Crush the USMLE Step 1 Exam: A Simple Guide


Without doubt, the USMLE Step 1 is the most difficult, yet most important exam that you will ever take. As a medical student who is aspiring to become a physician, you are not only expected to prepare for the most conceptually in-depth and complex exam in all of academia, but you are expected to do it while juggling a full course load, and with the reality in mind that this one test (which is far too hard, and which you don’t have enough time to prepare for) will, in large part, determine your entire future and everything that you have been working to achieve. That’s some heavy stuff. That said, find solace in knowing you aren’t the first student to take Step 1. In fact, thousands of med students before you have run the USMLE gauntlet and come out victorious on the other side (albeit slightly traumatized).

There are hundreds of guides out there, detailing out every little thing that you “need” to do in order to be successful on Step 1, but we have found that in spite of it all, your success is going to boil down to a few simple things. Much like how ratatouille, a simple peasant dish, was able to sweep a pompous, uptight food critic right off his feet in a beloved children’s movie, you too will find success on Step 1 by not overcomplicating the already labyrinthine experience. With all of that in mind, here are 3 simple steps to getting the score you want on the USMLE Step 1 exam:

1. Know what to expect from Step 1

This is obviously extremely important to understand as you start your preparations, so we broke it down for you here:

  • You are going to be tested on the basic sciences
    • Physiology
    • Biochemistry
    • Anatomy
    • Biostatistics and Epidemiology
    • Microbiology
    • Pathology
    • Pharmacology
    • Behavioral Sciences
  • You are also going to see material on the following interdisciplinary material
    • Immunology
    • Molecular and Cell Biology
    • Nutrition
    • Aging
    • Genetics
  • Tip From the Pros
    • As you begin to study, the sheer vastness of this content is almost certainly going to overwhelm you, but try not to panic. Because of that same vastness, and because Step 1 only consist of a few hundred questions, you will only actually be tested on a small portion of that material respectively, so if a particular section is destroying you and making other aspects of your studying suffer, just move on. You should approach your Step 1 prep with the intention to master everything, but if you find yourself beating your head against a wall without any progress for too long on a given area, then don’t be afraid to table it for the greater good.

Here are a couple of charts that help further break down what you might see, by percentage:

Now that you understand what to expect as far as content, let’s take a look at what your actual exam day is going to look like:

  • Your exam will be administered on a computer at a testing facility
  • It will be made up of 7 sections, with one hour being allotted for each section
  • Each section will include up to 40 questions, for a total of 280 questions
  • You will be allowed 45 total minutes during the test for personal breaks

At under 2 minutes per questions on average, Step 1 is like trying to sprint a marathon. Be sure to do what you need to in order to be comfortable with reading comprehension and with your ability to take in and synthesize massive amounts of complex information quickly (some of the question stems are egregiously long).

Now that you know what to expect from Step 1, you can start thinking about how to prepare for it.

2. Set a clear goal and make a simple, realistic plan to achieve it

Approaching any difficult task without setting a clear goal is like logging into Netflix without knowing beforehand what you are going to watch; an hour or two will pass by and you will realize that you have gotten lost down the rabbit hole of looking at titles and adding things to your watch list, but that you haven’t actually watched anything. With the outrageous amount of information that you are going to have to wade through in studying for Step 1, you will certainly want some kind of a roadmap so that you don’t get lost in it. Goals are by no means a guarantee of success, or a sure destination, but they do provide direction and clarity in the face of overwhelming tasks. As you set your goals, don’t forget to keep them simple, clear and defined. Here is how to set your goal:

  • Consider that 194 is the current minimum passing score for the USMLE Step 1 exam
  • Consider that 229 is the national average score for the USMLE Step 1 exam
  • With those numbers in mind, decide what specialty you are interested in, then figure out what kind of score will make you competitive. That score = your goal
    • Here is a chart that might help you get started

Setting the goal is the easy part. Once you have your goal in mind, you will need a roadmap, or plan that can help you make it a reality through effective study and inhuman dedication. Here are some tips:

  • Start using review resources and preparing early on
    • A common theme among students who have done well on Step 1 is that they have all started using study resources and preparing for Step 1 early on, so that by the time dedicated study time comes around, they are already familiar with the USMLE material.
  • Create a personalized study plan and stick with it
    • Like the title says, this is personal, so find what works for you and stick with it. Also, don’t waste too much time on this. The most important thing is to set something up and start the grind. There is no easy way around it.
  • Carefully track your progress and make adjustments as needed
    • Through question banks and practice exams you will be able to track your progress toward your goal and continuously make adjustments to help you reach it.

Set a clear goal, make a simple plan, crush Step 1

3. Don’t lose your head

With as much emphasis as is placed on it, it becomes extremely easy to despair as the reality of Step 1 begins to weigh on you. Physician burnout is real, and it’s a huge problem. Don’t let it happen to you. As you prepare for Step 1, don’t forget about the things make you, you.

  • Go the gym
  • Go out with your partner
  • Game
  • Go hiking
  • Paint
  • Write
  • Run
  • Go out with friends
  • Cook

No doubt, Step 1 is important, but you are going to be fine. Many students who have not done as well as they might have liked, or even as well as their desired specialties might have “required” have gone on to match where they wanted to and become outstanding and successful physicians. As you move forward, you will learn more and more that your future is going to be determined by a multi-faceted approach, and not entirely by one single 8-hour exam. You are going to be amazed at just how many opportunities you will be presented with to be competitive if you are constantly working at it.

All of that said, the brutal reality of it all is that you still need to do well on Step 1. There is no way around that. It is important, and it will impact your future, but you need to understand that you can, and you will be successful on it and that even you fall a little bit short of where you wanted to be, chances are that you’re still going to go on to do amazing things. This short, albeit painful period of your life will require sacrifice and dedication the likes of which most people will never be able to understand, but you must keep a healthy, long-term perspective and remember that there is life after the USMLE Step 1.

You are among the brightest and most exceptional people in the world, and you owe yourself some kudos. What you are doing is, by any measure, extraordinary and you are just getting started. Regardless of where you end up, your contribution to the medical community and to society is going to be invaluable. Now, as you move forward toward the USMLE Step 1, make sure that you know what to expect, set clear, realistic goals, and above all, take care of yourselves, my friends.

*here are some links to a few other worthwhile articles that may also provide you with some clarity and direction:



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