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My USMLE Step 1 Experience

Updated: 4 days ago

Preparing for the USMLE Step 1 is a high-cost, high-effort process, but one that I approached with no regrets. I took Step 1 in my final year of medical school, as it felt like the best and only time I could commit to it. The journey was as rewarding as it was challenging. Here’s a glimpse into my real study timeline and how I managed competing priorities along the way.

Why I took Step 1 in final year

I wanted Step 1 knowledge just before I started my elective because I wanted to be 'on par' with other US medical students on rotation and be able to demonstrate a commitment to matching to the specialty I want in the US. I also wanted to get Step 1 done and dusted within a 6-month time frame of the next Step 2 exam - to ensure some of the knowledge is still FRESH!

Other reasons included my finances and my time. I felt that I had less time to study for Step 1 in my previous years of medical school as I was doing clinical experiences during summers, research, and focusing on this platform.

After finishing my final medical school exams, I felt competent clinically but realised I needed to revisit foundational sciences. It didn’t take me as long as I expected to assimilate knowledge during my dedicated period (Feb - March) because I had a good grasp of most conditions, I mainly needed a refresher of pathophysiology and core concepts within Immunology and Biochemistry.

My study timeline

I originally booked my exam in July 2023 for late December 2023. USMLE-Rx was the first question bank I was using for 'light' studying when I had time after placements and in between assignments. They had a deal for 50% off their Step 1 and 2 question banks so I bought that package (however, I do not think it's a useful question bank for the real exam as it is a little bit too easy).

My medical school final exams were all in January and I had many assignments due in the autumn. I did not feel confident I would pass the exam if I took it in December 2023. Therefore, I pushed it back 3 months (the max you can do) to March 2024 for an extra fee (~£80). You can only do this once so March was set in stone - and it was now or never. In hindsight, book an exam date once you've started studying and can gage how much time you have to dedicate to JUST studying.

After my final exams were done, I started my dedicated period of study from mid January to March so just under 3 months.

My study materials

I used this free notion template for organising my step 1 prep and plotting my practice test scores. I bought a 3 month UWorld subscription which came with 1 past paper exam (4 hrs long). I ended up completing 80% of the q bank (most left-over questions were in biostats, ethics and psychiatry as those were my strongest subjects).

I took an Amboss free self-assessment in early February and went through all of Mehlman Medical's pdfs on different subjects and did the FREE LEARNING MODULES on Biochem, Microbiology and Pharmacology too.

I started Anki in February and would try to review at least 150 cards a day. These are the Anki decks I used (Google Drive Link).

Youtubers (used in final 2 weeks):

Paid resources

  • Can be found free here.

  • I used First Aid and Pathoma (ebooks) as places to reference and read up more about questions I'd got wrong in Uworld. Pathoma chapters 1-4 were a MUST-READ for key pathophysiological and immunologic concepts.

Practice exams

I did weekly offline NBME practice exams 25 - 31 during my dedicated period (can be found on same website as above) and the official Free 120 a couple of days before my exam date. I tracked my % correct scores and used the mark schemes to see the % chance of passing (see below for a screenshot from my Notion dashboard):

Pro tip: DO NOT compare yourself to any scores you see on Reddit. My scores were not amazing AT ALL but my Free 120 made me more confident in my abilities coming up to test day and I went into the exam determined to pass, calm and collected. The real thing was most similar to Free 120 and is what the real platform looks like. It is 120 questions = 3 hrs.

With your exam scores, just make sure you are seeing an overall upward trend in your % correct and make sure you know why you got answers wrong / where you need more work.

Balancing competing priorities

Despite the intense study schedule, I continued with my usual commitments:

  • Placement: I attended as much of my clinical placement as was necessary, which kept my practical skills sharp but also provided a break from constant studying. I would complete a 40q block of UWorld every day after placement (which would allow me to get through approx. 200 q's a week).

  • Research: I kept up with my research work (although I was not leading any projects at the time), which was another key priority.

  • Social life: This suffered the most but I made a conscious effort to celebrate my birthday, spend time with friends and family, and even go on a holiday in late February. Although I was close to cancelling many plans, the support and encouragement from my loved ones helped me find balance. They respected my dedication but also reminded me to take necessary breaks.

  • PSA: We had the prescribing safety exam in final year which I did not prioritise studying for. I attended a few evening sessions by a fellow F1 so I knew what to expect but the Prepare for the PSA course was good enough.

Overall, while I did sacrifice much of my social life and minimised time on social media, these sacrifices were essential for my success. It was a juggling act, constantly maneuvering my daily schedule to fit in study sessions, clinical duties, and personal time. Every time I thought I had the hang of it, another requirement or exam would pop up, but persistence paid off!

Exam day

Make sure to get to the venue you've booked at least 30 mins before the exam start time.

You put your bag in a locker and are allowed a clear water bottle into the exam room (a room with cubicles of computers to take the exam). Go to the toilet before going in, make sure you have snacks and plan out your breaks accordingly.

The total exam time is 8 hrs, 7 hours (7 blocks) of 40 questions (280 questions total) + 1 hr break time. The computer counts this down for you automatically even when you are away from your screen.

I did 2 (1hr) blocks of 40 questions and had a 15-20 mins break after each, sometimes even after 1 block towards the end of the day when I started to get tired, which took me up to the full hour. DO NOT go over your break time as it will eat into your question block time and you do not get that time back. This means you have less time to answer the same amount of questions

Every time you leave the exam room you will be patted down/searched and walk through a metal detector (factor this into your break times). On your breaks, you can use study materials like textbooks, use your phone and even head to the shops for lunch! I stayed on the premises and used breaks to snack and go toilet.

The results

Looking back, the sacrifices were worth it:

  • Passed my USMLE Step 1

  • Successfully interviewed at my top choice doctor job in London

  • Passed my finals

  • Passed the Prescribing Safety Assessment (PSA)

  • Got LORs and Honors grade on my elective rotations

A note on study materials and costs

I provided the specific study materials I used earlier on in this post, but there is an abundance of information available online. The best approach is to find resources that work for you personally.

For reference, the total cost of my USMLE Step 1 journey came to approximately £1,520.

This included:

  • £957.10 = book Step 1

  • £80 = extension period

  • £138.52 = USMLE Rx (50% off subscription) 1 year Step 1 and Step 2 CK questions

  • £344.72 = UWorld Step 1 (3 month subscription)

Total: £1520.34

Final thoughts

Preparing for the USMLE Step 1 while juggling multiple priorities is challenging, but it’s definitely doable with the right mindset and support system. My experience taught me the importance of balance, persistence, and the invaluable role of a supportive network. If you’re embarking on this journey, remember to stay focused, but also allow yourself the time to breathe and enjoy life’s moments.

Good luck to all future test-takers! You’ve got this.

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