Erik Reinertsen     Blog     Tech     Research     Talks

How I prepared for Step 1 of the USMLE

Resources I recommend

  • First Aid 2013
  • USMLE-Rx qbank (hereby referred to as “rx”)
  • USMLE World qbank (hereby referred to as “uworld”)
  • Picmonic
  • Pathoma

Resources I DO NOT recommend

  • Microbio made ridiculously simple – I didn’t like the text-heavy format. I could have just read First Aid, used flashcards, and done questions.
  • Emory-specific: every module textbook except for Lily cardiology (First Aid and Wikipedia are sufficient to understand pathophysiology) are a waste of money
  • Goljan is too dense and comprehensive; use Pathoma instead
  • Robbins & Cotran is even thicker than Goljan!

Scheduling (Emory-centric)

  • M2 ended on November 22nd, 2013.
  • I took Step 1 on January 27th, 2014.
  • This gave me 65 days (9 weeks, 2 days) to prepare.
  • I took 8 days off to travel to California for a conference, see my family for the holidays, etc. This left me with 57 days (8 weeks, 1 day) to prepare.
  • Realistically, I studied 5 to 6 full days per week, and used 8 weeks. This was a perfect amount of time. Less would be insufficient, and more would leave me burnt out.
  • To maintain balance and optimize long-term focus, I recommend regularly exercising, sleeping 6-8 hours a night, and maintaining some social activity.
  • I divided my studying into two phases: learning and question banks.

Phase 1 – Learning phase

  • 33 days (4 weeks, 5 days), from 11/23/2013 to 1/5/2014.
  • I reviewed First Aid 2013 cover to cover for a second time. This was not the first time, because I used First Aid 2013 as the framework from which I chose topics to focus my studies on during the modules. I chose to ignore our provided syllabi in lieu of material that was guaranteed to be high yield. I did not fail any module exams, and scored well on NBME exams. I highly recommend this. If I could go back, I would skip more lectures, study more First Aid, and do Rx or Firecracker as I went through M1 and M2.
  • Each section took 2-4 days to complete.
  • I read the material, then did module-specific Rx questions.
  • I chose to learn with Rx (not UWorld) because Rx ties directly to First Aid.
  • I only finished 40% of Rx; the goal was the reinforce learning of concepts via vignettes, not completion.
  • My strongest sections: GI, pulmonology, psych.
  • My weakest sections: microbiology, pharmacology, EBM (because we learned it so long ago), cardiology, neurology.
  • I wish I spent less time on Learning and more time on QBanks

Phase 2 – QBanks phase

  • 22 days (3 weeks, 1 day), from 1/6/2014 to 1/27/2014.
  • Every day, I did UWorld blocks of 46 questions on all random (every topic in First Aid) in tutorial mode.
  • I heavily annotated First Aid with colored pens and sticky notes.
  • I left a dot next to the topic in First Aid so I would know which topics were heavily tested.
  • The most common topics on UWorld were EBM, HIV, hepatitis, antiviral drugs, diabetes, psych drug side effects, P450 modulators, alpha and beta blockers, heart murmurs, IBD, … will update list later.
  • I eventually switched from tutorial to timed, do a block or two, then review the answers later.
  • At first, it took me a day (8 hours of studying) to answer and review two 46-question blocks. I averaged ~60%.
  • I improved my speed to four 46-question blocks (if I focused hard). My average score improved to >70%.
  • I finished all 2200+ UWorld questions a few days before I sat for Step 1. I then reviewed the questions I got wrong. I highly recommend this. Completion of a qbank builds confidence, even if retention is not 100%.
  • I also took both UWorld diagnostic exams (blocks of 4 questions that give you a representative score). I am unsure if this was useful.

Test day

  • I took Step 1 at a ProMetric center 20 minutes east of Atlanta, in Tucker, GA. I chose this location because I assumed a suburban area would have less traffic and easier parking than downtown Atlanta.
  • I took a practice NBME exam at the test center a few days before Step 1. This helped me get a feel for the parking, building layout, security process, and computer system layout. I highly recommend this.
  • On test day, I brought water, coffee, banana bread graciously baked by an M3 friend, and mixed nuts with dried fruits.
  • I took two blocks of 46 questions, then a 5-10 minute break. I paced my caffeine intake and maintained hydration.
  • I always finished every medical school exam and qbank block with time to spare, so I never worried about pacing. I usually finished a 46-question 60-minute block in about 45 minutes.
  • No matter how well-prepared, you will become mentally fatigued after the 5th straight block of 46 questions. Slow down, stretch, take deep breaths, and stay focused.
  • Answer every single question; guessing carries no penalty.