not ready to dive in head-first and give it 100%, take a week off and get yourself mentally psyched-up, but when you are ready to get ready for this monster of an exam, go at it with everything you have – and when you do, you will reap the benefits of your hours upon hours of hard work.

I really hope that plan you understand what you should do in order to maximize your chances for success.  If you have any questions don’t hesitate to email!


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