USMLE® Step 1 & 2

USMLE Step 1 FAQ: How, what to study to pass the exam

Brendan Murphy , Senior News Writer

AMA News Wire

USMLE Step 1 FAQ: How, what to study to pass the exam

Apr 22, 2024

For many medical students the spring season can be the height of preparation for Step 1 of the United States Medical Licensing Examination (USMLE). The exam aims to measure basic science knowledge and how a test-taker would apply key science principles to the practice of medicine.

What’s the best way to go about studying and what are some potential stumbling blocks during exam preparation? Experts on the exam and those who have taken it successfully have offered insight on questions that might arise during the preparation process.

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According to Joshua D. Brooks, PhD, associate director of medical academics at Kaplan Medical—one of many third-party study resource providers, along with AMBOSS, UWorld and others—it’s better to get started sooner than later.

Brooks said that students should create a study plan and get started at least six months, but preferably 12 months, before the exam. Early on, it’s more important to get into the rhythm of studying than to feel like you’re gaining knowledge. By starting early, you can also incorporate test prep into the studying you do for classes. Dive deeper:

In 2022, Step 1 moved from numerical score reporting to pass-fail scoring. That shift shouldn’t cause students to take the exam lightly.

David A. Marzano, MD, is an associate professor and director of the ob-gyn residency at Michigan Medicine.

“It shouldn't be disregarded because it's pass-fail,” he said. “If you're studying and preparing just to pass, there's a chance you might actually fail,” compared with the people who are “preparing to try to get a really high score.” The latter approach is “the kind of vim and vigor I would prepare with,” said Dr. Marzano.

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First, consider that nearly all medical students pass the Step 1 exam. In 2020, 98% of DO and MD students passed the exam on their first try. But if you don’t, the National Board of Medical Examiners allows a maximum of four attempts to pass each different level of the USMLE exam. If you fail, you get a score report that offers feedback on the areas in which you struggled.

“What we have found, most of the time, is that examinees who failed have performed poorly in a number of content areas, so that means that a different study strategy” should be pursued, said Alex J. Mechaber, MD, vice president of USMLE at the National Board of Medical Examiners.

Your best bet if you receive a failing score is to work with an academic adviser at your medical school to rectify the issue.

Osteopathic medical schools require students to pass the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX) Level 1 and Level 2 exams for graduation. The USMLE isn’t part of the required path for DO licensure or graduation, but many DO students still take the exam to help their chances during the residency-selection process. COMLEX Level 1 also moved to a pass-fail format in recent years.

Osteopathic medical students often feel they must take both board exams to compete with medical students from MD schools who take the USMLE series. With both first exams in the COMLEX and USMLE series going pass-fail, how might that affect the second phase of those exams?

“Discuss with your residency advising staff at your college the specialty that you are interested in, the geographic area you’d like to go to, what your whole CV and resume package looks like and make a decision on Step 2 test-taking based on all that information,” said Jody Gerome, DO, senior associate dean for medical education at Ohio University Heritage College of Osteopathic Medicine. “I practice medicine in Ohio, which has a large number of traditionally osteopathic training programs and many of our graduates are still successful matching into these types of competitive programs without taking USMLE.”

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Two key concepts to keep in mind during USMLE study are active learning and spaced retrieval.

In learning, the concept of spaced retrieval suggests that covering a topic once, or testing oneself on it, and then returning to it after some time is one of the most effective methods to ensure long-term retention.

USMLE study can involve a combination of passive methods, such as watching a video lecture, and more engaging activities such as quizzing yourself with a classmate or a question bank.  

Sara Keeth, PhD, is director of learning and institutional success at Lecturio, a German-based online learning company that offers online learning resources for USLME prep.

In citing the value of acting learning methods she offered that “if I'm lecturing you and I tell you a fact, you may or may not remember it,” Keeth said. “But if we’re playing a trivia game and I ask you a question, by trying to come up with the answer, the fact that you tried to recall that answer—even if you get it wrong—is going to help you remember the correct answer the next time you have this question.” 

 Diver deeper:

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Medical student sitting on a stack of textbooks

While the exam topic area of the USMLE Step 1 is considered foundational science concepts, certain areas commonly called high-yield topics tend to be more common on the exam.

“The general wisdom is that Step 1 has a significant portion of the test on physiology, pharmacology and pathology,” said Christopher Cimino, MD, chief medical officer at Kaplan Medical. “And some questions will have a combo of two or all three as part of the question.”

He added that “if a student wants to figure out what’s on the test, they should meet with other students and talk about it,” Dr. Cimino said. “If they reach a consensus, they are probably right.”

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Chantal Young, PhD, is director of medical student wellness at the Keck School of Medicine of the University of Southern California. She highlighted the importance of building in breaks to your studying.

“Students have initiated Step 1-free zones at our school, where you are not allowed to talk about it and the first person who does talk about it, pays a dollar,” she said.

“Taking full days in the middle of dedicated studying, if not two full days, of rest is very important. Sometimes you need to wake up in the morning and know you’re not touching it today. Your brain needs to rest and recover just like your body does if you are preparing for an incredibly difficult athletic event.”

Diver deeper: