USMLE (Step 1 and 2) Registration

Most students will take anywhere from 6-8 weeks of dedicated study time for Step 1, with some starting to study as early as December just to get ahead on some of the broader resources. Should students decide to do any studying prior to their dedicated study period, it’s usually recommended that they focus on resources like Sketchy and/or any other resources that they have considered incorporating but never used.

UWorld has long been the gold standard of question bank resources for quite some time. The quality of the questions, the depth of the explanations and the breadth of content all combine to truly calibrate you for test day. Of the many things you will do during your dedicated study period, UWorld is by far the resource we most strongly recommend you have completed, in full, before test day.

UWorld typically has at least approximately 3,300 or more questions and the platform will occasionally add new questions throughout the year so it’s important to be thoughtful about how you plan to complete the qbank. On average, if students can manage to complete 80 UWorld questions per day, six days each week, they’ll finish a first pass of the entire qbank in just under seven weeks.  However, keep in mind, you can also create 4-7 block “practice tests” by stacking randomized block of UWorld questions and doing them consecutively to simulate the test day experience. Ultimately, this only gets you through the qbank quicker and also offers you an opportunity to save those practice tests for when they would matter the most.

While some students begin their dedicated study period with a goal of reading First Aid from cover to cover, that is rarely the most efficient and/or necessary way to use it as a resource. 

One can reasonably characterize First Aid as the book Step 1 pulls from in terms of content, so everything in First Aid can certainly be considered “fair game” on Step 1. However, it’s incredibly unlikely that students exhaustively need to review and relearn everything in First Aid with the same intensity. With that in mind, it is often recommended to let incorrect questions from UWorld guide you towards the content you need to spend some focused time with in First Aid so that you can prioritize specific concepts and other information in the book that calls for a “deep dive” into the material. 

BCM provides students with a Pathoma subscription during the pre-clinical phase of the curriculum. This resource is typically a foundational component of review for organ systems and general pathology. 

While Sketchy Medical offers a wide variety of tools and resources to help reinforce pre-clinical content in biochem, pathology, pharmacology and microbiology, BCM students frequently cite Sketchy Micro and Sketchy Pharm as the most useful tools in the suite. With videos and Anki to go along with them, Sketchy offers a very user friendly and practical platform for covering the breadth of pharm and Infectious Disease/microbiology in a quick and easy way that has review built in through Anki from day one of your dedicated study period.

Boards and Beyond offers almost 450 videos across 20 different subject areas to provide a comprehensive overview of the Step 1 content, and even offers practice questions, quizzes after each video and an array of other notes pages, PowerPoint slides and other supplemental resources that can help support you during dedicated. 

Given that resource overload is certainly a factor for some, it is often recommended to take a targeted approach to Boards and Beyond and/or other comprehensive resources like it, so as to maximize your study time and be as efficient as possible. With that in mind, the biochem content in Boards and Beyond tends to be the major draw for most students, given the complexity of the topic and the way it’s tested on Step 1. Few students use this resource exhaustively, but the biochem content is often rated highly even amongst those that don’t typically use the resource at all.

There are a few different ways that Anki is usually incorporated into Step 1 studying:

Pre-Made decks

Zanki and Anking are two pre-made decks that have been curated over recent years to capture the best and most high yield Step 1 content from almost any and all resources that students find useful, including Pathoma, First Aid, Sketchy, etc. Both decks are very large and extremely comprehensive, sometimes emphasizing information that isn’t always high-yield or testable.

Making your own cards (content)

For some students, taking traditional handwritten or typed notes is cumbersome and disengaging. With that in mind, it’s not uncommon that students will do their “note taking” by taking the material they find in resources like First Aid, Boards and Beyond, etc and creating their own cards to capture the content in whatever way makes the most sense for them.

Making your own cards (missed questions)

Knowing that UWorld offers a wealth of information in the explanation of answer choices and through outlining the educational objectives of different question types, it should be no surprise that a lot of that content can be ideal for Anki. In this approach it’s important to do your best to pinpoint specific and succinct knowledge gaps so that you can make cards that aren’t so dense that they’re not helpful. It’s important to note that if not appropriately focused, this approach can be incredibly time intensive and can sometimes not be the most productive way to use your time, so be thoughtful in how you incorporate this into your overall study strategy.

Generally there are three types of practice tests that are usually incorporated into your Step 1 Study plans:

UWorld Self Assessments

There are two UWorld Self Assessments available, one of which you will receive along with your UWorld subscription, and another that is available for purchase on your own. The stems on these assessments are sometimes a bit more dense than what you’ll find in other practice tests but, in that, give you a good feel for what the test will actually feel like. It is often recommended that students use one of the assessments as a diagnostic towards the beginning of their study period and the other towards the end of their study period to track their progress.

NBME Practice Exams

NBME has their own independent library of practice exams that is updated roughly every two years or so to keep current with the way certain topics are tested and the incorporation of new topics or content on the Step exams in a given year. The stems on NBME practice exams can sometimes be a bit easier to follow and sometimes test very specific knowledge as opposed to the broader nature of the questions you’ll find in the UWorld self-assessments. There isn’t much of a plus/minus in terms of the NBME practice exams vs the UWorld self-assessments, however it’s usually suggested that the NBME exams serve as intermediate checkpoints between the UWorld self-assessments taken at the beginning and towards the end of your study period. These practice tests are only available by purchase so be mindful when deciding which ones are the most critical to your success.

Free 120

All students nationwide also have access to a “Free 120” practice test that is available through the USMLE. Students have free access to an additional 120 practice question in addition to the practice tests mentioned above. Given that one of the strongest predictors of success for Step 1 is the use of unique practice questions, so whether using these questions as just additional questions or as an additional practice test, covering this content usually bodes well for students that choose to use them.

Students typically dedicate about four weeks for Step 2 Studying, with some deciding to start light study as far as eight weeks out. Many will have a rotation or Sub-I leading into their dedicated Step 2 period and so that early study typically gets concentrated into the weekends and rarely involved more than 60-80 practice questions and 2-3 hours of focused content review.

Much like UWorld for Step 1, UWorld for Step 2 also holds the spot as the gold standard for question banks to prepare for the exam. It is also likely the highest yield study tool that you can be using during your study period.

UWorld for Step 2 typically can have over 3800 questions at any given time, and the platform will occasionally add new questions throughout the year so it’s even more important to be thoughtful about how you plan to complete the qbank. It’s common that many students go beyond the 80 questions per day pace from Step 1 in order to complete more questions given the usually shorter time frame of the dedicated study period for Step 2. However, keep in mind, you can still create 4-7 block “practice tests” by stacking randomized block of UWorld questions and doing them consecutively to simulate the test day experience. Ultimately, this not only gets you through the qbank quicker but also offers you an opportunity to save those practice tests for when they would matter the most.

Many students will have used the free Online MedEd videos at some point or another during clerkships. These relatively quick and straightforward videos are good for passive learning of some of the more foundational/fundamental information across the Step 2 content areas and offer a solid resource for building or re-establishing understanding in areas that you may not be testing well on.

These two textbooks are both resources that students have historically found to be useful as they prepare for Step 2. Step 2 Secrets tends to be the more practical of the two resources with very pointed information on tried and true strategies for working through the full breadth of questions one can expect to see on Step 2. It’s also a relatively light read compared to some of the other medical texts and can often be completed over a weekend without being too time intensive. Master the Boards, on the other hand, is a bit denser but is a reliable resource to supplement the content you’ll encounter on UWorld. Students rarely read this book from cover to cover, however, if there are any well-defined weak areas that students notice early in their study period, Master the Boards can be a great way to address any large knowledge gaps in a quick and efficient way.

Over the years upperclassmen have done a good job of keeping up with specific supplemental textbook resources for each rotation (BRS for Peds, Pastana’s/Divergillio’s for Surgery, Step Up 2 Medicine for Medicine, etc.). Students don’t often spend much time going back to these resources in full during their preparation for Step 2, however it is good to remember that they are at your disposal should you come across any information that requires a “deep dive” as you study.

Much like for Step 1, Zanki and Anking both have exhaustive pre-made decks that can go a long way in streamlining the way students review content, however, it’s still important to be mindful of how you incorporate this into a broader study strategy since the sheer volume of either deck can easily consume your days. With that, it’s usually a good idea to either do targeted sub-decks within either deck to address specific areas, or download the decks in full and use the tags to search for the specific cards that you think would be helpful.

Just as there are for Step 1, there are three types of practice tests that are usually incorporated into your Step 1 Study plans:

UWorld Self Assessments

There are still the two UWorld Self Assessments available. It is still recommended that students use one of the assessments as a diagnostic towards the beginning of their study period and the other towards the end of their study period to track their progress.

NBME Practice Exams

NBME practice exams are available for Step 2 as well but aren’t used as frequently for Step 2 as they may have been for some students as they prepare for Step 1. Again, there isn’t much of a plus/minus in terms of the NBME practice exams vs the UWorld self-assessments, however it may be useful to use at least one between the UWorld self-assessments taken at the beginning and towards the end of your study period just to have a checkpoint between the two. 

Free 120

All students nationwide also have access to a “Free 120” practice test that is available through the USMLE. Students have free access to an additional 120 practice question in addition to the practice tests mentioned above. Given that one of the strongest predictors of success for Step 1 is the use of unique practice questions, so whether using these questions as just additional questions or as an additional practice test, covering this content usually bodes well for students that choose to use them.