USMLE Step 1: How Do I Know I’m Learning What I Need to Know?

  • /Reviewed by: Amy Rontal, MD
  • At some time during medical school every student wonders if they are learning what they need to know for the boards. Are professors covering all of the high-yield material? Do I really need to know all of the details covered in my lectures? As tutors, these are some of the most common questions we hear from students.

    How to Ensure You’re On Track for Step 1 Prep in the First and Second Year of Med School:

    First Year: In general, first year is not a time to be panicking about the boards. This is a time when many of the details you are learning will ultimately not be tested on Step 1. However, that is not to say they are not important. The more detailed your understanding of normal anatomy and physiology the better you will be able to understand the pathophysiology and pathology introduced in the second year. There are however six foundational areas where you want to make sure you have covered the basics: biochemistry, immunology, microbiology, pharmacology, and public health / epidemiology. You could do this “self check-up” after each unit or at the beginning of second year as you start preparing to study for Step 1 over the course of the year.

    For each section flip through the pages of First Aid. Do you recognize all of the material? Does anything look unfamiliar to you? For each section make a plan about how you want to maintain your knowledge through second year. Depending on your curriculum you may need to make a plan to fill in deficiencies. Each student’s will be different, but here is an example plan:

    1. Biochemistry – use Anki flashcards to force yourself to study this throughout 2nd year
    2. Microbiology – plan to review 10 sketchy micro videos each week
    3. General Pharmacology – come back to equations and concepts in dedicated study, use Anki for drug names
    4. Immunology – use Anki flashcards to force yourself to study this throughout 2nd year
    5. Public Health / Epidemiology – purchase the u-world biostatistics add-on, complete it over winter break

    Second Year: Second year is a time when there is great variation between medical schools. Some schools allow professors to write all of their own exams, while others incorporate NBME exams, and still others rely solely on the NBME generated exams. Here is some advice on how to know if you are learning what you need to learn under each scenario.

    • Professor written exams only: For students who do not have the structure of NBME exams to help them assess their readiness for the boards it is still absolutely essential to incorporate a question bank for self-assessment from day one of second year. Plan to complete 5-10 questions a day for practice. If a topic comes up that wasn’t covered in lecture, then you are queued to turn to First Aid or Pathoma for some supplementary material. Give yourself a mini test right before your school’s exam by completing a few blocks of questions in a row. Make sure to incorporate material from prior blocks! If you “pass” these tests, you are learning what you need to learn for the boards!
    • NBME and professor written exams: Students who must contend with NBME written exams and professor written exams for each unit will likely have the most knowledge breadth and depth on test days. To prepare for exams it will be important to use lecture notes and outside resources such as Pathoma and First Aid because even your professors don’t know what will be covered on your NBME exam. After exam day, you must face the challenge of paring down and consolidating your knowledge. It is important to resist the urge to transcribe every detail of your lectures into First Aid. The minute details learned in lecture will help you understand the larger concepts that will be tested, but that doesn’t mean you need to continue to know every little detail.
    • NBME written exams only: For students who only have to study for NBME written exams, incorporating question banks and outside resources early on in the unit becomes essential. Previewing the material in these resources even before the unit begins can help you zero in on the high yield material as it is delivered in lectures. Let me be clear though, outside resources are usually not a substitute for lectures! While your lectures will cover more depth and breadth than you must know to get a 240+ on the boards, these details are essential in helping you to understand and solidify the high-yield material.

    Dedicated Study:

    During dedicated study the best way to find out if you are learning what you need to learn is to take the NBME practice exams. While it may be nerve racking, the best way to start off your dedicated study is by taking the plunge and starting off with an NBME. Taking this exam cold without “studying” for it will be the ultimate test of how well you have retained the material from the last two years of medical school. As you formulate your dedicated study plan, the best way to make sure you are learning what you need to learn, and not getting lost into the weeds, is to pick your resources wisely. If you are the type of student who took nice condensed notes and has a reasonable amount to review then you can consider using them. However, if you had professor written exams and have exhaustive notes beyond the scope of Step 1 you would be wise to stick with the basics! For most students, Pathoma, First Aid, Sketchy Medical, and BRS physiology along with U-world will provide a solid foundation for success.

    Further reading:

    What Scoring a 260 on Step 1 Really Means

    How to Set Up a Timeline for Your Step 1 Study Plan

    The Biggest Mistakes to Avoid When Studying for USMLE Step 1 and Step 2 CK

    How to Study for Step 1