When to start studying for USMLE Step 1

One of the most common questions medical students have during first and second year is when to start studying for USMLE Step 1. If you’re reading this, you probably have the same question. There is no question that USMLE Step 1 is a big deal. It makes everyone nervous. That said, hundreds of thousands of people have passed this test in the past and the odds are very, very good that you will too.

Everyone wants to do well on USMLE Step 1. Here’s the rub: for some specialties you need to do very well in order to match. This, however, is more important for determining how you study and how much time you devote to studying. It does not affect when to start studying for USMLE Step 1. We will revisit this later on.

Should I study for USMLE Step 1 during first year?

Regardless of how well you want or need to do on USMLE Step 1, you should not actively study for the exam during your first year. Here’s why: assuming your school follows a somewhat traditional curriculum, even at the end of your first year, you will only have received less than half of the information that you’ll need to study. Why less than half? The majority of the information on Step 1 is pathology (55-60%) and pharmacology/therapeutics (15-20%): information covered in the second year of medical school. Physiology, anatomy and biochemistry make up a smaller percentage of the exam. Take a look here for the content that is covered on the exam.

This same logic applies to the summer after your first year. In my opinion, your time is best spent enjoying your last “real summer.” If you want to improve your stock for residency applications, you can do things like research or volunteering, if that is something that interests you. If you’re hellbent on studying for Step 1, get your hands on a copy on First Aid for USMLE Step 1 (a used copy or last year’s edition is totally fine) and familiarize yourself with the textbook you’ll be using a lot during your dedicated study time. Review material that you learned about in first year that is in First Aid. Secondly, you can read over your notes/study material from first year. Prioritize reviewing physiology. If you have a clear understanding physiology, learning pathology will be easier and make more sense.

Well, when should I start studying for USMLE Step 1?

The second year of medical school is your best preparation for USMLE Step 1. This is when to start studying for USMLE Step 1. Studying for your classes during second year is efficient. It will both help you do well during second year and also help you in becoming proficient with the information on the USMLE Step 1. How well you do during second year and how well you do on Step 1 are closely correlated. Thus, the best thing you can do in terms of USMLE Step 1 preparation during your second year is to master the material that is presented to you in lecture and class.

Secondly, you should use First Aid for the USMLE Step 1 all year long. If you did not get a copy over the summer, grab one or an electronic copy to use with your studies. This will be your initial copy, and you will want to buy the newest edition that comes out around winter break (a perfect Christmas/Hanukkah gift). As you learn about a subject in lecture, read the corresponding section in First Aid. If you keep up with reading First Aid during second year, you will have read all of the material in First Aid at least once before your dedicated Step 1 study time. This will be very helpful. I recommend getting through First Aid at least twice before taking Step 1. It takes a long time to do that. You will be thankful to have seen all of the information before your dedicated study time!

In addition to using First Aid for the USMLE Step 1, if you are shooting for an elite score (something >250) you may want to consider buying a question bank (qbank) to use during second year. This really is not necessary unless you are trying to hit a very high score, or study best for class by doing questions. Completing a question bank takes a lot of time, so make sure that you want/need to devote this additional time to studying as you can do very well on Step 1 without working on a qbank during the school year. The best question bank for Step 1 is still UWorld. There are others that are okay, but tend to cover more esoteric, lower-yield information. These include USMLE-Rx and Kaplan. There are two schools of thought. One is to buy a longer subscription of UWorld, and complete one pass of all the questions before dedicated study. The other is to buy an alternative qbank to use during the year, and save the UWorld questions for dedicated study time. I do not think there is a wrong choice here. Go with one to use before your dedicated USMLE Step 1 study time. In a future post, I will go over the different qbanks in depth to help you make a decision.

You might wonder if you should write/take notes in your copy of First Aid. There are different philosophies on whether or not to annotate in First Aid. I will cover this is another post, but my general rule of thumb is to keep annotations to a minimum. This especially applies to lecture material, which usually covers more low-yield material than question banks. Only add things that you feel are VERY important or that will help you remember information contained in First Aid already. Chances are that what you want to add is not high-yield for USMLE Step 1, or is covered elsewhere in the textbook. You want the textbook to remain readable and not distract yourself with a lot of extraneous information.


Hopefully this write-up gives you a sense of when to start studying for USMLE Step 1. Take a deep breath, this test is hard, but you will get through it! If you have any questions or comments, leave them below and I will get back to you!

Summary of when to start studying for USMLE Step 1

First year

  • No dedicated studying for USMLE Step 1

Summer after first year

  • Enjoy it, it’s your last one!
  • Research and volunteering are likely a better use of your time than studying for USMLE Step 1
  • Becoming familiar with First Aid for USMLE Step 1 and reviewing your notes from first year (especially physiology) if you really want to study for Step 1.

Second year

  • This is when to start studying for USMLE Step 1
  • Review the relevant subjects in First Aid as you learn them in class
  • If you are shooting for an elite score, consider purchasing a question bank to complete during second year. Complete the questions that are relevant to the information you’re learning in class.
When to start studying for USMLE Step 1
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