USMLE Step 1 Guide

What is USMLE step 1?

The USMLE Step 1 computer-based test (CBT) is a 1-day test, taken on a computer, that’s administered once a day (except Sunday) on a year-round basis at hundreds of testing centers around the world. The test consists of a total of 350 multiple-choice, single-best-answer questions that are broken down into seven 1-hour blocks, with 50 questions per block. Examinees are given short breaks between blocks, as well as a lunch break.


Step 1 includes test items in the following content areas:

* anatomy,

* behavioral sciences,

* biochemistry,

* microbiology,

* pathology,

* pharmacology,

* physiology,

* interdisciplinary topics, such as nutrition, genetics, and aging.

Step 1 is a broadly based, integrated examination. Test items commonly require you to perform one or more of the following tasks:

* interpret graphic and tabular material,

* identify gross and microscopic pathologic and normal specimens,

* apply basic science knowledge to clinical problems.

Subjects which you can cover in 1st and 2nd year of your medical school along with your course books




Books you need to buy for step 1 for these subjects

There are a number of helpful resources for USMLE preparation. In terms of textbooks, one textbook that gives an excellent overview of the exam, including a database of high-yield facts and a detailed list of useful resources, is our First Aid for the USMLE Step 1.

It is very easy to go out and buy way too many books. Start off small with First Aid as your core text

Then buy a textbook and a review book for each course

Best review book for Gross anatomy is Kaplan Lecture notes

2nd best is High yield gross anatomy buy only one of these two.

Best review book for Biochemistry is Kaplan lecture notes

Best review book for physiology is BRS Physiology

2nd best is Kaplan lecture notes

Bottom line buy total of 4 books

1. First Aid Latest Edition

2. Either Kaplan lecture notes or High yield gross anatomy for Gross anatomy

3. Either BRS or Kaplan Lecture Notes for Physiology

4. Kaplan Lecture notes for Biochemistry

Subjects which you can cover in 2nd, 3rd and 4th year of medical school along with your course books

1. Behavioral sciences

2. Microbiology

3. Pathology

4. Pharmacology

5. Immunology

6. Biostatistics and epidemiology

7. Medical ethics

8. Genetics

Books you need to buy for step 1 for these subjects

1. For Behavioral science: Kaplan lectures notes are best…BRS is 2nd Best

2. For Microbiology Clinical Microbiology Made ridiculously simple is best…Kaplan is 2nd best

3. For Pathology Rapid review pathology; Goljan is single best book along with pathoma video lectures

4. For Pharmacology Kaplan Lectures notes are Best

5. For Immunology Kaplan lecture notes are best. High yield immunology 2nd best

6. For Biostatistics Kaplan lecture notes or High yield biostatistics both are best choose one between them

7. For Medical Ethics Master the Boards USMLE Medical Ethics: The Only USMLE Ethics High-Yield Review is best

8. For Genetics Kaplan lecture notes are best

Note) You will notice that many USMLE review books combine together the topics of Behavioral Sciences, Medical Ethics, Biostatistics and Epidemiology in one review book, usually labeled behavioral science.

How to Use These Books Along with your course books

1st of all have a command on your course books do a topic or a chapter from your course book when you think that you master the topic from your course book then give two or three reads to that topic from review book and then give a single read to that topic from first aid, after doing this make a connection between your course books and review books in form of notes of your own, integrate the knowledge You’ll just need an extra hour to go through review books and course books, and half hour to make notes.

You may feel that the first year of medical school is difficult enough without considering how you might be preparing for Step 1 of the USMLE. However, as anyone who has scored well on the exam can tell you, the foundation for their success began long before their dedicated study period.

Don’t view studying for Step 1 as separate from studying for your classes. There is a lot of overlap between class material and USMLE material than most people are willing to admit. The key is to recognize that most schools are testing you on rote memorization, and facts, while Step 1 will be testing you on the integration and application of information.

Use First Aid as a means of knowing what you should be learning along with their classes, like a target. Oftentimes, professors may not highlight the things that are most relevant for Step 1, and it is up to you to figure out which of the things are most Step 1 relevant. The best way to do this is to quickly scan through First Aid either right before or during the lecture, to make sure that you are getting the major points that are covered for Step 1. Then make sure that by the end of the day, that you have covered all of the major information in whatever relevant sections of First Aid there were.

Remember most of the people will discourage you to use First Aid book in 1st year but you stick to your plan and don’t listen to others because if you get familiar with First Aid now it’ll be very easy for you in latter years.

Don’t forget to make your own flash cards and notes, make your own notes and share it with others on the group.

What type of questions can be asked from Gross anatomy in step 1

Many medical students that we have talked to underestimate the amount of clinical material on the USMLE Step 1 examination. For example, a significant portion of the anatomy that is tested on the USMLE exam is based on one’s ability to recognize anatomical structures on common radiographic images, such as x-rays, CT, and MRI scans. The only way to prepare, would be to read review book during your course first year and find websites that have extensive amounts of abdominal coronal/axial CT scans showing both the normal and pathological. Go to a website and look up some basic CT, MRI and X-rays.

What type of questions can be asked from Biochemistry?

Biochemistry is a highly tested, yet often neglected basic science topic that is guaranteed to appear on the USMLE Step 1. Although preparing for biochemistry may be a daunting task because of the volume of information involved in thorough understanding, know that Step 1 does not require rote memorization of every intermediate and enzyme involved in each pathway. it is important to note that it is unnecessary to memorize all of them! In fact, it would be very inefficient to memorize each biosynthetic pathway in preparation for the USMLE. Instead, focus on the following: 1. Rate limiting steps: It is highly recommended that examinees be familiar with the rate limiting steps in each pathway (ex: phosphofructokinase in glycolysis, carbamoyl phosphate synthetase in the urea cycle etc). Along these same lines, sites of regulation and regulatory molecules are high-yield topics as well.

2.Cofactors required for specific enzymes: Cofactor and vitamin deficiencies are often encountered in disease states. As an example, recall that B12 and folate are required for erythropoiesis, and that deficiencies of these molecules result in differential physical exam and lab findings.

3.Enzymes implicated in disease: This is perhaps one of the easiest aspects of biochemistry. Inborn errors of metabolism are one of the few subjects that may be tested in “one-step” questions. Knowing the single gene mutation that causes an enzyme deficiency leading to SCID, or von Gierke’s, or acute intermittent porphyria can score quick points on Step 1.

Remember to focus your preparation on the finite number of topics tested on the USMLE

What kind of questions can be asked from physiology

Physiology is one of the most important subjects for USMLE Step 1. Without physiology you wouldn’t understand the pathology properly. Now, physiology is all about concepts, which means there is less memorization. And the board loves conceptual questions so make sure you know your physiology really well. all you need to do is make your basic concepts strong about every topic in physiology because there is less memorization and cramming in this subject.

What type of questions can be asked from Behavioral Science complex (statistics, doctor patient relationship, medicolegal and ethical issues).

All IMGs score very low in behavioral sciences and medicolegal and ethics issues. This is because they are not exposed yet to the US health care system and are unaware of the social issues that impact the communities in USA.

You’re going to have 2-3 types of questions on behav: psych, ethics, and stats (if you choose to count that as part of behav). Psych- it can be learned relatively effortlessly. Biostatistics and Epidemiology is one of the notorious topics. The key to excel in this field is by reading a good short concise book and then keep practicing questions as much as you can. Stats- it can be learned but on the day of the test it can prove quite time-consuming. A stats q involving calculations or that is poorly worded can easily cost you the point even if you get it right eventually- it’s going to eat up into another question’s time. What really will help you is Dr. Dougherty’s videos for Step 1 (of Kaplan). He explains this as easily as possible. You’ll need to dedicate some time to them, but they are worth it. Your best bet is to continue practice questions as much as you can.

Remember that this topic will be repeated in Step 1, Step 2 CK, and Step 3 exams, so investing a good time in it will really pay off.

What type of questions can be asked from Microbiology

Microbiology is one of the most important topics for Step 1 and I will be honest the board loves Microbiology. And it is one of the easiest topics to get easy points. You will get 7 to 8 questions per block on your exam. First Aid Microbiology section is extremely high yield and is all you need for Step 1. Every single questions will be from that section. You don’t have to be a Microbiology major or take any microbiology courses to ace this section. So what do you need to do? Well, don’t just read that section like a newspaper. Memorize those pages!!! Make sure you remember every single pages from the First Aid Microbiology section just like you remember your name! The easiest way to memorize them is by making your concepts stronger from review and course books.

Now, when it comes to the viruses you might find them difficult to remember. But, don’t worry you are not alone. The good news is, they will barely ask you any questions from the virus’s segment, envelope and etc. But please try your best to memorize them and know the famous viruses (e.g. EBV, CMV, HIV, Rubella and E.T.C). You must know the diseases and cancers that are associated with them.

What type of questions can be asked from Pathology

Pathology is one of the highest yield sections in the Step 1, so make sure you know it inside and out. Not only it will help you in Step 1 but it will keep coming back in the future Steps. So, what materials to use for this big guy? Here is how you should organize your pathology preparation.

* Doctor Najeeb – If you have zero knowledge in Pathology make sure you start watching Dr. Najeeb for pathology. He will draw everything on the board and make sure you understood every single point by quizzing you. One draw back to his

teaching method is that, his videos are extremely long and slow. You can always speed them up though. Now, if you have some knowledge in pathology or if you are in the middle of your preparation then do not watch all of his videos, just watch the videos that you are weak at, or you can skip to Pathoma.

Pathoma – Pathoma by Dr. Sattar is a must Make sure you buy the textbook(if Goljan is too lengthy for you) and watch all of his videos. Even if you are in the middle of the preparation make sure watch his videos. He is so damn good! Please, make sure you watch all of his videos at least once before going to the exam center.

Glojan: if you are REALLY solid on the basic sciences, ESPECIALLY Physiology, Biochemistry, and Pharm (and i suppose Micro/Immuno too), then Goljan RR is a joy to read. best way to read and study from goljan is by being SOLID in the basic sciences, then you’ll have less to memorize, and it becomes more about understanding the mechanisms, and how diseases integrate with what you already know from the basic sciences. don’t get me wrong, there is memorizatoin too. but the key (in my opinion) is to integrate as much as possible, so that you can minimize on the memorization aspect. Step 1 massively checks basic concepts and that huge chunk of questions if done right can land you easily 240+ … that is why people who have done even Kaplan patholgy properly are able to score in 250s … so what ever material you choose DON’T SCREW YOUR BASIC CONCEPTS at the expense of some new/obscure fact.

What type of questions can be asked from Pharmacology

Pharmacology is one of the easiest subjects for the Step 1. I mean its easy to get the questions right, they usually make them straight forward. Now, you have to study the right material and memorize the drugs to get almost all of the pharmacology questions right on the exam. You are going to get 3 to 4 questions per block on pharmacology. Trust me they don’t ask anything crazy. Everything they ask on Pharmacology is in First Aid. To get the maximum point on pharmacology you need 2 sources Kaplan, First Aid and USMLE World.Use Kaplan Pharm + First Aid. 95% of the questions can be answered using these books. The pharmacology book of Kaplan is wonderful, specially the first two or three sections, you have to read them very carefully and understand the concept very well. If you do these books and lectures you’ll answer most of the questions in your USMLE exam. Pay attention to side effects and mechanism of actions, uses especially the drug of choice for any disease they all come in the exam.

Few Must Know Sections:

* Autonomics

* Toxicities & Side Effects (Specific Antidotes)

* Drug Reactions

* P450

* Baclofen (Know everything about this drug)

* Anti-Psychotics

* Anti-Seizure Drugs

What type of questions can be asked from Immunology

No matter how many books you read in immunology you’ll still feel it’s the most difficult subject.Immunology is a high high high yield and difficult topic.Kaplan Microbiology and Immunology Notes plus FA are the bare minimum that you have to read for the exam.If you read any other book it would be much longer. You have to read it in details, everything the T cell development, selection, recirculation, and homing. Cellular and humoral immunity, AIDS and other immunodeficiency diseases, Hypersensitivities, CD markers, Lab techniques, …etc try to understand the

first few chapters that are the core chapters. dont waste too much time memorizing what are ALL the cytokines released by every single type of white cell. just memorize n learn what are the main functions of each white cell. then FA n kaplan will highlight the most important cytokines released by these cells n what they do. also understand the diff between chronic n acute inflammation reactions. this will help u in answering questions (ie, increased lymphocytes, or increased neutrophils, etc) which will lead u to clues about the disease, etc. tackle it slowly n calmly. Also memorize the hypersensitivity & autoimmune diseases. once u’ve done plenty of questions u will eventually remember the case presentation of the diseases. then it’ll be all ok. the beginning is always tough but it gets easier.

What type of questions can be asked from genetics

Genetics is a major thorn in most ppls’ side. IMGs usually abhor this subject an tend to do one of the two things: get anxious about it and overdo it [which is usually not a prob until it starts getting on your nerves n you begin to lose it], they fear it too much to go thru the real jist of the subject and end up doing it superficially [taking the coward’s way out]. The best deal for Genetics,is to do Kaplan with DVD plus FA. Some American students consider studying High Yield Molecular Biology. But it to contain a lot more information in excess of what’s required. Techniques should be referred from High Yield Molecular Biology as they are poorly explained in Kaplan. The first three chapters are fine. Add another chapter from Genetics chapter of the Pathology book. The last three chapters are something of a lost sheep wandering aimlessly. Techniques of genetic analysis are very commonly tested but they haven’t explained it in a satisfactory way. This problem also arises in the techniques chapter of Molecular Biology section where irrelevant details hamper acquiring a good command of the actual subject. Studying these techniques from high yield molecular biology may be time consuming, but they are well explained and may help you get questions correct. Although technique methodology is not tested, knowing the techniques give you confidence in answering the question so study them in detail. Don’t underestimate this topic!

Advice for international medical graduates

The most important advice for international medical graduates is to become familiar with taking exams on the computer. The vast majority of international medical graduates have never taken an exam on the computer, and this is a major obstacle. Factors such as eye strain and mouse dexterity can serve as a major obstacle when taking the examination. The more that one is able to become familiar with the specific test-taking environment, the better that person is able to concentrate on the test itself.

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