USMLE Step 1: What to Study and How to Study

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Studying for the USMLE may seem like a daunting task due to large quantity of information it covers. However, if you know what to study and how to study for the USMLE Step 1, getting a good grasp the material tested, it is possible.

Active Learning


Active use of material increases retention and facilitates recall. Repetition makes memories. Each instance of recall produces a new memory trace, linking it to another moment of life and increasing the chance for recall in the future. Memory is dynamic. Recall actually changes neuronal structures. To be truly useful, a piece of information needs to be triangulated, connected to a number of other concepts or, better yet, experiences. For the USMLE Step 1 exam, meaning, not mere information, is your goal.

Rereading textbooks from cover to cover and underlining—yet again, in a different color—every line on every page is not an efficient way to learn. You need to focus on the material most likely to be on the examination. Studying that material through active application is the best way to enhance your understanding and retention of the information.

The following study techniques will help you develop better ways to prepare for the exam, but remember, learning for retention and use requires active involvement.

Choosing What to Study


How can you possibly know what is likely to be on your examination? There are a number of approaches.

  • Talk to medical school faculty

    Talk to medical school faculty. They often have seen past exams or have reviewed an item analysis and can tell you the topics most likely to appear on the examination. They should be able to direct you to what is essential knowledge in their field and what is less important.

  • Download materials

    Download test materials from NBME website or the USMLE website. In the long term, these practice questions will indicate the content structure of the exam, but each exam may have sections not covered. Every year new topics are added to the content outline, and some older ones are eliminated. These changes are likely to indicate new questions that you will not hear about from any other source, so be sure to check out these sources.

  • Study standard topics

    Certain topics are standard. In general, topics begin to appear on the exam two to three years after they reach prominence in the scientific/lay community. Any interesting medical topic that appeared in the literature at least two years ago is a candidate for inclusion on the exam.

  • Don’t study the last exam

    Beware of the trap of “studying for the last exam”—exam content differs from year to year. This year’s exams will be different from last year’s. And within any given year, your exam will be different from that of others. This is especially true since the exam is computerized.

  • Talk to students and collegues

    Talk to students and colleagues who took the examination in past years. Do they remember some topics being particularly “hard hit”? Was there a “flavor” to the exam? For example, did there seem to be a lot of Pathology?

    Students who took the exam in the past cannot tell you what will be on the exam that you will take, but they can direct you to the high-yield content areas that you must make sure to master. It’s highly recommended to talk with people who have taken the exam. However, be cautious. Candidates typically overestimate how much of their weakest area was on the exam. They are most likely to recall tested content that they got wrong.



Choosing How to Study


Mastering the material you must learn for this exam is a three-stage process. These stages parallel the functional organization of memory.

  • Basic Terms and Definitions

    You must learn basic terms and definitions. This provides the core vocabulary to understand the content being tested. This stage is a matter of simple recognition and memorization. Terms and definitions are learned by the use of associational memory. This is the level where mnemonics can be useful.

  • Central Concepts

    You must learn central concepts for each of the seven subject areas. This stage is a matter of being able to explain the meaning of concepts, how they are used, and how they connect with other concepts. Understanding the cross-linkages within subjects and across subjects will serve you well over the course of the exam.

    Your basic mental task here is that of reconstructive memory, learning to recall concepts in terms of how things fit together. At this stage, the practice of recalling one concept facilitates the recall of other related ideas. Patterns begin to emerge. This is the level at which diagrams, tables, and pictures can be most helpful.

  • Application

    You must be able to apply the concepts in presented clinical settings and recognize what concepts are most important in mini-case presentations. This is the hardest stage of preparation, and the one that most students neglect. Achieving your best possible score depends on knowing not only what concepts mean, but also how they are applied in a given medical situation.

    The task at this level is that of reasoning, understanding the implications of presented information and being able to choose the appropriate action from the available options. At this level, study/discussion groups and doing practice questions can be most helpful.


Tips for How to Study


Your method of study and your study schedule should be arranged to allow you to master each of these stages in turn. As you make your decisions about how you will study, the following suggestions may be helpful:

• Be organized. Set up an organized study schedule and adhere to it. The biggest danger when preparing for the exam is spending too much time on one area or ignoring one subject altogether. Decide how much time you will study each day and put your time in like it is a job. Schedule regular breaks and keep them.

• Decide what your weak areas are by taking pretests, a diagnostic exam, using information from your coursework, or using the questions in each book. Begin your study plan with your weak areas and plan to cover those at least twice before the exam.

• Do not entirely neglect your strong areas, but allocate less time to them. This can be difficult. Research suggests that, left on their own, most students study what they know best and give less time to subjects that make them uncomfortable. Reverse this process and spend the most time on the subjects that make you the most uncomfortable.

• Emphasize integration by reviewing subjects together and/or by organ system. This will greatly aid your preparation for USMLE, which emphasizes the integration of basic sciences. This type of review is best conducted in a group with other people. Other people may look at the same material differently than you and help you expand your perspective and your understanding.

• Review materials in related clusters. For example, take the anemias and review how each might present, the basic epidemiology, what lab tests would differentiate, the underlying mechanisms, and initial therapies for each. Using this strategy allow you to “preview” questions and anticipate both the correct answer and the most likely distractors.

• Keep your sessions short; no more than an hour to an hour and a half with at least a 10-minute break. Your concentration declines significantly after an hour or so. Sitting longer will provide only minimal extra return. In addition, the break time allows the short-term memory to be consolidated into long-term memory.

• Do not reread textbooks. Use review books that consolidate the information for you.

• Limit the number of information sources from which you study. Select one main review book for each subject. If you have several books, use one as your primary study material and the others as back-up to clarify points as needed. Too many study sources creates overload, and overload stifles comprehension.

As you’re studying, keep in mind you must be able to recognize concepts, understand their importance, and apply them in presented situations.