USMLE Step 1 Exam Guide (Part 1/2)
- Ash Eighaei Sedeh MD
- 3 days ago
- 29 min read
Updated: 23 hours ago
Welcome,
Residency MATCH Applicants!
Getting prepared for your USMLE Step 1?
Let's get started with the part 1 of 2 of this USMLE Step 1 Exam Guide:
Let's get started with the part 1 of 2 of this USMLE Step 1 Exam Guide:
Table of contents:
Introduction:
USMLE Step 1 is the first of three examinations in the United States Medical Licensing Examination (USMLE) series. It is administered by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). Step 1 assesses a medical student's or graduate’s understanding and ability to apply important concepts of the foundational sciences fundamental to the practice of medicine, with an emphasis on principles and mechanisms underlying health, disease, and modes of therapy.
Purpose
Step 1 is designed to test whether the examinee understands and can apply basic science knowledge relevant to practicing medicine under supervision. It serves as a benchmark to ensure that a physician has the scientific knowledge necessary to deliver safe and effective care.
Eligibility Criteria for USMLE Step 1 exam
To be eligible to take the USMLE Step 1, candidates must meet specific educational and institutional requirements. Eligibility is based on whether the candidate is a medical student or medical graduate, and their medical school must be properly accredited.
Medical Students Enrolled in an Accredited Medical School
A medical student is eligible to take Step 1 if they meet the following conditions:
They are officially enrolled in a medical school that is listed in the World Directory of Medical Schools (WDOMS) with a recognized notation indicating it meets ECFMG eligibility requirements.
They have completed basic medical science coursework required for Step 1.
Their medical school is accredited by an appropriate governmental or educational authority in their country.
For U.S. and Canadian Students:
The school must be LCME-accredited (for MD programs) or COCA-accredited (for DO programs).
For International Medical Students (IMSs):
The school must be recognized by the Educational Commission for Foreign Medical Graduates (ECFMG).
Students must obtain an ECFMG Certification Number before applying.
Medical Graduates (IMGs and U.S. Graduates)
A medical graduate can take Step 1 if:
They have graduated from a recognized medical school that meets ECFMG criteria.
They have not already passed all three USMLE Steps (since Step 1 is part of the licensing pathway).
If they are an international medical graduate (IMG), they must apply through ECFMG and receive an ECFMG Certification Number before registration.
Special Considerations
No Bachelor’s Degree Requirement: Unlike some countries, a bachelor’s degree is not required—students from integrated medical programs (e.g., MBBS) can take Step 1 as long as they meet ECFMG criteria.
No Age or Nationality Restrictions: There is no specific age limit or nationality requirement.
No Limit on Number of Attempts (with Restrictions): Candidates can attempt Step 1 a maximum of four times (effective July 1, 2021).
Not Open to Non-Medical Graduates: Individuals without formal medical education (e.g., nurses, physician assistants) are not eligible to take Step 1.
How to Apply for Step 1
For U.S. and Canadian Students
Register via the National Board of Medical Examiners (NBME) website.
For International Medical Graduates (IMGs)
Register through ECFMG via the ECFMG On-line Applicant Portal (OASIS) or Interactive Web Applications (IWA).
Receive ECFMG Certification Number before completing registration.
The format of the USMLE Step 1 is structured to assess foundational medical knowledge through a standardized, computer-based examination conducted over the course of one day. Below is a comprehensive breakdown of its format:
Test Length and Structure
Total Duration: Approximately 8 hours
Testing Blocks: The exam consists of 7 separate blocks
Block Time Limit: Each block is 60 minutes long
Total Number of Questions: The exam includes a maximum of 280 multiple-choice questions
Questions per Block: Each block contains no more than 40 questions
Question Type
Single Best Answer Format: Each question consists of a vignette followed by a set of options (usually 5), with one best answer.
Clinical Vignettes: Most questions are clinical in nature, integrating basic science knowledge into clinical scenarios.
Focus on Application: Questions test the application and integration of foundational science concepts rather than mere recall.
Breaks
Total Break Time: Examinees are allowed up to 45 minutes of break time throughout the day.
Optional Tutorial: A 15-minute optional tutorial is provided at the beginning. If the tutorial is completed in less than 15 minutes, the remaining time is added to the total break time.
Extended Break Time: Additional break time can be gained by finishing test blocks or the tutorial early.
Interface and Tools
Computer-Based Testing (CBT): Administered at Prometric test centers using a standardized computer interface.
On-Screen Tools: Includes features like highlight, strikethrough, lab reference ranges, and exhibit buttons for clinical images or documents.
Tutorial: The tutorial at the beginning demonstrates how to use these tools and navigate through the test.
Content Distribution
While the exam does not have fixed percentages per subject, questions are derived from the following content areas:
Systems-Based Approach: Questions may be organized around organ systems such as cardiovascular, respiratory, gastrointestinal, etc.
Interdisciplinary Areas: Includes topics such as genetics, immunology, nutrition, aging, and pharmacogenomics.
Physician Tasks: Content may be categorized by tasks such as diagnosis, mechanisms of disease, interpretation of lab results, and understanding treatment principles.
Scoring Format
As of January 2022, Step 1 is scored as pass/fail only.
A pass or fail result is reported, and no numeric score is provided to examinees.
Exam Day Policies
Check-In Process: Includes identity verification and security screening.
Testing Environment: Quiet, monitored setting with individual workstations.
Rules on Personal Items: No personal items, food, or drink are allowed in the testing room. Lockers are provided for storage.
Step 1 Exam Content:
USMLE Step 1 focuses on assessing foundational medical sciences essential for the practice of medicine. The exam evaluates a candidate’s ability to apply basic science principles to clinical scenarios, integrating knowledge across disciplines. Below is a detailed breakdown of its content.
Disciplines Covered
Step 1 includes questions from the following basic science disciplines:
Anatomy:
Gross anatomy, histology, embryology, neuroanatomy
Biochemistry and Molecular Biology:
Metabolic pathways, enzyme function, genetic regulation
Physiology:
Normal function of organ systems, homeostasis, regulatory mechanisms
Pathology:
Disease mechanisms, histopathology, clinical correlations
Pharmacology:
Drug mechanisms, pharmacokinetics, pharmacodynamics, adverse effects
Microbiology and Immunology:
Bacteria, viruses, fungi, parasites, immune responses
Behavioral Science and Biostatistics:
Psychological and social aspects of medicine, research methodology, epidemiology
Organ Systems
The exam integrates content across the following organ systems:
Cardiovascular System:
Anatomy, physiology, pathology, pharmacology
Respiratory System:
Lung mechanics, gas exchange, pulmonary diseases
Gastrointestinal System:
Digestion, absorption, gastrointestinal disorders
Renal and Urinary System:
Kidney function, acid-base balance, renal diseases
Endocrine System:
Hormonal regulation, metabolic diseases, endocrine disorders
Nervous System:
Neuroanatomy, neurotransmitters, neurological disorders
Musculoskeletal, Skin, and Connective Tissue:
Bone, muscle, skin diseases
Hematology and Oncology:
Blood disorders, malignancies, immune system dysfunctions
Reproductive System:
Embryology, reproductive physiology, diseases of the reproductive organs
Multisystem Processes:
Inflammation, aging, neoplasia, genetics
Physician Task and Competencies
Questions are categorized by the type of task required:
Medical Knowledge:
Understanding mechanisms of disease and treatment strategies
Diagnosis:
Recognizing clinical presentations, laboratory findings, and imaging
Principles of Treatment:
Understanding pharmacologic and non-pharmacologic interventions
Mechanisms of Disease:
Understanding molecular and cellular changes leading to disease
Normal Processes:
Application of basic physiological and biochemical concepts
Interdisciplinary Topics
Genetics and Molecular Biology:
Inherited disorders, gene expression, epigenetics
Nutrition:
Metabolic functions, vitamin deficiencies, and their clinical implications
Immunology:
Immune mechanisms, hypersensitivities, autoimmunity, vaccines
Biostatistics and Epidemiology:
Statistical methods, study designs, evidence-based medicine
Ethics and Professionalism:
Patient confidentiality, informed consent, ethical decision-making
Clinical Presentation Approach
Step 1 questions often use clinical vignettes to test knowledge application:
Symptoms-Based:
Presenting symptoms requiring a differential diagnosis
Lab and Imaging-Based:
Interpretation of laboratory values and radiologic findings
Pathology Slides and Micrographs:
Identifying histopathological and microbiological specimens
Scoring Criteria and Method for USMLE Step 1
Scoring System
Pass/Fail:
As of January 26, 2022, USMLE Step 1 is reported as pass/fail only. Examinees no longer receive a numeric score.
Passing Standard:
The minimum score required to pass is set by the USMLE Management Committee and is periodically reviewed. As of the latest update, the approximate passing standard is 196 on the pre-2022 three-digit scale.
Scoring Methodology
Computer-Based Examination:
Step 1 is administered at Prometric testing centers and consists of multiple-choice questions (MCQs).
Item Response Theory (IRT):
The scoring is based on Item Response Theory, which considers:
The difficulty level of each question
The likelihood of a correct response given an examinee’s proficiency
The overall performance across the test
Equating Process:
To ensure fairness across different test versions, equating is used. This statistical process adjusts for variations in difficulty so that scores remain comparable across different exam administrations.
No Penalty for Guessing:
Incorrect answers do not result in a penalty. A blank answer is scored the same as an incorrect one, so it is recommended to answer every question.
Performance Report (If Failed)
If an examinee fails, the score report provides:
Pass/Fail Status
Performance Profiles: A breakdown of performance in different content areas, indicating relative strengths and weaknesses.
Impact of Pass/Fail on Residency Applications
Step 1 no longer provides a numeric score, shifting emphasis to Step 2 CK performance.
A first-attempt pass is still crucial, as some residency programs may filter applicants based on Step 1 attempts.
Clinical experience, Step 2 CK scores, research, and letters of recommendation now carry greater weight in residency selection.
Check our blog post on USMLE Step 2 CK HERE!
"If you like our help with research, check our complete list of active and upcoming research projects HERE and to see our available hands-on US clinical experiences, check HERE!"
How USMLE Step 1 is Used in the Residency Match Application Process (Post Pass/Fail Change)
Since January 26, 2022, USMLE Step 1 is reported as pass/fail, eliminating the numeric score that previously played a key role in residency selection. This change has significantly altered how Step 1 is used in the residency match application process, especially for international medical graduates (IMGs). Below is a detailed breakdown of its impact.
Importance of a First-Attempt Pass
First-time pass is crucial: Many residency programs screen applicants based on Step 1 attempts. A failed attempt can significantly weaken an application, as program directors often prefer candidates who pass on the first try.
Multiple attempts may limit interview opportunities: Some competitive specialties or programs may not consider applicants with a Step 1 failure, while others may still accept applicants with strong Step 2 CK scores and clinical experience.
Increased Emphasis on Step 2 CK
With Step 1 no longer providing a numeric score, Step 2 CK now serves as the primary objective academic metric.
A high Step 2 CK score is critical for IMGs to compensate for the loss of Step 1 numeric differentiation.
Many programs may set a Step 2 CK score cutoff for interview selection, particularly in competitive specialties.
Other Factors Gaining Importance
Since Step 1 no longer differentiates applicants numerically, residency programs are now placing greater weight on:
Clinical Rotations and US Clinical Experience (USCE)
Strong performance in clinical electives, observerships, or externships in the U.S. is now more important.
Clinical evaluation letters (CELs) and Letters of Recommendation (LoRs) from U.S. physicians carry more weight.
Medical School Performance (MSPE/Transcript)
Some programs may now pay more attention to medical school grades and class rankings, particularly in core clinical rotations like internal medicine, surgery, and pediatrics.
Research and Publications
Research experience, publications, and presentations can strengthen an application, especially for competitive specialties.
Personal Statement and Interviews
With fewer standardized scores available, a compelling personal statement and strong interview performance have become even more important for standing out.
Specialty Choice Strategy
Competitive specialties (e.g., dermatology, neurosurgery, orthopedic surgery) have become even more difficult for IMGs without a Step 1 numerical advantage.
Many IMGs now focus on IMG-friendly specialties such as internal medicine, family medicine, and pediatrics, where program directors may be more flexible regarding Step 1 pass/fail status.
Screening and Filtering by Residency Programs
Residency programs have different approaches to handling Step 1 pass/fail:
Some programs still use Step 1 as a basic screening tool:
Applicants must pass on the first attempt to be considered.
Many programs now require Step 2 CK scores at the time of application:
Some programs will not review applications without a reported Step 2 CK score.
Some programs may request additional academic information:
This could include medical school grades, NBME shelf exam scores, or even additional entrance exams for some IMG applicants.
Strategic Recommendations for IMGs
Given the new Step 1 pass/fail system, IMGs should focus on:
Passing Step 1 on the first attempt to avoid red flags on applications.
Achieving a high Step 2 CK score (aiming for at least 250+ in competitive specialties).
Gaining strong U.S. clinical experience through observerships, or hands-on externships.
Securing strong letters of recommendation from U.S. physicians.
Enhancing their application with research, publications, and leadership roles.
Applying strategically to IMG-friendly programs based on match data trends.
Check our blog post on USMLE Step 2 CK HERE!
"If you like our help with research, check our complete list of active and upcoming research projects HERE and to see our available hands-on US clinical experiences, check HERE!"
Can You Still Match into Residency if You Fail Step 1?
Yes, it is still possible to match into U.S. residency training after failing Step 1, but it becomes significantly more challenging. Many residency programs screen applicants based on first-attempt pass rates, and multiple attempts on Step 1 can limit interview opportunities. However, there are strategies to overcome a Step 1 failure and still secure a match.
Understanding the Impact of a Step 1 Failure
Loss of First-Attempt Pass Advantage:
Many programs prefer applicants who pass Step 1 on the first attempt, as multiple attempts may raise concerns about academic readiness.
Program Screening Filters:
Some residency programs automatically filter out applicants with failed Step 1 attempts, while others may still consider candidates with strong Step 2 CK scores and clinical experience.
IMG-Specific Challenges:
IMGs already face a competitive disadvantage, and a Step 1 failure can further reduce the number of programs willing to consider the application.
Strategies to Overcome a Step 1 Failure and Still Match
Pass Step 1 on the Next Attempt with a Strong Performance
A passing score on a second attempt is critical. Programs may overlook a failure if the second attempt is successful.
Ensure that you thoroughly prepare before retaking the exam to avoid multiple failures.
Score High on Step 2 CK (250+ Preferred for IMGs)
Since Step 1 is now pass/fail, Step 2 CK is the most important academic metric.
A high Step 2 CK score can demonstrate strong clinical knowledge and compensate for a Step 1 failure.
Gain Strong U.S. Clinical Experience (USCE)
Clinical electives, observerships, or externships in the U.S. are crucial, especially with strong performance evaluations.
Letters of Recommendation (LoRs) from U.S. physicians can help offset concerns about a Step 1 failure.
Apply Strategically to IMG-Friendly and Less Competitive Specialties
Some IMG-friendly specialties may be more willing to consider applicants with a Step 1 failure, especially if they have strong Step 2 CK scores and U.S. clinical experience.
More flexible specialties include:
Internal Medicine
Family Medicine
Pediatrics
Psychiatry
Pathology
Strengthen the Residency Application in Other Ways
Medical School Performance: Programs may review your Medical Student Performance Evaluation (MSPE) and core clinical rotation grades more closely.
Research and Publications: Having research experience and published work in reputable journals can improve your profile.
Personal Statement and Interview: A compelling personal statement that addresses setbacks and highlights growth can help.
Which Residency Programs May Still Consider Applicants with a Step 1 Failure?
Some programs are more forgiving of a Step 1 failure, especially in less competitive specialties. Programs that consider applicants with failed attempts typically have:
A history of matching IMGs
No automatic filtering based on Step 1 attempts
More emphasis on Step 2 CK, clinical experience, and LoRs
To increase your chances:
Research programs carefully to determine if they have a strict "first-pass only" policy.
Network with current residents to understand program preferences.
Apply broadly to maximize interview chances.
Can You Still Get a Visa Sponsorship with a Step 1 Failure?
Some H-1B visa-sponsoring programs may have stricter Step 1 policies.
J-1 visa-sponsoring programs are generally more flexible, but still prefer first-time Step 1 passes.
Strong Step 2 CK and U.S. experience are critical for visa-requiring IMGs.
For our complete match support package, check HERE.
"If you like our help with research, check our complete list of active and upcoming research projects HERE and to see our available hands-on US clinical experiences, check HERE!"
What is Prometric for Step 1?
Prometric is the official testing service provider for the USMLE Step 1 and other USMLE exams. It operates computer-based testing centers worldwide, where candidates take their Step 1 exam under standardized and secure conditions.
Role of Prometric in Step 1
Administers the Step 1 exam on behalf of the USMLE.
Provides a secure testing environment to ensure exam integrity.
Offers testing locations worldwide, making it accessible to both U.S. and international medical graduates (IMGs).
Handles scheduling and rescheduling of Step 1 exam appointments.
Eligibility Period for USMLE Step 1
The eligibility period for USMLE Step 1 refers to the window of time in which a candidate is eligible to take the exam after receiving their Scheduling Permit. This period is important because it defines the timeframe within which a candidate must sit for the exam after registering.
General Eligibility Period
The eligibility period for Step 1 typically lasts 12 months from the date that the candidate’s application is approved by ECFMG (for IMGs) or NBME (for U.S. students).
This period begins once:
You receive your Scheduling Permit.
The eligibility period is valid for 12 months from that date.
Important Dates
Scheduling Permit: After registering for Step 1 through NBME (for U.S. students) or ECFMG (for IMGs), you will receive your Scheduling Permit, which is valid for 12 months.
Test Scheduling: You must schedule and sit for the exam within this 12-month window.
Extensions and Deferrals
No automatic extensions are granted for the eligibility period. However, if you are unable to sit for the exam during the eligibility period (due to unforeseen circumstances), you may request an extension or deferral through the ECFMG (for IMGs) or NBME (for U.S. students).
If your eligibility period expires and you have not taken Step 1, you will need to reapply and pay the associated fees for a new eligibility period.
Important Notes for International Medical Graduates (IMGs)
IMGs must apply through ECFMG to receive an eligibility period and scheduling permit for Step 1.
If you are an IMG, ECFMG’s eligibility period is the same 12-month rule, but you must also consider the time for obtaining an ECFMG certification number to apply for Step 1.
Exam Retakes and Eligibility Period
If you need to retake Step 1 after failing, the eligibility period for the retake is also typically 12 months from the original application date. You will need to reapply and get approval from the appropriate licensing body before scheduling your retake.
Can You Take Step 2 CK Before Step 1?
Generally, Step 2 CK (Clinical Knowledge) is intended to be taken after completing Step 1 in the USMLE sequence, as Step 2 CK tests your ability to apply medical knowledge and clinical skills that are typically built on the foundational knowledge assessed in Step 1.
However, yes, it is possible to take Step 2 CK before Step 1, though it is not the standard approach. Some people prefer to do this as step 2 CK has a 3 digit score and they want to spend more time studying for it before being hit by step 1 fatigue. Here are some important details:
Eligibility to Take Step 2 CK
No Direct Prerequisite of Step 1:
You do not have to have passed Step 1 to be eligible for Step 2 CK. You can apply and register for Step 2 CK independently of your Step 1 results.
Medical School Enrollment:
You need to be enrolled in an accredited medical school or have graduated from one to be eligible to sit for Step 2 CK.
Practical Considerations
Knowledge Gap:
Since Step 2 CK assumes a foundational understanding of basic science concepts (as assessed in Step 1), taking Step 2 CK before Step 1 may present a knowledge gap for some candidates. You will need to be prepared for clinical vignettes that require an understanding of medical knowledge built on basic sciences.
USMLE Sequence:
It is rare for candidates to take Step 2 CK before Step 1 because the exams are designed to be taken in sequence (Step 1 -> Step 2 CK -> Step 3). Step 1 prepares you for many of the clinical concepts tested in Step 2 CK.
When Might This Happen?
Special Circumstances:
Some candidates, especially international medical graduates (IMGs), may be in a situation where they take Step 2 CK before Step 1 due to specific medical school schedules, personal preference, or strategic planning to improve their residency applications.
Residency Requirements:
No specific requirements regarding the order of step 1 and step 2 CK
Possible Risks and Benefits
Benefits:
Taking Step 2 CK earlier could provide more time to study for step 2 CK which is now more important before the step 1 fatigue hits you, especially for those who feel confident about clinical knowledge.
Risks:
You might not have a complete grasp of basic science concepts needed for Step 2 CK.
If you fail Step 2 CK before Step 1, it may raise concerns for residency programs, as it can appear that you're taking the exams out of the typical sequence.
Check our blog post on USMLE Step 2 CK HERE!
"If you like our help with research, check our complete list of active and upcoming research projects HERE and to see our available hands-on US clinical experiences, check HERE!"
The Recall Dilemma and USMLE Score Revocations
This is an illegal activity and can ruin your medical career, do NOT attempt it.
The "recall dilemma" refers to an issue in which test takers attempt to recall or reproduce USMLE exam questions, after they’ve completed the exam. This practice has led to the revocation or cancellation of scores for some students who engage in it or who are suspected of attempting it.
What is the Recall Dilemma?
The Recall Dilemma occurs when candidates try to remember and share specific test questions after the exam is completed, often for the purpose of sharing them with others.
The dilemma is about whether or not a candidate may have tried to memorize or distribute questions from the exam to other students in the form of "question banks," personal recall sheets, or online forums.
This can lead to concerns about exam integrity, as USMLE exams are highly confidential, and the questions are intended to test a candidate’s knowledge at a specific point in time.
Why Do Some Students Attempt Recall?
Stress and Anxiety:
After a high-stakes exam like Step 1, candidates may feel anxious to discuss questions with others or "validate" their answers by sharing what they remember.
Exam Preparation:
Some students believe that sharing questions or revisiting exam content can help in future study preparations for themselves or others.
Why Are USMLE Scores Revoked or Canceled?
The USMLE and its administrator, the NBME, have strict policies to maintain the integrity of the exam and to ensure fairness for all candidates. Violating these policies, especially regarding recall of test items, can result in the revocation or cancellation of scores.
Some of the reasons for score revocation include:
Sharing Exam Content or Recall Attempts
If a candidate is found to have shared or attempted to recall test questions (in any form) after the exam, their scores can be canceled. This is considered a violation of the test security policy.
The USMLE exam is confidential, and any disclosure of its contents is strictly prohibited. Recalling specific questions can be seen as an attempt to cheat by preparing future candidates with prior knowledge.
Engaging in Exam Misconduct
Exam misconduct can include behaviors such as cheating, plagiarism, or using unauthorized materials during the exam. If a student is found to have violated these rules, their score is typically revoked.
Suspicion of Cheating or Unfair Practices
The USMLE program actively monitors and investigates any suspicious behavior during the exam, which includes unusual patterns of answers that suggest a candidate may have had prior knowledge of the questions. This could lead to an investigation and potential score cancellation.
Security Breaches and Violations
Prometric, the testing center, and USMLE maintain a robust security system, including video monitoring, surveillance, and biometric checks. Any security breach or violation of test conditions could result in score cancellation.
Consequences of Score Revocation
When USMLE scores are revoked or canceled, it can have serious consequences for a medical student's career and residency applications:
Residency Applications: Many residency programs place a high emphasis on USMLE scores as part of the application process. A revoked or canceled score can harm an applicant’s chances in the match.
Future Attempts: If a score is revoked, candidates may have to reapply for the exam and might be monitored more closely in future attempts. This can also affect their ability to sit for the exam in the future.
How the USMLE Detects Recall Attempts
Statistical Monitoring: USMLE and Prometric use advanced data analysis to detect unusual answer patterns or anomalies in the timing of responses.
Post-Exam Monitoring: After the exam, test-takers' responses are analyzed to detect any instances of cheating or behavior indicative of prior knowledge of exam content.
Investigations: If test questions are recalled and shared online or in forums, USMLE/NBME may investigate patterns of response among candidates who had previously taken the same exam.
How to Avoid Violating USMLE Policies
Do Not Share or Recall Questions: Avoid discussing or trying to remember specific questions from the exam after completing it. The confidentiality of the exam is paramount.
Focus on Preparation: Ensure you are adequately prepared for the exam with authentic study resources such as question banks, books, and clinical experience, rather than relying on test recall.
Understand the Rules: Familiarize yourself with the USMLE Testing and Conduct Policies to ensure you follow the correct protocols.
Best Books to Study for USMLE Step 1 by Discipline
When preparing for USMLE Step 1, it’s essential to study from high-yield, comprehensive resources that cover the core topics efficiently. Below are the best recommended books for each major discipline, as well as general resources to tie them all together.
General Overview and Core Resources
First Aid for the USMLE Step 1
Purpose:
This is the most widely used comprehensive resource for Step 1. It provides high-yield review of all subjects in the format you’ll encounter on the exam.
Contents:
Review of major topics, high-yield facts, mnemonics, and clinical correlations.
UWorld (Question Bank)
Purpose:
The best tool for practicing exam-style questions and applying knowledge.
Contents:
Over 2,000 questions that simulate the real exam experience, with detailed explanations for every answer.
Goljan's Rapid Review Pathology
Purpose:
Another strong resource for pathology. This book is highly comprehensive and often considered a classic.
Contents:
High-yield pathology facts and explanations for understanding disease processes.
Subject-Specific Recommendations
Anatomy
Gray’s Anatomy for Students
Purpose:
Comprehensive and widely recommended for understanding human anatomy.
Contents:
Detailed diagrams, clinical correlations, and explanations.
Netter’s Atlas of Human Anatomy
Purpose:
Excellent for visual learners who benefit from high-quality anatomical illustrations.
Contents:
A collection of the best anatomical images, with clinical context.
Clinically Oriented Anatomy (Moore & Dalley)
Purpose:
A more clinically oriented resource that ties basic anatomy to clinical practice.
Contents:
Excellent for understanding clinical relevance.
Biochemistry
Lippincott’s Illustrated Reviews: Biochemistry
Purpose:
The go-to book for biochemistry. It explains metabolic pathways, molecular biology, and genetics clearly.
Contents:
High-yield summaries, clinical correlations, and illustrations.
High-Yield Biochemistry
Purpose:
A concise and focused review book with emphasis on high-yield material for Step 1.
Contents:
Key metabolic pathways, important enzymes, and clinical relevance.
Microbiology
Microbiology Made Ridiculously Simple
Purpose:
A student favorite for simplifying microbiology concepts.
Contents:
Simplified, mnemonic-based approach to understanding microbiology with high-yield information on bacteria, viruses, fungi, and parasites.
Clinical Microbiology Made Ridiculously Simple
Purpose:
Another great resource for medical students, offering simplified and condensed microbiological concepts.
Contents:
Focused on clinical features and management of infections.
Medical Microbiology (Jawetz)
Purpose:
Comprehensive and authoritative resource for microbiology.
Contents:
Detailed explanations of pathogens, mechanisms of infection, and clinical correlations.
Pharmacology
Lippincott’s Illustrated Reviews: Pharmacology
Purpose:
Comprehensive yet concise pharmacology text, often regarded as one of the best for Step 1.
Contents:
Organized by drug class with pharmacodynamics, pharmacokinetics, and clinical applications.
Pharmacology Made Ridiculously Simple
Purpose:
A more concise and high-yield version of pharmacology, excellent for quick reviews.
Contents:
Focuses on key drugs, mechanisms, and clinical uses.
High-Yield Pharmacology
Purpose:
A concise and to-the-point book that highlights high-yield pharmacology topics.
Contents:
Core pharmacology principles, drug classes, and side effects.
Physiology
BRS Physiology
Purpose:
A detailed yet concise physiology review book that is widely recommended for Step 1.
Contents:
In-depth explanations of physiological processes, with emphasis on high-yield concepts.
Guyton and Hall Textbook of Medical Physiology
Purpose:
The gold standard for comprehensive physiology. Great for students who prefer a deep dive.
Contents:
Thorough explanations of physiological mechanisms, often used for in-depth study.
High-Yield Physiology
Purpose:
A condensed, high-yield review of physiology topics.
Contents:
Focuses on core concepts that are likely to appear on Step 1.
Pathology
Robbins and Cotran Pathologic Basis of Disease
Purpose:
Comprehensive and often regarded as the definitive textbook on pathology.
Contents:
In-depth information on pathophysiology, clinical features, and disease processes.
Rapid Review Pathology (Goljan)
Purpose:
Concise and focused on high-yield pathology topics.
Contents:
Key concepts and high-yield information in pathology, with clinical correlations.
Behavioral Sciences
BRS Behavioral Science
Purpose:
A focused review of behavioral science for Step 1.
Contents:
Topics include mental health disorders, ethics, and public health.
High-Yield Behavioral Science
Purpose:
A concise review book focusing on high-yield behavioral science concepts.
Contents:
Important facts, including psychiatric disorders, mental health, and social sciences.
Immunology
Janeway’s Immunobiology
Purpose:
A comprehensive resource for immunology, though more detailed than what’s required for Step 1.
Contents:
In-depth exploration of the immune system and its clinical relevance.
High-Yield Immunology
Purpose:
A condensed resource for immunology with a focus on high-yield material.
Contents:
Key concepts in immunology, with clinical applications.
Check our blog post on USMLE Step 2 CK HERE!
"If you like our help with research, check our complete list of active and upcoming research projects HERE and to see our available hands-on US clinical experiences, check HERE!"
Best Audio and Video Resources for USMLE Step 1 by Discipline
While books are essential for in-depth understanding, audio and video resources can be incredibly helpful for reinforcing concepts, providing different perspectives, and offering more dynamic ways to learn. Here are the best audio and video resources for each major discipline for the USMLE Step 1 exam:
General Resources
Pathoma Videos and Lectures
Purpose:
Pathoma offers a highly effective series of videos and accompanying textbook focused on pathology. The videos explain complex pathological concepts in a simplified, high-yield manner.
Content:
Dr. Sattar’s videos and concise explanations of key pathological processes with clinical correlations.
Boards and Beyond
Purpose:
A comprehensive video resource for Step 1 preparation, covering all major disciplines.
Content:
High-yield videos on biochemistry, physiology, microbiology, pharmacology, and pathology. It also offers deep dives into clinical correlations and clinical cases.
Sketchy Medical (Visual mnemonics)
Purpose:
Sketchy provides visual storytelling and mnemonic techniques for microbiology and pharmacology. The vivid and memorable stories help solidify complicated concepts.
Content:
Visual mnemonics for bacteria, viruses, fungi, parasites, and pharmacological mechanisms.
Subject-Specific Audio/Video Resources
Anatomy
The Kaplan Anatomy Video Lectures
Purpose:
A well-structured video series for mastering anatomy concepts and structures.
Content:
Detailed dissection-based anatomical videos, with clinically relevant discussions, including embryology and neuroanatomy.
Anatomy Video Lectures (YouTube Channels)
Purpose:
Free resources, often hosted by medical professionals, offering detailed anatomical explanations.
Content:
These channels feature both surface and internal anatomy with visual demonstrations. Channels like Dr. Najeeb Lectures also cover anatomy topics.
Biochemistry
Dr. Najeeb Lectures (Biochemistry)
Purpose:
A favorite for many students, Dr. Najeeb provides thorough, easily understandable videos on a range of subjects, including biochemistry.
Content:
In-depth explanations of metabolic pathways, enzyme mechanisms, molecular biology, and genetics.
Boards and Beyond (Biochemistry)
Purpose:
For a more concise overview, Boards and Beyond’s biochemistry videos help you understand the key concepts and clinical relevance.
Content:
High-yield topics such as glycolysis, Krebs cycle, and DNA/RNA replication, with clinical correlations.
Microbiology
Sketchy Medical (Microbiology)
Purpose:
Sketchy’s video mnemonics for microbiology are widely regarded as some of the best resources to retain complex details about pathogens.
Content:
Visual mnemonics for bacteria, viruses, fungi, and parasites, with memorable stories and images.
Lecturio (Microbiology)
Purpose: Lecturio provides concise video lectures that cover microbiology topics, integrating clinical cases and high-yield material.
Content: High-yield videos on bacteria, viruses, parasites, and clinical microbiology.
Pharmacology
Sketchy Medical (Pharmacology)
Purpose:
Known for making pharmacology easier to remember through visual storytelling.
Content:
Drugs and their mechanisms of action are depicted through memorable images and stories, which help solidify complex pharmacological concepts.
Lecturio (Pharmacology)
Purpose:
Provides high-quality pharmacology videos that include clinical correlations and essential pharmacokinetics.
Content:
Covers drug classes, mechanisms, adverse effects, and side effects.
Online MedEd (Pharmacology)
Purpose:
Provides an accessible and engaging way to learn pharmacology with clear explanations.
Content:
High-yield pharmacology lectures integrated with clinical practice.
Physiology
BRS Physiology Video Lectures
Purpose: These video lectures provide a good breakdown of physiologic principles, especially the more difficult concepts.
Content: Focuses on high-yield physiology topics, such as cardiovascular, renal, and respiratory physiology.
Lecturio (Physiology)
Purpose:
A comprehensive video lecture series on physiology, integrating clinical cases to emphasize how basic principles are applied.
Content:
High-yield physiology topics with clinical correlations.
Dr. Najeeb Lectures (Physiology)
Purpose:
Provides highly detailed physiology videos for those who prefer an in-depth approach.
Content:
Covers cellular physiology, body systems, and detailed mechanisms with clinical correlations.
Pathology
Pathoma Videos
Purpose:
Dr. Sattar’s video series for Pathoma is an excellent resource for mastering pathology. It covers all core pathology topics in a concise, high-yield format.
Content:
High-yield pathology concepts and diseases, explained clearly with clinical context.
Goljan’s Rapid Review Pathology Audio
Purpose:
Goljan’s audio lectures are a great way to reinforce pathology concepts. Many students use this resource during their commute or free time.
Content:
The audio covers major pathology topics and disease mechanisms with clinical applications
Lecturio (Pathology)
Purpose:
Offers well-organized, high-yield pathology videos that are concise and easy to understand.
Content:
Covers all essential pathology topics and integrates clinical applications.
Behavioral Science
Lecturio (Behavioral Science)
Purpose:
Video lectures that explain high-yield behavioral science concepts for USMLE Step 1, including mental health disorders and social sciences.
Content:
Topics like psychiatry, public health, ethics, and epidemiology.
High-Yield Behavioral Science Audio
Purpose:
This audio series focuses on high-yield topics in psychiatry, psychology, and sociology.
Content:
Covers major behavioral science topics that appear frequently on Step 1.
Immunology
Immunology Made Ridiculously Simple (Audio)
Purpose:
Offers easy-to-understand explanations and is available in audio format for on-the-go learning.
Content:
Covers basic immunology concepts, immune cells, antibodies, and clinical correlations.
Dr. Najeeb Lectures (Immunology)
Purpose:
Provides in-depth and detailed lectures on immunology.
Content:
Covers the immune system’s mechanisms, disorders, and clinical relevance.
Best Resources for Practice MCQs for USMLE Step 1
Practicing multiple-choice questions (MCQs) is a crucial part of preparing for the USMLE Step 1, as it allows you to apply your knowledge, test your recall, and get familiar with the format and timing of the exam. Below are the best resources for practice MCQs, including question banks, textbooks with practice questions, and other platforms:
UWorld (Question Bank)
Why It’s Recommended:
UWorld is widely regarded as the gold standard for USMLE Step 1 practice questions. It offers thousands of high-quality, exam-style questions that closely mimic the difficulty and structure of the real exam.
Features:
Detailed Explanations:
Each question has in-depth explanations for both correct and incorrect answers, helping you understand why a certain answer is correct or wrong.
Progress Tracking:
You can track your progress and identify weak areas.
Customizable Practice:
Allows you to create custom practice sessions focusing on specific topics or systems.
Test Simulation:
UWorld’s interface mimics the real exam, which helps you practice under realistic conditions.
Best For: All disciplines, especially for integrated clinical knowledge and high-yield concepts.
Amboss (Question Bank)
Why It’s Recommended:
Amboss is another comprehensive resource that offers a large question bank with an interactive interface. It’s a great alternative or supplement to UWorld.
Features:
Detailed Explanations and References:
Every question comes with an explanation, and Amboss has a built-in medical library where you can click on specific terms or concepts to get detailed explanations.
Customizable Question Sets:
Allows you to focus on specific areas of weakness, organ systems, or high-yield topics.
Innovative Features:
The "highlighting" feature allows you to mark important concepts during your practice sessions.
Best For:
Students who want a more interactive and multimedia approach to learning and who appreciate in-depth explanations.
Kaplan (Question Bank)
Why It’s Recommended:
Kaplan’s Step 1 question bank is highly comprehensive and widely used. It is a great resource for practicing MCQs and testing knowledge across all topics.
Features:
Extensive Question Bank:
Thousands of questions covering every subject for Step 1.
Video Explanations:
Many questions have accompanying video explanations that provide additional insight.
Clinical Correlations:
Strong emphasis on integrating clinical concepts into basic sciences.
Customizable Practice:
Allows you to focus on weak areas and systems.
Best For:
Those who need more clinical correlation and prefer a question bank that is paired with video explanations.
UWorld and Amboss Mobile Apps
Why It’s Recommended:
Both UWorld and Amboss offer mobile apps for practicing questions on the go. These apps allow you to practice questions during short breaks and improve your efficiency in utilizing your time.
Best For:
On-the-go practice, ensuring you can make the most out of your downtime.
First Aid for the USMLE Step 1 (With Question Bank Integration)
Why It’s Recommended:
First Aid is the quintessential review book for Step 1, and its corresponding question bank is an excellent way to reinforce the material.
Features:
Integrated Questions: There are questions within First Aid itself that correspond to the high-yield facts in each chapter.
Focus on High-Yield Content: The questions primarily focus on key concepts that are likely to appear on the exam.
Supplementary Question Bank: First Aid’s online question bank (offered by USMLE-Rx) provides a comprehensive set of questions.
Best For: Students who want to solidify their knowledge with integrated questions and are focused on high-yield material.
USMLE-Rx (Question Bank)
Why It’s Recommended:
Developed by the same people behind First Aid, this question bank offers highly relevant questions that align well with the material in the First Aid for Step 1 book.
Features:
Integrated with First Aid: The questions are designed to complement the First Aid content, which makes this a great supplementary resource.
Targeted Practice: You can select questions based on specific chapters from First Aid to reinforce individual topics.
Flashcards and Video Explanations: Provides additional ways to reinforce your knowledge.
Best For: Those who are using First Aid and want a well-integrated question bank.
Online MedEd (Practice Questions)
Why It’s Recommended:
While primarily known for its video lectures, Online MedEd also offers a question bank with practice questions that integrate well with the video material.
Features:
Practice Questions Integrated with Videos: This is a good resource for testing knowledge after watching the videos.
Clinical Focus: Emphasizes clinical questions with strong explanations and clinical correlations.
Free Access to Some Questions: A portion of the question bank is free, making it a good resource for students with limited budgets.
Best For: Students who are using Online MedEd videos and need practice questions to reinforce what they’ve learned.
MedQuest (Question Bank)
Why It’s Recommended:
MedQuest offers a question bank and videos specifically tailored for Step 1 preparation. It has a reputation for providing well-structured questions and explanations.
Features:
Comprehensive Coverage: Covers all major subjects for Step 1 with a large question pool.
Clear, Concise Explanations: Focuses on high-yield facts and provides clinical relevance.
Integrated Approach: Combines questions with educational videos.
Best For: Those who are looking for well-organized questions and clinical integration.
Kaplan QBank (Review Notes and Practice Questions)
Why It’s Recommended:
Kaplan's QBank is one of the oldest and most respected resources in USMLE preparation.
Features:
Comprehensive Question Pool:
Thousands of practice questions, ensuring wide coverage of Step 1 material.
Video and Test Bank Integration:
Combine questions with video lectures for deep understanding.
Review Notes:
Offers thorough explanations of answers and review notes for each question.
Best For:
Students who need a well-established question bank that covers all topics with detailed explanations.
Question Banks by Subject
Pathoma (For Pathology):
Offers practice questions and quizzes directly related to Pathology content.
PharmacoBank (For Pharmacology):
A question bank focused on high-yield pharmacology topics and drug classes.
High-Yield Question Banks (For Multiple Disciplines):
Several publishers offer subject-specific question banks (e.g., High-Yield Pharmacology or High-Yield Microbiology) to help reinforce individual disciplines.
Free Resources for MCQs
NBME Self-Assessments
Purpose:
These are official self-assessment exams published by the National Board of Medical Examiners. Although not comprehensive question banks, they provide realistic exam questions and offer a good sense of your readiness for the actual exam.
Amboss Free Questions
Purpose:
Amboss offers a selection of free practice questions, which can be helpful for low-budget study plans.
UWorld Tutor Mode vs Timed Mode
The decision between Tutor Mode and Timed Mode while using USMLE Step 1 question banks largely depends on your goals at various stages of your preparation.
Here’s a detailed breakdown to help you decide when to use each mode:
Tutor Mode
When to Use:
Early Stages of Preparation:
Tutor mode is ideal for when you're learning new material or filling gaps in your knowledge. This is especially helpful when you're not yet familiar with the content or the types of questions that will be asked.
Understanding Concepts:
It provides detailed explanations for both the correct and incorrect answers, which is critical for improving your understanding of key concepts.
Reviewing Incorrect Answers:
Tutor mode allows you to go back and see detailed explanations for every question you miss. This is valuable for reinforcing your understanding and learning from mistakes.
Slower Pace:
It’s best if you want to spend time reflecting on each question and thoroughly review each concept before moving on. It helps reduce mistakes from rushing through questions.
Advantages:
In-depth Explanations:
You get detailed rationales for each answer, which helps improve understanding.
Focus on Learning:
You can focus on concepts you don’t understand and learn more effectively.
Flexible:
It’s not constrained by time pressure, allowing you to spend more time on difficult topics.
Disadvantages:
Not Exam Simulation:
Since there’s no time pressure, it may not replicate the stress or pacing of the real exam.
Can Slow Down Progress:
If you’re too detailed in your review, you may not get through as many questions as you would in timed mode, potentially slowing your overall progress.
Timed Mode
When to Use:
Later Stages of Preparation:
Timed mode is best when you’re closer to your exam date and need to simulate actual exam conditions. This helps improve time management and get used to working under pressure.
Building Stamina:
The USMLE Step 1 is a lengthy exam, and practicing in timed mode helps you build endurance and get accustomed to the physical and mental demands of the real test.
Assessment of Readiness:
Timed mode is useful when you want to evaluate your overall readiness and determine how well you’re performing under time constraints.
Refining Test-Taking Strategies:
You can use this mode to practice strategies like skipping difficult questions and coming back to them later, as well as identifying and eliminating obviously wrong answers quickly.
Advantages:
Realistic Simulation:
Timed mode simulates the pressure of the real exam, which is essential for developing exam-day strategies.
Time Management:
It helps you become more efficient at pacing yourself, ensuring that you don’t spend too much time on any one question.
Stamina Building:
By practicing with the clock ticking, you’ll improve your ability to maintain focus and stay sharp during a lengthy exam.
Disadvantages:
Limited Learning Opportunity:
If you rush through questions just to finish within the time limit, you may not fully grasp the reasoning behind each answer. You might miss the opportunity for thorough learning, especially for weak areas.
Can Lead to Anxiety:
Practicing under time pressure may increase anxiety, especially if you’re not yet comfortable with the material.
How to Use Both Modes Effectively
Start with Tutor Mode:
Begin by using Tutor Mode, especially in the early phases of your preparation. This helps you build a strong understanding of the material and ensures you’re learning the why behind each question, not just memorizing answers.
Switch to Timed Mode:
As you approach the later stages of your preparation (typically within 4-6 weeks of the exam), start incorporating more Timed Mode sessions. This will help you simulate exam conditions and improve your speed and accuracy.
Mix Both Modes:
Even during the final stages, you can mix Tutor Mode with Timed Mode. For example, you could do a timed practice session and then review the explanations (Tutor Mode) afterward for the questions you missed. This gives you the best of both worlds: exam simulation and concept reinforcement.
Use Timed Mode for Full-Length Practice Exams:
Take full-length practice exams in Timed Mode (e.g., UWorld, NBME) to assess your endurance and overall exam readiness. This is a great way to measure how well you’ve internalized the material while still managing the clock.
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