STEP 1 SUMMARY / GUIDE

- By Inu

USMLE Step 1 stats:

Semi-dedicated: 7 months
- Taking my time learning the ropes. If tallied up and averaged, probably 2-4 hours a day.
Dedicated: 4 months
- Reviewing now. If averaged, probably started at around 6 hours a day and then nearer to the
end went up to 8-10 hours a day (averaged - some days more some less).

Major Resources:
● First Aid
○ 2015
○ 2016
○ 2017(x3)
● First Aid for the USMLE Step 1 Q&A
● USMLE Rx Qmax
● UWorld
○ 1 pass + redid all marked/incorrect
● Pathoma
○ ~2 passes over 1 year
● SketchyMicro
○ 1st pass @ 1x speed
○ 2nd pass @2x speed

Minor Resources (little bits of each to help when major resources weren't enough to get it
through my head, YMMV):
● Youtube(Osmosis/Lecturio/Khan Academy/others)
○ sometimes other people explain stuff more succinctly than the resources above,
especially in terms of physio.
● Google/wikipedia
○ For those weird tidbits that you don’t know about
● Picmonic
○ When you ​still​ can’t remember
● Dr. Najeeb
○ When you really are coming from nothing
● Kaplan Medical videos
○ Really only use for embryology and gross anatomy, as well as if you can’t
 understand a specific topic

Scheduling service (recommended but optional):

● Cramfighter
○ If you’re like me and don’t know what to do everyday, this is a godsend. Be
reasonable and adjust so that your load isn’t a walk in the park, but it’s still
achievable. Find that sweet spot of feeling accomplished and challenging
yourself.
○ Helps to give you an idea of when you can book the exam or take your practice
tests.

Study Tips: Learn more than you need, and you’ll often recall just enough. Kinda that idea of
aim high so that even if you don't remember every tidbit, you're not falling short.

Uworld 1st Pass: 75% cumulative.

06/01/17 (~ 4 months out. After I finished USMLE-Rx) NBME 17: 213
07/16/17 (~ 2.5 months out. 20-30% through Uworld) NBME 18: 228
08/04/17 (~ 8 weeks out. 75-80% through Uworld) UWSA1: 258
09/22/17 ( 1 week out) UWSA2: 254
Step 1 Score: 251

Expanded guide:
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Preface
I'm going to try and be as straightforward as possible -- I came from a school which
prioritizes rote memorization. Very little emphasis (if at all) was put on actually developing good
clinical thinking or skills. It's not that there was no one there to teach any of those things (a
handful of teachers did), it was that in the course itself it was almost useless. Skills like that had
very little impact on your grades, and questions for exams were repeated so often that just
going over previous test papers would be more useful to ace an exam (since 80% of the
questions were exactly the same as past years). Along with that, due to some language
barriers, answers for tests were literally graded on the basis of if they were word-for-word of
what was presented on lecture slides. There was no room for explaining your understanding of
a subject, if your explanation wasn't exactly the way that the teacher wrote it. Those who did
well at memorizing and regurgitating, would find themselves doing well on the exams.
That was just the way things worked. Everyone did it, teachers promoted it, you got great
results on your tests, and so there wasn't a reason to break that mold. This all was a false sense
of adequacy. As anyone who has started studying for the USMLE can see, that type of learning
is not at all what the USMLE demands from you (nor what medicine does). The thing is, that
was my background. I didn't have any science background, and the time I had to build it (med
school) was wasted participating in a rat race of getting solid scores on tests that didn't
adequately assess my knowledge. I may have performed well in the race, but ultimately it was
meaningless for what I was actually training to become. In the end, you cannot change where
you come from. You cannot change your past, nor the mistakes that were part of it. All you can
do is point ahead and change where you go from now on.
Needless to say, when I looked at step 1 questions for the first time in my final years, I
was absolutely freaked out. It felt like I was punched in the gut, after going through five years of
schooling for it to not work when I needed it to. I couldn't come to terms with it, I went between
thinking either I am simply stupid or being angry at my university. Neither of which was going to
help me on this exam which I had to take to achieve my goals.
I didn't do much else in terms of step 1 studying for a while. I couldn't bear to look at any
questions, and I didn't even know where to start fixing this problem. I couldn't move forward,
because it meant I had to come to terms with certain things which I struggled to accept about
myself. That was the biggest barrier for myself, taking responsibility and autonomy of my
circumstance and choices in life. Stop blaming my school. Stop blaming my friends who were
"all" doing the same thing as I was at the time. Stop blaming people in my life for "pressuring"
me to go down this path. Stop blaming the system.
See, If you push responsibility of your situation on others, you're not likely to change the
only aspect of a situation that you have control over, yourself. You're not going to feel the
ultimate desire to pull yourself out of the hole you have found yourself in. Deep down you'll
believe someone else will do it for you, because in your mind they had a part in putting you
there. If you relate to what I'm saying, then you’ve got to dig deep and stop yourself. You're not
doing yourself any favors. You might feel like crap now, but you’ll feel better sooner than you
think. What you have to do is rebuild yourself, pull yourself up out of that pit and be excited for
what you are going to accomplish. By taking responsibility, you will have earned the right to be
proud of crossing the hurdles ahead of you.
This brings me to my next point -- not everything is going to work out perfectly, and
sometimes they won't even work out well. Hopefully my post will help you make some better
decisions on your path, but trust me when I say you're going to have to have your own personal
struggles that will feel like no one but you is going through. You will have to get out of those
ditches too and move forward the best that you can, no matter how many times you fall back in.
Your life and circumstance is unique, but you will still have to try to improve it where you can.
I remember before I started studying, people close to me would tell me "Oh I know
'so-so' who when they had to study for the step, just put themselves in their room for 3 months
and told their parents to not disturb them or have anyone over. You should do that!" Now, I
know they meant well, but not everyone is in a situation which can afford that type of lifestyle.
Some people have jobs, some people have kids, and I had my own circumstance to work within.
I have a dad with cancer I care for. I had huge family problems going on. I'm in an LDR, and
have that to think about as well. I didn’t have my own car. I didn't have much money (though I
am fortunate to have had family for my basic necessities). I slept in not so comfortable places
with household disturbances (kids, people coming in and out etc) and little privacy.
That’s my circumstance, but I did what I could to either make a shitty situation bearable,
or to find an alternative somehow. I gave myself the weekends off to take care of dad and the
house. I worked around my dad’s chemo. I found an outlet for the emotional difficulties with
family, often talking to my friends when I needed to. I tried to use my mornings on the weekends
to beat the time difference and spend time with my SO. I borrowed a bicycle and biked to the
coffee shops where I studied. I didn’t have a laptop, so I used my android tablet with a stand
until I had to get one. I used FA as an ebook until I had to get the text. I used food stamps to get
some groceries and took food with me often. I got a sleeping mask and earplugs and a foam
sheet plus a few blankets to lay on, so I could get better sleep quality.
What I'm trying to say is this: whatever your circumstance, all you can do is your best. If
you can change something, do it. If you can't, make the best of it. If you still can't do that, then
come to terms with it and deal with it until you can change it. Find an outlet for the stress you’re
bound to build up. If you don't have something like that, make one.
This journey for me was all ups and downs. It wasn’t normal, it wasn’t even something I
was familiar with. Yet through all of it, I came out on the other side and if I can do that, whoever
is reading this can likely do it too.

---

UFAPS+

This is how I'm going to break things down in terms of where someone should start for
this exam and what they should do. Feel free to adjust this to however you need, I simply aim to
give some idea structure or context to people who like me were very wary of how to prep for this
exam.

EASY MODE
“Learning the ropes”

NBME = I know I won’t get much at all so I’m not wasting $50

● I recommend starting here for people who like me, are really approaching this from a
point of very little knowledge and confidence. If you’re like that, don’t skip this because
you likely will not be ready for later Qbanks, and may end up wasting them. If you have
more knowledge (I’d say if an NBME puts you near passing level), this won’t harm you
but it will add some considerable time to your prep.

What to use:
● FA
● First Aid for the USMLE Step 1 Q&A
● Pathoma
● Sketchy Micro/Pharma
● Extra:
○ Osmosis, Lecturio, Youtube, Dr. Najeeb, Kaplan embryology/anatomy videos

First Aid​:

This is the first time you'll be going through first aid. This book is known as the bible for a
reason, it's not a textbook that you'll read through and through and come away with a complete
understanding of the content. Like the bible, lots of little details are littered throughout the book
in different sections and areas, all of which are relevant to a variety of disease processes, drugs
and physiology. This pass is all about getting an overview. You'll likely be utilizing diagrams to
help understand things for the first time, but not all topics will have diagrams. Use youtube,
google or any other text when you're having trouble understanding a concept. Try to understand
a topic before you move forward. While you're likely to forget many pieces of it, a part of it will
remain and when you do go over it again later it’ll be easier and you'll know that you were able
to understand it at one point.
I was able to finish around 20 pages per day. Your mileage may vary. I don't know if
annotating would be useful at this point, as likely a majority of the topics will be brand new and
hence you'll be writing a lot. I say focus on understanding, leave the book largely untouched
(other than if you want to draw in a diagram to help). You'll have plenty of time later to destroy
your book.

First Aid for the USMLE Step 1 Q&A​:

A Qbank to match your first aid studying. This book is a bit outdated yes, but what it has
that makes it special is its alignment with the FA text. Every chapter in first aid will have an
associated section in this bank. And since it's outdated, also all the content in this Qbank will be
present in the text. So after you study a chapter, you're going to do the questions in this book
that is in the same chapter. The questions are easier for sure, but that can be a good thing if it's
your first time into this type of test taking. It helps begin the thinking process in the questions
you'll see for the rest of your studying. Time yourself if need be, but I think you'll have enough to
get timing once you're on Rx and UW.
Remember to read all the explanations, for all the answer choices regardless of whether
you got the answer correct or not. When you're done with the entire bank, do the test banks.

Pathoma​:

Hussain Sattar is amazing at putting concepts that are fundamental to disease

processes into relatable terms for people new to pathology. He often explains a disease process
by finding everyday parallels, which is perfect when you don't have a strong basis in pathology
and physiology. Watch his videos alongside the sections in FA or even before the pathology
sections of FA, as the FA text occasionally has more info that is more easily understood once
the basic pathophysiology is. I would recommend at this point to pay attention and often come
back to his lectures on growth adaptations, inflammation and neoplasia. When he discusses
later disease processes, challenge yourself to dig within those basic concepts and remind
yourself of how that process occurs. While forgetting details is inevitable along the journey of
Step 1 prep, a good amount of active recall here will save you time and headache in the future
when digesting new information.

Sketchy Micro/Pharma:​

This is the time where we'll take advantage of a memorization background and try and
get in all those (largely) tiny details in your head. Microbe structures, toxins, microbe names,
antibiotics, drugs, etc. These you need to know cold, and often they're unique and don't have a
underlying process to connect multiple microbes. SketchyMedical really does an awesome job
of explaining micro through a storyboard, and from the day I first watched sketchy to the day i
took the exam, a lot of the images and stories stayed in my head. They'll help you immensely
when it comes down to remembering differences. I did a first run at 1x speed, and then after that
I increased the speed as a review.
Don't feel shy to rewatch a video or section if you need to, maybe using their review
function to make it more active. I used Micro, but I wasn't able to use Pharma entirely because it
wasn't entirely released when I started studying. With that said, I watched a few and it is very
similar, with the only differences seeming to be there is a bit more content to be understood for
each of the pharma videos as well as the narrator change. I believe this to be a must-use early
on even if you don't come back to it later, as you'll likely draw the images back from your
memory whenever you need to work with microbes/drugs.

Extra: Osmosis, Lecturio, Youtube, Dr. Najeeb, Kaplan embryology/anatomy

videos

Often along this course you're going to need some other piece of information to really
solidify a picture or concept in your head. This is often the case with biochemistry, embryology,
and physiology topics as FA is largely a high-yield concise text. Use whatever you are
comfortable with. My recommendations though, are Osmosis, Lecturio, and Dr. Najeeb, and a
few kaplan videos. Osmosis is awesome with visually explaining processes, and they have a
massive amount of videos. It's animated and narrated well. I highly recommend it for
vasculitides and renal pathology as I really needed a visual companion of sorts.
I only used Lecturio for lipid metabolism and hyperlipidemias. It was a god-send in
explaining those two subjects to me. Dr. Najeeb I only used extremely early on, and I only really
recommend him if you really don't have any clue what the point of something is (for eg. EKG,
TCA). His videos are very long (you need to speed it up) and aren't focused on step 1 alone, as
they branch off into derivatives of step 2 and 3. That could be good or bad for you, but just be
wary.
I used the 2010 Kaplan medical videos for embryology and gross anatomy as they were
shorter videos on concepts that aren’t explained well if at all in FA. Those two topics don’t get
into too much details, but they really provide underlying concepts for understanding a lot of the
anatomy/embryology details mentioned in FA. Otherwise you won’t have much of a conceptual
basis to fall back on if you forget those things. I also used their biochem videos only when I
needed it for a particular cycle or pathway (nucleotide synthesis/metabolism) that I wasn’t too
comfortable with. I don’t recommend you watch all their stuff as it often covers a whole bunch of
stuff that is already present in FA and resources above, and it has more low-yield details than is
often required.

INTERMEDIATE MODE
“Putting it all together”

NBME = I’ll pass, but not by much

What to use:
● FA
● USMLE Rx
 ● Pathoma
● Anki

First Aid​:

Welcome back. You just finished this book and are now familiar with it's content and
have laid a good foundation. Now FA truly becomes a review book. This run you'll likely go a bit
faster, and pick up on the smaller details within each topic. This time you'll also be annotating.
As you do questions, add in tidbits that you didn't know and that help expand your
understanding of each topic.

USMLE Rx​:

Things are getting good now and will challenge you more. This qbank is closer in
difficulty to the actual exam, with good questions and explanations. Again, read all explanations
and diagrams. The best thing about this qbank is its fallback on the FA text. It will often display a
FA section that the question is related to, which is a great opportunity to re-read the section.
The more review the better. It's great when you make a mistake, say on DPGN, that at the same
time you are able to review all the nephritic pathologies. Helps remind you of the bigger pictures
and differentiating factors. The qbank also has keywords which allow you to easily look up more
info on wikipedia, google, FA, or pubmed. Annotate FA as you go, to keep all the interesting
things you learn handy.
I recommend you do timed/random/40q, as you should be moving fast enough through
all this stuff that you'll finish the corresponding subject in FA/Pathoma far before you finish the
amount of questions relevant to that subject in Rx. I was only able to get 2 blocks done a day,
as I spend 1 hour to do the block and often ~2-3 hours reviewing it. Remember to review all
explanations and diagrams, regardless of whether you got it right or wrong.

Pathoma​:

Review time for this too. Increase the speed and watch it all the way through, again
alongside FA. Use the text if you need.

Anki​:

This is the time to start making flashcards for stuff that you continue to struggle with. I
recommend using a PDF form of FA and the snipper tool (or a Mac equivalent) plus cloze
deletions to easily add cards to your deck. If you don’t know how to make cards easily, there are
a bunch of threads on it on reddit and videos on youtube. I often used Anki for small and
confusing details, since I'd often forget them. Things such as algorithms, P450 modulators, the
different rash types, biochemistry stuff, drugs etc. Add whatever you feel you need. Don't worry
too much about adding too many cards, just focus on making the cards quality. Make them
something that helps your memory and that makes a question unique. You could also use
already made banks like brosencephalon etc. They're great, but since they're not personalized
you may be spending a lot more time on stuff you're better with rather than topics you need to
review more often. 100 new cards a day usually took ~2 hours.

​------
Take an NBME after this.
------

ADVANCED MODE
“Polishing”

NBME = I’m doing pretty good

● FA
● UWorld
● Pathoma
● Anki

First Aid​:

Similar to last time, you're going to go through FA (albeit faster) alongside Pathoma
while annotating from Uworld.

UWorld​:

Uworld is the gold standard of Qbanks for a reason. This qbank has brilliantly written
questions that really drive your thinking. It makes sure you're not only competent, but also that
you're confident. There are few low yield things you'll learn going through, but out of all the
Qbanks this one is the one you don't want to miss a word of. Read all the explanations, pay
attention to all diagrams and videos. Understand, and move on to the next question. Timed
random 40q is the way to go all the way. Here's my tip: don't get down too much when your
scores fluctuate. The average score is around 65 or something, and it increases as you go
along. I started at 60s and went up to 80s by the end. So will you. Remember to dig deeper on
things you don't quite get, or you're unfamiliar with. I'd recommend marking anything you are
stumped by during the test, as well as all the questions you got wrong.

Get the UWSA1 and 2 + Qbank package. Do UWSA1 once you finish Uworld. After
finishing Uworld, maybe think about doing another pass of just what you marked. It's not super
necessary if you're consistent with your blocks as well as reading and understanding the
explanations.

Pathoma​:

High speed train! Go through it again, speeding through and then doing the FA chapter.
If you're entirely comfortable with the stuff in this, and you've annotated FA well, you could skip
this (or only do what you still are weak on)

Anki​:

By now, you should have a decently sized deck that is largely reviewed already if you
have been doing the questions regularly. Keep up with it, and add those big weaknesses to
really tighten up those loose ends (for me it was lysosomal storage diseases, DNA and RNA
virus structure and characteristics, P450 inhibitors, Renal tubular acidosis).

---
Take UWSA2
---

BEFORE THE EXAM

At this point hopefully your exam date is real close, and depending on how much time
you have left you can do a broad review or a more concise one. Cover in FA what you need, go
through Anki, watch whichever videos you need, but also get yourself into the right zone for the
exam.
I had a week left, so I did a very fast run through FA, Pathoma, and Anki. FA I managed
to do around 60-70 pages a day, as a somewhat general refresh. I timed it so my behavioral
sciences/biostats were the last chapters are done (since I forget equations first and needed it for
the exam). Two days before the exam I did all the rapid review section in FA, the behavioral
science chapter and I reviewed the renal and cardiac equations.
On the day before the exam I did just the equations part of rapid review in the afternoon
(15 minutes), and other than that I just went ahead and relaxed. Get some good sleep, calm
your nerves. Don't change anything on the exam day that you've been doing normally. If you've
been drinking coffee, drink it. If you've been jogging in the morning, jog. I would take some
acetaminophen before the exam if you think it’s a chance you may get a headache or some
other pain during the exam.
I recommend getting a sweater just in case (I used mine), as well as wearing a simple
t-shirt and pants. The less pockets on you the better. They’ll have you empty your pockets each
and every time you check in or out, so the less pockets you have the quicker that will become
and you’ll be get more break time/be able to estimate your break time better. If you’re an
earplugs person, bring your own. There’s usually a few click sounds from other people using
their computers.
Take a good lunch with you and plenty of snacks and drinks (it’s better to have more
food than less). Time your breaks well. I did 2 blocks then 10 minute break. Did that twice then
took a 20 min break, then 2 more blocks and another 25 minute break, then went back in for the
last block. I had 5 min of break time left just because I wanted a little bit of a buffer so there’s
very little chance I’ll go over on time.
Remember that you’ll be okay! By now you've been practicing for months, and are a
veteran of these questions. It'll just be like your practice tests, and you will do it just as always,
one question at a time. After this, you'll be done! Congratulations!