I’ve been getting a lot of questions lately about how to study for step 1 of the USMLE. While everyone’s strategy will be a little different, there are some things that you might want to think about as you’re preparing your own study plan.

I thought I’d break this into a series of posts. Today we’ll start with study strategies and resources. Later, we’ll talk about test-taking strategies and helpful hints offered by students who have just finished the boards.

First, some general facts about the exam:

  • Step 1 consists of 7 one-hour blocks of 46 questions, for a total of 322 questions.
  • You have 8 hours to complete the exam – that amounts to 78 seconds per question.
  • 75-95% of questions are in the form of clinical vignettes.
  • Passing is 188 (you need to answer 60-70% of the questions correctly).
  • The mean is 221 (standard deviation is 23).
  • Some questions don’t count (they are “test” questions for future exams).

You might think that the students who do the best on boards are those who know the most, or who had the highest grades in medical school. It’s true that the more you learn during the first two years (as opposed to during board review), the better. However, board success depends on more than just your knowledge of facts. It also depends on how thoroughly and efficiently you review for boards, how well you take tests, and – don’t discount this – your attitude. We’ll look at some review strategies and some general test-taking strategies in this post. Having an optimistic attitude is up to you (and you can do it!).

So what sources should you use? There are, as you probably know, tons of resources for studying for boards. Here are some that our students have found useful (the resources with the asterisks have been really, really useful):

Book and question resources
First Aid for the USMLE Step 1 (as an outline) *
Kaplan Q bank and Vignettes *
Goljan Rapid Review (books and audio tapes) *
USMLEWorld Qbank
Med Essentials (Kaplan)
Board Review Series books (especially Phys and Path but also Biochem,  and Cell and Molecular Biology)
High Yield books (e.g., Histology, Embryology, Anatomies, Behavioral Science)
Robbins Review of Pathology
Gold Series CD’s
BRS Flashcards for Pharm, Micro

Online resources
1. USMLE Step 1 2011 Computer-Based Content and Sample Questions. This resource gives you 150 questions similar to authentic board questions. It’s free! Here’s where to get general info and a description of the software you’ll need to download:  http://www.usmle.org/Orientation/2011/readme.html#Gen. And here’s where you download the sample test questions: http://www.usmle.org/Orientation/2011/menu.html. *
2. http://www.doctorsintraining.com/ *
3. http://www.usmleworld.com
4. http://www.score95.com/
5. www.usmlesteps123.com
6. www.usmlerx.com
7. www.apextesting.com
8. http://www.usmleconsult.com/other-products/other-products.cfm
9. http://www.studystack.com/USMLE

It’s easy to get overwhelmed with all of these possibilities! If I had to pick two resources that are most useful, it would be First Aid and Kaplan Q bank. First Aid is more of an outline – you need to supplement it with more detailed sources – but it’s a great outline. And the Q bank questions are also great for practicing your skills. Look at these resources, and if you need to add some of the others, that’s fine. Just don’t overdo it! You don’t have time to do everything. Pick a few tried-and-true sources, and be done with it.

Making a study plan
In general, no matter how you choose to attack the material, there are two things you need to do:

1. Make (and follow) your own, structured plan for reviewing high-yield material.
2. Answer lots of board-style questions.

Don’t skimp on either one! Build time for both into your plan (see below for a sample plan).

There are three basic ways to review material. You can do it by subject (anatomy, physiology, etc.), by system (cardiovascular, endocrine, etc.), or both. Most students use both methods of review. Here are some guidelines for each part of the review.

Subject-based review
1. It’s a good idea to review by subject following the chart on the inside cover of First Aid.
2. Make sure to cover the following subjects (note: It’s particularly important to do biochemistry and immunology/microbiology as subjects! You can’t expect to get everything you need to know in these two subjects during your system-based review!)

  • Biochemistry *
  • Immunology/Microbiology *
  • Anatomies (gross, embryo, histo, neuro)
  • Physiology
  • Pathology
  • Pharmacology
  • Behavioral sciences
  • Interdisciplinary (genetics, nutrition)

3. Pay attention to the general principles of each subject (First Aid has good high-yield general principles).
4. Get through the subjects section of First Aid at least 1-2 times.

System-based review
1. For each system, start with anatomy, then do physiology, then pathology, then micro, then pharmacology.
2. Make sure to cover the following systems (the order will depend on your own particular strengths/weaknesses):

  • Cardiovascular
  • Respiratory
  • Renal
  • GI
  • Dermatology/musculoskeletal
  • Endocrine/reproductive
  • Nervous system
  • Hematopoiesis and immune defenses

3. Each system should be covered in 2-4 days.

A review schedule for the remaining time before boards
So, can you do all this in the few months remaining before boards? Yes you can! Even if you haven’t started studying yet, you can do this. You  might break it down by month (February’s almost gone, so that leaves four months):

  1. March-April: subject-based review
  2. May-June: system-based review

You should plan to study for 6 days a week. 8-10 hours a day is best, it seems: students who do less than 8 hours or more than 10 hours fare less well. Make sure you do lots of practice questions. Every morning, do 20-25 questions on material you covered the night before. Later that day, do some more questions on material you covered on previous days.

Here’s an example of how this might work during your systems review. Let’s say you’re reviewing respiratory:

  • Monday morning: Review anatomy, embryology, and histology of the respiratory system.
  • Monday afternoon: Review physiology of the respiratory system.
  • Tuesday morning: Do 20-25 questions on respiratory anatomy/embryology/histology/physiology.
  • Tuesday afternoon: Review pathology. Do questions on previous systems.
  • Wednesday morning: Do 20-25 questions on respiratory pathology. Review pharmacology.
  • Wednesday afternoon: Do questions on previous systems. Review microbiology of the respiratory system.

Whatever you do, make sure you a) review both systems and subjects, and b) do lots of questions. The exact methods are, of course, up to you! These are just suggestions based on what I know has worked for our medical students.

Next up: some test-taking (questions-answering) strategies for boards…because boards questions may be different from questions you’re used to in medical school.