How to Study for the USMLE Step 1 — Part 3

  • /Reviewed by: Amy Rontal, MD
  • Thanks for joining us for Part 3 of the Ultimate Guide to Step 1 Studying. If you haven’t already, start with the first post in our How to Study for Step 1 series.

    By the end of this 7-part series, you will have a clearly defined picture of the optimal way to study for step 1, and how to achieve the highest step 1 score possible. You will utilize the upper echelons of your efficiency and be rewarded for your efforts. Without further ado, enjoy part 3 of How to Study for Step 1.

    So far we’ve talked about the first essential elements. In Part 1, we discussed the importance of doing whatever it takes to excel during your first years of coursework. Then, in Part 2, we went over the necessity of building a bulletproof study schedule. What to do now?

    Step 3: As you approach your dedicated step 1 study period, read First Aid cover to cover.

    This is about the time when readers start cringing. “Are you serious? Read a reference book cover to cover? Could anything be more boring? Is this even possible?” Before your head starts spinning like Linda Blair in The Exorcist, hear me out.

    This read-through of First Aid is just that: a read-through. A once-over. It’s just like when actors do a table read of a script. The intention is not to internalize the entirety of the information. It’s not to build an erudite framework tree on which to hang your knowledge ornaments. This first read of First Aid is the way to prime your mental engine.

    How to approach this Herculean task? One page at a time. Just read. Don’t memorize, don’t fret, don’t annotate. Just read. The biggest mistake that you can make here is going really slowly and getting hung up on factoids. You want this pass to be swift, but useful. Don’t skim, but rather read each page.

    In doing so, you will find 4 huge benefits which I’ll elaborate on below.

    1. Refamiliarize yourself with forgotten subjects
    2. Come across information which you’ve never seen before
    3. Adding another set to your mental workout
    4. Gently accelerate into hardcore studying

    Pretend it’s March or April, and you are covering your final system in the curriculum, gastrointestinal/hepatic. You are feeling the thrill as you complete the puzzle of how all of the body’s systems work together. But, when your professor tells you that chronic mesenteric ischemia is “angina of the gut,” you realize how little you remember about coronary artery disease, as cardiology got covered last September. The sheer volume of knowledge you need to accrue throughout your coursework can only be learned at a relatively slow pace. This means that large blocks of time separate you from the subjects you once knew so well. While every subject will need reviewing before Test Day, the systems that you haven’t covered for 6+ months will need the most dusting off. The first pass of First Aid should feel like a dusting off, as opposed to a deep cleaning. It will allow you to refamiliarize yourself with concepts that you once memorized without issue.

    We put our faith in our medical school curriculum to teach us everything that we need to know about medicine. Then, when you get a UWorld question wrong because you never learned about paraneoplastic encephalomyelitis caused by anti-Hu antibodies, you will be up in arms. The earlier you accept it, the earlier you can move on. Your medical school will not have covered everything that you will see on the test. They should have covered a very overwhelming majority of the necessary conceptual information, but it would be an impossibility to get through it all. You will have to do a bit of self-guided learning. This first pass of First Aid provides an excellent opportunity to see where your med school did you a solid by teaching a subject in its “entirety,” and also find out where they might have left you hanging. Maybe a snowstorm prevented you from learning about 4th generation cephalosporins. (This happened to my medical school class. Just replace “4th generation cephalosporins” with “any antibiotics!”) . Or sick leave stood between you and mastery spinal cord lesions. We all have our weak spots for one reason or another, and the first read-through will allow you to see the compendium of material before you need to learn it. This is subtly but importantly different from our next benefit.

    In medical school, there is a certain but identifiable phenomenon that you probably have experienced by this point. When you have enormous amounts of material to learn, it is very difficult to keep all of it in your head at one time. Throughout your career, you will do a lot of learning a concept in full, committing it to memory, and then forgetting it almost entirely. Then, when you need to call upon that knowledge again in the future, it will be much easier to assemble quickly. You will go through these cycles of memorizing, forgetting, and then relearning concepts over and over again. Every occasion after the first time you learned it will be easier than your initial exposure to the concept. The first pass of First Aid serves to let you see everything for the first time, so that when you actually get down to hardcore studying, you won’t be looking at anything for the first time. Even if you only glanced at it once before, to some degree, it has now become “review material.” You don’t even need to delve very deeply in order to benefit from this phenomenon. A good solid read before your dedicated study period will make everything a little easier to mentally access.

    By the time you reach Day 1 of your dedicated study period, you will want to be firing on all cylinders. If it takes you a week to really hit your stride, as much as 20% of your study period might have passed you by. There is no getting that time back without delaying your test, which might mean cancelling that much needed vacation, or postponing essential clerkships. No bueno. Making your way through First Aid this first time will flip the switch in your mind and let you know that “it’s on.” You’ll get a feel for how the publication is laid out, and start to form ideas about how it will fit into your studying. You’ll be most familiar with the book just in time to really exploit it for all that it’s worth, and know just what to expect as you make your way through when you are clamoring for knowledge.


    Start this once-over about 2 weeks before your dedicated study period, with the goal of completion just before studying begins. It’s totally fine if it overlaps with coursework. Don’t stress. Just read.

    Up Next: Day O. An NBME

    Ultimate Guide to How to Study for USMLE Step 1 –

    1. Do amazing in class. If class is lacking, bolster your own knowledge
    2. Building a calendar
    3. Starting up – the Once through of First Aid
    4. Day 0. An NBME
    5. Day 1-30. The first Pass
    6. Day 30-42. The second pass
    7. The final countdown → Test Day