Our Most Detailed USMLE Step 1 Study Schedule: Physiology Edition

  • /Reviewed by: Amy Rontal, MD
  • In my 4+ years helping medical students prepare for the USMLE exams, I have found that most students think their main problem with the exam is that they don’t have a good enough memory.

    “How do I remember all this stuff? Coagulase positive, catalase negative… it all seems like a blur.”

    The truth is that for people who have already gotten themselves into medical school and passed their first two years of classes, their ability to memorize things is almost never what is holding them back.

    The real issue is that Step 1 is testing them on more material on one exam than they have ever experienced before. This requires not just memorizing the material and understanding it, but organizing it so that it is a network of facts and ideas that are useable on test day. In truth, the same sorts of skills will eventually be used to make a student into an excellent clinician.

    This is why one of the most important things I focus on as a tutor for MST has been to prepare an individualized schedule for students preparing for Step 1, and convince my students that it is of the utmost importance to follow it as closely as possible.

    I have already written about the basics of making a schedule here, but in this post I want to cover a different aspect of making a study schedule.

    Physiology: The Biggest Bang for Your Buck

    At MST, we like to classify different subjects tested on Step 1 as either being predominantly memorization-heavy or predominantly comprehension-heavy. Subjects requiring predominantly memorization include microbiology and biochemistry, whereas subjects requiring predominantly comprehension include physiology and pathophysiology.

    Subjects requiring mostly memorization often benefit from tools like flashcards that allow organized repetition to master the subject material. As far as the subjects requiring comprehension, I have found that the biggest bang for your buck comes from mastering physiology because so much in medicine today is based on basic human physiology, and the Step 1 exam reflects that.

    For example: An understanding of all pathophysiologic processes involved in disease states are based on a thorough understanding of how things should work in the first place (physiology) and what goes wrong when they don’t. In addition, knowing what drugs treat which diseases is also made much easier if we understand receptor physiology of a specific drug. Even the questions about side effects of medication, which tend to be plentiful on the Step 1 exam, often become simple when we know how the drugs are working to treat the condition for which they are being prescribed. Lastly, many of the graphs and figures on Step 1 are testing physiology such as pressure volume loops, cardiac function, curves, etc.

    The Need for Dedicated Time for Physiology


    Most of the time, the Step 1 study schedules that I make for Step 1 students are systems-based. This means that a student studies first the basic anatomy, physiology, and embryology of a system followed by the pathophysiology, microbiology and pharmacology of the same system before going on to the next system. There are times, however, when it is warranted to spend some dedicated time on a specific subject if that subject is holding a student back and there is time to set aside for it.

    We have noticed that many students never had a firm enough grasp of basic physiology, probably because it didn’t receive as much attention as it deserved during their med school classes. In cases like these, I may program a few days, or in extreme cases up to a week, where a student will focus primarily on one specific subject.

    Probably the two most frequent subjects that require this are biochemistry and physiology for opposite reasons. Biochemistry has an almost dizzying amount of genetic diseases including inborn errors of metabolism that often require a bit of extra cramming right before test day. Physiology, on the other hand, sometimes requires a bit of review at the beginning of exam preparation to make sure that students have a foundational understanding of basic subjects that come up over and over again in medicine and on the USMLE Step 1.

    The following is a week-long study schedule that can be used by a student who has found that this is a particularly weak subject. It can be modified as needed to fit the needs of the individual or even for other subjects, if needed.

    Sample USMLE Step 1 Physiology Study Schedule PDF

    [Note: The page references made are from First Aid’s 2015 edition, and BRS Physiology’s 5th edition.]

    P.S. If you brush up on physio this way, come exam day, you’ll be able to walk away at least saying: