Studying for the USMLE® Step 1

What You Need to Know to Prepare

What is the USMLE Step 1 exam?

The USMLE® Step 1 (“The Boards”) is an important and extremely challenging exam that all new med students must take. It is the first in a series of three exams that comprise the United States Medical Licensing Examination, all of which students must pass in order to become a licensed physician in the United States.

Typically, the exam is taken once medical students have completed their foundational sciences in their second year, before their clerkships. However, some curricula are tailored in such a way that students take it after their clerkships.

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What topics does the Step 1 exam cover?

Generally, the Step 1 exam will cover these traditionally defined disciplines: anatomy, behavioral sciences, biochemistry, biostatistics and epidemiology, microbiology, pathology, pharmacology and physiology. It also touches upon these interdisciplinary areas: genetics, aging, immunology, nutrition and molecular and cell biology.

Step 1 tests students on their understanding and application of the “basic sciences to the practice of medicine, focusing especially on the principles of health, disease, and therapeutic interventions.” Each question gives an example of a possible clinical exam scenario with a patient who describes their symptoms and medical history. Through these scenarios, you’ll be asked the what and why behind their symptoms. Often it’s through the interpretation of diagnostic images, charts and graphs and pathologic and normal specimens.

How, when and where can I take it?

The Step 1 exam is usually taken after your second year of med school, though this highly depends on your university’s curriculum. You can apply for it with the NBME (National Board of Medical Examiners) for a fee of $645 (as of 2021). The test is administered at any of several Prometric computer testing sites.

What’s exam day like?

Step 1 is a one-day exam. It is divided into seven 60-minute blocks and taken in one 8-hour testing session. Each block will usually not exceed 40 questions, and the entire exam will not exceed 280 questions.

Mastering time-management for exam day is almost as important as mastering Step 1 topics. The right study tool should train you not just to understand topics, but to draw from that knowledge quickly and effectively. When studying, try practicing on timed, exam-simulated USMLE interfaces to get a better feel for what you’ll experience on exam day.

What’s considered a good Step 1 score?

The exam is graded from a 1-300, with a minimum passing score being 194. Most scores fall between a wide range of 140-260; more detailed information on what your score means can be found in the USMLE Score Interpretation Guidelines. Students usually get their grade three to four weeks after the exam.

Should you fail the exam, you can take it again (up to six times), but do be aware that your failing grades could follow you through your career.

If you take the exam and aren’t happy with your grade, it’s not possible to take it again to raise your score.

What can I do to prepare for Step 1?

The Step 1 exam looms large for many medical students because it’s such a pivotal exam. How you perform on it will set the tone for the rest of your medical school career, and it is one of the most decisive factors considered by program directors when choosing applicants for a match to residency positions.

The pressure to do well can feel overwhelming. Students often have trouble dealing with what feels like too much information (about 2 years worth of materials!) and not enough time. Not to mention having to recall information learned very early on in your studies.

Getting exam-day-ready comes down to getting the right resources and tools. Budget for a few, high-quality resources that perform on multiple levels instead of shelling out for too many. You’ll want resources that can help you both cover a lot of ground and as well as get down to the details.

Ideally, the best resource you can find will offer a combination of the following features:

  • A comprehensive Qbank
  • A cross-linked, information- and multimedia-rich medical Library
  • The ability to access both the Qbank and Library simultaneously as you study
  • Smart features that can enhance critical thinking and problem-solving approaches
  • High-yield pathological and histological images
  • An interface that simulates exam day conditions
  • Progress-tracking capabilities

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