1 Step at a Time

Q: “How does one prepare for USMLE Step 1? Could you suggest us briefly how many months one should read First Aid and how many months does one take to finish UWorld?”

A: At the outset, I'd like to say that the following answer is one that has been subjectively answered. The basis for the following points has been taken from shared experiences of the team at Dumb-CQs. We do not bear any affiliations with the resources we mention in this article.

To answer your question, I would like to begin by discussing the anatomy of the Step 1 Exam.

The Step 1 exam is an 8 hour exam comprising of 7 blocks of 60 minutes duration of around 40 questions each.

In this exam you will be tested in the basic sciences viz. Anatomy, Biochemistry, Physiology, Pathology, Microbiology, Pharmacology, Behavorial Sciences, Ethics and Biostatistics.

That being said, most of the questions are based on clinical encounters and patient profiles, so a solid understanding of disease presentations and clinical acumen is essential for acing the exam.

At the end of the exam you will get a three digit score which cannot be changed if you pass.

Hence at the outset we remind everyone that this score will be with you for seven years and it is better to take your time with it. Some people take 6 months for preparation while others may take even upto 1.5 years.

Resources:

Preparing for any competitive exam involves two parts:

1. Learning your concepts
2. Practicing and enhancing your skills through tests

For A) You would need a primary learning tool:

The ones my friends and I used was Kaplan Step 1 Notes with Lecture Videos. We used it for every subject except Pathology.

Kaplan notes with the videos is a very comprehensive tool for grasping concepts and exposing yourself to everything. However, one must note that it isn’t ‘High Yield’ ie. not everything mentioned is statistically significant to show up in your exam, but we highly recommend you start off with this as it will clear your concepts, and offer you a lot of Eureka! moments and build a solid base to grasp (and memorise) things. They also have a separate question bank book that you can finish intermittently after the completion of every chapter.

If you are balancing studying with work it would be realistic to finish 2 subjects a month, if you’re dedicated, and that would amount to about 4 months to finish the course.

For Pathology, we highly recommend Pathoma by Dr Husain A. Sattar, he as an incredible gift of simplifying concepts and presenting them in a very lucid, no-nonsense manner through video and text. Pathology is arguably the most important subject for Step 1 and mastery in this subject will make you a great test taker (and clinician)!

For Ethics we recommend USMLE Medical Ethics by Dr Conrad Fischer, it covers nearly every ethical conundrum you’re likely to encounter in your exam. (And hopefully not in your practice!)

Now, after finishing with your concept building, it’s essential to summarise and recapitulate what you’ve learnt, and it would be excellent to go through the above texts once again but that’s often impossible owing to time constraints and mental fatigue.

The best book, also considered the gold standard book for Step 1 is the First Aid for Step 1. It’s a great book, very high-yield and packed with frequently asked facts. It’s a difficult book to start your preparation with but if you can do 5 pages daily with everything else in parallel, it would do you good.

Once you’re done with Kaplan and Pathoma it is imperative that you finish First Aid at least twice! Their facts should be firmly ingrained in your short term memory before the exam.

B) Practicing through tests

This can be achieved by two tools: UWorld and NBMEs

UWorld:

This is an incredible, easy to use question bank that covers every subject and is very close to the actual test (the layout is practically the same). One must also remember to use it primarily as a learning tool! Don’t be disheartened if you’re getting a lot of incorrects in the start, and we recommend you add the additional things you learn on UWorld onto your copy of First Aid for consolidating your information! Finish the Qbank and simulators before you give your exam.

It would be realistic to do about 40 questions per day, so about 70 days should be enough to complete UWorld.

NBMEs: These are practice tests offered by the National Board of Examiners, there are about 5 of them available every year and they offer an accurate representation of your possible score +/- 20. Attempt your exam only if you consistently score within 20 points of your desired Step 1 Score.

So looking at all the above: 4 months for Kaplan, 1.5 months for UWorld and another month for practice tests - 6-7 months should be adequate for Step 1 if you are focussed and dedicated.
Again, this varies from person to person and your NBME scores should be your marker to assess your readiness for the test.

Additional Tips:

• Preparation is a marathon not a sprint, consistency is more rewarding than occasional all-nighters!
• Discuss with your peers about the things you learn and the exam process. It can get very tiring to pursue this all alone. WhatsApp groups to discuss questions are always a good idea!
• Identify your weak points in your post test analyses and work on them!
• Again, do not hesitate to delaying your exam if your scores aren't up to the mark in your NBMEs, a bad score in hand is worse than a great score in the bush!

By Dr Ashwin Mahesh