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USMLE Step 1 Prep: The Truth & Myths of Getting Started

Lauryn Falcone, MD, PhD and Shelby Wood contributed to this post.

From the day most students start medical school, they learn about the USMLE Step 1 exam. As the months go on, talk of the exam becomes an almost daily occurrence. It’s not surprising, then, that many students feel they need to devote as much time and energy to preparing for this exam as possible.

For some, this manifests as weekly USMLE practice questions and frequent skimming of review books as early as first year. Others may spend their entire first summer preparing for Step 1. Some students sacrifice Thanksgiving, Christmas, and spring breaks to prepare. On the contrary, other students do little prep before their dedicated Step 1 study period.

So, the question remains: what do you need to know about getting a head start on USMLE Step 1 exam prep?

The following offers some myths and truths to guide you through the process.


NBME vs UWSA: When & How to Use Practice Tests for USMLE Step 1

One of the most common questions I get as a USMLE tutor is:

"What is the difference between the NBME Comprehensive Basic Science Self Assessments (often referred to as just NBMEs) and the UWorld Self Assessments (UWSAs)?"

For starters, the NBME and UWSA are both practice tests that students take to help them prepare for the USMLE Step 1 exam, to gauge their study progress, and to predict their final score.

There are six NBMEs that are available for purchase for $60 each (and in 2020 an additional five that are available for free). There are two UWSAs that are included in your UWorld subscription if you buy at least a 180 day subscription.

NBMEs consist of four sections of 50 questions while the UWSAs contain four sections of 40 questions. The actual USMLE Step 1 exam is made up of 7 blocks of a maximum of 40 questions per block. 

Now, That's What I Call High-Yield: Biochemistry

How would you describe studying for Step 1? Is it internalizing data? Or would you call it pattern recognition? Is it retaining facts, or applying knowledge? Likely all the above. But at some level, studying for Step 1, or any exam for that matter, is about triaging information. In your 800 pages of First Aid and 2000+ UWorld questions (leaving aside hundreds of flash cards and possible second question bank), your task is to learn as much as possible. Hanging onto the entirety of this information is an impossibility; at some point you need to be happy enough with having an “acceptable” handle on the material. While aiming for “good enough” might feel like selling yourself short, many students will express the feeling of having “hit capacity,” and find it difficult to put more info into a fact-laden noggin.

Jumpstart Your USMLE Prep from Day One
Malina Filkins by Malina Filkins on Aug 11, 2020 in USMLE Step 1

As a new medical student trying to figure out how to succeed in their coursework many students will eventually face the same question: When and how do I start preparing for Step 1?

How to Make & Use a UWorld Journal — Plus Free Journal Templates

When I finished the USMLE Step 1 exam, I was almost too eager to finally throw away two years worth of medical school notes, old textbooks, and study guides. It was a cathartic release and a final closure on two years of hard work. But still sitting on my shelf, nearly three years later, is my UWorld/Step 1 journal.

I think I kept it all these years as a reminder to myself about how important it was. I still sometimes pick it up and show it to students during a tutoring session to prove to them that I really did keep a journal and that they should too. Making and using a UWorld Step 1 Journal can be a golden ticket to a high Step 1 score. Read on for how to get started!

USMLE Score Reporting: What to Expect

The only thing more nerve-wracking than studying and sitting for the USMLE exams is waiting for your score report to be released. Many of you may be wondering: what happens after I leave the Prometric center and how long will it take for me to receive my score? 

M2 vs. M3: You're Taking USMLE Step 1 When?
Brian Radvansky by Brian Radvansky on Jun 21, 2020 in USMLE, USMLE Step 1
If you've learned anything up to this point in medicine, it's likely that the field has strong foundations in dogma and tradition. Routinely, medical school consisted of two years of basic science classroom work followed by two years of clinical clerkships, with these two phases being separated by our timeless friend (or greatest nemesis), the USMLE Step 1 exam.

In recent years, however — and amid the COVID era — many schools have positioned Step 1 at the end of third year, just after completion of clerkships. The impact this has almost certainly depends on each individual student. What we can tell you, however, is how to use your third-year clerkship experience to your advantage if you happen to be in one of these programs.

The Numbers Game: What Scoring a 260 on USMLE Step 1 Really Means
*Blog post updated June 17, 2020 to reflect most recent USMLE data below.*

I have been putting off the writing of this post for a while. I’m not sure why. I guess I wasn’t sure how to say anything genuine that would convince you guys that you shouldn’t be hard on yourself for falling short of the lofty goals that you set for yourself before beginning the arduous process of studying for the USMLE Step 1.

Perhaps it’s because I was in your shoes once, and no amount of reason could penetrate my longing for that perfect score, the one that I believed would either complete my application to dermatology residency (and therefore complete me), or dash my chances at my dream job against the harsh rocky shores of reality.
USMLE Step 1: Pass/Fail & What It Means for Med Students
Med School Tutors by Med School Tutors on Apr 9, 2020 in USMLE Step 1

Dr. Brian Radvansky contributed to this post. 

Though the USMLE Step 1 passing score is currently 194, after years of debate, the Invitational Conference on USMLE Scoring (InCUS) announced their long-awaited decision to transition the USMLE Step 1 to only a pass/fail outcome.

In the weeks and months to follow as everyone awaits further information from InCUS, there will be much speculation. For now, here are the answers to the questions we've gotten so far from the update:

When Your USMLE Step 1 NBME Scores Say No, But Your Calendar Says Yes
Med School Tutors by Med School Tutors on Mar 12, 2020 in USMLE, USMLE Step 1, nbme

Lauryn Falcone and Dr. Eli Freiman contributed to this post. 

For most students, the anticipation leading up to their first NBME practice test is the same. Most wonder: Am I truly prepared? What happens if my score prediction is much lower than my goal Step 1 score?

Frequently, the answers to these questions may initially feel negative (it’s common for students to receive an early NBME score or two that’s below their ideal score). Many students see this as an opportunity for improvement, but what happens if the NBME scores don’t continue to rise? What happens if you truly aren’t scoring where you want on NBMEs before your step 1 test day?

Don’t worry. Everyone experiences score plateaus on practice tests, and there are numerous reasons for this. There is no way for an exam to adequately test you on your specific growing body of knowledge, so there will be huge amounts of variability from exam to exam.

You could be at a 250 level but get a 235 – that’s how much variability you could have by nature of being tested on a finite, specific body of knowledge. You could also have a bad testing day, or just have not been up to taking a practice NBME when you just want to get the real one over with.

Often, we underperform on exam practices because they aren’t as important as the real test. Most students will interpret stagnation on NBMEs as a sign that they haven’t been studying the right information or that they are inefficiently studying – this is usually not the case. You’ve still been learning! 

That said, we have some tips to help you break through score plateaus for your NBME practice exams. Read on for more on how to break through NBME practice test score stagnation!

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