by Maggie Chung, MS2, Warren Alpert Medical School of Brown University

Step 1 is often viewed as a daunting feat. Performing well on this exam is an important component of being a competitive candidate for residency. Given the weight of this exam, you should be prepared to put in a considerable amount of time and energy into preparation. Here are some tips to keep in mind while studying to help you excel.

First, the timeline is key. Start your Step 1 studying early because, given the breadth of information that is covered, you will need ample time to review topics more than once. You should make a plan early on and consider what study methods have worked for you to date. Whether it is flashcards or diagrams and charts, everyone has a unique way to condense material in order to commit it to memory. While many high-scoring students share their winning methods, remember that you have the best understanding of the learning methods that are most effective for you. You should apply the same methods to help you understand, recall, and apply the material on Step 1. That being said, if by the fall of second year you still feel that your studying methods and habits are not working for you, you should not be afraid to modify your techniques. However, give yourself ample time to get comfortable with these changes so that your Step 1 preparation will be as efficient as possible.

Next, an important part of doing well on Step 1 is knowing which resources to focus on with your limited study time. There are countless resources, and some of the most popular ones will be mentioned here. You should familiarize yourself with First Aid by reading it cover to cover several times. You should know First Aid well enough to comfortably recall minute details and to reason through questions that integrate concepts from disparate subject areas. It is helpful to begin integrating First Aid and Step 1 preparation into your coursework early during your second year. With each subject your coursework focuses on, you should supplement your studying with question banks (Qbanks). Doing questions will help you become comfortable with the test format and solidify the important concepts within each subject area. USMLE World, Kaplan, and USMLE Rx are the most popular Qbanks. USMLE World should be the last Qbank you complete before taking Step 1, as it is said to most closely resemble the actual exam. If you start your Step 1 preparation before your school’s allotted study time, Kaplan and USMLE Rx are helpful resources to use alongside your coursework. Remember that Qbanks are study tools. Rather than worrying about the percentages you score on each set of questions, you should focus on identifying what key concepts and areas are emphasized. After each set of questions, you should read the explanations for both the correct and the incorrect answers. Doing so will help you gain a better understanding of the material and guide you in reasoning through any curve balls the test writers may throw at you. As you complete Qbank questions, you should underline details in First Aid that appear often. First Aid is not comprehensive; you should also annotate the text with additional details from your Qbank. Doing so as you complete Qbanks condenses multiple sources into a single, portable resource and allows you to review these pearls of knowledge throughout your preparation.

While you familiarize yourself with the essential learning tools, you can supplement your Step 1 preparation with additional resources. Some factors to consider when choosing supplemental resources include cost, time commitment, and learning style. Pathoma is a series of pathology lectures that provide a concise review of high-yield topics. The lectures include simple, but excellent visuals that present the material in a format conducive to long-term memory. It requires a significant time commitment though. The lectures cover 19 chapters, each about 2-3 hours. Picmonic (which I have found especially helpful for reinforcing pharmacology) is a memory tool extremely effective for visual learners. The program provides a creative picture for each high-yield topic with 5-10 details embedded in the visual to help you associate with the topic. This tool is flexible and can be easily integrated into study breaks during your allotted study period. Firecracker (previously known as Gunner Training) is a flashcard database of high-yield topics and USMLE style questions. Students have historically found Firecracker most helpful if started at the end of first year or early second year. Boards Review Series and High Yield have produced several subject review books with a more thorough overview of individual topics than is found in First Aid. When making your supplement selections, please keep in mind that more is not always better. It may be a more effective use of your time to master 2-3 resources than to get the gist of 5-6. Restrict your supplemental resources to those subject areas that are tough for you according to your Qbank statistics, or that are not as emphasized in your coursework.

Lastly, doing well on the Step 1 also requires a healthy mindset and sufficient self-care. Take study breaks to keep up with activities you enjoy. Remember that this process is a marathon, not a sprint. Doing well on Step 1 requires self-discipline and long-term commitment to your study approach. To commit something to long-term memory will require many repetitions at regular intervals. You will forget the material again and again. Instead of feeling discouraged, realize that the goal is not to know every morsel of information that could be tested—doing so would be impossible. Once you have reviewed a concept sufficiently, you will be prepared to handle almost any tricky questions the test writers may come up with for this exam. If you study meticulously and efficiently with these tips, you will maximize your potential. Good luck!