Studying for the USMLE: Tips and Tricks

Studying for the US Medical Licensing Exam or USMLE can feel like a grave task. The USMLE is divided into 3 parts, Step 1, Step 2 Clinical Knowledge (CK), and Step 3. In previous years, Step 2 was a 2-part exam that included the Clinical Knowledge portion and a Clinical Skills in-person bedside exam. Due to COVID, the Clinical Skills portion is permanently removed! Hooray!

Another major change in recent years is the elimination of a “score” for Step 1. Previously, we received a 3-digit score based on our performance on the exam. Now, the exam results indicate either a “pass” or a “fail.” This seemingly reduces stress for medical students who may want to apply to competitive residency since higher scores well above 250 may have been a requirement in prior years. For medical students who are foreign medical graduates, this may present as a downfall since many foreign medical graduates, like me, rely on our USMLE scores to set us apart from the crowd.

For any foreign medical graduates visiting this page, don’t worry! Step 2 CK will continue to produce a 3-digit score and will likely carry a lot of weight when residency applications are reviewed. Therefore scoring high on your USMLE still matters and having a calculated approach to studying is crucial. Outlined below is a step-by-step study plan which helped me obtain 240+ on my USMLE exams. While now studying for my Internal Medicine Board Exam, I will use much of the same approach.

1. Consolidate Your Resources

I recommend picking only a handful of resources, especially since nowadays there are more resources than you can count! I recommend picking one to two textbook and one question bank as the core study resources for your USMLE’s.

Resources I Used for Each Step:

1. Step 1: First Aid for Step 1, Pathoma, Doctors in Training, Uworld Question Bank, Goljan Audio

2. Step 2: First Aid for Step 2 CK, Uworld Question Bank

3. Step 3: First Aid for Step 3, Crush Step 3 CC, Uworld Question Bank and CCS Prep

First Aid of the USMLE Step 1 is the holy grail study text material for this exam, but you probably already knew that! I recommend reading this book once, again, and then again and again and again. After that, read it one more time! To be quite honest, I read First Aid of the USMLE Step 1 about 15 times. The reason is to attempt to memorize or place into memory as many words, headings, charts, tables, and pictures as possible.

Although the USMLE mostly tests medical reasoning, having most of the high yield information nearly memorized will prevent you from wasting time thinking about the facts during the exam. You want to have as many facts in your back pocket ready to whip out since USMLE questions can require multiple steps to answer. Let’s take a look at a USMLE question posted on the USMLE official website to show this point:

Example Item
A 32-year-old woman with type 1 diabetes mellitus has had a progressive renal failure during the past 2 years.
She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL,
hematocrit is 28%, and mean corpuscular volume is 94 μm3. A blood smear shows normochromic, normocytic
cells. Which of the following is the most likely cause?
(A) Acute blood loss
(B) Chronic lymphocytic leukemia
(C) Erythrocyte enzyme deficiency
(D) Erythropoietin deficiency
(E) Immunohemolysis
(F) Microangiopathic hemolysis
(G) Polycythemia vera
(H) Sickle cell disease
(I) Sideroblastic anemia
(J) β-Thalassemia trait
(Answer: D) Source: https://www.usmle.org/pdfs/step-1/samples_step1.pdf

In order to answer the above question, you would have to know that the patient has a low HCT and normal MCV. This means that the patient has normocytic anemia, of which one of the causes of anemia or chronic disease/anemia of renal disease. You would also have to recognize the mechanism of anemia in this case is poor erythropoietin production since erythropoietin is created in the kidneys. Therefore the patient’s renal dysfunction is leading to poor erythropoietin production causing a normocytic anemia. Most of this question is fact base and having memorized the facts, answering the question would then be a breeze.

For Step 2 CK and Step 3, I had friends who used Master the Boards (MTB) as their text resource. I used (MTB) on and off and believe it’s also a great resource. The difference between FA and MTB is that FA has a lot of facts condensed together so that everything is visualized on the same page or over a few pages. MTB has its material spread out over multiple pages who lessen the burden on the eyes. I preferred the ability to see everything at one glance and also enjoyed the FA tables. Therefore, I chose to stick with First Aid. In addition to First Aid for Step 3, I used Crush Step 3 CCS which was God-sent! I highly recommend reading through the cases in this book at least twice before the exam in addition to practicing the CCS cases on Uworld.

When it comes to question banks, Uworld is the best of the best. The interface is very similar to that of the actual USMLE exam’s interface, therefore allowing you to familiarize yourself with the layouts and question formats. I personally have not tried any other question banks for the Steps and honestly, I have not heard of any good competitors. Uworld all the way!

2. Make A Schedule

Creating a schedule is as important as studying. My daily schedules are listed below but pick whatever works for you!

Daily Schedule 4 months before Step 1:

• 5:30am-7:30am: Round 1: 40 Uworld question sets/review. Annotate into First Aid
• 7:30am-10:30am: 5 DIT daily videos
• 10:30am-12:30pm: Round 1: 40 Uworld question sets/review. Annotate into First Aid
• 12:30pm: Lunch
• 1pm-2pm: Brisk walk on the Treadmill while listening to Goljan Audio
• 2pm-4pm: Pathoma. Annotate into First Aid
• 4-6pm: 4 DIT daily videos
• 6-8pm: Read through First Aid to familiarize myself

Daily Schedule 2 Months Before Step 1:

• 5:30am-7:30am: Round 2: 40 Uworld question sets/review
• 7:30am-10:30am: Study First Aid cover to cover
• 10:30am-12:30pm: Round 2: 40 Uworld question sets/review
• 12:30pm: Lunch
• 1pm-2pm: Brisk walk on the Treadmill while listening to Goljan Audio
• 2pm-4pm: Pathoma
• 4-6pm: Study First Aid cover to cover
• 6-8pm: Review anything I was struggling with

For Step 2 CK and Step 3, I did not think cover-to-cover memorization of First Aid was as necessary since understanding the general concepts was given more priority. 1 Month before my Steps, I began taking one NBME per week. 2 weeks before my exams, I would take 2 NBMEs per week. Once I started consistently scoring 240s, I knew it was time to take the USMLE!