As most medical students know, the U.S. Medical Licensing Examination Step 1 — or “The Boards,” as the exam is commonly called — is challenging, and arguably the most difficult of the three-part exam series. Understanding what’s on the test and how to prepare for it are key to surmounting this first hurdle on your path to a medical career.
The USMLE Step 1 tests your ability to apply a vast array of basic science knowledge to medical practice. In short, it is a multiple-choice, computer-based test that takes about eight hours to complete. The exam content covers the systems and processes of the following science topics:
- Behavioral sciences
- Biostatistics and epidemiology
- Molecular and cell biology
Follow this link for a comprehensive overview of the USMLE Step 1 and its component parts.
When Should I Take Step 1?
The best time to take Step 1 is when basic science knowledge is fresh in your mind and you’ve had sufficient time to study. The Boards generally require the most preparation of all of the USMLE steps, so most medical schools build one to two months of dedicated study time into the curriculum once students complete the basic science courses. And many test-prep companies suggest two to three months of nearly full-time study to prepare adequately.
Medical schools that follow a traditional program structure recommend taking Step 1 late in the second year, which is the point at which students will have finished the science curricula that forms the basis of the exam. By contrast, those schools that have adopted a newer program architecture that weaves together these basic science classes with early clinical experience may suggest that their candidates take Step 1 at any point between the end of the first year to the third year. Check with your medical school to learn its specific recommendations.
There are a range of different resources that students can utilize to prepare for the USMLE Step 1. These fall broadly into three categories:
1. Prep Courses
Test-prep courses offer structured classroom lectures and preparation materials.
Your Medical School
Some medical schools offer preparation courses as part of the curriculum. If courses are available, it’s definitely worthwhile to avail yourself of the opportunity to take them.
As with the MCAT, there are Step 1 preparation courses offered by well-known national companies like Kaplan as well as smaller, regional providers. And while most students are familiar with the big names, some of the lesser known courses, such as USMLE Success Academy, Doctors in Training, and Becker Reviews receive higher reviews.
Please note that you do not need to take a live course to excel at USMLE Step 1. Courses are best for students who do well in structured settings with a defined program and schedule. If you decide to pursue this option, be sure to ask about the timeline, study materials, teachers’ backgrounds, student-to-teacher ratio, and the company’s success rate for each of the courses you’re considering. These classes can run into thousands of dollars, so be sure you’re getting exactly what you need if you go this route.
2. Question Banks
Question banks are essential for USMLE Step 1 preparation. They provide hundreds of questions that students can take as full tests, blocks, or by category — either timed or untimed — and they provide explanations of each answer.
Each year, USMLE offers free tutorial and practice test items for Step 1. These include a tutorial, overview, and three question blocks, which can be timed. This is a great resource to begin with so you can quickly learn how to navigate the test’s computer system and get comfortable with the question style. The program is only available for PCs.
The National Board of Medical Examiners (NBME) offers a comprehensive basic science self-assessment (CBSSA) for $50. This resource, in conjunction with the USMLE free practice questions, is helpful to see where you stand early in your preparation and to highlight those areas in which you need to focus on more closely.
Proprietary Question Banks
There are many companies that offer their own proprietary question banks. Students can subscribe for a fee, which affords them access to the questions for periods typically ranging from 30 to 180 days. Several of the most popular options are UWorld, Kaplan QBank, and USMLE Rx Qmax.
Free Question Banks
There are also free question banks available, if you are willing to scour the Web and cobble together resources. Ben White, a medical resident at the time of his posting, gathered an excellent set of these resources for readers of his blog. That said, collecting all of these questions is a time-consuming undertaking, and you’re probably better off paying (if you are able) for the formal resources so you can spend your time studying.
3. Study Guides
“First Aid” has long been known as the bible of Step 1 preparation books. Many argue that a good schedule combined with “First Aid” and a question bank are all you need to excel on Step 1. As you study, transfer all of the notes you’ve taken in other books into First Aid so that it becomes the only text you use in your final review.
There are many preparation books for each subject, but be careful not to get overwhelmed by trying to study from 20 different books at the same time. The best strategy is to use one board book as part of your classroom studying while you are learning the subject, and then transfer these notes to “First Aid” when you begin Step 1 preparation. Kaplan Lecture Notes rate highly in most subjects, but there are others that are effective, as well.
Below is a list of the most popular Step 1 books by subject:
Anatomy: “High-Yield Gross Anatomy”
Behavioral Science: “High-Yield Behavioral Science” or “BRS Behavioral Science”
Biochemistry: “Lippincott’s Illustrated Reviews: Biochemistry”, “BRS Biochemistry and Molecular Biology”, or “High-Yield Biochemistry”
Biostatistics: “High Yield Biostatistics”
Embryology: “High-Yield Embryology” or “BRS Embryology”
Genetics: “High Yield Genetics”
Histology: “High-Yield Histology” or “BRS Cell Biology and Histology”
Immunology: “High-Yield Immunology or “Review of Medical Microbiology and Immunology”
Medical Ethics: “Master the Boards USMLE Medical Ethics: The Only USMLE Ethics High-Yield Review “ or “Khan's Cases: Medical Ethics”
Microbiology: “Clinical Microbiology Made Ridiculously Simple”
Neuroanatomy: “High-Yield Neuroanatomy” or “Clinical Neuroanatomy Made Ridiculously Simple”
Pathology: “Rapid Review Pathology” (Goljan)
Pharmacology: “Lippincott’s Illustrated Reviews: Pharmacology” or “Katzung and Trevor's Pharmacology”
Physiology: “BRS Physiology”
Once you’ve decided whether you’re going to enroll in a prep course, and which question bank and books you’ll be using to study, you can also begin to practice the following preparation strategies:
Start preparing for the USMLE Step 1 the moment you set foot into medical school by using board books as you are taking courses in each subject. For example, while you are studying microbiology, review “Clinical Microbiology Made Ridiculously Simple.”
Before any official studying begins, make a schedule that includes breaks and time to eat, as well as days for taking full practice tests. If your schedule isn’t working, change it so you can get to all of these activities — each one is important!
Take a practice test early to see where you stand.
Complete as many practice questions as you can. Go through your question bank — then go through it again.
Be sure to do as many full-length practice tests as possible in a test-like setting to ensure you are finishing blocks in the allotted 60 minutes and preparing your body for a long test day. Prometric Test Centers allow you to take a USMLE practice test for a fee that ranges from $75 to $266, depending on where you are taking it. This practice session is worth every penny. Schedule it at least a month before your actual test date so you have adequate time to sharpen your skills if the test doesn’t go as you hoped.
Study what you don’t know. It’s easy to fall into the trap of studying the subjects you’re already confident in, but if you’ve mastered a subject, spend time focusing on areas in which you are struggling.
Study with a friend, and use humor and other potential mnemonics to help with memorization. Remember, the amygdala (emotion) is connected to the hippocampus (memory).
Take breaks in your study day. Get outside. Exercise.
-If you are retaking the test, focus your preparation on the areas in which you did not excel. Fortunately, the score report from your previous test provides graphical performance profiles for each testing category that will allow you to see where you need the most work.
When the test day arrives, here are some tips to help you approach the USMLE Step 1 with assurance that you will be successful:
Know how to get to the test site, and do a practice run. There is nothing worse than feeling rushed on the morning of the test.
Get to the test site at least 30 minutes early, and be sure to have a current picture ID with your signature, along with a printed copy of your scheduling permit.
Bring a lunch, snack, and ear plugs.
Answer every question. Wrong answers do not count against you.
Think of the exam as seven mini-tests — that is, seven blocks of 44 questions each.
Focus solely on the block you are in, complete it, clear your mind, and move to the next block.
Be sure you have checked all the questions in a block before hitting “end.” Once a block is ended, you cannot re-enter it to review your answers.
Gain extra break time by skipping the optional 15-minute tutorial. At this point, you should be so familiar with how the test works that you won’t need the tutorial — but an extra break will be welcome.
Decide your plan for breaks ahead of time, and practice the strategy. For example, you could try the following plan:
- Complete two blocks
- Take a 10-minute stretch/bathroom break
- Complete two blocks
- Take a 30-minute lunch break
- Complete two blocks
- Take a 10-minute stretch/bathroom/snack break
- Complete one block
Or you could decide to complete four blocks, take a quick lunch break, and return to complete the final three blocks. Whatever strategy you choose, perform it over and over on practice tests to simulate the real test environment and train your body to become accustomed to the challenge of a long test day.
Get a great night’s sleep the night before the exam. Anecdotally, students and admissions counselors report that this night of sleep is one of the most important (and easily accomplished) steps you can take to enhance test performance.
Though the USMLE Step 1 may be one of the most challenging exams you’ll ever take, with diligent and focused work, it is possible to be prepared and confident when you walk in on test day.