Step 1: First Aid

I bought First Aid for the USMLE Step 1 (2010) toward the end of the first semester of my first year, but I didn't open it and start studying from it until the middle of my second semester of my first year. This is a common story and a common mistake.


There's a lot of hype about First Aid, and for good reason. Back when I first started freaking about Step 1 (the vast majority of medical students do at one point or another), First Aid was to me like an anchor: something tangible and finite. I thought that all I had to do was learn everything in First Aid and I'd be fine. I'm sure many other medical students have felt the same way. In reality, First Aid is only a convenient outline of what must be studied to do well on the Step 1 and to be prepared for clerkships. That's why for me it became so important to study from First Aid as I worked through my classes: I came to view my coursework as one big Step 1 prep course.

I wish I had started using First Aid during my Blood and Lymph (Hematology/Oncology) and Disease and Defense (Immunology) courses at the beginning of second-semester-first-year, but I only began studying seriously from First Aid starting with the cardiovascular block. This consisted of taking notes in it during lecture and constantly using it as a reference as I moved through my courses. I read the relevant sections in First Aid before their corresponding lectures, which definitely helped in terms of repetition.

I did this for the pulmonary and renal blocks, too. During Summer vacation after my first year, I re-read the cardiovascular, pulmonary, and renal chapters and also went through the other chapters that we had already covered: hematology/oncology, immunology, biochemistry, behavioral sciences, psychiatry. I also read through the neurology chapter in preparation for that block in the Fall.

I similarly pre-read the gastrointestinal, endocrine, reproductive, microbiology, etc... chapters before the start of their respective courses. When I say "read," I really mean "read" and not "memorize." I just got a general feel for the nature of the material I would be learning, the general structure of how it would be presented, and when I came across something that looked interesting, I looked it up to learn more about it.

So, by the end of my second year, I had read through First Aid once all the way through, having read some chapters more than once. I think this is a reasonable goal for most medical students preparing for Step 1.

Some people like to un-bind the book, 3-hole-punch it, and stick it in a binder. I was resistant to that idea, mostly because I like to hold a book in my hands and flip easily back and forth from one page to another. The advantage to hole-punching First Aid, though, is that you can mix in useful diagrams or tables from lecture notes or other resources that complement First Aid or better summarize the material. I finally did this in the middle of Year 2 Semester 1 for less than $10 at Kinko's and wish that I had done it earlier.

By the time the dedicated study period rolled around, I was really only using First Aid as a guide for studying a given subject in greater detail. For example, when I first started reviewing embryology, I first flipped through that chapter in First Aid. I had already made a bunch of highlights and underlined what I thought to be important information and made notes in the margin, so this went fairly quickly. Then, as I was reading through a more detailed text or reference (in this case, Langman’s Medical Embryology), I would refer back to First Aid only when necessary.

Bottom line: Overall, First Aid is as necessary for studying for the USMLE Step 1 as everyone says, but its limitations should be recognized, and it should be used for studying while going through the basic science curriculum.