Why You Need to Master the USMLE Step 1

By askdoc / March 12, 2016
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why you need to master the USMLE step 1

Why Do I Need to Master the USMLE Step 1?

One of the most important thing you need to realize if you want to do well or ace the USMLE Step 1 is to know what makes it hard. You need to know why you need to master the USMLE Step 1 before you can start to address the difficulty properly.

Crash Diets and USMLE Prep

Ever since I started my USMLE prep way back in 2005 to 2006, it seems too many people believe that all they needed to do is read through First Aid a couple of times and they will pass Step 1. There are even those who think that memorizing everything in First Aid and the online q banks is enough to ace this exam. Despite evidence that a lot of people studying this way keeps on failing the exam, it seems people continue to believe that this is all they have to do in order to pass or even excel in the USMLE Step 1. It seems people are afraid to admit the truth. That they have to work hard to pass this exam, and work even harder if they want to ace it.

I call this the crash diet method of USMLE prep and it seems too many people believe in it and want it to be effective. Or more like desperately want it to be true. Please read my post on “Crash Diets and Good Habits in USMLE Prep” before continuing. People just want to take the easy way out. But remember, rewards always equal more or less effort. And don’t expect that anything with a large reward will be easy. And the reverse is also true, anything easy will most likely not be very rewarding.

Therefore there is a need for us to understand why the USMLE is not easy. And once you realize that, then you know shortcuts won’t work. Once you understand that, you can start to become truly prepared for this rather tough exam. You can start putting in the necessary work needed to pass and even excel in this exam and not just wishing about it. (Read Wishing and Doing in USMLE Prep)

Know thy enemy and know thyself.  In a hundred battles, thou shalt never know defeat.”

Sun Tzu’s Art of War

Know Thy Enemy

The first step to defeating any enemy, overcome any obstacle or solve any problem is to know the nature of the enemy, obstacle or problem you are dealing with. A major reason why people fail to realize that using First Aid and online Q banks alone will not work is because they lack knowledge of what they are actually facing when they sit doe the USMLE Exam.

They may know it’s a hard exam but hard is relative to your own skill or knowledge. Lifting a 100 pound barbell may be hard for most of us but not for a professional bodybuilder. Running a 4-minute mile maybe impossible for the average human but easy for an Olympic sprinter. Therefore, just knowing that something is hard will not help you solve it. You need to know in detail why it is hard, so that you can address each reason and deal with it in your prep.

If you ever have a chance to look at an ancient maps, the ancient cartographers will usually draw the familiar places in detail, but the unknown territories will just be a big blank and sometimes even labelled as ‘here be dragons or monsters‘, making the unknown, dark and foreboding.

By just labeling the USMLE Step 1 as hard without knowing the reasons, you make it seem insurmountable in your head. Something dark and foreboding, something to fear. Only by knowing why it’s hard can you even start to understand what you need to overcome it.

7 Reasons Why the USMLE Step 1 is Hard

Listed below are the 7 main reasons why the USMLE is hard. I will write in more detail about each of the 7 reasons, the reason why the USMLE designed the exam this way and what you can do in your prep to mitigate its effects in another post. You may want to subscribe to our email list for future updates. Meanwhile I will just give a short description of each reason.

  1. A wide range of medical concepts are covered by the USMLE Step 1. If you go to the USMLE website and look at the list of medical concepts covered by the exam, it covers just about everything in the basic medical sciences textbooks, as well as published medical journals. Take about wide.
  2. The USMLE Step 1 is a very time-limited exam. For most people there is barely enough time to finish the exam, much less time to review answers. In fact, running out of time during the exam is one of the most common reason for failing the USMLE Step 1. Meanwhile I finished my first block in 27 minutes. So there is a solution.
  3. The USMLE Step 1 has relatively few questions for its large coverage. There are 308 questions divided into 7 blocks of 44 questions per block. The limited number of questions limits the topic that will be tested and yet there is no limit to the topics covered. This can result in a lot of concepts you studied not coming out, or worse, a lot of things you failed to study actually coming out. You need to make sure you study the right things and not study things that will not come out.
  4. The USMLE Step 1 is a multiple choice exam with some matching type. The good thing about MCQs is that one of the choices is always the correct answer. The bad news is the way the USMLE implements MCQs makes you chose the wrong answer even if you know the topic being asked. Find out ow this is done, and what you can do about it.
  5. The USMLE Step 1 uses Computer-based Testing. Taking paper-based exam is very much different from taking computer-based exam. That can impact how fast you can finish the exam, since a lot of shortcuts you learned in paper-based exams are not applicable in computer-based exam.
  6. The USMLE Step 1 is a very long and exhausting exam. If they had just conducted the exam over two or even four days, scores would be much, much higher. Learn how you can factor this into your prep.
  7. As far as the USMLE Step 1 is concerned, only what happens on exam day counts. The USMLE Step 1 imposes a very high standard of performance to pass its test. If you can’t answer the question, you don’t know the topic. It does not give you partial points for studying the topic, partially knowing the answer or answering tons of questions about it correctly during prep.

Know Thyself

After knowing everything about the enemy, obstacle or problem, the second step is to know yourself. Knowing your weak points and your limitations. Knowing what knowledge and skills you lack to accomplish the task at hand. Only then can you have a plan of action that will get you from point A to Point B. You first have to know where you are going (point B). Then you have you have to know where you are starting from (Point A). Then you know how far you have to go. What knowledge and skills you need to acquire. What you need to do.

We will only deal with personal limitations that are directly related to prepping for the USMLE. I have not listed emotional strength and endurance as one of them although I believe half of the reason why people fail has more to do with their motivation and emotional health than any skill or knowledge factors. However, we will discuss these factors in a separate section that deals with motivational and social issues that indirectly affects people’s ability to prep properly, or even willingness to do so.

For example, I had a student who basically make decisions to please her family. From the point of view of passing the USMLE and getting a good residency position, her decision seem wrong and stupid and so hard to understand. But if you realize that her decision was based instead on her relationship with her family and personal preference, it all makes sense. It is important to be sure that passing the USMLE is really your goal. I will be presenting individual case studies in the motivational and social issue sections and how they eventually resolved or did not resolve the situation.

7 Factors That Limit Your USMLE Step 1 Scores

Listed below are the 7 main personal limitations that will limit your ability to get a high score. I will write in more detail about each of the 7 limitation, how to determine your strengths and weakness relative to the average test-taker and what remedial measures you need to undertake to cover for these weaknesses. You may want to subscribe to our email list for future updates. Meanwhile I will just give a short description of each limitations.

  1. Limited memory and intelligence. We all have limited memory capacity. Some larger, some smaller. Ditto with intelligence. The USMLE Step 1 is designed for the average medical student, therefore you need to know how you fare compared to your peers.
  2. Tendency to forget. We all have a tendency to forget over time. Some faster, some slower. Normally this is not a problem as the rate of forgetting is usually small. But the length of most USMLE prep is quite long and the longer the prep, the more this limitation becomes a problem.
  3. Recalling and Retaining Information. Retention and recall are not the same although they are related. Retention is how well you memorize the information while recall is being able to get it back out. Too often you can remember something but cannot recall it. There are ways to improve both.
  4. Time-bounded prep. You can’t study forever. And depending on your personal circumstances, you may have a very limited time to prep for this exam.
  5. Study skills. Good study skills help in understanding, memorization and retention. Good students usually have good study skills, which is why they tend to get better scores in the USMLE Step 1.
  6. Test-taking skills. How good you are at taking tests has a big impact on your scores. The test is difficult not only because the medical facts tested is hard, but a lot of times, because of the way the questions are constructed. Good test taking skills help make tough questions easier.
  7. Physical endurance. The USMLE Step 1 is a marathon not a hundred yard dash. Both the exam itself and the prep. You need to be physically able to complete the whole task. Physical endurance depends on your age, your general health and your physical fitness.

Preparing for Battle

After you have found out everything about the USMLE Step 1 and understand your own strengths and weaknesses, it is time to map out a battle plan on how to tackle the USMLE Step 1.

Imagine you are a part of a Special Forces team tasked to rescue a group of hostages held in an armed camp. You attend the mission briefing and when you asked the commander what is the plan, he replies. Go in. Kill as many of the enemy as you can. Find as many of the hostages and get the hell out of there. And of course, don’t get killed. No map of the camp. No estimate of enemy strength or firepower. Not even the number of hostages held. What chances do you think you have of accomplishing your mission?

Yet, you won’t believe how many people plan their prep the same way. When you ask them what’s the plan, they will answer. Oh I will read the reviewers once or twice. Maybe memorize First Aid and do the qbanks. That’s it. And that is supposed to guarantee that they will pass Step 1 and maybe even ace it.

We will discuss in more detail about how to make battle plans in the section on “Creating a Study Plan for the USMLE Step 1.” Meanwhile you may want to download my mini-book “How to Create a Study Plan for the USMLE” for free. It outlines what you need to do to create a USMLE Study Plan. Meanwhile, the blog section will discuss the details of each step and guide you through step by step until you come up with a workable study plan for the USMLE Step 1.

7 Steps to Mastery of the USMLE Step 1

Listed below are 7 steps you need to incorporate into your study plan if you truly want to master the USMLE Step 1. I will write in more details about the 7 Steps in a future post. You may want to subscribe to our email list for future updates. Meanwhile I will just give a short description of each of these steps.

  1. Expand limited memory. Even though we all have limited memory, there are ways to “expand” our limited memory so we can remember more things than we normally do. We will discuss them here.
  2. Right-size the USMLE Step 1. Even though the coverage of the USMLE is quite broad, there are ways to make them easier to manage and memorize. You can make sure that whatever topic is tested, it’s in your head.
  3. Speed up your thought process. There are practical ways to increase your ability to learn, understand and analyze information and make them faster. Learn how here.
  4. Stretch your limited prep time. There are various methodologies to increase the efficiency of your prep, so you are able to do more in less time. Discussed here.
  5. Minimize forgetting process. We all forget. But there are various ways to limit the rate of forgetting. Learn how to implement them.
  6. Hone test taking skills. Good test-taking skills increases your chances of getting the correct answer. It also increases your test-taking speed. Learn them.
  7. Maximize your score. One of the best thing you could do is insure that you get the best score you can. There are many things that can prevent you from maximizing your full potential and getting the highest score you can. Make sure you avoid them.

–> Mastering the USMLE Step 1

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  • smita says:

    I have following questions about using ‘USMLEWORLD Qbank’ for USMLE STEP1 .

    1) I have taken the 30 day q bank. Should I repeat it during the 2 weeks prior to my USMLE, considering I give NBME two weeks before my USMLE STEP1? OR should i go for an another set of Qbank from uworld during that period?

    2) What scores are needed on USMLEWORLD Q bank to ace(99) the USMLE STEP 1?

    Thanks in advance,

  • askdoc says:

    Hi smita,

    There is no benefit in redoing UW qbank once you finish 1 round. Just study the questions and answers. Use a different qbank, best is Kaplan qbank.

    In order to have a chance at 99, you should average in your last 10 blocks, timed, random, mixed, unused, around 72%. If you want a sure 99, that is very small possibility of falling below 99, then it should be about 78%.


  • smita says:

    Hi askdoc,
    Should I do a new q bank in the last 2 weeks before my STEP 1? Or should i just study the material i have read and NOT do any new questions…?

    Thanks in advance,

  • lingk says:

    dear askdoc:

    i need help.

    and i do mean not the usual “run-of-the-mill” type of asking. it’s a downright plea for help.

    i recently failed step 2 CK with a miserable failure of 74%. I am an old IMG, Filipino like yourself. I’ve never failed an exam in my life, I already have a subspecialty! I was perhaps too hasty in my preparation, too complacent. Either that, or I have knowledge inadequacy. When I eventually saw my results, I was devastated to say the least. On the verge of giving up, even.

    I was searching the web for any info when I came to your site. You do remarkable work. When you mentioned you specialize in USMLE failures, I felt renewed hope. Perhaps I can do this, I’m thinking. Maybe there is hope after all?

    And with that came my resolve: to ace all exams.I feel that the only way to redeem that miserable failure is to ace it the second time around. As well as the other steps in the process. And even with that plan, I may still even face serious obstacles in matching. Thus, my goal of a 99 in the exam is non-negotiable. I am going for it. It sounds insane, but I’m actually really going for it.

    I know it’s never going to be simple. I have my work cut out for me, recent financial woes have demanded I cut back on unnecessary resources. Odds are seemingly stacked against this goal. But if I give up now, I’ll forever berate myself. And this is why I’m turning to you for help. Any advice I’ll take to heart as I prep for step 1. I have decided to step away from step 2 for now and master step 1 before I re-attempt step 2.

    Thank you.

  • sarah says:

    dear askdoc
    I have failed step 1 twice am at a state of shock. on my second attempt when i got out of my exam i thought i did good like i passed but when i open up my score i didn’t pass. i dont know what to do. my heart says study again and take it for the 3rd time but my mind is like how am i going to start studying again. any advice of how should i redirect my studying habits.
    what i did for the my 2nd attempt istudied first aid over and over again that i can literally picture the pages with my eyes closed. i read thur kaplan lecture notes onces, i listen to golgan audio like 3times, i work out usmel word like 100 of times, i did kaplan ? and nbme like all of it offline. please i need ur help am real disparate

  • askdoc says:

    Hi sara,

    You can memorize 100% of FA and fail. That is why it never surprises me why people expect to pass this exam by reading FA. Reading Kaplan notes once is only feasible if you have photographic memory, which I presume you don’t. Goljan lectures can help you score high, but only if you have prepped properly first. Otherwise, you will still fail as you have noticed. Read my blog and know how to prep properly.


  • hi says:

    hi i have basically till mid october to take my exam ,please i need ur advice as my knowledge is realtively bad,i will appreciate if u help me so i could achieve maximum success

  • askdoc says:

    Hi hi,

    I wrote a short summary of what you need to do in order to prep properly for Step 1. This was in reply to USMLE100 at NBME Self-assessment Tests and USMLE Review. If you want to read up more details, you can explore the blog as everything is there. As to getting ready by October. If you are really that bad, it would be impossible to do it in such a short time. For the average new graduate, it is possible to pass after 3 to 4 months of total preparation time, but really hard to get a high score. So depends on your current situation.


  • karen says:

    dear askdoc

    i need help if im doing fine for step 1…

    i did Uworld qbank for 2 months, my average for timed, unused, mixed in about 50% and then i studies FA, Kaplan for few weeks and did qbank again, timed, mixed, incorrect and i was averaging 70-75%.. i did nbme 3 (CBSSA-290)… my exam is in exactly 2 weeks, am i ready for the exam? i need to pass step 1 and hoping for 85ish… please help me.. thanks..


  • yanis says:

    dear askdoc,

    I just get my step 1 result and i failed. It was my first attempt. Do you think i still got a chance to do residency/ matching ?please help.. thank you

  • askdoc says:

    Hi yanks,

    Although your chance of getting an interview after failing the exam is considerably less, it’s not impossible. What you should not do is fail a second time. So try to make sure you do your prep properly this time. And make sure you can not only pass but score high before you sit for the next one.


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