USMLE Step 1 Exam Guide (Part 2/2)
- Ash Eighaei Sedeh MD
- 5 days ago
- 31 min read
Updated: 3 days ago
Welcome,
Residency MATCH Applicants!
Getting prepared for your USMLE Step 1?
Let's get started with the part 2 of 2 of this USMLE Step 1 Exam Guide:
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Table of contents:
Average UWorld score to feel "safe" about passing the exam
The average score on UWorld for a student to pass Step 1 depends on various factors, but a safe target score would generally be around 60% to 65% on UWorld’s question bank. Here's a more detailed breakdown of how to interpret this:
What Does the Score Reflect?
UWorld’s scoring is based on your percentage of correct answers, and it’s an approximation of your likelihood of success on Step 1. However, the real score you get on the actual exam depends on several factors, including your timing, test-taking strategy, and exam conditions. While the UWorld score is an important metric, it’s not an exact predictor, but it is helpful for tracking progress and understanding areas of weakness.
General Guidelines for Passing
60% to 65%:
This is generally considered a safe average score to be in a good position to pass Step 1. It indicates you are consistently getting a majority of questions correct and are likely on track to perform well.
Higher Than 65%:
If you're consistently scoring above 65%, you're likely in a strong position, and you're preparing well for Step 1. This score range is generally aligned with passing or scoring in the average to above-average range on the actual exam.
Below 60%:
If your average is consistently below 60%, it may indicate gaps in knowledge, and you should consider intensifying your review or addressing weak areas. While a 60% on UWorld can still be acceptable, below 60% should prompt a review of difficult topics.
Progress Over Time
Your UWorld score may improve as you progress through your study schedule. It’s important to track your performance over time to see if you’re improving as you move through the questions and review the explanations.
Keep in Mind the Question Difficulty
UWorld questions are not necessarily an exact match for the level of difficulty on Step 1, but they are often considered more challenging. UWorld’s questions tend to be more difficult than the real exam, and they test your ability to integrate information across disciplines. Therefore, scoring slightly lower on UWorld could still translate to a good performance on the real test, especially if you are consistently improving.
Additional Context
Final Practice Tests:
As you get closer to your exam, consider taking full-length practice tests, such as those from NBME or UWorld’s self-assessments, which are more directly predictive of Step 1 performance.
Quality over Quantity:
Simply getting a high percentage on UWorld isn’t enough. Make sure you understand the material thoroughly by reviewing your incorrect answers carefully. Understanding why an answer was wrong is key to improving.
What are the best mock exams to take before the step 1 of the usmle?
Taking mock exams before the USMLE Step 1 is a crucial step in assessing your readiness, simulating the exam experience, and identifying any areas that need additional attention. Below are the best mock exams to take in preparation for Step 1:
NBME Self-Assessments (National Board of Medical Examiners)
Overview:
The NBME offers official self-assessments that are extremely helpful in simulating real exam conditions and providing an idea of your expected performance on the actual exam.
Why It’s Recommended:
These exams are developed by the same organization that writes the USMLE exams, meaning they closely mirror the content and style of the actual test.
The NBME self-assessments offer predictive scoring, which can help estimate your score on the real exam.
Realistic simulation of exam conditions (timed, same question format, etc.).
How to Use:
Take 2-3 assessments:
You can use these assessments throughout your preparation to check progress. Some students take the first one early to gauge where they stand, and then retake one or two closer to their exam date.
Analyze Your Performance:
After completing the NBME exams, carefully review the explanations for your wrong answers.
Recommended NBME Self-Assessments:
NBME 19 (or more recent):
Highly recommended, as it closely simulates the difficulty of the Step 1 exam.
NBME 20, 21, 22:
These are good to take as your exam approaches.
NBME Comprehensive Basic Science Self-Assessment:
Useful for gauging your readiness closer to exam time.
UWorld Self-Assessments
Overview:
UWorld’s self-assessment exams are another excellent way to simulate the real exam environment.
Why It’s Recommended:
UWorld is considered the gold standard for Step 1 practice questions, and their self-assessments are designed to reflect the difficulty level and question format of the real exam.
These exams are useful for assessing your readiness, as well as getting used to the timing and pacing of Step 1.
Provides detailed explanations for incorrect answers, which helps in review.
UWorld assessments come with a score prediction that is fairly accurate based on your performance.
How to Use:
Take one or two UWorld self-assessments about two to three weeks before the exam. You can take one a few weeks earlier as a baseline and another closer to the exam to track your progress.
Review your weak areas carefully after each assessment and refine your study plan accordingly.
USMLE-Rx (First Aid Question Bank) Self-Assessments
Overview:
The USMLE-Rx question bank, created by the authors of First Aid, also offers a set of practice exams that are designed to closely align with the material in First Aid for Step 1.
Why It’s Recommended:
These assessments are good for practicing high-yield topics and are especially useful if you are using First Aid as your primary resource.
While not as widely used as UWorld, they offer a good way to reinforce high-yield concepts and test your recall.
The question explanations are concise and linked with First Aid, making it easier to relate to your main study material.
How to Use:
Take one or two self-assessments from USMLE-Rx to reinforce key concepts and test your recall of high-yield facts.
AMBSO (Amboss Self-Assessment)
Overview:
Amboss provides a robust self-assessment tool that is ideal for tracking your progress and simulating exam conditions.
Why It’s Recommended:
Amboss’s self-assessment exams are comprehensive and cover all major subjects of the Step 1 exam, making it a good tool for a holistic review.
The questions are integrated and require critical thinking, reflecting the style of the real exam.
It provides in-depth explanations for both correct and incorrect answers, with references to Amboss's medical library, which enhances understanding.
How to Use:
Consider taking one or two Amboss self-assessments as part of your review. These are particularly useful if you’re already using Amboss for your primary question bank or resource.
Kaplan Practice Exams
Overview:
Kaplan provides practice exams that simulate the USMLE Step 1 exam format.
Why It’s Recommended:
Kaplan has been around for many years and offers a comprehensive resource for exam preparation.
Their practice exams are similar in format and question style to the real exam, making them a good option to get used to the testing environment.
Kaplan’s exams come with detailed explanations, which helps with learning.
How to Use:
Take one Kaplan practice exam towards the middle or end of your preparation to get a feel for the exam and identify areas of weakness.
NBME Practice Exams (Free Ones)
Overview:
In addition to the paid self-assessments, the NBME offers free practice exams (though limited in number).
Why It’s Recommended:
These exams are still developed by the same organization that creates the actual USMLE exams.
The free practice exams are helpful for a quick self-assessment or as an extra practice tool.
How to Use:
If available, take these free exams as an additional resource for practice in the weeks leading up to your exam.
UWorld Mini Exams
Overview:
UWorld also offers a series of mini exams designed for additional practice.
Why It’s Recommended:
These shorter exams are a good option for assessing targeted areas, giving you the flexibility to focus on specific weaknesses.
Like UWorld’s full-length exams, they provide in-depth rationales and test your ability to integrate concepts.
How to Use:
You can take these mini exams as supplementary exams to practice specific areas in a focused manner.
When to Take These Exams
Start with Practice Exams 4-6 Weeks Before the Exam:
Taking NBME or UWorld self-assessments a few weeks before your exam is crucial to get a realistic prediction of your score and to identify areas of weakness.
Take at Least 2-3 Full-Length Practice Exams:
These exams should be taken during your final weeks of preparation to simulate exam conditions, assess your pacing, and pinpoint any remaining weak spots.
Take Your Final Mock Exam 3-5 Days Before the Exam:
This gives you time to review any weak points from the practice exam while keeping your performance fresh in your mind.
Check our blog post on USMLE Step 2 CK HERE!
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How is the correlation of the mock exams uwsa1 and uwsa 2 and nbme exams to the real performance to pass the step 1 exam?
The UWorld Self-Assessments (UWSA1 and UWSA2) and NBME practice exams are two of the most commonly used tools for predicting your performance on the USMLE Step 1 exam. While no mock exam can guarantee an exact prediction of your actual score, both of these resources have shown a good correlation with real exam performance, especially when used strategically in the final weeks of your preparation. Here's a breakdown of the correlation between these practice exams and real performance:
UWorld Self-Assessments (UWSA1 and UWSA2)
Correlation to Real Exam Performance
UWSA1 and UWSA2 are designed to be high-fidelity simulations of the USMLE Step 1 in terms of question difficulty, format, and timing. The UWSA exams are considered to be some of the best predictors of your actual performance, though they are not perfect.
Predictive Accuracy:
The UWSA1 and UWSA2 scores tend to correlate strongly with the actual Step 1 scores, with most students who score in the high 240s or above on UWSA1 and UWSA2 generally performing well in that range or higher on the real exam. A score below 240 on UWSA exams may indicate potential areas for improvement, although this is not always the case.
Score Correlation:
Research and anecdotal evidence suggest that your UWSA score is generally predictive of your real Step 1 performance within about 5-10 points. For example:
UWSA1 score of 240-250: Likely to correlate with an actual Step 1 score in the 240-255 range.
UWSA1 score of 230-240: Likely to correlate with an actual Step 1 score in the 220-240 range.
UWSA1 score of 210-220: Likely to correlate with an actual Step 1 score of 200-220.
Use for Predicting Pass/Fail Status
A UWSA score of around 215-220 or higher is often a good indication that you will pass the exam. However, a score below 215 may indicate a higher risk of failure, and you should consider further review or addressing weak areas before taking the real exam.
Trend Over Time:
The UWSA2 is often used as the final indicator of readiness. Many students take UWSA2 closer to the exam date (about 1-2 weeks before) to assess how well they have integrated all the material and to predict if they are on track for success.
2. NBME Practice Exams (NBME 19, 20, 21, 22, etc.)
Correlation to Real Exam Performance
The NBME practice exams are developed by the same organization that administers the USMLE, making them one of the most accurate predictors of your performance on the real test.
Predictive Accuracy:
The NBME practice exams are generally considered to be slightly more accurate in predicting Step 1 scores compared to the UWSA exams. The correlation between NBME scores and the actual Step 1 score is relatively high, and it tends to be a good indicator of whether you are on track to pass.
An NBME score of 220-230 usually correlates with a passing Step 1 score.
NBME scores in the 230-240 range are predictive of higher Step 1 scores, and scores above 240 are likely to correlate with an above-average performance on the real exam.
Use for Predicting Pass/Fail Status
NBME scores are reliable for pass/fail predictions. Most students who score above 220 on an NBME practice exam are likely to pass the real exam. However, students who score below 215-220 might need to assess their preparation and adjust their study plans if they are aiming for a pass.
General Correlation Patterns Between UWSA, NBME, and Step 1 Scores
UWSA Scores:
UWSA1 and UWSA2 scores are often predictive of the Step 1 performance, with accurate predictions within 5-10 points of the real score.
A UWSA score below 230 often signals areas of weakness and indicates that further focused review is needed.
A score of 240 or higher on UWSA1 and UWSA2 is a strong indicator that you’re well-prepared and likely to perform well on Step 1.
NBME Scores:
NBME scores in the range of 220-230 are generally indicative of passing the real exam. Scores higher than this range typically correlate with a higher Step 1 score.
The NBME exams are slightly more predictive of actual performance, and many students use them in the final weeks of their prep as a reliable benchmark for readiness.
Pass/Fail Prediction:
UWSA and NBME scores above 220 typically indicate that you're on track to pass the real exam.
Scores below 220 from these practice exams signal a greater risk of failing and may require additional review before taking the actual exam.
Best Strategy for Using These Mock Exams
Take NBME Early for Baseline:
Start with an NBME practice exam (such as NBME 19 or 20) early in your preparation. This will give you an initial baseline of your knowledge.
Use UWSA for Final Review:
Take UWSA1 and UWSA2 towards the end of your study period (within 2-3 weeks of your exam) to assess your readiness and gauge your score prediction.
Track Progress:
Throughout your study period, monitor your progress using both UWSA and NBME practice exams. This will help you track improvement and fine-tune your study approach.
Final Simulation:
For the final week before your exam, use UWSA2 and NBME (preferably one last practice exam) to simulate exam conditions and confirm your readiness.
When should I take the mock exams and in what order do you recommend to take the mock exams?
Taking mock exams at the right time and in the right order is critical for ensuring you're fully prepared for the USMLE Step 1 exam. The goal is to use these exams to assess your progress, identify weak areas, and simulate the real test conditions in the final stages of your preparation. Here’s a recommended timeline for when to take each mock exam and in what order:
Timeline and Recommended Order for Mock Exams
Initial Baseline Assessment (6-8 Weeks Before Exam)
Purpose:
To gauge where you stand in your preparation and identify weak areas early on.
Recommended Exam:
NBME Practice Exam (e.g., NBME 19, 20, or 21):
Take an NBME practice exam early (about 6-8 weeks before your exam) as your first diagnostic test. This will give you a clear baseline of your current knowledge and allow you to gauge how much you need to improve.
What to Do with the Results:
Review weak areas carefully and adjust your study plan accordingly. This is a good time to review high-yield topics and ensure you're on track with your primary resources (e.g., UWorld, First Aid, etc.).
Don't stress too much about your score at this point; just focus on improvement.
Mid-Preparation Assessment (4-5 Weeks Before Exam)
Purpose:
To check your progress and identify any remaining weak areas.
Recommended Exams:
UWorld Self-Assessment (UWSA1):
This is an excellent tool for checking your progress. Aim to take UWSA1 about 4-5 weeks before your exam. It will help you assess your readiness and give you a rough idea of what your score might be on the real exam.
NBME Practice Exam (e.g., NBME 22):
If you have not already taken one, you can take another NBME practice exam at this stage to see how much progress you've made since your initial baseline.
What to Do with the Results:
After these exams, identify any lingering weak spots. Revisit concepts you're struggling with, and ensure you're refining your high-yield material and test-taking strategies.
If your UWSA1 or NBME score is significantly lower than expected (e.g., below 220), it may be an indication to step up your review in key areas.
Final Review and Readiness Assessment (2-3 Weeks Before Exam)
Purpose:
To simulate exam conditions and refine your test-taking strategies.
Recommended Exams:
UWorld Self-Assessment (UWSA2): Take UWSA2 about 2-3 weeks before your exam. This is your final readiness check, and it will help you gauge how prepared you are for the real exam. By this point, your score on UWSA2 should be fairly close to your predicted Step 1 score if you've been following a consistent and effective study plan.
NBME Practice Exam (e.g., NBME 23, 24):
Take another NBME practice exam around the same time as UWSA2 to see how much progress you've made and to confirm that you’re on track to pass. This gives you a final, reliable prediction of your performance.
What to Do with the Results:
If your UWSA2 or NBME score is in the range you want (e.g., 220+ for passing), then you're on track. Focus on fine-tuning your weak areas and continuing to reinforce high-yield material.
If the score is lower than expected (e.g., below 220), it may indicate that you need to focus on specific topics or adjust your study methods in the final weeks.
Final Simulation (1 Week Before Exam)
Purpose:
To simulate the actual testing experience and finalize your exam strategy.
Recommended Exam:
UWorld Mini Exams or NBME Free Practice Exam: Take a mini UWorld exam or any NBME free practice exam 1 week before the exam. These are shorter than the full-length exams, but they provide a good final practice of both knowledge and timing. Optional: You can also take the NBME practice exam for a final time if you feel it will help you assess your readiness one last time.
What to Do with the Results:
Review the exam as thoroughly as possible, but don't overanalyze it. The goal is to reinforce the material and give you one last run-through of the question format.
Rest and relax: In the final 3-5 days before your exam, limit your studying to light review. Ensure you get adequate sleep and manage any stress.
Summary of Recommended Mock Exam Timeline
6-8 Weeks Before Exam:
NBME Practice Exam (e.g., NBME 19, 20, 21): Baseline assessment.
4-5 Weeks Before Exam:
UWSA1: First full mock exam to assess progress.
NBME Practice Exam (e.g., NBME 22): Second practice exam to track improvement.
2-3 Weeks Before Exam:
UWSA2: Final mock exam for readiness.
NBME Practice Exam (e.g., NBME 23, 24): Final assessment of readiness.
1 Week Before Exam:
Mini UWorld Exam or NBME Free Practice Exam:
Shorter exams to simulate the real test day.
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!"
What is the free 120 in the context of the usmle step1 exam?
The Free 120 is a set of 120 practice questions offered by the USMLE as a free resource to help candidates prepare for the Step 1 exam. It is available on the USMLE website and is designed to give test-takers a realistic preview of the types of questions they will encounter on the actual Step 1 exam.
Key Points About the Free 120:
Content:
The Free 120 contains 120 practice questions, which are designed to reflect the format and difficulty level of the real Step 1 exam. These questions cover a range of topics from the basic medical sciences, including:
Anatomy
Physiology
Biochemistry
Pathology
Pharmacology
Microbiology
Behavioral Science
Genetics
Purpose:
The Free 120 is intended to help students familiarize themselves with the style and structure of the questions on the actual Step 1 exam.
It gives a taste of the content distribution and test-taking experience, allowing students to practice time management and assess their readiness.
It can also serve as a diagnostic tool to identify areas where further study is needed.
Availability:
The Free 120 is available to anyone who is registered for the USMLE Step 1 exam. It can be accessed through the official USMLE website or via the Prometric testing center.
Not a Full-Length Practice Test:
While the Free 120 is a helpful resource, it is important to note that it is not a full-length exam. The real Step 1 consists of 280 questions, divided into 7 blocks of 40 questions each, over a 8-hour period.
The Free 120 is a good starting point, but students should supplement it with other resources like UWorld, NBME self-assessments, or UWSA to get a fuller understanding of the exam format and question difficulty.
Question Format:
The questions in the Free 120 are similar to the actual Step 1 questions in terms of multiple-choice format and clinical vignette style, though they may not cover all the topics or complexities that appear on the real exam.
Score Reporting:
The Free 120 does not provide a score prediction like the UWorld or NBME self-assessments. Instead, it allows you to review your answers and assess your strengths and weaknesses based on the feedback provided.
What is a safe score on the free 120 to pass the usmle step 1? How long before the step 1 exam?
The Free 120 is a diagnostic tool provided by the USMLE to help candidates gauge their readiness for the Step 1 exam. While it does not offer a direct score prediction for the actual Step 1 exam, it can provide valuable insight into your performance and indicate whether you're on track to pass.
What is a Safe Score on the Free 120?
The Free 120 is not scored in the same way as other practice resources like UWorld or NBME exams. However, based on anecdotal feedback and general trends, a safe score to aim for on the Free 120 is typically around 75% or higher (i.e., correctly answering about 90 out of 120 questions).
Aiming for 75%+ on the Free 120 generally suggests that you are on track for a passing score on the real Step 1 exam.
Below 70% might indicate that you need to focus on weak areas and review more before taking the real exam.
Timing: When Should You Take the Free 120?
It is generally recommended to take the Free 120 approximately 1-2 weeks before your actual Step 1 exam. Here's why:
Final Preparation:
At this point, you should have already completed most of your content review and practice questions. The Free 120 serves as a final checkpoint to assess whether you are fully prepared for the exam.
Realistic Experience:
Taking it closer to the exam date allows you to experience a mock set of questions similar to what you'll face on test day, giving you a sense of timing and question format.
Not a Full Practice Test:
Since the Free 120 is only 120 questions (compared to the 280 on Step 1), it should not be relied upon as the only practice test. Use it in conjunction with other resources like UWorld or NBME practice exams for a more comprehensive assessment.
Using the Free 120 Effectively
Take it under exam conditions:
Simulate real test conditions (timed, no interruptions) to get the most out of the experience.
Review mistakes:
The Free 120 allows you to review the questions you got wrong. Use this feedback to identify weak areas that need more attention in the final days before the exam.
Don’t overanalyze:
Since it's just one resource, don’t stress if you score lower than expected. The goal is to gain confidence and identify areas for last-minute review.
How long should I spend preparing for the step 1 if I work full time? What if I'm not working and can study full time?
The amount of time you should spend preparing for the USMLE Step 1 depends significantly on your personal situation, such as whether you're working full-time or studying full-time.
Here's a breakdown of recommended study timelines for both scenarios:
If You Are Working Full-Time
Preparing for Step 1 while working full-time presents a challenge, but it is definitely doable with proper planning. The key is to structure your study time efficiently and make the most of the limited hours available during the week.
Recommended Study Time:
Total Preparation Time:
Aim for 6-9 months of preparation if you are working full-time. This timeline allows for steady, consistent progress without feeling overwhelmed.
Daily Study Hours:
Since you're working full-time, your study hours will need to be adjusted accordingly:
Weekdays: Try to study for 2-3 hours per day after work, focusing on high-yield material and key concepts.
Weekends: Plan for 8-10 hours per day on weekends, as you will have more time to dedicate to studying.
Study Plan Breakdown:
First 3-4 Months:
Use this time for content review and building a strong foundation. Use resources like First Aid, UWorld, and subject-specific review books.
Weekdays: Focus on reviewing material for 2 hours per day. Prioritize weak areas and focus on mastering high-yield topics.
Weekends: Dedicate these to completing practice questions and reviewing weak topics.
Next 2-3 Months:
Transition to more practice-based learning. Spend the majority of your time doing question banks (UWorld) and reviewing high-yield topics in detail.
Weekdays: Focus on practice questions for about 2-3 hours during the week.
Weekends: Complete block questions and review explanations for 8-10 hours.
Final 1-2 Months:
This phase should focus primarily on high-yield review and mock exams. Take NBME and UWSA exams to gauge your progress and simulate exam day.
Weekdays: Limit yourself to light review and focused study of weak areas.
Weekends: Take full-length practice exams (e.g., UWSA1, UWSA2, NBME) and spend time reviewing mistakes.
If You Are Studying Full-Time
If you can dedicate yourself to full-time studying, you have more flexibility and can aim to complete your preparation in a shorter timeframe, but it still requires discipline and effective time management.
Recommended Study Time:
Total Preparation Time:
You can aim for 4-6 months of preparation if studying full-time.
Daily Study Hours:
With full-time study, you should be aiming for around 8-10 hours of study per day to make the most of your time.
Study Plan Breakdown:
First 1-2 Months:
Similar to working full-time, begin with content review and building a foundation. Use resources like First Aid, Kaplan notes, and UWorld.
Study for about 8 hours per day, focusing on different subjects each day and mastering basic concepts in the first two months.
Incorporate active recall techniques (flashcards, self-quizzing) to reinforce learning.
Next 1-2 Months: Begin to transition to question banks like UWorld. Aim to complete a few blocks of questions per day while reviewing explanations in-depth.
In the second month, spend more time doing practice questions (aim for at least 40 questions per day) and reinforcing weak topics from your content review phase.
Final 1-2 Months:
This is the most critical period where you should focus on practice exams and high-yield review. Take UWSA exams, NBME practice exams, and other mocks regularly to simulate test conditions and refine your exam strategy.
Focus on timing and test-taking strategies during this phase.
Weekdays:
Use this time to review your errors, focus on weak areas, and do quick review of high-yield topics.
Weekends:
Take full-length exams and practice under timed conditions. Review errors thoroughly to avoid making the same mistakes on the actual exam.
Can you offer a system-based USMLE step 1 study schedule?
Creating a USMLE Step 1 study schedule by body system is an excellent way to systematically cover the vast amount of material. Focusing on each body system allows you to connect related topics and ensure a more organized review. Below is a study schedule organized by body system, assuming a 6-month study timeline (which can be adjusted based on your available time).
USMLE Step 1, 6-Month Study Schedule by Body System
This schedule assumes you're studying full-time. You can adjust it if you're working part-time or full-time.
Month 1: Foundations & Early Body Systems
Week 1-2: General Principles & Foundations
Topics to cover:
Biochemistry:
Enzyme kinetics, metabolism, genetic disorders, molecular biology.
Genetics:
DNA, RNA, mutations, inheritance patterns, genetic disorders.
Cell Biology:
Membrane structure, transport, cell signaling, protein synthesis.
Microbiology:
Basic microbiology concepts (bacteria, viruses, fungi, parasites).
Recommended Resources:
First Aid (General overview).
Kaplan Biochemistry or Pathoma for concise explanations.
UWorld Qbank for practice questions related to biochemistry, microbiology, and genetics.
Week 3-4: Cardiovascular System
Topics to cover:
Cardiac Anatomy & Physiology:
Heart chambers, conduction system, action potential.
Cardiac Pathology:
Myocardial infarction, ischemic heart disease, arrhythmias.
Pharmacology:
Drugs affecting the cardiovascular system (beta-blockers, ACE inhibitors, anti-arrhythmics).
Microbiology:
Endocarditis, staph/strep infections.
Recommended Resources:
First Aid (Cardiovascular section).
Pathoma (Cardiac pathology).
Kaplan Cardiovascular Physiology.
UWorld Qbank (Cardiovascular system).
Month 2: Respiratory & Renal Systems
Week 5-6: Respiratory System
Topics to cover:
Respiratory Anatomy & Physiology:
Lung volumes, gas exchange, ventilation/perfusion.
Respiratory Pathology:
Pneumonia, tuberculosis, COPD, lung cancer.
Pharmacology:
Bronchodilators, corticosteroids, antitussives.
Microbiology:
Respiratory pathogens (Streptococcus pneumoniae, Mycobacterium tuberculosis, etc.).
Recommended Resources:
First Aid (Respiratory section).
Pathoma (Respiratory pathology).
Kaplan Respiratory Physiology.
UWorld Qbank (Respiratory system).
Week 7-8: Renal System
Topics to cover:
Renal Anatomy & Physiology:
Nephron function, filtration, acid-base balance, fluid/electrolyte balance.
Renal Pathology:
Glomerulonephritis, nephrotic syndrome, acute/chronic kidney disease, renal tumors.
Pharmacology:
Diuretics, antihypertensive medications.
Microbiology:
Urinary tract infections, pyelonephritis.
Recommended Resources:
First Aid (Renal section).
Pathoma (Renal pathology).
Kaplan Renal Physiology.
UWorld Qbank (Renal system).
Month 3: Gastrointestinal, Hepatic, and Endocrine Systems
Week 9-10: Gastrointestinal System
Topics to cover:
GI Anatomy & Physiology:
Digestion, motility, absorption, enzymes.
GI Pathology:
Inflammatory bowel disease, liver diseases (cirrhosis, hepatitis), colorectal cancer.
Pharmacology:
Antacids, antidiarrheals, proton pump inhibitors, laxatives.
Microbiology:
Helicobacter pylori, viral hepatitis, gastroenteritis.
Recommended Resources:
First Aid (GI section).
Pathoma (GI pathology).
Kaplan GI Physiology.
UWorld Qbank (Gastrointestinal system).
Week 11-12: Hepatic & Endocrine Systems
Topics to cover:
Hepatic Physiology: Liver metabolism, bilirubin metabolism, hepatic drug metabolism.
Endocrine System: Hormone synthesis, hypothalamic-pituitary-adrenal axis, thyroid and adrenal disorders, diabetes mellitus.
Endocrine Pathology: Thyroid disorders (hyperthyroidism, hypothyroidism), diabetes, adrenal insufficiency.
Pharmacology: Insulin, thyroid medications, steroids, hormone replacement therapy.
Recommended Resources:
First Aid (Endocrine section).
Pathoma (Hepatic and endocrine pathology).
Kaplan Endocrine Physiology.
UWorld Qbank (Endocrine and GI systems).
Month 4: Nervous System & Musculoskeletal Systems
Week 13-14: Nervous System
Topics to cover:
Neuroanatomy & Physiology:
Neurotransmitters, blood-brain barrier, cranial nerves, brainstem, and spinal cord anatomy.
Neuropharmacology:
Anticonvulsants, antipsychotics, antidepressants.
Neuropathology:
Strokes, seizures, neurodegenerative diseases, brain tumors.
Neuro microbiology:
Meningitis, encephalitis, neuroinvasive viruses (e.g., herpes simplex, HIV).
Recommended Resources:
First Aid (Neurology section).
Pathoma (Neurology pathology).
Kaplan Neuroanatomy.
UWorld Qbank (Nervous system).
Week 15-16: Musculoskeletal & Skin Systems
Topics to cover:
Musculoskeletal Anatomy & Physiology:
Bone structure, joint physiology, muscle contraction.
Musculoskeletal Pathology:
Osteoporosis, osteoarthritis, rheumatoid arthritis, bone tumors.
Skin Anatomy & Physiology:
Skin layers, sweat glands, and dermis function.
Dermatology Pathology:
Psoriasis, skin cancer, dermatitis.
Pharmacology:
NSAIDs, DMARDs, biologics.
Recommended Resources:
First Aid (Musculoskeletal & Skin section).
Pathoma (Musculoskeletal pathology).
Kaplan Musculoskeletal Physiology.
UWorld Qbank (Musculoskeletal and skin systems).
Month 5: Hematology & Immunology
Week 17-18: Hematology
Topics to cover:
Hematology Anatomy & Physiology:
Blood cell types, hematopoiesis, blood clotting mechanisms.
Hematology Pathology:
Anemia, leukemia, lymphoma, bleeding disorders.
Pharmacology:
Anticoagulants, blood transfusions, chemotherapy.
Recommended Resources:
First Aid (Hematology section).
Pathoma (Hematology pathology).
UWorld Qbank (Hematology)
Week 19-20: Immunology
Topics to cover:
Immune System:
Innate and adaptive immunity, T-cells, B-cells, antibodies.
Immunopathology:
Autoimmune diseases, hypersensitivity reactions, immunodeficiency.
Pharmacology:
Vaccines, immunosuppressants, biologic agents.
Recommended Resources:
First Aid (Immunology section).
Kaplan Immunology.
UWorld Qbank (Immunology).
Month 6: Review and Mock Exams
Week 21-22: Systematic Review
Review all high-yield topics from each body system.
Focus on weak areas and reinforce concepts with First Aid, UWorld, and Kaplan resources.
Week 23-24: Practice Exams and Final Review
Take full-length practice exams (e.g., UWSA, NBME, Free 120).
Analyze your mistakes and focus on final review of weak points.
Prioritize high-yield topics and key concepts.
"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 tips do you give for the day before the usmle step1 exam?
The day before the USMLE Step 1 exam is crucial for mental preparation and ensuring you are in the best possible condition to perform well.
Here are some tips to help you optimize your preparation and calm your nerves:
Focus on Rest and Relaxation
Prioritize Rest:
Aim for a full night of sleep (7-9 hours). This will help ensure you're mentally alert and physically refreshed for the exam.
Avoid Cramming:
Resist the urge to cram. At this point, your brain is unlikely to absorb new information effectively, and cramming can lead to unnecessary stress.
Relaxation:
Engage in calming activities that help lower your stress. This could include reading, meditation, light stretching, or listening to calming music.
Review High-Yield Materials
Light Review:
Spend no more than 1-2 hours reviewing high-yield topics or your personal weak areas. This should be very low-pressure review, something that reinforces your knowledge rather than introduces new concepts.
First Aid:
Quickly skim through First Aid, focusing on your weaker areas.
UWorld Highlights:
Review the incorrect questions in UWorld that you got wrong, but avoid doing any new question blocks.
Anki/Flashcards:
If you use Anki or another flashcard system, do a brief review of high-yield cards.
Ensure You Have All Logistics in Order
Review Exam Details:
Double-check the time, location, and any materials you need to bring (ID, confirmation letter, etc.).
Get Your Exam Day Essentials Ready:
Prepare everything you need the night before—your ID, exam confirmation, and other allowed items (e.g., snack for the break, water, etc.).
Know the Location:
Plan your route to the testing center and make sure you have all logistics planned (e.g., transportation, parking, etc.).
Prepare for Test Day
Set an Alarm:
Ensure that you wake up on time to allow for a stress-free morning.
Have a Healthy Breakfast:
Eat a nutritious, balanced breakfast the morning of the exam. Avoid heavy or greasy foods that could make you sluggish, and stay away from excessive caffeine.
Avoid Stimulants:
Limit your caffeine intake the day before and on exam day, as too much caffeine can make you jittery or anxious.
Hydrate:
Drink plenty of water the day before and the morning of the exam. Stay hydrated but avoid excessive liquid intake right before the exam to prevent frequent bathroom breaks.
Manage Your Stress
Practice Deep Breathing or Meditation:
If you feel anxious, try deep breathing exercises, progressive muscle relaxation, or brief meditation. This will help calm your nerves and improve focus.
Stay Positive:
Maintain a positive mindset. Trust in your preparation and remind yourself that you've put in the work and are ready for the exam.
Avoid Negative Thoughts:
Don’t entertain thoughts of failure or overwhelm. Stay focused on the fact that you are prepared and capable.
Take It Easy in the Afternoon/Evening
Avoid Intense Studying:
In the afternoon and evening, stop studying at least 4-6 hours before bed. Doing so will give your mind time to relax and wind down.
Engage in a Non-Exam-Related Activity:
Do something enjoyable and relaxing that distracts you from the exam, take a walk, watch a light movie, or talk to a friend or family member.
Prepare Your Mind for Sleep:
If you're feeling anxious, try to wind down in a calm, distraction-free environment before bed. Avoid using electronics or engaging in stimulating activities.
Eat a Light Meal the Night Before
Avoid Overeating:
Have a nutritious, easy-to-digest dinner that won’t leave you feeling too full or sluggish.
Eat Comforting Foods:
Avoid foods that may cause stomach discomfort or fatigue. Consider eating simple meals like pasta, rice, vegetables, and lean proteins.
Visualize Success
Positive Visualization:
Spend a few minutes visualizing yourself walking into the exam room, remaining calm, answering questions confidently, and finishing the exam successfully.
Self-Affirmation:
Remind yourself that you are prepared, and you've put in the effort required to succeed.
Early to Bed
Sleep Well:
Aim to get to bed early, especially if you have an early morning exam. A good night’s rest is essential for mental clarity and focus the next day.
USMLE Step 1 Exam Day Policies
On the day of your USMLE Step 1 exam, Prometric, the testing service provider, enforces several policies and procedures to ensure a secure and standardized testing environment. Below are the key policies and guidelines you should follow:
Check-in and Security Procedures
Arrival Time:
Arrive at the Prometric testing center at least 30 minutes before your scheduled test time.
Late arrivals (more than 15 minutes after the scheduled time) may not be allowed to test and could lose their exam fee.
Identification:
You must bring a valid government-issued photo ID (e.g., passport, driver's license, or national ID).
The name on your ID must match exactly the name you used during registration for the exam.
Security Screening:
Fingerprinting and photographs will be taken at check-in.
You will also undergo a security check, which includes the screening of any personal belongings.
Items such as bags, books, notes, and electronic devices (including cell phones) are not allowed in the testing room. These must be stored in a designated area outside the testing area.
Personal Items and What to Bring
Permitted Items:
You are allowed to bring only the following items into the testing room:
Valid ID
Scheduling Permit
Comfort items such as tissues or medications (which must be inspected and approved).
Prohibited Items:
Cell phones, smartwatches, pagers, calculators, or any other electronic devices are strictly prohibited.
Books, notes, highlighters, or other study materials are not permitted.
Personal belongings like bags, purses, coats, or hats must be stored in a secure area outside the test room.
Test Environment and Breaks
Test Duration:
The exam is 8 hours long with 7 blocks of 40 multiple-choice questions each.
Total break time is 45 minutes, which you can take during any scheduled break time.
Breaks:
Scheduled breaks occur between each block of questions, where you can take a break, stretch, or use the restroom. You are not required to take the full 45 minutes of breaks; unused break time can accumulate.
There are also optional tutorial breaks at the beginning of the test, which lasts 15 minutes, and if skipped, this time is added to your break time.
Restroom Use:
You can leave the testing room to use the restroom during your break time or between blocks.
However, any unscheduled breaks or leaving the test room during blocks could result in time being deducted from your allotted time.
Test Conduct and Behavior
No Talking or Communication:
No communication with other candidates is allowed during the exam.
Talking, whispering, or any form of discussion is strictly prohibited during the test.
Cheating Prevention:
No unauthorized materials are allowed in the exam room.
Prometric strictly monitors for cheating or any suspicious activity, and candidates found violating test protocols could be disqualified from the exam.
Behavior and Professionalism:
Prometric expects you to follow all rules and behave professionally during the exam. Any violations of the testing policies can lead to serious consequences, including disqualification.
During the Exam
Screen Interface:
The exam is administered on a computer.
Questions are presented in a random order, and you must select one answer per question. You will not be penalized for guessing.
Time Management:
The computer will display a timer during the exam. It is important to manage your time as each block has a fixed time limit, and you should aim to complete all questions within that time.
No Extra Time for Review:
While you can review and change answers within a block, you are not given extra time for review once a block is completed. Time spent reviewing is included in the overall time for that block.
Test Completion
Completion of the Exam:
Once you complete the exam, you will be prompted to submit your answers electronically.
After submitting, you will receive a completion notice, and you can leave the test center.
Post-Test Information:
Scores: Step 1 scores are not immediately available on test day. You will typically receive your score report within 3-4 weeks after the exam date.
Rescheduling or Cancelling the Exam
If you need to reschedule or cancel your exam, you must do so through Prometric's website.
Fees may apply for rescheduling, especially if changes are made close to the exam date.
If you miss your exam without notifying Prometric or if you are late for your exam, you may forfeit your exam fees.
Special Accommodations
If you require special accommodations (e.g., extra time, a separate room), you must submit a request to Prometric in advance with appropriate documentation.
Accommodations are granted based on specific requirements and approval by the USMLE.
Check our blog post on USMLE Step 3 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 tips do you give for the day of the usmle step1 exam? how to use my step 1 breaks?
The day of the USMLE Step 1 exam can be stressful, but with the right strategies, you can maximize your performance and maintain a calm, focused mindset throughout the day. Here are some tips for the exam day itself, including how to use your breaks effectively:
Arrive Early and Stay Calm
Arrive Early:
Aim to arrive at the testing center 30-45 minutes before your scheduled start time. This will give you time to go through security, settle in, and avoid feeling rushed.
Relax and Breathe:
Before entering the testing room, take a few deep breaths to calm your nerves. Stay composed and remember that you've prepared for this.
Stay Organized with Materials
ID and Essentials:
Double-check that you have your valid ID and any other necessary materials. This may include your admission ticket, or anything else required by the testing center.
Allowed Items:
Bring a snack and water for your breaks, as well as any other items the testing center allows. Make sure your watch or timer is set to help you keep track of time.
Understand the Structure of the Exam Day
Exam Format:
The USMLE Step 1 is divided into 7 blocks of 40 questions each. The total testing time is 8 hours, which includes a break after each block.
Breaks:
You are allotted 45 minutes of total break time during the exam, which can be taken between blocks or at other times during the exam. You’ll have 1 hour for lunch and additional time after specific blocks.
Managing Breaks Effectively
During the Exam:
First Break (After Block 1):
Quick Stretch:
Use this time to stretch your legs, get some fresh air, or do deep breathing exercises.
Stay Hydrated:
Drink water but avoid heavy or caffeinated beverages, as they can make you jittery.
Avoid Reviewing:
Don’t try to review questions you’ve already answered. You’ve done your best for each block and stressing over past questions will not help.
Between Other Blocks (Breaks 2-6):
Quick Refresh:
You can take a quick walk around, stretch, or simply sit and relax. These short breaks are for mental relaxation—don’t waste them reviewing content or trying to study.
Stay Calm:
Try to avoid discussing questions with other test-takers. This can lead to unnecessary anxiety.
Snack:
Have a small, healthy snack (e.g., granola bar, nuts, or fruit) to keep your energy up. Avoid anything too sugary or heavy that might cause a crash in energy.
Lunch Break:
Eat a Balanced Meal:
Take your 1-hour lunch break and eat a light, balanced meal that won’t make you feel sluggish. Focus on lean proteins, fruits, vegetables, and whole grains.
Mental Break:
Try to completely disengage from the exam for a bit. Go for a short walk, listen to calming music, or chat with someone (if you feel like it). This will help reset your focus and relieve stress before the second half of the exam.
Stay Hydrated:
Keep drinking water during lunch, but avoid consuming too much caffeine or soda.
What to Avoid During Breaks:
Overthinking the Exam:
Don’t dwell on questions from previous blocks, and don’t second-guess your answers. Your time during the breaks is better spent refreshing yourself for the next set of questions.
Engaging in Negative Thoughts:
Avoid listening to negative or anxious chatter from other test-takers. Stay focused on staying positive and calm.
Intense Cramming:
Do not try to cram or review new materials during breaks. Your brain is likely already overloaded with information, and trying to learn more at this point will only increase stress and decrease performance.
Pacing Yourself
Time Management:
Keep an eye on your time for each block, but don’t obsess over the clock. Aim to pace yourself so that you can answer every question without rushing at the end.
Move Quickly, But Don’t Rush:
If you’re unsure about a question, don’t spend too much time on it. Mark it and move on, so you don’t risk running out of time.
Mental Focus and Staying Calm
Stay Calm During the Exam:
If you feel yourself getting stressed during the exam, take a few deep breaths and remind yourself to stay calm. If you hit a difficult question, take a moment, but don’t panic. Remember that there will always be harder questions, and the goal is to get through them methodically.
Positive Mindset:
Keep a positive attitude throughout the exam. If you feel stressed, use positive self-talk to remind yourself that you’ve prepared well for this and you can handle it.
What to Do After the Exam
Celebrate:
After you complete the exam, take a moment to relax and celebrate your hard work. You’ve done your best.
Don’t Discuss Questions:
Avoid discussing specific questions with other test-takers. This is a good way to avoid unnecessary anxiety or confusion about answers.
Rest and Recover:
After the exam, give yourself time to recover mentally and physically. You’ve completed a challenging and mentally taxing test, so take some time to relax before moving on to the next stage of your medical journey.
What do you recommend for snacks for breaks during the usmle step 1 exam
For the USMLE Step 1 exam, it’s important to choose snacks that will maintain your energy levels without causing any distractions or crashes in blood sugar. Since you'll be sitting for a long period and need to stay focused, opt for snacks that are nutritious, easy to digest, and won't make you feel sluggish.
Some snack ideas that are ideal for the breaks during the exam:
Protein-Rich Snacks
Protein can help maintain your energy levels and keep you feeling full without a sugar crash.
Nuts:
Almonds, walnuts, cashews, or mixed nuts (unsweetened, no added salt).
Trail Mix:
A mix of nuts, seeds, and a small amount of dried fruit (be mindful of sugar content).
Greek Yogurt:
A small cup of plain, low-fat Greek yogurt.
Protein Bars:
Choose ones with minimal sugar and high protein content. Some options include Quest Bars or RXBARs (check the ingredients to avoid excess sugar).
Carbohydrates for Sustained Energy
Carbs provide quick and sustained energy when paired with protein.
Whole-Grain Crackers:
Look for whole-grain or seed-based crackers to provide slow-release energy.
Oatmeal Packets:
Instant oatmeal packets with low sugar or plain oats (can be prepared at the testing center if hot water is available).
Rice Cakes:
Choose unsweetened or lightly salted rice cakes. You can pair them with a small spread of peanut butter or almond butter for added protein.
Granola Bars:
Choose bars with whole grains, minimal sugar, and a balance of protein and carbs (e.g., KIND bars or Nature Valley).
Fresh Fruits for a Quick Energy Boost
Fruits are a good source of vitamins and natural sugars for quick energy.
Bananas:
Packed with potassium, which is great for maintaining your energy levels and preventing muscle cramps.
Apple Slices:
Apples provide fiber and natural sugars that offer steady energy.
Grapes:
Easy to snack on and don’t require refrigeration.
Berries:
Blueberries, strawberries, or raspberries are rich in antioxidants and vitamins.
Hydration
Water:
Always carry a water bottle. Staying hydrated is critical for focus and avoiding fatigue. Avoid sugary drinks or energy drinks, as they can cause crashes.
Coconut Water:
A good alternative for hydration if you want something with natural electrolytes.
Electrolyte Drinks:
If you're a heavy sweater or feel dehydrated, a low-sugar electrolyte drink (like Gatorade Zero or Propel) can help maintain fluid balance without the extra sugar.
Healthy Fats for Sustained Energy
Avocado:
If you have a longer break or are bringing a packed lunch, avocado can be a great addition to a snack. You can spread it on crackers or rice cakes.
Nut Butter:
Small packets of peanut butter, almond butter, or cashew butter are easy to carry and pair well with fruits or crackers.
Light, Non-Caffeinated Snacks
Dark Chocolate:
A small square of dark chocolate (70% or higher) can provide a mild energy boost without the sugar spike.
Protein Smoothies:
If allowed by the testing center, you can bring a protein smoothie made with low-sugar protein powder, milk, or a milk alternative.
Here it is again,
You made it all the way to the end of this blog post!
We hope you have found the information offered here by IMG Rotations useful in your usmle step 1 exam preparation, and we would like to wish you the best of luck in your exam.
Don't forget to check our blog post on the ERAS residency match 2026 HERE.
Any questions? Email us: admin@imgrotations.com
Dr Ashkan Eighaei Sedeh, MD