USMLE STEP 1 guide

Contents
1. About (eligibility/ registration / cost etc)
2. Timeline
3. Written resources
4. Video resources
5. Anki
6. Question banks
7. Test resources
8. Last 2 weeks
9. D day
10. Helpful Insta/ YouTube accounts

This is a genuine effort from my side to provide as much detailed description about USMLE STEP 1 as
I can.

Feel free to contact me on my twitter @Masum0813/

LinkedIn https://www.linkedin.com/in/masum-patel-01a0bb134 / WhatsApp.

Special acknowledgment-
Hello I am Masum Patel, BJMC Batch 2019.
I started my USMLE preparation from 2nd year and cleared my step 1 in Sept 2022.
It was not a easy journey since there was a LOT to learn and it is indeed “a path less taken”
Hence, I felt the dire need to extend my knowledge to everyone else wanting to pursue USMLE.

My journey till now has been only possible because of the immense support from my family, my
Pappa Dr. Sanjay Patel and Mummy Chirag Patel and Yashvi Thakkar (Batch 19 NHL MMC)
Also, my heartfelt gratitude to my batchmate and the fellow contributor of this guide - Shubham
Patel (2019 batch BJMC)
LinkedIn – https://www.linkedin.com/in/shubham-p-5a1979b8
And lastly I feel nothing less than special to have seniors like Divya Patel (2018 batch BJMC), Aditya
Shah (batch 2017 BJMC) and Manan Patel (batch 2017 BJMC) who guided us in every step of the
journey.

I have attached my own notes/timeline and a few links just and try to make it personalised. So, let’s
begin
1.About
There are 3 steps

1. USMLE Step 1
2. USMLE Step 2 CK (clinical knowledge) [Step 2 cs clinical skills is obsolete now]
3. USMLE Step 3

-You need step 1/2 to apply for residency. And apply for JI visa.
-Step 3 before your residency will give you an additional benefit in interviews and get you H1 visa.

Eligibility

• any year of medical school

• your college should be registered in the global directory of medical schools
• After ECFMG registration

Questions

• 1 block- 40 Qs , mixture from all units

• Total 7 blocks 280 Qs

Time

• duration: 8 hours
• 7 blocks - maximum 1 hour each
• Total 60 mins break

If you complete your block in 45 mins -> additional 15 mins get added to you break time

Registration & slot picking

I am linking this video - I suggest to follow step by step registration exactly according to it.
It is a complete guide and it guides you from ECFMG registration to choosing date.
https://youtu.be/43SDvxHYqos

• ANY 3 consequent months

• Keep a target of about 5-7 months preparation

[ Eg if I start in January, according to average pace , take the slot as May-June-July ]

Cost

Major expense will be

• ECFMG registration
• Exam scheduling
• U WORLD/ other subscriptions
• College verification fees (like ₹5000 in BJMC) / VSLO Verification
• USCE / electives / observership - applications / US visa and travel / US stays

Website for cost estimate

Cost of USMLE - GUIDING IMGS TO MATCH INTO THEIR DREAM US RESIDENCY
YouTube video
https://youtu.be/prHplxW8jeA
2.Timeline
Preferred to start in latest in 2nd year but a lot of people appear in/after internship as well.
Basically you just need 4-6 months, enough to pass the test.
I have also mentioned each resource in detail in the next section.

• Year 1 (optional)
Apart from your standard Indian textbooks

1. Anatomy - nil
2. Physiology - Kaplan only if you have time
3. Biochemistry - watch Kaplan or Boards and Beyond

• Year 2 (Necessary from here)

1. Pharmacology - Sketchy (highly recommend)
2. Microbiology - Sketchy (highly recommend) + Kaplan immunology
3. Pathology- Pathoma videos and notes

(Summary of Robbins)
>> If you started USMLE prep from 2nd year - no need to do any additional things for 1st year

• Year 3
Registration and slot picking

Complete all the ECFMG registration/ college verification/ slot taking in the first 2 months (*refer to
the registration subsection)

Pre- Dedicated period

• Boards and Beyond (BnB) videos

• First Aid - first read
• Sketchy revision
• Total about 1.5 months
• Reinforce and focus on “understanding” the topics
• Use other resources only for your weak topics
• No need of BnB microbio if you have watched sketchy
Dedicated period

• Uworld and First Aid revision parallel (About 3 months)

• Start NBMES when about 70% of your UW is complete
• UW SA1/2 in the last month

My timeline
I started in March 2022 and appeared for my step 1 on Sept 6 th – exactly 6 months… enough time to get you
around 230-240s.

IMP – try to write down your daily progress somewhere because it is a long journey and there might be days
you will feel as if you wasted time.

Here I am attaching snaps of my daily updates ..( I used OneNote )

3.Written resources

1.First Aid

Most important and must have resource

“Bhagwad geeta” for step 1

HOW TO READ FA

• It is more like an Index to what points we are supposed to know

• Always read the page number xix- xxii and 1-25 to get an orientation
• A list of top-rated review resources is given in FA at the end (pg. 737)
• Do NOT try to write things from Bnb into first aid (if it is important, it will be mentioned
somewhere in FA, or else it’s not important)
• Try to “understand” and not memorise during first reading
• Avoid highlighting in initial readings
• Add info into FA only from Uworld
• Multiple revisions will be needed for retention

ORDER
(Advisable, NOT necessary)

• Biochemistry > general Patho > general Pharmac first

• Systems can be done in any order but these are the systems you should do together
• cardio / Renal / Respi
• Endo/Repro
• Musculo/Neuro
• GI / hemat
• Psychiatry, Microbiology, public health are independent

2.Notes from Pathoma/ sketchy

3.self-made notes are not needed

• Specially DO NOT make notes from FA It is already a concise format

• You can make notes of very volatile topics and revise them again and again specially before
each NBMEs and during the last month
4.Video sources
BASED ON PRIORITY

1.Boards and Beyond ( BnB) videos

• Most important
• Short duration videos
• Good for revision of 1st /2nd year subjects
• Information dense
• Good for getting familiar to FA
• Use it as an understanding tool and do not take notes
• Do NOT try to write things from Bnb into first aid ( if it is important it will be mentioned
somewhere in FA, or else its not important)
• See BnB videos and read the relevant page number (mentioned in the official BnB website
under every video for free)

2.Pathoma

• Mandatory for reading pathology

• Should do in 2nd year
• Very well explained concepts
• General pathology- Very important

3.Sketchy

• Along with pdf/ coloured notes

• Must watch for micro
• Highly advised for pharmac
• Multiple revisions needed but good for long-term retaining
• Use Anki (refer to flashcard subsection)
4.Dirty medicine

• On youtube(free) https://youtube.com/@DirtyMedicine
• Very good for last months of step 1 prep
• Best mnemonics for volatile topics / ethics
• I am linking my playlist

https://youtube.com/playlist?list=PLvzRm2RJ0zMQ8m1hDz6k3GUPKleJf7KJL

5.Kaplan

• Very detailed
• Should do in 1st or 2nd year
• Must do for - immunology / neurosurgery

6.Pixorise

• For biochemistry topics like glycogen storage /lysosomal etc

• Like sketchy
• Advised During dedicated period

This how I used to calculate my daily work…

5.Anki
Anki is basically an app where you can revise using flashcards. But WHY do we need it? Have you ever heard about
the forgetting curve…? Here, take a look

Well, I assume it will be easy to figure out that spaced repetition is the only way out… so we have anki to remind us
‘when to revise this topic next’

HOW TO USE
1. Download the official app
2. You can create your own flashcards or download a deck directly. [ there are many decks like
anking / lightyear et already made for step 1…I will link some of my personal favourites below]
3. Every day, you review all the flashcards Anki gives you
4. Rate each card as easy, good, hard. According to your answer, Anki schedules that card for a
specific range of days.
For example, if you found the "Good" card, you'll see the card the next day. But if you didn't know
the card's answer, you'll see it in less than 10 minutes.

COST

- Free mobile app for android

- Paid app for IOS (but totally worth it)
- Can use their web version for free as well

USE

- You don’t need to know any advanced settings, but you can watch simple YouTube tutorials incase
- Subject wise for Pathoma / sketchy micro / sketchy pharm (MUST DO if you start from 2nd year)
Download subject wise any deck from reddit
- Rapid review section of FA (during the last month of step 1 )
Deck Download: https://drive.google.com/open?id=1qiXk0tHjntBTE0Cg0EdAGMT-aDPGronj
6.Question banks

1.UWorld
• MUST do
• As important as first aid
• Costs about $500 for 6 months ( I think 6 months UW is enough if you start in your dedicated
period) ( some people buy 1 year and sell the remaining months away to batchmates in
need.)
• Do NOT share UW account since you have to solve all the Qs by yourself. It is not like marrow
• You can buy UW at a cheaper price by contacting them for college discounts.
• You can buy UW early and can activate each of the 3 – UW Question Bank/ UWSA1/UWSA2
individually as and when you need them.

Eg. I bought UW in March and activated UW Question bank in May (after completing FA
once) and activated UWSAs in Aug ( a month before exams)

• You can do up to 2 passes (i.e. you can reset and erase the data once)
• First pass - use as a learning resource
• Do it in TIMED & TEST mode
• Can use TUTOR mode sometimes
• Never use UNTIMED mode
• Start with 1 block a day >> up to 3 blocks per day

UW REVIEW

• Review Qs the same day and revisit the First Aid at the same time
• Read explanations of ALL the questions (even the correct ones) and ALL options as it will
help you develop differential diagnosis
• Mark the questions during review— mostly incorrect and corrects but difficult Qs
• Can revise only the marked Qs at last

(I did not do a 2nd pass of UW, rather just solved my marked Qs again, about 1500 of them)

• You can keep a separate notebook for writing your UW mistakes / directly add them in FA
(advised)
 • Image based questions like histo and radio images -> make flashcards in Uworld itself (very
Imp)

(I had about 150-200 flashcards)

UW APPROACH
Complete first aid (1.5 months)
Then start U world

• I started solving Qs system-wise

• I did not read FA immediately before doing UW and visited my FA only during review ( thats
what I meant by using it as a learning resource)
• Target an average score only ( I got about 64% average at the end ranging from 55% to 85% )
• Solve about 60% questions of each unit and then move to the next unit
• At last you’ll have about 50-250Qs left from EACH unit
• Solve those remaining Qs in RANDOM mode

2.Amboss
• Really good but not mandatory for step 1
• Can do only for weak units
• I personally did not do it so I do not know how to approach the Qs
7.Testing resources

1.NBMEs
NATIONAL BOARD OF MEDICAL EXAMINATIONS

• NMBEs are the self-assessments by the board which help you know where you are in your
preparation. They are available for all 3 USMLE steps.

• You can get them at @ https://www.mynbme.org/s/, creating an account and purchase

them. Each NBME costs about $60 with 90 days of validity from the date of
purchase. Offline NBMEs Yes, you can find these test and solutions on telegram or any
other forums. Kindly take time to search. Its not an absolute necessary but I suggest to do
all the 6 newer one's [ offline/online]

• There are total 6 newer NBMEs 25,26,27,28,29,30. And the older ones are 17,18,19 etc.

• NMBEs have 4 blocks each of 50 questions for 1hr 15 min. [Real exam has 7 blocks each of
40 questions for 1 hr.]

• Order - All the new NBMEs are almost equally predictable. 25/26 are relatively difficult,
while 27/28 are easier. So you can alternate between 1 easy and 1 hard. 29/30 are the
most predictable, so keep them at last.

• Score calculation - Find the graph for each NBMEs on reddit/google. You will find
something like this. Place x as the number of incorrect Qs.
 • Time - start with an older NBME (I did NBME 18/24) once you complete 70-90% of your
Uworld. Once you complete the syllabus, start with the newer NBMEs, about 2 weeks
apart and you can do last few NBMEs in the last month. [ try to complete only few units
between each NBME, and do not rush through all units… you will eventually cover all of
them by your last NBMEs]. Here is my schedule of NBMEs

• Interpretation - If you are at good stage of preparation, you final score may be the average
or within the range of the NBMES. It may be +/- 5 points of the latest NBME you take. It's
the percentage more important for improvement than the score.

• Reviewing- take at least 24 hours and review each and every Q of the NBME even if you
solved it. Read the explanations for other options as well. Then make notes of the incorrect
/ difficult Qs and read it in the last week.
• Here is a snap from my NBME incorrect notes….
2.UWSAs (UW Self-assessment)

• These are paid assessment tests

• There are 2 UWSAs available and you can reset them one time each
• Each comprise of 4 blocks of 40Qs each (usually bought with UW subscription)
• Order and Predictability
1. UWSA1 - in between your NBMEs (might be over predictable by around 15-20 points)
2. UWSA2 - in the last 2 week of your exam (very good predictable value of +/- 5
points)
8.Last 2 weeks before step1
For the last 2weeks, I would suggest you cover the following things -

EXTERNAL SOURCES

1. High yield images videos by dirty medicine on YouTube

2. Listen to heart sounds by Medzcool on YouTube
https://youtube.com/playlist?list=PL3n8cHP87ijCI2KZffJ7j4COi2nXiAT1R
3. All NBME images - there's a pdf available on telegram.
4. Golden radiology YouTube
images https://youtube.com/playlist?list=PLGWleTab_TJUTcBV-DCbL0yjQ1YC3fuZg

PERSONAL RESOURCES

1. Review uworld flashcards - on browse mode. Specifically those that you thing require
revision.
2. Biostatistics , pharmacokinetics and other formulae
3. Read pathoma chapters 1,2,3 without fail
4. Review all Incorrects of UWSAs and NBMEs
5. Read FA. Parts which require constant revision like the cytokines, interleukins etc
6. Without fail revise the tumour markers and oncogenes

HACKS FOR LAST DAY

• Dirty medicine bio-hacks were very useful https://youtu.be/zJgjMZk8_To

• Pro-metric centre guide https://www.prometric.com/test-takers/what-expect

• Call the pro-metric centre on the previous day to confirm your appointment
9. D-day tips
- Visit the test enter one day before and heck the setting and location to avoid rush.
- Have sufficient breakfast but avoid carbs / sugars since you might have sugar crashes later on. Instead have
protein & fats.
- Don’t forget Documents and IDs
- Reach the centre minimum 30 mins before the exam (advised 50mins)
- Things you can take with you – 2-3 fruits/ water/ protein bars / black coffee/ lemonade
- Security frisking – will be done by the supervisors before assigning you your cubicle and while re-entering
the testing area after each break (don’t worry it is very quick)
- Wear something with less or no pockets to save more time while frisking
- Things allowed with you in the testing area-
1. Locker key
2. Passport
3. Noise cancelling soft ear plugs
4. Jacket

- BREAK SESSIONS-
I advise to take a break of 5-10 mins after every block, just freshen up, go to the bathroom, eat something and
go back. It might seem unnecessary at the start but you might get drained out later.
You can also use your phone during your breaks (listen to songs or can even call someone if you need)

- Some blocks will be difficult but rest will be easy… but make sure not to waste your time in one single Qs

- If you find a Q difficult, do not leave it blank…. select the most probable answer and mark the Q for reviewing
later… this was you are ready even in case you don’t get time to review.

- After Completing the test , ask them for the completion confirmation letter.

- Expect results by 2nd-3rd wednesday after your step1 ( On FSMB at 10:30am and in mail at the same night )
9.Instagram accounts to follow
I admit that I would not have known a lot of stuff if it wasn’t from these accounts. So here …

• matcharesident
• inside_thematch
• projectimg
• usmle.derma_to_im*
• chandran_ish*
• thegirlnextdoor
• advt7
• doctor.sebas
• malkeasaad*
• doctor.deva*
• Medschoolboiz
• drapurva_popat
• _manikmadaan_*

*These creators are also on YouTube channel and provide very helpful content

Feel free to pass it on to anyone in need.

And this compilation is purely based on my perspective and approach, and hence don’t forget to personalise
your journey the way you feel comfortable. Also don’t forget to take ample breaks and weekends off since
they will recharge you for the long journey.

ALL THE BEST.

- Masum Patel
BJMC 19