USMLE Step 1 Guide

Registration and Location

The test is given at Prometric learning centers which are located across the United States. You may choose any learning center (as you may want to study at home for the summer and take it at a center near your home). Be sure to register early. Send in your first registration located on the AAMC Step 1 website early. With this registration you can select a 3-month period to take your test. Aim for March. In a few weeks, you will get a registration card, which allows you to register a specific date with a test center. You can reschedule when you get closer to your test date, but try to pick a realistic date as it will be difficult to reschedule when you get closer to the exam date.

Study Plan

Most Vanderbilt Medical Students study anywhere from four to six weeks. Many who study past six weeks find that the recall of information that they studied at the beginning is poor. Many students take a week off before starting to study and at least a week off before starting rotations. Board review books are the way to go. DO NOT try to relive the year and a half of medical school again by going through each lesson. You may want to go over a couple of lectures that you want to review better (e.g. the antibiotic lectures from pharmacology). It is better to use review books as these are geared more for the Step 1 test.

First Aid for Step 1 is one of the best overview books that you can buy. It describes in detail what the test is like and gives tips on how to study. It also contains a very general overview (but still a good review book) of the main subjects tested on the Step 1 exam. It has an excellent high-yield section to view the day before the test.

The main books that most students use are BRS, Lippincott, and High-Yield. These are all review series books that summarize each subject efficiently. Find a review series that works for you and buy the different subjects that are a mainstay on the exam.

Using a Question Bank is of utmost importance. Current research of Vanderbilt Medical Students who have taken Step 1 have shown that the most realistic and useful Question Bank is USMLEWORLD. Other Question Banks that are available include QBank by Kaplan and USMLERx (from the makers of First Aid). Most Vanderbilt medical students use multiple question banks (sometimes all three). 

The subjects that are emphasized most are Physiology, Pathology (with a bit of Histology), Pharmacology, Microbiology, Biochemistry, Neurology, Anatomy/Embryology, Psychology, Lab Diagnosis, and Physical Diagnosis (in a somewhat descending order). Each test will emphasize a bit different subject matter so it is not wise to ask another student what was on their test as the Step 1 may test a different subject area than was on their test.

Also a select number of questions are thrown out on each test, so don't get flustered when you don't have a good section. Keep your head up and try to do your best on each subject. It's possible that those questions that you find the most difficult are the experimental questions and will be thrown out.

Study Tips

While studying, be sure to get a good night's sleep and be sure to take frequent breaks. Also be sure to exercise. Students find it best to exercise in the morning as it helps with studying later in the day. Make a schedule and stick to it. In the spring, third year medical students will come to the second year class and pass around their own schedules and give advice on what worked and didn't work for them. Don't cram the information. Get as much sleep as you need each night so that you feel refreshed and can hit the next day full of energy. Try not to schedule any big events during your study time. Many students found it very stressful to move between apartments during their study preparation.

The Week Before

For the week before the test, be sure to use Qbank and try to wake up around the time you would on test day so that you will not feel drowsy during the test. Sometime during that week take a "test run" to the center to see how long it will take you to get there and also just to know where it is. The day before the test, do things that are relaxing to you… watch a movie, go shopping, go for a run, etc. Do NOT take a nap as you will not be able to sleep that night. Also try not to take any sleeping pills as this might affect you the next morning. Have your meals all planned out with snacks and be sure to get some caffeine in there as well (not too much though because you can only take breaks between sections)! Think about a nice breakfast and then a healthy lunch. Try to take any variable out of the day so that you can be focused on the test.

Exam Format

Remember, the Step 1 exam is seven blocks of 46 questions each for a total of 322 questions. You have one hour of total break that can be divided any way that you like to ration it out. Most Vanderbilt students have suggested the following: Block 1 – 60 min, Block 2 – 60 min, Break – 10 min, Block 3 – 60 min, Break – 10 min, Block 4 – 60 min, Break – 25 min (lunch), Block 5 – 60 min, Break – 5 min, Block 6 – 60 min, Break – 10 min, and Block 7 – 60 min Be sure to go over the tutorial on how to navigate the exam at home the week before. This way you can save 15 minutes of your free time. Otherwise, if you have to go through the tutorial at the test center, it will cut into your free time so that you only have 45 minutes remaining. This tutorial can be found on the AAMC Step 1 website. However, you should check your headphones during the tutorial to make sure they work for when you have to listen to heart sounds.

Other General Comments

Many people have said that they didn't feel that they knew much before hand and it all came together for them despite feeling as though they did not learn the information well during their first two years of medical school.

As a side note, remember that you can't take in any digital watches or cell phones into the computer room. The only watch that you can use is an analog watch.

Everyone's test is different and focuses on different topics. It takes six weeks to get your scores as each question is normalized. The score to "aim for" is controversial. The most important goal for all students is passing the exam. Beyond achieving a passing score, some specialties require higher scores as they are more competitive.

Lockers are small, but you can store items outside the locker as well. Administrators aren't liable for those items.

Remember to bring your registration slip and a valid government-issued ID.

Good Luck!!!