The Ultimate Study Guide for Your USMLE Step 1 Preparation

So, you’re looking for a guide to prepare for your USMLE Step 1, and you feel confused about the amount of information available on this topic – sound familiar?

Don’t worry, I went through the exact same thing. In this article, I’ll share my perspective and the best tips I wish I could have found when I was starting this journey.  

The first thing to keep in mind is that since January 2022, the Step 1 exam officially became pass/fail.

Although this change was made to reduce medical students’ burnout, one shouldn’t take the Step 1 exam and its preparation lightly.


First, you still have to pass, which isn’t that easy! 

Second, the Step 2 CK score became one of the only objective ways to select between candidates, so good Step 1 preparation will help you have a solid basis to score higher in Step 2 CK.

1. Understand what the Step 1 exam is

It’s crucial to know the subjects and topics studied in Step 1.

On exam day, you will be tested on your knowledge on the following topics:

General Principles:

  • Biochemistry
  • Immunology 
  • Microbiology
  • General principles of Pathology
  • General principles of Pharmacology
  • Public Health Sciences

Organ Systems: 

  • Cardiovascular
  • Psychiatry  
  • Endocrine 
  • Renal  
  • Gastrointestinal 
  • Reproductive  
  • Hematology & Oncology 
  • Respiratory
  • Neurology & Special Senses  

You’ll learn about each organ system’s embryology, anatomy, physiology, pathology, and pharmacology.

2. Get familiar with the exam day

At the end of your preparation, an exam lasting 8 hours awaits you! 

More precisely, it’s 7 hours with a 45-minute break. During the exam you’ll be confronted with 280 multiple-choice questions split into 7 blocks, each block made up of 40 questions.

Each question is a clinical scenario revolving around a specific case. 

Example: Your knowledge of anatomy will be tested by asking you to deduce the artery involved in a patient having a myocardial infarction. 

And it will be the same for other topics.

In other words, to ace your preparation, you must bear in mind that passing Step 1 is about how to apply your knowledge.

Give a read to my survival guide on how to ace USMLE STEP Exam Day

3. Know which materials to use for your Step 1 preparation

When it comes to the study materials, you will find extensive lists of resources on the internet that you can use for your Step 1 preparation.

The fact that you will be spoilt for choice can be somewhat confusing when choosing which resources will work best for you.


depending on factors such as how much time has passed since you finished medical school or what type of learner you are, you’ll have to carefully select your study materials. 

This section will introduce the most popular resources used for Step 1 and, more importantly, which ones to use based on your weakness. 

Quick reminder:  The Step 1 exam is about learning and memorizing concepts to apply them on test day by answering case scenarios. 

Therefore, I like to classify the study materials into three categories based on the value they will bring you: Learning, Memorizing, and Applying. 

1) Learning:

This category encompasses all the materials you will use to build your knowledge, which applies mainly to old IMG. Considering that you may have finished medical school one, five, or even ten years ago, you might not be familiar with neoglucogenesis and the urea cycle anymore! 

This means you will need to spend more time refamiliarizing yourself with these concepts. If that’s the case, then Board and Beyond, Pathoma, Physeo, and Kaplan are your new best friends! 

2) Memorizing

Learning by heart is fun for nobody, especially when it comes to memorizing unpronounceable bug names or remembering lists of drug side effects as long as the Mississippi River. 

Unfortunately, this isn’t a step you can skip in medicine, and this applies even more to Step 1. 

However, you can make this process easier and more fun by using resources like Sketchy Pharmacology and Sketchy Microbiology. 

I’m not going to lie; when I started using them, I wasn’t convinced as I wasn’t familiar with the concept of learning using stories and sketches. But the thing is, it works! 

For a lot of people, memorizing is what they struggle the most with. 

But again, Step 1 is all about quickly and efficiently applying your knowledge to answer questions, which means you need to get to the point where you intuitively access the information in your brain. 

Don’t spend too much time watching videos or reading the same explanation over and over again if you’re struggling to memorize it.

Anki Flashcard is, in my opinion, the go-to resource to strengthen your memory and train you to rapidly answer questions. You just need to download the app, and you’ll be able to find flashcards related to the USMLE Steps.

3) Applying

The main purpose of your preparation is to learn how to apply your knowledge efficiently and quickly. 

By offering up questions similar to the exam, a bank of questions (Qbank) trains you on how to approach a question properly. 

Don’t forget that the test is timed. Thus, practicing as many questions as you can will help you: 

  • Familiarize yourself with the question format
  • Identify your area of weakness
  • Learn how to manage your time

That said, Qbanks are considered the “Swiss Army Knives” of any Step exam, as they also play the role of powerful learning and memorization tools. The most popular Qbank, and the one I have used during all my Steps preparation, is UWorld

There are, of course, other Qbanks, such as Lecturio and Amboss, which offer free trials, but I personally prefer UWorld, which I think remains the most effective option and will be the backbone of your preparation.  

Now, you may wonder why I didn’t talk about Step 1 First Aid

Well, this is simply because, in my opinion, Step 1 First Aid represents the Goal. 

Let me explain why.

People refer to First Aid Step 1 as the Bible of the Step 1 exam. 

This is simply because everything, and I literally mean absolutely everything you’ll be tested on, is in that book. 

Ultimately, every study material you use is to help you master that book. 

The book contains a lot of information but little to no explanation. 

The videos and supporting books we discussed will help you understand the First Aid content, and the Qbank will allow you to apply and contextualize what’s in the First Aid

In other words: Master the book, and you will master the exam!

How long does it take to prepare for the USMLE Step 1?

While there are no definitive answers to this question, we usually consider 3 to 6 months of preparation adequate for IMGs. 

The date of the exam will be influenced by several factors specific to you, such as:

  • Your time since graduation: If you graduated five years ago, you would most likely spend more time rebuilding your knowledge of basic science in comparison with a fresh grad who just needs to “refresh” their knowledge.
  • Your current English proficiency: USMLE aspirants who didn’t do their medical study in English will need some adjustment time to get used to studying the materials in English. 
  • Your schedule: If you work or cannot dedicate yourself fully to studying for Step 1, you might need more time to prepare for the big day. 

Those are just examples, but they give you an idea of how every person and situation is unique.

Indeed, there is a lot of pressure on IMGs, especially if you graduated long ago and thus can’t afford to spend months studying for one exam.

However, you mustn’t rush your preparation, as a failed attempt may negatively impact your residency application.

Moreover, the time you spend preparing for Step 1 will make your Step 2 CK preparation easier and quicker!

To ensure that you are fully prepared for the USMLE Step 1, it is essential to follow a comprehensive study schedule and preparation plan. Get access to the one I have shared in my article about this specific topic!

Frequently Asked Questions

Is Uworld enough for USMLE Step 1?

Yes, it can be enough. Uworld is a Qbank that will help you learn, memorize, and apply your knowledge. In addition, Uworld will help you familiarize yourself with the exam format and improve your time management.  

How many UWorld questions should I do a day?

At the beginning of your preparation, one block of 40 questions daily is an excellent start. During your dedicated study period, do as many questions as possible, as it will help you train for the exam day when you have to answer 280 questions! 

How many hours should I study for Step 1?

As your test day approaches, 7 to 8 hours of studying is usually considered more than enough during this important period. Even if you can study longer, it’s essential not to overwork yourself.  

When should I take Self-Assessments? 

For any questions, please feel free to reach out through the contact section! You can also visit USMLE’s official website to get the latest updates and more context about the exam.

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