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How To Study For Step 1 Pass/Fail

The United States Medical Licensing Exam (USMLE) Step 1 is a critical component of the process of becoming a physician in the United States. It is the first of three USMLE exams taken by medical students and has traditionally been used by residency programs as a metric for evaluating applicants. 

On January 26, 2022, USMLE Step 1 score reporting shifted from a three-digit score to a simple pass-fail, with the intent to address concerns about student well-being and to promote the evaluations of students for residency programs in a more holistic way. 

Prospective and current medical students need to consider how this change may potentially affect them, how residency applications may now be evaluated, and how to successfully prepare for the exam.

How Step 1 has Changed Since Becoming Pass/Fail

Since January 2022, when the USMLE Step 1 shifted from being scored to a pass/fail grading structure, prospective and current medical students have had to consider how the lack of a numerical score may affect them and how residency applications may be evaluated. 

The change intends to address concerns about student well-being and promote more holistic evaluations of applicants for residency programs. With this shift, students are now relieved of the pressure associated with achieving a competitive score and can remain engaged with their medical school curriculum. 

However, the emphasis on the USMLE Step 2 CK score increases, as does the pressure to prepare for the exam during clinical rotations. Additionally, international medical students have had to reconsider the best ways to distinguish themselves within residency programs. Despite the change, students should still study effectively and aim to pass the USMLE Step 1 on their first attempt.

Self-Assessments for Step 1 in the Pass/Fail Environment

7 Reasons Why Self-Assessments are Essential for Step 1 in the Pass/Fail Environment

  • Understand Your Weaknesses: Self-assessments can give you insight into your weak areas and help you identify any gaps in knowledge. This will help you to focus on the topics that need more attention.

  • Prepare for Step 2: Self-assessments can help you build a strong foundation of knowledge for Step 2, helping you to score better and ultimately get into a better residency program.

  • Improve Content Retention: Self-assessments can help you become more familiar with the content and make recalling information easier.

  • Identify Your Strengths: Self-assessments can help you recognize your strengths and focus on topics where you excel.

  • Achieve Balance: Self-assessments can help ensure that you are devoting enough time to both clinical and pre-clinical material and not over-focusing on one at the expense of the other.

  • Be Prepared: Self-assessments can help prepare you for the changing difficulty of the exam, ensuring that you are confident come exam day.

  • Save Time: Self-assessments can help make your studying as efficient as possible, allowing you to use fewer resources and save time.

Paulino Gárate’s Preparation Tips for Step 1

6 Preparation Tips for Step 1 from USMLE Test-Taker Paulino Gárate

  • Focus on a few key resources: Review your knowledge of a topic with the relevant AMBOSS article, deepen your understanding with a related Boards & Beyond video, and then test yourself by answering the relevant AMBOSS question block.

  • Utilize efficient studying: Focus on developing an understanding of the topic, enough to be able to reason your way through most practice questions.

  • Choose high-yield topics wisely: With the need to achieve a high score no longer a factor, choose topics that are high-yield and will help you develop a solid knowledge base for the clinical years.

  • Be prepared and confident: Step 1 is constantly evolving so it’s crucial that you don’t take any chances and are prepared and confident come exam day.

  • Keep your health in check: Your health is priority number one, so don’t forget to sleep, eat well, and stay positive.

  • Prioritize understanding: Set your sights on becoming a well-rounded and effective physician, not just achieving a particular score.


The Best Resources for Building Foundational Knowledge for Step 1

The USMLE Step 1 exam has gone pass/fail, making it more important than ever to build a strong foundation of knowledge. Here are the best resources for building foundational knowledge for the exam:

  • Lecture Notes from Class: The lecture notes from your classes are a great way to review topics and concepts that you have learned in class.

  • Video Resources: Videos such as Sketchy, OME, and Boards & Beyond are great for helping to visualize topics and make them easier to understand.

  • Subject-Specific Resources: Pathoma is a great resource for reviewing topics related to pathology, while First Aid is a great all-around resource for reviewing topics across the board.

  • Qbanks: Qbanks such as Brocali give you the opportunity to test your knowledge on a variety of topics, helping you prepare and become comfortable with the exam format.

  • High-Yield Topics: Be sure to focus your attention on high-yield topics so that you don't waste time studying unnecessary topics. Brocali has a handy feature that highlights topics so you can focus on what you need to know.

By using these resources and focusing on high-yield topics, you can make sure that you are prepared and confident come exam day.

What to Do on Exam Day to Prepare for Step 1

  • Follow Your Usual Wake-Up Routine: Make sure to set your alarm for the same time you plan on waking up on the day of your USMLE Step 1 exam. Eating the same breakfast as you plan to have on test day and drinking the same amount of caffeinated beverage of your choice can help you adjust to the standardized time.

  • Figure Out Your Route To The Test Center: Practice your transportation to the test center so you know how much time it will take to get there on the day of the exam. This can help reduce stress and make sure you can arrive on time.

  • Exercise: Exercising the day before your exam can help reduce anxiety and help you focus on the task ahead. Just make sure not to overexert yourself and leave yourself enough time for adequate rest.

  • Eat Well-Balanced Meals: Eating healthy meals on the day prior to the exam will help you feel your best on the day of. Make sure to get enough fruits, vegetables, and protein and avoid sugary snacks or those loaded with carbohydrates.

  • Do a Gentle Review of USMLE Step 1 Materials: Spend no more than 1-2 hours reviewing any materials that you have difficulty with before the exam. This is not a day for learning new concepts, but rather reinforcing some final concepts so they are solid for test day.

  • Get Adequate Rest: Make sure to get to bed at a reasonable hour so you can leave yourself with at least 8 hours of uninterrupted sleep time. Practice good sleep hygiene and use deep breathing exercises if you have difficulty falling asleep due to pre-test jitters.

Pass program USMLE step 1

PASS Program USMLE Step 1: 5 Reasons Why You Should Consider It

  • Live Instruction: The PASS Program offers some of the best live instruction in USMLE prep, with personalized private tutoring to help you stay on track.

  • Immersive Experience: The course offers an immersive, hands-on experience with hours of targeted prep work, ensuring that you’re ready for the exam.

  • High Quality Prep Book: The PASS Program USMLE Prep Book is extremely well written, providing an in-depth look at the topics you’ll need to know for the exam.

  • Bootcamp-Style Approach: The PASS Program takes a bootcamp-style approach to learning, helping you to master the material and build your confidence.

  • Multiple Course Options: There are multiple course options available, including live on-site, live online and on-demand home study packages, giving you the flexibility to choose the best option for your needs.

USMLE step 1 study schedule for IMGs

For IMGs, preparing for the USMLE Step 1 exam can be a daunting task. To ensure you’re fully prepared, it’s essential to follow a comprehensive study schedule and preparation plan. Here’s a guide to help IMGs create the right study plan:

Creating a successful study schedule for USMLE Step 1 can seem like a daunting task. However, with the right plan and resources, you can make a study schedule that works for you and sets you up for success on exam day. Here are some tips on how to make a successful study schedule for USMLE Step 1.

  • Understand What the USMLE Step 1 Exam Is: The Step 1 exam tests your knowledge on topics such as biochemistry, immunology, microbiology, general principles of pathology, pharmacology, public health sciences, cardiovascular, psychiatry, endocrine, renal, gastrointestinal, reproductive, hematology & oncology, respiratory, neurology & special senses.

  • Get Familiar with the Exam Day: On exam day, you will be tested on 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.

  • Know Which Materials to Use for Your Step 1 Preparation: 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. Popular resources include Board and Beyond, Pathoma, Physeo, Kaplan, Sketchy Pharmacology and Sketchy Microbiology, Anki Flashcard and UWorld.

  • Create a Comprehensive Study Schedule: Consider factors such as your time since graduation, your current English proficiency and your schedule when deciding on how much time to dedicate to studying for Step 1. Generally speaking, 3-6 months of preparation is adequate for IMGs.

Assess Your Knowledge with Self-Assessments: Self-assessments are a great way to measure your understanding of the material and identify areas for improvement. Popular self-assessment tools include NBME and USMLE World Self-Assessment Services.


Q: What are the high yield topics for USMLE Step 1?

A: High yield topics for USMLE Step 1 include anatomy, pharmacology, physiology, pathology, biochemistry, microbiology, and epidemiology/biostatistics. It is important to focus on understanding the core concepts in each of these areas, as well as having a good knowledge base of the most commonly tested facts. Additionally, it is vital to practice questions and understand the thought process behind them.

Q: Is UWorld enough to pass USMLE Step 1?

A: UWorld is an important part of preparing for the USMLE Step 1 exam, but it is not the only study tool you should use. UWorld should be supplemented with other materials like First Aid, lecture notes, and flashcards to ensure you have a comprehensive understanding of the material. Additionally, taking practice tests is an important part of your test preparation, and UWorld can help in this regard.

Q: What topics are tested on USMLE Step 1?

A: USMLE Step 1 tests knowledge of anatomy, biochemistry, pharmacology, pathology, microbiology, physiology, and behavioral science. The test also covers the clinical sciences, including diagnostic testing and interpretation, as well as the application of scientific principles to clinical situations.

Q. How many questions are in each section of USMLE Step 1?

A. USMLE Step 1 is composed of seven 60-minute blocks and a total of 280 multiple-choice questions. The questions are divided into seven content areas: Foundations of Independent Practice (FIP), General Principles, Physiology, Microbiology/Immunology, Pathology, Pharmacology, and Biochemistry/Medical Genetics. Each block contains 40 questions and there are no breaks between the blocks.

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