How to Study for the USMLE Step 1 — Part 4

  • /Reviewed by: Amy Rontal, MD
  • Thanks for joining us for Part 4 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

    When you ask a medical student how to study for Step 1, they probably tell you “Do UWorld and read First Aid, then go for it.” When you ask MedSchoolTutors how to study for Step 1, you get a 10,000 word, 7-part series on how to ace what is likely the most important test you’ll ever take. Our first three parts (1, 2, and 3 linked***) got us from Day 1 of medical school to the weeks leading up to the exam. This post, part 4, will cover what you should do right as your dedicated study period begins. You could call it Day 1 of your intensive study period, but this day is so important, it needs a much more intense moniker….Day 0. What to do on Day 0 of your dedicated study period?

    Step 4: Take an NBME exam on the day before you start your proper Step 1 studying.

    This advice is often frightening for students. “Start my study period with an NBME? I haven’t even started studying! I’m going to do terribly.” That’s okay. We at MedSchoolTutors absolutely love NBMEs. They are probably the most overlooked essential element of your study plan. We’ve discussed in depth why we love NBMEs and how to employ them in your study schedule here, here, and here (links***).. But as this is such an important necessity, it bears repeating.

    Here are some NBME myths that stand in the way of students who need to use them for Step 1 (and 2) studying. Let’s start dispelling.

    Myth 1 – Without any good explanations, NBME questions are useless to me.

    Before we start throwing around ideas like key study aids being useless or unnecessary, we have to understand their place in the schema. NBME tests don’t serve as a “learning tool” so much as a test simulator. Taking an NBME feels much different from cruising through a UWorld block. The questions are blunt and unfriendly. You answer a question and move on, without the excitement of a green check or the disappointment of a red “X.”

    Do I wish that incorrect NBME questions (or all NBME test questions, for that matter) came with in-depth, polished explanations involving every answer choice? Of course! But the lack of said feedback is far from deal-breaking. Completing each NBME test is a rite of passage, and there is still so much to learn from each one, not just in medical material, but in test-taking skills and experience. The first one that you take is an irreplaceable milepost to kick off your study period.

    Actionable step: Use each incorrect NBME question as a jumping off point to concept mastery through self-study. Delve deep into the concept behind the question you missed, and leave it with newfound brilliance (while staying off the USMLE forums!)

    Myth 2 – I’m answering enough questions with UWorld, NBME questions are just superfluous.

    First off, the premise of having ever answered “enough” questions is a myth in and of itself. There is nothing superfluous about NBME tests, or the questions contained therein. Think of UWorld as the tool that helps you build knowledge in order to answer NBME (and the actual Step 1) test questions correctly.

    By the time Test Day rolls around, you should certainly have made it through UWorld at least once (depending on whether or not you utilized another question bank), and completed at the very least 2 NBME tests. Think of UWorld as your tool to compile knowledge, and NBME tests as a chance to apply this knowledge.

    Actionable step: Remember that any novel question you answer is another chance to build knowledge and test-taking skill. Appreciate every NBME question for what it has to offer.


    Myth 3 – I’m obviously going to do poorly on this first NBME; it’s pointless to take.

    We’ve all gotta start somewhere. And by taking an NBME test on Day 0, you will know exactly where you are starting. This first test also serves as an indelible line of demarcation to let you and your brain emphatically know that studying has begun. If there was ever a time to stamp out indifference, apathy, poor work ethic, and negative self-talk, it’s when you click “START” on your first NBME.

    By comparing your 3-digit Day 0 score to scores obtained on subsequent NBME exams, you can see how effective your studying is, and how far you are from your goal. This will guide your fortitude and intensity of study, and make it clear if you are on the right track, or if you need to postpone your Test Day and double your efforts in between. Taking this test up front will also open your mind to the wide breadth of material that you will have to cover, and give you a sense of how deeply you must understand concepts (i.e., the depth of minutiae) in order to get questions right. You will be surprised by how many times you conjure up a memory of this first test during your study period.

    Actionable step: Knowing that your score is not going to be your goal/dream score, just take your NBME on Day 0, do your best, and utilize the ordeal as a learning experience.


    When this first of many NBME exams is over, take a breath, sharpen your pencils, unwrap your fancy 0.38mm gel pens, and get ready to shift your mind into overdrive. It’s time to actually start studying for Step 1.


    Up Next: Day 1-30. The first Pass

    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