Five Biggest Mistakes Students Make with First Aid for USMLE Step 1

  • /Reviewed by: Amy Rontal, MD
  • We all know a review book is a must for the USMLE. Our review book of choice here at Med School Tutors is First Aid for the USMLE Step 1, commonly referred to as “First Aid.” This is no surprise, as it is the most commonly used review book for the USMLE—not just nationally but worldwide. Every student utilizes First Aid, but the spread of scores they receive run the gamut of failing to curve-setting. The difference comes down to how they are utilizing First Aid. When to start? What to write inside? How many times to read it? While there are many ways to get through the experience with your goal score on your score report, from the thousands of hours we’ve spent helping students achieve their goals, we’ve found these to be five biggest mistakes students make with First Aid while studying for Step 1.

    1. Starting First Aid too early (or too late)

    I often cast stones from my ivory tower at the first-year medical students who are walking around on Day one of medical school with First Aid under their arm. There is no need to even possess First Aid any time before the beginning of M2 year. At the same time, you don’t want to be looking at it for the first time just 6 weeks before your test. A good happy medium is halfway through second year, or when you have 5 or 6 months before the exam. Don’t start internalizing the book at that point. Simply familiarize yourself with the format and layout, and get a general sense of the depth of the material covered therein. There will be plenty of time to dive in deep during your dedicated study period; the heavy lifting can wait until then. As always, the most important thing to do, regardless of what you do with First Aid, is to give your full attention to classwork so that you can truly learn during your basic science years.

    2. Annotating too much (or nothing at all)

    Remember when we called First Aid concise? The 2019 version is a mere 816 pages. Yes, that’s a half-ton of pages. But on the other hand, it’s nearly everything you need to know for Step 1, a summary of 2 years of basic science lecturing and a handful of books on histology, pathophysiology, anatomy, etc., all rolled into one.

    There are enough words in First Aid as it stands. Very little raw information needs to be added to the book by you. If there’s a brilliant mnemonic or a small reminder that you will be better served by having in there, by all means, take your pen to the paper. But don’t double the amount of text and data contained between the covers. It has been curated and winnowed down already, and there’s no need to undo the editor’s work.

    3. Relying on reading too much

    All I have to do is memorize First Aid, and I’m golden, right? 270, here I come!

    If only it were that simple. Yes, knowledge of the material contained in this book is essential, but sadly, it’s not enough. The students who score highest on the USMLE are those who do the most questions. I must repeat that because I’ve seen too many students eschew doing questions because “they aren’t ready” or because they want to get more reading in. Questions are king. As good as First Aid is, if given the choice, I’d rather do multiple question banks through and through without reading First Aid at all, than to prepare for the test with only First Aid and not going through any Q-banks.

    First Aid is merely one piece of the studying puzzle. Question banks are even more important, but above all, the fund of knowledge you have built up over your basic science courses takes the cake.

    4. Failing to do a cover-to-cover First Aid read-through

    This one often falls through the cracks, but so many students thank me when they follow this advice. As you are about to ramp into your study period, you should do a light reading of First Aid from start to finish. It’s a bit of a slap upside the head, but serves as a good way to light the fire underneath you. You will be reacquainted with some familiar material, and see some topics which you feel completely in the dark on. You don’t have to start committing material to memory, but you should give it more than a skim. This first run through will also help to cement a framework of knowledge in your head, so that as you pick up the tons of facts along the way, you’ve got places to mentally store them.

    5. Winging it

    “Yeah, I’ll just read First Aid to review, do a bunch of questions, and see how far I get by the time the test rolls around.” You’d be surprised how many students’ study plans are not much more developed than that. We’ve talked at length about the importance of putting together an bulletproof Step 1 study schedule.

    You should know exactly what chapter you are going to be committing to memory each day. You should be able to look at the study calendar that you’ve built before your dedicated study period, and have the explicit assurance to say “On the morning of May 1st, I’m going to read the first 15 pages of First Aid Cardiovascular. That night, I’ll finish the Cardiovascular section.” It sounds like way too much work and detail, but it will pay serious dividends in the long run.

    Don’t make these mistakes! Do what it takes to get your timing right, ace you class exams, build a solid study schedule, understand the structure of First Aid, utilize question banks, and take mindful, succinct notes in First Aid