How to Create a Study Plan for the USMLE

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Note: This was initially published in 6 parts and was then consolidated into a downloadable ebook.

Why create a study plan for the USMLE?

This is probably the question foremost in the mind of anyone who ever thought of tackling the USMLE. I remember when I was starting out, how this pre-occupied me a lot. Although studying for the USMLE is a big endeavor, studying how to study for the USMLE is no mean feat either. Just like an architect or engineer needs to plan out how to build a building before actually building it, we need to plan out how to prepare for the USMLE before we even begin studying.

Now some people can just jump right into reviewing and 3 to 5 months later take the exam and come out with a 99. I’m not one of those and so are I believe majority of those taking the USMLE. Some will start by applying and scheduling an exam 5 months later, only to find out that they’re not ready. So they extend their period of eligibility and still they’re not ready. Some will take the exam and fail or score so low that it amounts to the same thing. Some will forfeit the application fees and reapply later. Of those who do, some wind up getting good scores because they’ve learned their lesson and did better preparation this time, while for others the results are going to be poor because they did not change anything they’ve done before. Proper planning is crucial for proper preparation

Steps to creating a USMLE study plan.

Often, in forums, I’ve heard people refer to taking the USMLE in military terms. Going to War against the USMLE, they call it. Military generals never go to war without a thorough battle plan, that is if they expect to win and neither should you. We’ll be tackling this topic head on.

The Steps to creating a study plan are:

  1. Determine your objective
  2. Know thy enemy
  3. Know the learning process
  4. Know the components of a good study plan
  5. Know the factors that can affect your study plan
  6. Scheduling
  7. Importance of sleep, rest and recreation
  8. Putting it all together

Determine your objective for the USMLE.

Just like all battle plans, you start out with what is your main objective.

  1. Is it to pass the exam?
  2. Get an average score?
  3. Beat the mean?
  4. Ace it?

High scores isn’t everything in the match. But it can make up for other deficiencies in your resume, like less than stellar grades in medical school, older grad, lack of USCE, etc. Often you see people in forums posting their study plans and asking if it is enough, but enough for what. Determining your objective is the first step in assessing whether your study plan is adequate or not.

So how high a score should you aim for? Well, it is a universal truth that most people do not achieve what they aim for so it is a good maxim to aim high. In the Greatest Salesman in the World, Og Mandino stated that

“It is better to aim for the moon and hit an eagle then to aim for the eagle and hit a rock.”

If you aim for a 75 and fail to reach it, you are in trouble. If you really want a 99 aim for a high 99 so you have points to spare in case not everything went as planned.

One word about setting objectives is to never set it in stone. As you finish your study plan and even as you begin your studies, you may find that your objective may change. Either you’ve underestimated yourself and have found out that you could do better, or your situation’s change, (e.g. your wife gets pregnant or you got pregnant, lost your job, got promoted, etc.) Do not be afraid to reset your objective, just be aware how it will impact your over-all chance in the match.

We’ve often heard about how people downgrade their objectives when they are unable to follow through on their plans. But how often have you heard of people who failed to upgrade their objectives when presented with the opportunity.

In 1863, on the first day of the Battle of Gettysburg, when Gen. Robert E. Lee’s Confederate Army defeated the Union Soldiers defending the three ridges south of Gettysburg, Lt. Gen. Robert Ewell refused to take Cemetery Hill, which wasn’t part of the original Battle Plan, even though it was lightly defended at that time. On days 2 and 3 after Cemetery Hill was reinforced by Union troops, the Confederates made numerous charges to take Cemetery Hill to no avail. This led to the famous Pickett’s charge by 12,500 Confederate troops on the 3rd day of battle which was repulsed by union rifle and artillery fire at great loss to the Confederates. By refusing to upgrade his objective, Gen. Ewell missed an opportunity that could have changed the outcome of the war and the destiny of the United States.


Know thy enemy.

Now like all good Generals, we have decided on our main objective for the USMLE. The next step is to study the nature of the enemy, only then can we know how to defeat it.

Now someone might say, why don’t you just post a study plan and like good soldiers we will follow them. Well that would be easier for me, but I doubt it will work or be effective for a lot of you. You see, a plan presumes that there is an objective, takes into account where you are coming from, your skills and particular strengths and weaknesses and your particular condition. A one-size fits all plan presumes you have the same objective, the same skill sets, the same background and the same prevailing environment which is just not true.

Now normally when somebody asks you how to go to Times Square, you presume he is somewhere in NY. But in the internet, the person may be in San Francisco, Baltimore, London, Karachi or even Manila. And the answer would be different in each case.

So too must your study plan be different depending on your particular circumstances. Just as a doctor tailor makes his treatment plans depending on your circumstances (child, adult, geriatrics or healthy, immuno-compromised, debilitated) we must tailor make our study plans accordingly. But just as doctors have treatment guidelines to guide them in formulating a good treatment plan, so too does this book attempt to provide you with guidelines on how to study to help you formulate a good study plan.

Now a thorough analysis of the USMLE even just Step 1 is impossible in a short article such as this due to its complexity. For those who want more details, refer to my post here and here.

The purpose of the USMLE Step 1 is to test your knowledge of Basic Science concepts relevant to the practice of Medicine and to that extent it has been faithful. All questions you will find are related to the basic sciences like pathology, microbiology, pharmacology, etc. However, to emphasize its relation to the practice of Medicine, a lot of the questions are in the form of clinical vignettes. In Step 1, most of the Clinical Vignettes are classical presentations rather than atypical presentations. For more information about Clinical Vignettes, refer to my post here and here

Another thing you’ll notice is that whereas in Step 2 and 3, the cases are usually common diseases, Step 1 cases includes a lot of diseases that are fairly uncommon. The reason is that USMLE Step 1 emphasizes basic sciences and sometimes, important basic science concepts are illustrated by uncommon diseases. For example, Angelman and Prader-Willi Syndromes are fairly uncommon but demonstrates the principle of Imprinting. Small cell CA of the lung demonstrates the concept of para-neoplastic syndrome but is actually less common than squamous cell CA or AdenoCA. So this should guide what you should emphasize on your review.

All USMLE Steps also require you to be able to recall all this information in a minute or so. What you cannot recall, you do not know as far as the USMLE is concerned. So knowing something is not enough, you must be able to recall it too. Increasingly, questions are 2 to 3 step in order to avoid aided recall from the answer choices themselves. (For more about different types of recall, refer to this post)

All this impacts what we have to study, how we study and what steps will be involve in our review in order to be able to do well in the exam. We will continue next time and talk about how we learn and master information and how to apply this in coming up with a study plan for the USMLE.



Know the learning process involved in preparing for the USMLE.

We now have our objective and we know what the USMLE wants us to know and in what form it will test us for that knowledge. The third part is to understand how we learn and accumulate knowledge.

I’ve found the following to be a useful framework for analyzing and understanding where I am in my review and assess my strength and weaknesses. Using this framework will help us not only in preparing our study plan, but also in assessing any problems we have during our review and remedying them. We can divide our review preparations into 3 parts.

1.       Knowledge Acquisition (KA) – This is where you put information into your Knowledge Bank (KB) Most new graduates are extremely fine here (Except if you’re one of those who barely made it. Crammed for every test and promptly forgot everything afterwards. Most Old graduates and some IMG graduates usually have problems here. This can impact how long your review period should be and the amount of “hitting the books” you have to do.

2.       Knowledge Recall or Review (KR) – This is how well you extract information from your KB. Most new graduates have some problem only here. FA and the QBanks makes a fantastic tool for improving Recall. So people with problems here (New grads mostly) usually give fantastic ratings to FA and Qbank. Other methods to improve recall include flashcards and group discussions. If you have a KA problem, you still have to do KR after you have remedied your KR problems.

3.       Test Preparedness (TP) – If you are not familiar with CBT, MCQ or clinical slant to questions, this is where your problem is. Problems with sitting for 8 hour exam is also classified here. Difficulty in answering 2 to 3 step thinking questions and running out of time during the exam also falls here. This is where QBanks are the most effective.

How long, how detailed and how demanding your study plan will depend on where you are standing right now. If you have lot’s of KA’s to do, then you have your work cut out for you. Textbooks may even be in order and not just Study Notes and Outline Notes. If it’s mostly KR, then repetition, repetition and more repetition is the way to go, especially outline notes and Qbanks. If its TP then Kaplan and UW Qbank will be most helpful.

For a more thorough explanation of the learning process, refer to my post here. For a more thorough discussion of KA, KR, TP refer to my posts here.



Know the components of a good study plan for the USMLE

We now discuss the different phases of a complete study plan.

The three phases are as follows

  1. Learning Phase: This is where you try to learn everything that you still do not know about medical concepts tested in the USMLE.
  2. Mastery Phase: at this point, you already know the concepts, you just need to put them into immediate recall so that you can recall them in the minute or so that USMLE requires.
  3. Psychological Preparation: It is important to prepare yourself both physically and mentally for the grueling 7 to 8 hour exam(16 hours for step 3). Failure to do so may mean low scores or worse failing the exam altogether.

Many people tends to skip the learning phase and go directly to the mastery phase by purchasing review books like FA or BRS then use them almost exclusively for their studies. Depending on your goals and your current situation, this could be either a minor problem or a catastrophic one. One cannot master what one does not know. You can’t review materials you do not know. You need to study them.

The longer you are out of medical school the more time you need to spend here. The lower your scores were during medical school, the more you need to concentrate in learning all the important concepts tested by the USMLE.

Even recent graduates who are very good students cannot remember everything they’ve studied and usually there are gaps in their knowledge due to a variety of reasons. (eg. Subject not covered by professor, etc.) Therefore, it still makes sense to realize that there will be concepts you do not know and the best place to prepare for them is during the learning phase. This is especially crucial because you should not schedule your exam before you finish your learning phase (a common mistake committed by many). You should only schedule the exam once you are in your mastery phase where the time frame for accomplishing most preparations is more predictable. We will deal with scheduling later.

The mastery phase is what most thinks of when they talk of reviewing and in truth for most people, this is where most of their preparations should be. The main objective of the mastery phase is to get as many information as possible into immediate recall so that one can do well in a timed exam like the USMLE. (Refer to my post on different types of recall here.) Given enough time, one can recall almost anything one has learned and that’s the reason USMLE is a timed exam. It wants to test how much material you’ve mastered rather than how much you’ve learned. Outline notes, Qbanks and Flashcards are the way to go during mastery phase.

The psychological preparation phase is commonly skipped and yet many times this can be crucial to doing well in the examination or even passing it. Even if you are physically able to finish 8 hours, being mentally alert by the 6th to 7th hour is not that easy. Horror stories abound of people panicking and going blank during the examination.

In boxing for example, Boxers do not do much training in the last week before the fight. They’ve finished their training by then and if they’ve not then there is a big chance they will lose. However, they still go to the gym not to train but to keep focus and to prepare themselves for the upcoming bout. Therefore, it is important to give yourself time before the exam to physically recuperate from a long and arduous preparation and mentally focus on the upcoming examination.

Know the factors that can affect your USMLE study plan.

We will now discuss the various aspects that make making a one size fits all study plan practically impossible. This will be just an overview and we will discuss them in more detail later.

An important factor that will affect how you prepare for the USMLE is your background.

  • Are you a recent graduate or an old one?
  • AMG? Or IMG?
  • Good student acing all exams? Or barely made it through medical school?
  • Top school, run of the mill or diploma mill?
  • English as medium of instruction or other language?
  • Native English speaker or poor in English? (Having to translate the questions in your head can just be enough to break the exam for you.)

Any of these factors will affect how you prepare, how long you prepare and what additional steps you have to take in order to be ready for the USMLE.

Another important factor is your strengths and weaknesses and particular skill sets which you possess.

  • Fast reader vs. slow reader?
  • Good comprehension skills vs. weak comprehension skills.
  • Good memory and retention vs. poor memory and retention.
  • High IQ vs. very High IQ. (It is presumed that since you finished medical school, you probably have a high IQ or at least above average. A minimum IQ of 125 is needed in order to reasonably finish Medical school in the time allotted for it.)
  • Whether you study better by reading, listening to lectures or group discussion.
  • Long attention span vs. short attention span.
  • Good concentration vs. easily distracted.
  • Strong self-discipline vs. poor self discipline.
  • Favorite subject. (You tend to learn and retain better information on subjects you like and if they happen to be heavily tested subjects, ie. Patho, Micro and Pharma in Step 1 or IM in step 2 and 3, this could influence how well your review will go. If you hate them, it will be harder.)

Last, but not least, your present circumstances can affect not only your study schedule but how high a score you should be aiming for.

  • Working full time, part time, jobless.
  • Head of the Family and sole breadwinner
  • Pregnant
  • Have small kids particularly toddlers and infants
  • Amount of Social support you can draw on
  • Parents take care of all financial needs (The social pressures from relatives can be particularly demanding in this situation.)
  • Family expectations
  • Visa issues
  • Your age and your health

All of the above circumstances will affect your study plan. It will also affect your schedule including when you should schedule your examination. Let’s look at them in more detail.

Your Background

We will discuss how your educational background affects your study plans. We will go to the different aspect of your background.

New grad vs. Old grad.

High scores are more important to an old grad. Also the need for longer study time and additional responsibilities like work and taking care of kids makes their study plans much more complex and demanding than for new grads.

AMG vs. IMG.

IMGs need higher scores and longer study schedules than AMGs. AMGs have an advantage in Behavioral Sciences. US medical schools prepare AMGs to do well in the USMLE. This includes special pathophysiology classes and clinical correlations. While most IMGs are left on their own to integrate the concepts. That’s the reason for the popularity of Goljan’s lectures. When he goes “mechanisms, mechanisms, mechanisms”, he means “pathophysiology, pathophysiology, pathophysiology.”

To read more about the alleged differences between the difficulty of the exam for AMGs and IMGs, refer to my post here.

Good Student vs. Barely Made it.

If you barely made it through med school, then there probably are large gaps in your knowledge of concepts tested by the USMLE. It is important for you to hit the books, especially on frequently tested concepts you have not mastered. Even if you were a good student, there could still be some gap in your knowledge and it pays to go through outline notes like FA or BRS to find weak points.

Top school, run of the mill, or diploma mill?

There are topnotch graduates from diploma mill schools and there are really bad students from top schools, but on average you expect students from top schools to do better, therefore your school can affect how much preparation you need to make.

English as medium of instruction.

Even if you are proficient in English, having learned medicine in a foreign language can affect you. Most medical terms are not taught or learned outside of school. English is the medium of instruction at our school. Although I am proficient in both Filipino and Chinese, I learned medical terms in Filipino only after long practice and still have difficulty with medical terminology in Chinese.

Native English Speaker or Poor in English

The USMLE is in English and having to translate medical terms and even regular words in your head can slow you down a lot. In a timed exam like the USMLE, it could prove fatal. So if you have language problems, work on it first before attempting the USMLE.

Your educational background can and will impact your performance in the USMLE. Make sure you take that into consideration in your preparation.

Your Strengths and Weaknesses

We will deal with how your particular strengths and weakness impacts your study plan. Different people possess different skill sets. Your particular skill set will determine how you should conduct your review.

Fast vs. Slow Reader

Fast readers have a tremendous advantage in reviewing. If you are a slow reader, read up on some tips to increase reading speed in my post here. Also fast readers have an advantage when tackling the kilometric questions that appear in Step 2 CK.

Good Comprehension Skills vs. Poor Comprehension Skills

If you have poor comprehension skills, compensate by rereading the topics if needed. You need to understand it to learn it. What matters if you finish fast but did not learn anything. Again, main reason why you should not schedule examination until you finish your learning phase, since how fast you learn is variable.

Good memory vs. poor memory

Memorization is just repetition. If you have poor memory, do more repetition. Mnemonics is unreliable most of the time due to time constraints of the exam. Frequently tested material must be in immediate recall. Use mnemonics for more peripheral, less tested information.

High IQ vs. Very High IQ

If you finish med school than you can pass the USMLE. You just need proper preparation. The USMLE is tough but definitely doable. Having a Very High IQ just makes it easier.

Study Mode: Reading, Lectures, Group Discussions, etc.

Some people learn better reading, others hearing lectures and others by group discussion. As I said before people learn best by association. A lot of times you remember facts not because you read them, but because the lecturer said something humorous or you remember a particular incident during group discussions. Different people learn better in different environment. Understand what environment suits you best and include that in your study plan.

Good Concentration vs. easily distracted.

Some people can study with the TV on while wearing an ipod and with children wailing in the background. Others need absolute quiet to study. You should determine under what environment you can study well. Phone calls, social events and other distractions will affect how long your preparation will eventually be.

Long attention span vs. short attention span.

Some can study for hours, while others get bored after some time. Schedule your review to take this into consideration. Short attention span can be offset by variety, either in topics reviewed or in study mode. For example, studying pathology and anatomy or physiology in parallel or alternately can offset boredom. Alternating between reading, taking short quizzes, group discussion and listening to lectures can also offset boredom.

Strong self-discipline vs. poor self-discipline.

Some people can make a study plan and stick to it. Others, well, others make a study plan and try to stick to it. (wink..wink..) If you lack self-discipline, it’s best to recruit others to help you. Enrolling in a class (and showing up) can help. Joining a study group can also help. Do not schedule your exam in the hope it will force you to stick to the plan. You’ll wind up losing $$ or failing the exam.

Favorite Subject

Pathology, Anatomy and Physiology are my favorite basic science subjects in Med School. Which just means that I tend to study and retain what I study on these subjects. You probably mastered more medical concepts in your favorite subjects than others. When reviewing for the USMLE you need to concentrate on the big subjects rather than what is your favorite subject. The big three is pathology, pharmacology and microbiology. If these are not your favorite subject then you know you have your work cut out with you. If they happen to be, then you probably can make do with less study time.

Your Present Circumstances

Each one of us have a life outside of studying for the USMLE. We will analyze how your present circumstances affect your study plan.

Working full time, part time, jobless.


Some people have to work full-time. Which just means that they have to consider that their review period will be longer and that their schedule will be constantly interrupted. It is important for them to make sure that they set aside time for study and during those set time to isolate themselves from worries at work. The same could be said of those who work part time although their problem is not as bad as full-timer.


Head of the Family and sole breadwinner


Being head of the family and sole breadwinner is more challenging than just being employed. The pressure is physical, emotional and psychological. Having adequate social support is crucial if you want to pass or do well in the USMLE



Pregnancy brings with it a lot of problems not the least of which is going into labor at an inconvenient time.(eg. Like in the middle of the exam) Preparation for the exam and the exam itself are extremely high stress situation, so proceed with caution.

Have small kids particularly toddlers and infants


Children are fascinating, cute and lovable except when they won’t eat, become cranky and irritable. Then they’re nearly impossible. Hats off to all USMLE takers who have toddlers and infants and still able to study well. For others, well, asking for help from other adult family members may be needed. So it is important to anticipate and prepare for this before start of preparation.


Amount of Social support you can draw on


Support from family, relatives and friends can make a difference in your psychological preparedness for both the preparation phase and actual examination. There is a difference if people are rooting for your success or your failure.

Parents take care of all financial needs


Most new grads belong in this category. It is both a blessing and for some also a burden. The pressure to succeed at your first try because somebody else is paying for it can be overwhelming. Although for some there may also be a tendency to take it easy since they don’t have to worry about the financial burden.

Family expectations

High family expectations can be a spur to do well, or can hamper performance. Low family expectations can result in the same things as well. Again the result differs depends on each individual’s particular situation and their reaction to them.

Visa issues


You need to take the Step 2 CS exam in the United States and if you need a visa to enter the US, you will need to anticipate the time delay it takes to get one. So schedule your review with that in mind.

Your age and your health

Suffice to say, younger people have more stamina than those older, although you can also say that older people may be wiser. In addition, poor health can affect concentration and study time.



Now we talk about scheduling. There are different aspects of scheduling that we have to consider. Foremost is in what order do I take the USMLE. For AMGs the answer is moot and academic, since this is dictated more by the medical school than personal preference. For IMGs, who are free to chose their own sequence, it is more problematic. While it is true that for some IMGs it is more beneficial to take the USMLE Step 2 CK, I believe that for majority of exam takers, taking it in sequence provides tremendous benefits. I’ll discuss the reasons in more detail in a future post in my blog.

The next consideration is how long a preparation time should I allot for review. Again, this is so dependent on individual differences, it is hard to give an estimate. However, for the ideal graduate, meaning fresh grad, good student from good school, 2 to 3 months for Step 1 and 1 to 2 months for Step 2 CK is about average to pass and do well but not to ace the exam. (Again, there are geniuses who probably will be able to ace the exam, though) But outside of ideal, you will have to make adjustments.

Often, I see in forums people who will declare that they’ve signed up to take the examination in 5 or 6 months (or 2 or 3 or whatever), then ask plaintively, “what do I do now?”  All I could do is shake my head since they are headed for disaster.

I have already discussed about the learning phase and mastery phase in your study plan. Mastery phase is most predictable. Usually 2 to 3 months to pass Step 1 on average and 3 to 4 months to ace it. Other factors like reading speed, IQ, available study time, etc. will affect it but the estimates are average. The learning phase is most unpredictable. That is why you should not schedule your examination until you are starting your mastery phase.

The last advice I can give is to schedule your exam to achieve a certain score rather than to finish by a certain date. By all means schedule your exam to finish by a certain date but if by that date you are not ready then postpone the exam. It takes as much time, effort and money to retake an exam as to cancel it and take it later. Except if you fail and retake it, it can do irreparable harm to your ability to match.

Importance of sleep, rest and recreation.

Having enough sleep, rest and recreation is very important in the review process. The worst time to burn out is just before the actual exam day. Also, studies have shown that neural connections are made during sleep and that unless we sleep, whatever we have learned during the day is not stored in long term memory. Infants sleep all day, because they have more information to process than adults. So not sleeping to study is not considered good quid pro quo.

Rest breaks are also important within the day as monotony will tend to dull your attention. Your eyes may be moving through the words but your brain is not recording it. 45 to 50 minutes study with 10 to 15 minute break is a good rule of thumb although again, personal differences may mean you have to adjust the actual rest break.

Now, there will be people whose total review period will go beyond 5 to 6 months due to circumstances not within their control and as such, they will need to have a break. Burn out is a big possibility and it is better to extend total preparation time by a month to rest in between.

We have finished our short guide on how to create a study plan for the USMLE. I hope that this will help people prepare better for the examination. From time to time, this guide will be updated and revised, so it may be a good idea to visit my blog to see if there is an updated edition.


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  • Karina says:

    Thank you for sharing this and for all the valuable information here. I just bumped into your blog last night and have read a few posts. A lot of great insight here and inspiration.

    I am an IMG and in this long and arduous journey. Reading others’ experiences and perhaps if we’re lucky, a good advice like this, helps a lot!


    All the best to you!

  • sikha says:


    thanks a lot, for posting all of this information… i certainly know now and i am absolutely overwhelmed by the sheer intensity of the struggle that lies ahead if indeed, i muster all my courage to attempt takin this exam !!! i’m scared shits bout even thinkin bout it ! i have a lotta questions which i wish i could ask u without sounding like a clod but i guess i’d rather reserve them for my seniors who have completed this already !! adios amigo !!

    god bless u !

  • askdoc says:

    Hi sikha,

    USMLE is hard but not impossible. What is needed is proper prep. I, too was terrified when I started contemplating on taking it. But knowledge is power. By knowing all there is to know about the exam, how you are tested, how you are graded, what is tested and the mechanics of the exam itself, it was easier to design a program that will ensure success. Prep right and you will succeed. Most people fail because of improper prep rather than any other reason.


  • yoojin says:

    what happened to the ebook? I click on the link and it doesn’t go anywhere 🙁

  • askdoc says:

    Hi yoojin,

    Sorry, I made some fix-ups on the blog software which unfortunately have the side effect of making the download page unreachable. I’ve already fixed it. Thank you for informing me.


  • Dahlia says:

    Thanks alot for such valued information ..
    I am a newly grad from Saudi Arabia .. this blog turned to be my favorite USMLE guide !
    as an international medical student I know few things about USMLE; the plan described above helped me alot, now i am more enthusiastic to start studying for the exam.

  • Francisco says:

    Hi! Thanks for this guide, it is really helpful!

    I had a question regarding the study plan. I’ve taken a whole semester off from medical school to dedicate myself exclusively to study for the exam and hopefuly ace it. I made a plan which dedicates a whole month for Pharma, another for Pathology, and then the crammable subjects towards the final months. The last 3 months I plan on taking a CenterPrep self study course, which hopefuly will help reinforce what I studied during the first 2-3 months. I want to start with Pharmacology, because in my school we didn;t finish covering all the coursework and I can’t recall some things. Nevertheless, is it more practical a systems-based approach to my study or to study the different subjects separately?

    Many thanks!

  • askdoc says:

    Hi Francisco,

    Depends on whether we are talking about the learning phase or the mastery phase. In learning phase, systems-based is good. But in mastery phase you should cover them by subject. If you are only dedicating 1 month to Pathology, then you need to read all the articles in my blog and forum, because it means you haven’t.


  • Francisco says:

    Hi, doc, thanks for your reply, I was wondering if you knew of a good q bank or questions book by subject that I could use to accompany Lippincott’s illustrated review of Pharmacology. I’m finding the book very helpful, but could use questions to assess my learning of each chapter. Im trying to find one that preferably covers each of the different pharmacology subjects. Would kaplan Q book be useful!

    Many thanks! and thanks for the blog, it’s really helpful to prepare my study plan!.

  • askdoc says:

    Hi Francisco,

    You are welcome. For Pathology I recommend Robbin’s Review of Pathology question book. For micro/immuno, I recommend Levinson and Jawetz Microbiology and Immunology book by Lange. The questions in the back are good chapter by chapter quiz. For Pharmacology, Katzung and Trevors Pharmacology Review book (not the textbook) have very good chapter by chapter quiz at the end of each chapter. For the rest of the subjects, Kaplan q book would be fine.


  • Dr.Mohak Mehta says:

    Hello !
    I can see that the problem with me is in the knowledge acquisition phase.
    Could you please go into a little detail on how to tackle “that” situation ?
    Thanks !

  • Dr.Mohak Mehta says:

    I forgot to go into a little detail in my previous comment.
    I’ll be frank. I was not that great a student. And hence many of my basic medical concepts are weak.
    But being an IMG, its important for me to not only pass the USMLE but also get a good score. So, how should I go about the KA phase that you mention.
    Kaplan Notes vs. The BIG books ??
    Coz what I feel is, there’s not enough time left for me to review all the heavy material in a time period of 6 months or so.
    What would you advise ?

  • askdoc says:

    Hi Dr. Mehta,

    If you are weak on concepts, no choice but to hit the big books. If you know the concepts but find it hard to learn the details, then Kaplan notes may suffice. However, Kaplan notes are not organized for efficient recall. In fact in my prep course, I am forced to write my own notes to cover this deficiency. Initially I just wrote notes for Pathology, but most of my students want me to write notes for all the rest of the other subjects rather than use Kaplan notes. Again, you need to read up on the 3 phases of preparation, learning phase, mastery phase and test preparation phase. It’s posted in somewhere in my blog. You need to do all 3 right if you want to get a good score.


  • rm says:

    Thank you askdoc,i read your posts at pre4usmle site as well long ago but didnt know if you had blog as well,glad to find it :).
    I read in one reply of yours to one comment here(in blog) where you talking about learning phase and mastery phase.but where actually did you discuss these two i couldn’t find in your blog.kindly direct me to your that blog post.

  • askdoc says:

    Hi rm,

    It’s in the posts about my prep courses.’s-usmle-step-1-prep-course/

    It’s in the middle of the above post.


  • Francisco says:

    Hi doc.

    I’m having a little trouble on how to proceed with my study plan. As I mentioned in some other post, Im a mexican student who just completed the basic sciences courses. Since my school doesn;t allot time to dedicate to boards prep (unless you wait until you get your degree, 5 1/2 to 6 years), I took the semester off to prepare myself, made my own study plan, and have been following it almost very faithfully (some colleages from school have done similar stuff like that).

    I did however also buy a centerprep kaplan course for 3 months starting this month to complement my study prep (as this was the only way I could take a semester off, taking it as if it where an ‘exchange’ program with Kaplan, but I’m at a loss as to if I should start focusing more on the type of prep Kaplan offers, with its personal learning system, or just follow my original study plan, with some review books I already have. So far I’ve covered all Pharmacology and most of Pathology with my own plan (lippincott, katzung, BRS, with robbins review and goljan to complement), and I’m starting on the other subjects remaining.

    I took the diagnostic test kaplan offers for the PLS, and came out with a scary total score of 57%. I know I never had the behavioral sciences courses in my mexican curriculum, nor some aspects of anatomy, so some of my weak areas came there. It was only a 3 block, 3 hour exam of 150 qs, so I’m sure it’s not a very accurate diagnosis of my present status, because in the Practice Test offered by Prometric (I know, I blew my confirmatory test to assess my readiness for usmle before I ended my review; it was only later I found out when reading your post) I got a 65%.

    So, though I’m worried about having enough time to study the lecture notes on my own AFTER reading them together with the DVDs, should I stick to my original plan with other review books or focus from now on on Kaplan?

    Many Thanks!

  • askdoc says:

    Hi Francisco,

    Sorry for the late reply. Been really busy with preparing my online live lectures for my prep course. 6 live online lectures on Study Methods and Test taking strategy for my September class. Anyway, I have started writing a reply for your question, but it’s become really long and I might expand it to a full post later with full explanation. Anyway the short reply is this. When you use Kaplan, you are actually relying on Kaplan to tell you what you need to study. If you use your own study plan, you are relying on your own judgment on what you need to study. The question you have to ask yourself is how confident are you about your ability to judge what you need to know in order to do well in the exam. When you enroll in a course like Kaplan or in my course, you are using substituted judgment, or substituting Kaplan or my judgment on what to study, how much to study and how to study rather than using your own judgment. Kaplan actually just gives you what to study, not how much to study and how to study unlike in my course.

    Anyway, the materials you use will determine what you will study and if that is not enough to get the score you want, then you won’t get it. For example, First Aid is very good study material, but First Aid’s goal is to help you pass, not get a high score. So if you study everything in FA, you will probably pass. but if you just read FA a couple of times, you won’t even learn enough to pass. Kaplan provides enough material for you to get 90’s, probably even 99. But you need to study everything very well and high 99 is probably out of the question. I will go into more detail about this in a full post as this will be a very long discussion. Actually this is the topic of the first of my 6 live online lecture in my prep course. The first topic discusses what to study, how to study and how much to study in order to master Step 1. The other 5 live lectures deals with studying specific subjects, planning your whole prep schedule from the start until you sit for the exam including when to do qbanks, when to do NBME and when to actually schedule the exam and lastly, test preparation strategy including speed building, analyzing test questions to catch tricks, drills to eliminate bad habits exploited by test makers, etc.

    As to getting a 57% in the Kaplan diagnostic exam. Well in 2005, I also did the diagnostic exam and I got a measly 45%. But 8 months later, I got a 99 / 256. I also did the Practice test given in the USMLE CD and got somewhere in the 50’s. But was scoring in the 90’s with only 1 to 2 items wrong per block around 3 weeks before the exam. So you see, my statistics was even worse. So it’s not where you are starting from, but what you actually reach that counts. And what you do during the journey makes a lot of difference on where you wind up in the end.

    Finally, no you did not blow your confirmatory test. The confirmatory test is NBME assessment test which has six forms for Step 1 and not the prometric exam. The prometric exam is very, very easy compared to the actual exam.


  • Dahlia says:

    Hi Askdoc,

    I am a fresh IMG who graduated last year. I started to prepare for Pathology as my first subject in my step 1 study plan. I have some gaps in knowledge so according your advise i will start by the KA phase.
    I chose the following notes: Kaplan lecture Note Pathology (Study note), Goljan’s Rapid review Pathology & BRS Pathology (Outline notes).

    my questions:
    1. do you think those resources are enough? I am an an average student, a hard worker and committed, and i aim to ace the usmle.
    2. shall i start firstly by reading Kaplan thoroughly till i finish it, then go through the outline notes afterwards?
    3. when shall i use the Q’s books; side by side with study notes or by the end of each chapter? which Q books you advise me at this stage; Kaplan Qbook or Qbank? or UW?

    Thank you very much for all your efforts, I really appreciate you.

  • Dahlia says:

    Another thing,

    I took a general view at the Pathology demo you provided in your prep course. I really liked your study notes as i found them more comprehensive than the Kaplan’s lecture note -at least in Patho-.
    As i wrote above i just started my USMLE journey and i am still in the KA phase.
    My question: is there a chance i can get the full Pathology 25 chapters online even i am not enrolled in your course? is it free or i need to pay for this, if yes how much is the price?

    Thanks again

  • Dahlia says:

    Dear Askdoc,

    sorry to bother again and again.
    well, after reading almost everything you wrote wither in blog, forum, and the prep course methodology, i believe you will be my best advisor to prepare for the USMLE step 1 as I liked your systemic approach which really fits my studying way.

    I tried to join the November 2009 batch but after submitting my information and before payment I noticed there are only 2 options to choose: either September 09 or October 09 !
    there was no November Batch and i am afraid to miss the chance to join this class, i would really like to finish by May 2010.

    I tried to email you in private but actually i don’t know how to do that. I would appreciate it if you inform me how to join your course as a student in the November 2009 batch.

    Many Thanks.


  • askdoc says:

    Hi Dahlia,

    I had not been able to update the enrollment site due to pressing work. You are the third person to point that out to me, so I have fixed the enrollment system today. Please read as there are new information about the course beginning with November batch. For example 6 live online lecture are now included with the course. Plus there is a downloadable pdf file for the Suggested Prep Schedule for the course. Plus access to online resources will now be 9 months, although the group chat and lecture sessions will only be for 3 months. You will still have support via pm from month 4 to month 9.

    There will be available starting March, an option to enroll in the course only for the notes and online quizzes without lectures or the chat sessions. It will be called guided self-prep course. This was what you were asking about in the earlier post.


  • noha says:

    hi dr , well im a new img from egypt and want to do usmle but really i m confused by what to take first step1 or 2???? thank u

  • askdoc says:

    Hi noha,

    It is best to do Step 1 first before Step 2 CK. This is because 40% of Step 2 CK is actually covered in Step 1 review. Therefore if you start with Step 2 CK, after reviewing clinical medicine you have to review Systems Pathology and Pharmacology before taking Step 2 CK in order to do well there. So makes sense to start with Step 1 first.


  • Hussayn says:

    can some1 can tell me how to contact Askdoc via email? Do not understand the instruction he gave in regards to his calling number+ @+ URL. I need to ask a couple of questions!

  • askdoc says:

    Hi Hussayn,

    You can contact me by logging into my forum at and pm me. My callsign is askdoc.


  • Hussayn says:

    Hello Askdoc,
    I have tried to contact you by clicking the link you provided, I have sent PMs and email but nothing. Would you mind telling me if I am doing the right thing? thx!

  • askdoc says:


    Excuse me please. I do not spend my time just sitting here doing nothing and giving free advise. I have patients to see. I have a family. And I work for a living. So I suggest you pay somebody so He is at your beck and call. Thank You.


  • Hussayn says:

    Hello Askdoc,

    I deeply apologise if i have offended you in anyway. It was far from my intentions to do so. I perhaps wrongly explain myself. It is just that I am new to the blogging and forum system. I was not sure if I was doing the right thing or using the right procedure. It was not my intention to offend in that way once again I apologise.


  • Hussayn says:

    I forgot to mention that my sole intentions was to ask a couple of questions before I make the decision to enroll in your course. I just wanted to enroll in the course at the right time, then plan ahead in order to enroll and complete the course successfully. I must say that you’re words were a bit Harsh and Hasty towards me…

  • Hussayn says:

    Hello Askdoc,

    I hope we can get pass our misunderstanding. Here is the message I sent you via your forum. I understand that you are very busy. I will understand if you do not wish to reply…but I do hope you will reply since I would like to enroll in your online course. As I read in one of your posts that you prefer to answer via your blog since it could be benefit others…I am very pleased with that.

    I must say that I was very impressed with your blog and its stunning truth. I think your advice are good not only for the USMLE steps but also for regular exams. I read almost all the posts since I also want to score 99 on the USMLE step1.

    Here is my problem, I have just finished the premed portion of my programme
    and I am now going to start on my MD degree in MAY 2010. My school has a
    very bad structure when it come to prepare students for the USMLE but it
    follows the US curriculum. 2 students scored in the 90 and 1 scored 99 but
    most took a year before taking the exam. I was wondering when should I
    start preparing for the USMLE. My professors told me it is too early to
    start now, I should start after my second semester of MD. Why would you
    advise me?

    Also Which Q bank shall I use. I read your posts about the USMLE world,
    Kaplan Q banks and NMBE but nothing about or other available Qbanks using a mixture of MCQs and EMQs. I understand those you’ve stated are the most popular.

    It is a requirement of the medical schools in my country to pass Step 1 and
    2 before graduation, otherwise no degree. Therefore, I must take the exam
    even though I have no intentions to practice in the US but the UK. So after step 1 and 2 I have to take the MRCP UK examinations or

    Please advise me of what shall I do and when shall I enroll in your course to get the best benefit out of it?
    Oh I must say that I will register for the steps as an IMG…

  • askdoc says:

    Hi Hussayn,

    I have answered your pm at the forum.


  • rahul says:

    Hi askdoc.

    I am an IMG. Completed my final year of medical school in march. Plan to give step 1 around mid-november (it may get extended as I am not upto speed as yet). Aiming high 99 (I dont have a option … need to score that).

    I have been an above-average student through out (not to boast .. but to give my background to you) and my basic science funda (acc to me) are quite above average.

    I have all the review books I know its not required. But collecting books and not reading it – is my hobby haha.

    Anyways, now on a serious note, I have completed till now 75% Pathology (once in 3rd year of medical school and once right now with Goljan RR and audios) and Immunology (Kaplan LN and videos – i found both of them amazing).

    My need for advices are as follows

    1) Can someone gimme a rough study speed and guidance on books from now, so that i am totally prepped by november.

    2) I am ready to spend money on kaplan qbank and usmleworld (I know its a must) … but what i mean is that if required, i dont mind signing up for both. My BIG question is (I have read everywhere but cant find a genuine answer to this) – which bank should be subscribed when ? Both are necessary? Should I do kaplan qbank along with my first reading now and solve it subject wise and do usmleworld in last months to judge my prep? PLEASE do advise on this.

    3) Obviously aiming at high 99 means, i need to know High-yield info like crazy but also know Low-yield info very well as well. Any advice how to cope up with that? What extra effort needs to be given for that?

    4) Where do q books such as Lange Q and A, Kaplan q book, First aid Q and A, Robbins Review of Pathology etc stand in the prep ?

  • satya says:

    hello sir,

    i became graduate on 2010 MAY.i m going to take my step1 at the end of november 2010. may i know how many attempts offered by examination board on step1 exam? eventhough i will go with one attempt i mean to know about this.i attempt step1 know if not satisfied with score whether i have to wait for another seven years? i came to know from someone about this correct information what i got?

    looking forward for your reply.!


  • askdoc says:

    Hi satya,

    If you attempt Step 1 and you fail, you can retake the exam anytime. If you attempt step 1 and you pass, you cannot retake the exam until after 7 years have passed. But if you do that, chances are you will be unlicensable in many states as most states require you to pass all 3 steps including Step 3 within a 7 year period from the first time you first took the exam or you will not be eligible to be licensed. You can still take your USMLE but you need to research which states do not have this 7 year limitation because only in those states will they accept your USMLE scores for licensing purpose. You can make as many attempts as you like although again your chances of getting a residency or being licensed is nil.


  • Lynk says:

    I have taken the step 4x and wonder if there is still a chance to complete my MD. I am capable of the information however get killed by time in each attempt. Throughout undergrad and med school I was granted time x 1.5 but was denied by the USMLE despite extensive documentation. Ideally I just want to get through this. I am looking at taking a course now (so many to choose from) but live in NW Canada and there absolutely none offered.

    I suppose there are 3 options:
    A: Quit, not something I want to do
    B: Take an online course, ideally the best option due to lower cost
    C: Travel to a location that offers a course, could be very costly, but worth it if it is valuable enough for me to learn what i need to know

    Can you offer any guidance or recommendation?


  • askdoc says:

    Hi Lynk,

    First, you definitely need to join a course. What kind depends on your main problem. If you problem is self-discipline to study on your own, then definitely online courses like what I offer is out. You need a more structured environment. If your problem is understanding concepts, either type of courses is good. If problem is that you have problem retaining the information, then you need to know how to study and my prep course is more suited for that. So determine first why you are failing. If you want to read one of my students who have failed step 1 multiple times but finally pass, go to my forum under exam experience or click the link.


  • Mohammed says:

    Hi ,,

    First I have to say what a stunning blogs that u have made ,, Thanks for ur effort .
    I really enjoyed reading ur advices ,but still have some Qs. if u don’t mind

    My college is following another system , since we have 7 years for medical degree 1yr ( pre-med ) 3yr (basic phase ) 2yr(clinical phase) 1yr ( internship )

    I’m in the third year which is the second year of the basic phase , so i’m planning to take the USMLE step 1 after finishing the basic phase .

    what is the possible plane to preparing ? I’m thinking to consider the Kaplan Home studying program as a source for the rest of the basic phase ?
    and is’t a best time for preparing ?

    i will take the USMLE step 1 in the end of the Basic phase .

    thanks a lot

  • michael soliman says:

    hi, I took the usmle step 1 and failed 4 times, I’m 28 years old grad of class 2006, I have just scheduled for the step 1 for the 5th time on 1st of nov. 2011, I have about 7 hours to study daily, I went though most of the study material and as for the q banks, it was only UW . I’m sure there is something wrong with what I do but I failed to spot it, If u could help I’d really appreciate it

  • askdoc says:

    Hi michael,

    Really hard to pinpoint what your problem is unless well I know you better. You can enroll in my course. That way you can learn how to properly study and compare it with the way you are studying. Plus, there are chat sessions where we can sit down and go thru what you are doing wrong.


  • Aracely says:

    hi, I am an old graduated IMG , already passed step 1 and 2, since i did not apply for residency this year , I am planning to take step 3 and also make some externship . i am really focused in what i want , which is work as Md in USA.Please give some advice for material review for step 3 and also any website to look into USCS, cause i like apply directly to the hospitals cause those companies that hook u up charge too much. Also like to say to my colleges in the same situation Please do not surrender, keep your self up. thanks.

  • EN says:

    Seriously, is any statistics available on IMG residency acceptance from overseas (without visa, etc.)? I bow to those people and feel totally useless not being able to try hardER myself… Plus, where people get info on other than Match residency programs? As far as I understand, Match is only a portion of ALL residency programs available, which change greatly year by year, and is mainly aimed for top-notch AMGs. Thank you!

  • askdoc says:

    Hi EN,

    Actually there is no real study done on how many IMG’s matched per year. But there are ways to get an estimate. I can’t go into detail in this short reply, maybe one day I will write a full post on it. In a report I read a few years ago when they were debating about providing universal health coverage for all Amaericans, they cited the need for at least 200,000 new doctors in the next 10 years plus an additional 120,000 if they want to provide universal coverage. It also cited that there are approximately 25,000 residency positions open in the US per year and that is just enough to replace those retiring but not for the expanding population. The total number of US medical graduates per year is between 16,000 to 17,000. Which leaves about 8,000 residency positions filled by IMG. NRMP only reports about 4,000 positions filled by IMG every year which leaves about 4,000 positions filled outside the match. NRMP also reports about 1,000 positions filled by USC IMG’s which leaves about 3,000 IMG needing visas accepted through the match. Presuming same number of USC IMGs getting residencies outside the match, then there is at least 6,000 IMGs needing visas entering residency in the US every year. Of course the main problem is there are only 8,000 residency positions for IMGs to fill, about 11,000 to 12,000 IMGs pass the Steps every year. So it’s obvious in a situation of supply surplus, score matters not just passing.


  • EN says:

    Hi Askdoc,

    Thank you very much. Many numbers, not many hopes sadly, because among those IMGs are graduates of nearby non-US medical schools who grab the majority of those 8,000 seats. If US Congress pass the universal health coverage in next few years, then it may make more sense to do all these “sacrifices” (how many broken families! – part of the reason I refused to do it earlier). But for now it is pretty much pure luck [read: gambling](and efficient networking) to get a residency position. I was told before when I did my preparations years back that “it’s a priviledge, NOT a right” to practice in this country…how sad 🙁

    But on optimistic note, it is definitely worth trying: everybody I know who tried – succeeded by far disregard age and graduation year (with only 1 overseas example, unfortunately, who came to do his postdoc here first anyway).

    I guess the take home message (use it or loose it) is: weigh in all pros and cons BEFORE you even start studing. For me, situation has changed greatly (kids are big now and I’m not THAT old yet:). Looking back at all my experiences, I’ve always been held back PROFESSIONALLY by the fact that (1) my diploma is not quite what it’s supposed to be even though it’s “leveraged” to PhD, (2) I had no “real” PhD to cover that up and be successful in NIH funding. Sorry for such a long story… I’m just on that crossroad again…

  • EN says:

    P.S. I’m sorry I didn’t know that USC abbreviation was for US citizens, I missed that point completely. It’s hard to believe they comprise only 25% (!) Then the odds are pretty good for those young and optimistic getting 99s – in contrast to grumpy old me 🙂

  • EN says:

    P.P.S it was a great example of how one wrongfully read/ignored abbreviation could spoil the deal

  • preeti says:

    i am a student of 2nd year mbbs in russia and want to know about the usmle n how to prepare for it and what are the requirments plz can you help me out.(and before everything i want to be honest i am not soo good as a student)please help.thanyou

  • USMLEMe says:

    Hi there, I find your website very informative and this post is especially good. I think the eBook idea is pretty cool!

    Just an FYI I’ve placed a link on our website so that our users can find your study method if they’te interested! We’ve aggregated a few other resources too,

  • askdoc says:

    Hi Preeti,

    First you can start by reading all my different posts here to help you. But if you are really very poor in study skills, then you need close supervision and mentoring. That can only happen by enrolling in a prep course.


  • mark ram says:

    hi doc , i am a slow reader..but i can grasp quickly from the will it b sufficient to focus only on the kaplan live lectures without reading the materials ????

  • askdoc says:

    Hi Mark,

    If you read my posts, you will know its not. You need to memorize the materials not just understand them. It’s almost impossible to memorize an audio or video lecture. Try it and see.


  • […] How to Create a Study Plan for the USMLE. – Note: This was initially published in 6 parts and was then consolidated into a downloadable ebook. Why create a study plan for the USMLE? This is probably the …… […]

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