Step 1: Studying for USMLE Step 1 during my first two years

Note: This post is mainly intended for medical students looking to hear what others have done in terms of studying for the USMLE Step 1. It will likely not be very interesting to anyone else.

I have purposefully avoided writing about how I study for the USMLE Step 1 until now for two major reasons. First, there tends to be a high level of anxiety among medical students about studying for this test, and I prefer to avoid accidentally stepping on anyone's toes by needlessly broadcasting my approach to studying. More importantly, until now, I hadn't actually gone through the process and had time to look back and assess what worked and what didn't. Now that the whole thing is behind me, I feel that I am in a good position to describe how I studied for the USMLE Step 1 during my first two years of medical school and to comment on what I might have done differently.

Before jumping in, it's important to point out the obvious: everyone is different, with their own personalities and their own study habits and their own preferred ways of learning. What works for me may be ineffective for someone else. I am the kind of person who likes to start early and work steadily on a large project, so my approach to studying for Step 1 may not be as relevant for people who like to procrastinate or to cram as much studying as possible into a short period of time.

It's also important to point out that my perspective and experiences will have the greatest significance for people going through my program at the University of Colorado School of Medicine, which has an organ systems approach. For ease of reference, here is an outline of the basic science curriculum during the first two years:

Year 1, Semester 1:
* Human Body (Anatomy)
* Molecules to Medicine
* Year 1: Winter Break
Year 1, Semester 2:
* Blood and Lymph + Disease and Defense
* Cardiovascular + Pulmonary + Renal
* Year 1: Summer Break
Year 2, Semester 1:
* Neurology
* Digestive + Endocrine + Metabolism
* Winter Break
Year 2, Semester 2:
* Life Cycles + Infectious Diseases
* Dedicated study period
The Bottom Line


Year 1, Semester 1: Anatomy

I didn't do any studying specifically for the boards during Anatomy, and that's the way it should be. However, the one thing I would do differently during Anatomy, with respect to Step 1, is to take the embryology lectures more seriously. I used Langman's Medical Embryology as a reference during Anatomy and ended up finding it extremely useful as a resource when I reviewed embryology during the dedicated study period.

Year 1, Semester 1: Molecules to Medicine

I was so exhausted after finishing Anatomy that I wasn't really thinking in terms of studying for the USMLE Step 1 during Molecules to Medicine. I did buy First Aid for the USMLE Step 1 toward the end of the semester, but I didn't even open it for a couple months. If I could do it over again, I would have had First Aid in my hands before Anatomy ended, and I would read over the relevant sections as we moved through Molecules to Medicine. It's really just scattered parts of the Biochemistry section and some organ system sections, but the point is that it would get me used to doing that for the rest of my courses.

Year 1: Winter Break

I didn't do any studying for the boards over Winter Break of my first year. If I could do it over again, I would flip through First Aid to familiarize myself with its organization and layout. I would get a better sense as to the kind of material I would be expected to learn over the next year-and-a-half. I would also read more carefully through the Immunology, Hematology/Oncology, and Pharmacology sections because those are all covered by Blood and Lymph and Disease and Defense. The same goes for reading relevant sections in First Aid before all of the other blocks.

Year 1, Semester 2: CVPR

CVPR in the second half of Year 1 Semester 2 marks a turning point at which the curriculum becomes much more clinically-oriented. I started using a question bank during the Renal portion of CVPR and found it very useful to prepare for that exam. If I could do it over again, I would have started using the USMLE Rx question bank during the Cardiovascular portion of CVPR (see this post that addresses question banks specifically). I also would have bought BRS Physiology and actively read through the relevant sections as we covered them in class.

Year 1: Summer Break

Whether or not or how much to study for Step 1 during our Last-Summer-Vacation-Ever can be a sensitive issue for medical students. I did study for Step 1 over Summer break, but I felt like I shouldn't talk about it with my classmates. It's not like I hid the fact that I studied, but I didn't want to come across as grandstanding or showing off, and I didn't want to make someone feel bad if they weren't doing any studying themselves.

I didn't keep track of my studying over the Summer like I did during the dedicated study period, but I probably spent an average of 3 hours per day studying. All of this consisted of going through First Aid (see this post) and doing practice questions (see this post). I think that this was a good balance between studying and enjoying my Summer vacation.

Year 2, Semester 1: Neuro and DEMS

Once second-year started, I felt like I needed to be more systematic about my studying. Reality had set in that Step 1 really wasn't all that far off. I tried to map out how many pages of First Aid I would read per day in order to read through it all again before Winter break. The idea was to move through separate topics while also covering the Neurology chapter during the Neuro block and the Gastrointestinal/Biochemistry/Endocrinology chapters during DEMS. This turned out to be too rigid an approach. Also, I found that I was splitting myself in too many directions.

Ultimately, moving through First Aid in course-relevant chapters, along with doing USMLE Step 1 practice questions somewhat regularly, was for me sufficient studying for Step 1. I do wish that I had had BRS Physiology for the Neuro block, too. It would have been useful for parts of DEMS, but it strangely lacks any mention of the liver and pancreas, which are both heavily tested on Step 1.

Year 2: Winter Break

In contrast to Summer vacation, I think it's pretty much understood that the majority of medical students will be studying over the Winter break before the exam. I went home for Winter break and managed to get in some good relaxation time, but I also studied around 6 hours per day. This consisted mostly of reading through BRS Physiology and parts of BRS Pathology.

I think that this was a good balance between studying and enjoying my Winter vacation. However, in the end I was dissatisfied with BRS Pathology. I wish that I had instead used that time listening to the Goljan lectures while at the same time reading through Goljan's Rapid Review Pathology.

Year 2, Semester 2: Life Cycles + Infectious Diseases

This is crunch-time. Two more blocks and four months before the Big Test. The block directors were very aware of this and made significant effort so that the material covered was relevant to Step 1. I think there is some debate as to how effective they were at accomplishing this. In my opinion, the material covered in these two blocks was very relevant for Boards (ID more than LC), but I was frustrated that the questions on the exams were more nit-picky and less clinically-oriented than USMLE-style questions.

It would have been easy for me to spend more time studying for Step 1 instead of focusing on Life Cycles and Infectious Diseases. But I decided that it would be best to consider these blocks as an extension of my dedicated study period. In fact, by the end of my dedicated study period, I realized that all of the basic science curriculum during the first two years is essentially a study period for the USMLE Step 1.

As I progressed through LD/ID, I stepped up the number of practice questions I was doing per day. In addition to doing questions related to those courses, I also started doing one full timed set of practice questions (48 questions in 1 hour). Looking back, I think this was helpful for transitioning into the dedicated study period, and I don't think I would do much more than that.