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Preparing for the USMLE Step 1 as a Pass/Fail Exam

A medical school student holding a notebook and looking at a laptop while preparing for the USMLE Step 1 as a pass/fail exam.


The time has come for you to prepare for the USMLE Step 1! This can be an exciting but also nerve-racking time. However, with the recent change that the USMLE Step 1 is now a purely pass/fail examination. You can find respite in knowing that all you have to do is pass the USMLE Step 1. Given this new development in the USMLEs, many students are unsure of the best way to study for Step 1 and what resources they should turn to.


Previously, students would spend weeks and months preparing for this exam, taking advantage of a plethora of resources. While that is still a valid approach to passing Step 1, it may not be completely necessary or the most efficient way to spend your time. We here at Elite Medical Prep are here to provide our thoughts on how to best prepare for the USMLE Step 1 now that it is a pass/fail exam.



Our General Approach to Preparing for USMLE Step 1


Previously, we normally would recommend for most students using a variety of Step 1 resources, each of which specializes in a different part of the examination. However, we now recommend starting with a core number of high-yield resources, and then layering in supplemental resources if needed. What does this actually look like in practice? Well, here are our general recommendations which we will explain further below:


  1. Take a practice test and figure out how close you are to passing
  2. Determine your target test date and create your study schedule
  3. Utilize the core resources
  4. Reevaluate your progress with another practice test
  5. Integrate additional resources, if needed
  6. Repeat 3, 4 and 5 until you have reached your target score
  7. Take the test



Steps 1 and 2: Practice Test and Determining Your Target Date


We highly recommend taking a practice test before starting your studies. Many students are hesitant to do so as they are afraid to see a score that is lower than they hope for. This is normal! Nobody should expect to pass this test with flying colors without studying! Taking a practice test prior to beginning your studies is extremely important as it will establish your baseline and help you determine your target test date.


For example, if you take your practice test and are ten to fifteen points within passing, then you may only need three to four weeks of intense studying to comfortably pass. On the other hand, if you are thirty to forty points away from passing, you may need seven to ten weeks of dedicated studying to reach that passing score. There is no specific formula to determine exactly when you will be ready. However, by taking a practice test and determining your baseline score, you can make an educated guess based on your availability and study skills on when you believe you will be appropriately prepared to pass USMLE Step 1. Once you determine how many weeks you think you will need to prepare for this exam, create a daily study schedule! Here are some examples we have created for you based on a 5-week and 10-week timeline.



Step 3: Utilize The Core USMLE Step 1 Resources


There are many resources on the market to help you prepare for USMLE Step 1. However, you do not need to use all of them. It is easy to become overwhelmed with the number of choices of study material. While everyone learns differently, and you should find the resources that work best for you, most students can be successful using two major resources: a textbook and a question bank.


Preparing for Step 1 Using Textbooks


Regarding textbooks, the resource that has stood the test of time and is beloved by many is First Aid For The USMLE Step 1. This book provides an extensive and nearly comprehensive overview of all of the material in a very efficient and easy-to-understand manner. We like how this text is written in bullet point format as this provides you with the highest yield material quickly.


We highly recommend reading this book cover to cover at least once, and preferably early on during your study period. While you should not expect to memorize all of the material in this book on your first pass, the utility of reading a textbook is to familiarize yourself with the material. This will then be reinforced through practice questions (more on this soon). There are other books on the market including those from Kaplan, USMLE Step Secrets, and more. We highly recommend you take the time to find one book that works for you. We do not recommend using more than one textbook as this can become overwhelming for students.


Step 1 Question Bank


After you pick your textbook, it’s time to dive into questions through a question bank. Just like textbooks, there are many question banks out there on the market, but the gold standard is UWorld. This question bank provides a surplus of questions and detailed answer explanations. Additionally, the user interface allows you to create customized tests using a similar interface you will see on test day. We recommend completing this question bank in its entirety prior to test day.


Once you have these two core resources, get to work! These two resources alone may be all you need to pass this test. Most students will require additional resources, which we will talk about soon, but these two core resources should be the foundation of your studying as they will be the highest-yield resources for you on your journey to pass this test.



Step 4: Reevaluate Your Progress with Another Practice Test


We recommend integrating practice tests throughout your study period and not leaving them all for the end. We favor this approach as this allows you to receive more frequent feedback and fine tune your study approach and resources sooner rather than later. The most representative practice tests available for students are those directly from the NBME. We highly recommend using all of their practice examinations found online. However, many students do want to utilize more practice tests and you can generally find more from your question bank. For example, both UWorld offers practice tests with score estimates and answer explanations.


As you take these practice tests, it is important for you to track your overall progress and your progress in each organ system. Why is this important? Well, if the two core resources we mentioned before are not working for you in some areas, then it may be time to add on an additional resource.



Step 5: Integrate Additional Resources, if Needed


Some students may find that they struggle in some disciplines more than others. For example, it is very common for students to find microbiology, pharmacology, and pathology quite challenging. While a textbook and question bank may be solely sufficient for some students to score well in these areas, for others, they may need additional help. This is where additional resources come in.


We recommend finding resources other than your core question bank or textbook to help you in targeted areas. We want to stress that these additional resources should be focused on your weakness and not simply be another version of a core resource. For example, getting another textbook that focuses just on microbiology, but is similar to First Aid is unlikely to improve your score. We recommend exploring other media like videos, flashcards, tutoring or study groups, etc. Some common supplemental Step 1 resources include Sketchy, Pathoma, and Anki. Additionally, it may not be necessary to use these additional resources in their entirety. For example, if you just struggle with autonomic drugs, it may be helpful to watch specific Sketchy Pharmacology videos on this topic, rather than all of the Sketchy Pharmacology videos.



Step 6 and 7: Repeat Steps 3, 4 and 5, and Take Your Test!


Once you get into a rhythm, keep studying and taking practice tests until you hit your target score. We highly recommend scoring near your target range on at least two different occasions to really ensure that you (1) can score in a range comfortably above passing and (2) repeatedly do so. Once you are ready, go in and take your test. On test day, remember that you will encounter questions that are nearly identical to those that you completed in your question bank so do not try anything new! What you have been doing in the past has been working so keep it up.


One of the most difficult parts of this process is knowing if you are taking the right approach and progressing at an appropriate rate. If you are concerned or feel lost, we highly recommend reaching out to friends or seeking out a tutor who can help guide you in this process. It can be quite daunting at first, but you do not need to go through this alone! Reach out if you need any assistance! To schedule a complimentary consultation and learn more about 1-on-1 tutoring with Elite Medical Prep click here.

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