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USMLE Documents

How do I prepare for USMLE Step 1?

How do I prepare for Step 1?

Several things have been proven to help students prepare to do their best of Step

1. LEARN the material you are currently studying in your classes.

Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. It is the purpose of the testing agency to see how adept you are at taking partial information and, based on that, figuring out an answer you consider to be a high probability response. And you can’t do that with MEMORIZED material, but you can do it using material that you have LEARNED.

2. KNOW how to approach multiple choice questions and PRACTICE.

Some people seem to instinctively know how to answer multiple choice questions correctly, others of us not so much. There are skills that you can learn to help you answer these kinds of test questions. Here’s how Kaplan recommends approaching vignette styled multiple choice questions:

      1. Assemble key clues into a mental “snapshot” of the patient.
      2. Understand precisely what is being asked
      3. Allow a few moments to think, recall, and to anticipate possible answers
      4. Compare the given choices to your anticipated answer
      5. Mark choices that match best
      6. Rule out choices that don’t account for all findings
      7. Mark the best answer

Kaplan’s experts say that people who are bad at multiple choice questions focus on the choices rather than the stems of the questions. This is a very inefficient approach and one that tends to result in more mistakes. Those who are good at multiple choice questions focus on the stems, not the choices.

If you always feel that your performance on multiple choice tests doesn’t equate with your mastery of the material, you might think about having your test taking analyzed. The University of Missouri at Kansas City’s Institute for Professional Preparation (IPP) offers an online Step 1 diagnostic test. When analyzed, these tests not only evaluate performance in each of the seven basic sciences areas, but also look at some 40 other intra-test variables which can help you gain insight into the types of errors you may be committing as you go through a test, especially when these errors may be depressing your overall performance. Variables such as: the amount of time spent on different types of questions; correlations between the length of a question and the likelihood of answering it successfully; performance on questions which rely on strict definitions or precise interpretation of technical vocabulary; and the extent to which you are able to narrow down your choices to two good answers and the extent to which your second choices are correct, are examples of the intra-test variables analyzed when you take a “Diagnostic” test. In addition to a summary data sheet showing your performance in these areas, they may also provide a computer generated six to eight page report which discusses these variables and gives some concrete suggestions for minimizing the impact of these “error patterns”. This diagnostic test is available for a small fee. For details and how to order a test, please go to http://www.umkc.edu/ipp/cbt.asp. They also offer a full-length Mock Board Exam.

3. ALLOW enough time to prepare, but not too much.

Although you will have approximately 10 weeks from the time school ends to the deadline for taking Step 1 (June 30), four to six weeks should be plenty of time to prepare for Step 1. Many students in the past who have taken longer than 6 weeks to prepare later said they felt they took too much time, and actually lost ground with their studying. Analysis of our own students over the years shows that you get the most “bang for your buck” by studying for 6 to 9 hours per day for 4 to 6 weeks. Below you’ll see a graph of hours/day and weeks of studying graphed against actual Step 1 scores.

USMLE Step 1 Study Time
Hours/day and weeks of studying graphed
against actual USMLE Step 1 scores.

4. MAKE a study schedule and stick to it.

This is a critical step in successful Step 1 preparation. More detailed information about study schedules is in the following section.

5. STUDY smart.

Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study. Explain concepts out loud to a study partner, practice answering questions by explaining why the right answers are right and the wrong answers are wrong. If concept mapping works for you, do it. If there are other methods that work for you, use them.


Judy Schwenker, Kaplan’s Curriculum Director, talked about the ways in which USMLE exams are similar to medical practice:

      1. you must find key information
      2. the information you need may be buried
      3. there are distractions 4. there is time pressure
      4. you must use probabilities to make decisions
      5. you’ll never know it all
      6. situations won’t exactly fit what you’ve learned
    1. She also talked about the mistakes most commonly made when preparing for Step 1:
      1. Passive studying
      2. Insufficient practice with questions
      3. Memorizing, not understanding the material
      4. Inappropriate test day strategies
      5. Misreading or misinterpreting questions