How to Score 270+ on the USMLE Step 1

First of all I want to say that my initial goal was 240. It seemed like the magical
number that would at least get you in the door at most specialties. The point I
want to make is this, get a score in mind that you want to achieve and work
towards it. You need goals in order to push you further. If you surpass your goals
in your studies then continue to increase your goal so that you can achieve the
highest score you possibly can. Even though 240 was my goal internally and a
score that I would be happy with, I was really pushing for 250. When it comes to
standardized exams I have learned in my experience that I fail in achieving my
goals more often than not. Maybe that is just because I set too high of goals for
myself to begin with but thats another story. The idea here is that shoot for the
moon because if you fail at least youll fall among the stars. But when I started
getting 250s on my practice exams I tried to push for a 260. Dont sell yourself
short! Believe in yourself!
My study prep really was based on a few guiding principles that I used. I also
experimented a bit with different methods but I will give below the schedule that
I would follow knowing what I know now starting in the fall. This method is really
just my own but I think it gives you the best chance to get the highest score you
possibly can.
The first principle I based my schedule on was the idea that we can only
remember about 75% of what we see/read. Since we are not in clinic yet (US
medical students) it can be hard to remember everything without actually having
experienced it. This concept led me to use multiple resources that used different
types of learning modalities. The idea is that you read something, listen or watch
something, and then also answer questions on the topic.
The next principle kind of ties into the last one in a sense because I knew I would
forget things, I decided that I was also in need of spaced repetition. I did this by
narrowing down resources as the year went along. Ill explain this a bit later but
all I really did was start with subject books focused on anatomy, biochemistry,
etc. before starting a comprehensive review source like First Aid. It made
knowing the information in first aid seem like it wasnt too much and just the
bare essentials. I added in firecracker also here but I used it in a way that I dont
think many have tried. Ill detail it out more below.
The last and probably most important principle I used was that it takes 10,000 of
something to become proficient. In this case it is 10,000 questions. They dont
necessarily all have to be unique but you want to try to go through the thinking
process of eliminating all the answers for a certain reason. For instance maybe
the first time I see a question I only know what the correct answer is but all the
other choices dont make sense. The second time I see the question I want to try
to eliminate all the others based on the information in the stem in order to lead
me to the correct answer choice. This makes the question just as valuable the

second time around.

Now on to the schedule!
If I were to do it again I would personally start my STEP prep in August. I would
spend the fall getting a broad understanding of all the topics I covered in first
year and then onto in second year including the things we are going to cover in
the upcoming spring semester. By reading all of these books you may not
remember everything in the book but you become familiar with the book to the
point that you can use it for quick reference during dedicated studying. Then if
you have to reread up on lets say the difference between conus medullaris and
cauda equina syndrome you have a general sense of where it is in the book and it
only takes a few moments to jog your memory rather than having to learn it for
the first time. At my medical school the topics we were on a block schedule so
during first year we covered anatomy, biochemistry and cell biology, physiology,
microbiology and immunology. In the fall of second year we covered
neuroanatomy and pathology principles including hematology/oncology
pathology and musculoskeletal pathology. During the spring we covered
behavioral science, cardiology pathology, pulmonary pathology, renal pathology,
gastrointestinal pathology, endocrine pathology, reproductive pathology, and
skin pathology.
Anatomy HY Anatomy I read this book during the fall semester, I dont
necessarily feel that it aided me in any questions but it was a good review of
anatomy from the previous year and I think helps in creating a solid foundation
to build on that you need in this area. As many have said before they have many
radiographic images that are helpful. I hardly ever missed any anatomy questions
when I finally got to qbanks so maybe it could be attributed to this book or just
learning it really well during the block.
Embryology HY Embryology This is really a great book! I didnt feel like I
really learned my embryology well during our anatomy block but after reading
this book I felt much more comfortable answering the questions that would come
up. I think if you feel weak in this area, I would definitely pick this up because its
a quick read and prepares you well to answer questions on the topic.
Biochemistry Lippincott Biochemistry I also read this book during the fall
semester. It was extremely useful! I know that many say it is too long and is not
worth it. I graduated with my undergraduate degree in biochemistry and I felt
this was so much better organized than RR Biochemistry. The images and
diagrams were easy to navigate and I referred to it many times during my
dedicated step study
Cell Biology HY Cell and Molecular Biology I was also a cell and molecular
biology minor so this book was something I was really familiar with. It was a good
refresher and a quick read so not too much of a commitment.

Genetics HY Genetics This was also a very quick read and had good coverage
of the topics that were covered in questions. Not a big commitment in terms of
reading but I felt worth the little amount of effort.
Physiology BRS physiology The gold standard when it comes to physiology.
You cant really go wrong with this book. I re-read it but felt it was lacking in
some areas specifically cardiac physiology and respiratory physiology. Maybe
thats just because I used big Costanza and West respiratory physiology. I went
back and added in some info that I felt was important to the book but they ended
up not being very important in the end. Just stick to this book for physiology and
youll be good to go as far as the basics.
Microbiology and Immunology Review of Medical Microbiology and
Immunology (Levinson) I actually read Medical Microbiology Made
Ridiculously Simple (MMRS) but I felt this book was much better and didnt have
all the fluff that was in MMRS. Maybe I didnt get a lot out of MMRS because I
also used picmonic (Ill talk about picmonic soon!), which has a similar kind of
learning style but much better organized. The parasite review was just so much
better in Levinson and that was a weakness I felt that I had so that could be it as
well. The immunology section was also short and to the point. I have a pretty
strong background in immunology so maybe it wouldnt be ideal for those that
feel a weakness.
Neuroanatomy HY Neuroanatomy This is another book that is great! Has
everything in it that you need to know for STEP and more. I would highly
recommend it! Plus it is short and does not take long to read.
Behavioral Science BRS Behavioral Science I know that the last edition of
First Aid recommended HY Behavioral Science but it is just not enough. I read
the HY and constantly had to go back and read the BRS. I wish I would have just
sucked it up and read the BRS to begin with like I planned. My lowest test subject
on my actual exam ended up being this so I ended up paying for not reading this
book. In addition to reading this book I would also recommend watching the
Kaplan videos on Behavioral Science. The guy that does them is absolutely
amazing and simplifies the subject enough to help answer a lot of questions.
Pharmacology Katzung & Trevors Pharmacology Board Review and
Examination There are two of these books that seem similar online but one is
the entire text and the other is a review. Pick the review book! It was short and
had basic information that allowed me to create a framework for each of the
actual drugs. Questions at the end of each chapter were nice as well to make sure
you picked out important information. I also watched the Kaplan videos for this
topic because Raymond is amazing and helps a lot with understanding the
pharmacology.
Pathology Pathoma/RR Pathology Your test no matter what subject it is
heavy in or balanced will be mainly pathology. It makes sense then to read a

couple of books on the topic. I started with Pathoma and watched all the videos
while reading the text. I then read RR. I did not listen to the audio and Ill tell you
why. Those tapes are now almost 15 years old! Information has changed and he
has everything that he talks about in the book. Read the book and youll be better
prepared. It brings everything together at the end because he integrates the
physiology and biochemistry with the pathology.
So those are the books I would read during the fall to prepare you for a spring full
of questions and First Aid. The reason for reading is mainly a leveling process.
Each school is slightly different in the curriculum they stress so all of our
education is slightly different. I feel these books are basic enough where it is
material that everyone should have at least heard of after the first two years of
medical school. I added in videos to the topics of behavioral science,
pharmacology, and pathology because I think they are the most tested. I know
microbiology is also heavily tested but it is just memorization in the end and we
also had very good lectures in the subject at my school. I also think here is a good
time to talk about picmonic. If you havent heard of it check it out. It is definitely
not for everyone but it helped me immensely to have a starting point for
memorizing the topics they covered. I think that for me personally it worked best
for biochemistry and microbiology but that was most likely due to the fact that it
hasnt been around very long and those were really the only cards I got to see a
lot. I would focus on doing whatever cards you are currently learning in class. If
you are in microbiology learning about gram-positive bacteria do those cards.
Listen to the audio for each card once at the very beginning of the week or two
weeks you are studying that topic and then during the week look at them right
before you go to sleep. Youll have some crazy dreams but it makes them stick in
your mind when you are under pressure. They have added many more cards now
and I tried to use them but I had already memorized the topic before seeing them
so they werent as helpful. They correlate directly with what is in First Aid so you
know it is essential information that will show up on the exam. The amount of
questions I got right in biochemistry and microbiology were mainly due to this
resource so I would highly recommend it.
The springtime is for learning how to answer questions and getting First Aid
filled out to use as the ultimate resource in your final study period. After all this
reading you might think that you would be well prepared to answer questions but
it really doesnt happen that way. It takes time to understand how concepts are
going to be asked and what the important information is. Dont worry! I had the
same experience and it is just a process of playing the game.
First qbank USMLE Rx Start with this qbank! There are a little over 2700
questions so try to have it done by the end of February. The questions all have
links to the page where it is in First Aid. This helps you get acquainted with FA
and where everything is. I cannot tell you even after doing this how many times I
would write something somewhere and then find it printed somewhere else.
Learn where things are in FA and youll save yourself time from writing down
redundant information. Go through the qbank by the way it is divided in First

Aid. For instance I started with Behavioral Science. I first read the section in FA
and then would answer the questions associated with that topic. This will be your
first read through FA and will also aid in knowing where everything is. For
pharmacology and pathology, I answered the questions by organ system instead.
Reading FA and then answering questions over the topic helps to cement the
information in your mind. When putting information from the question into FA I
only wrote down the core objective at the end of each question. I did the
questions in tutor mode because immediate feedback is so important. I only used
timed mode when I was in my final prep period. I will explain this in more detail
later though.
Second qbank Uworld The reason for doing this second is that you can reset
this bank and you want to do this twice because it really is the best prep for the
detail on the exam. This will be your first pass through the bank. It is harder than
Rx so dont worry if you see your scores drop. (Also unlike Rx when you click on
an answer it doesnt let you change it and shows you the explanation.) Do it on
tutor mode and write in all the educational objectives at the end of the
explanations into your First Aid. Dont do this by specific topic like you did with
the previous one. Select all subjects and organ systems so you start to get a feel
for what its like to have mixed exams. Youll want to try to complete this by the
end of March.
Third qbank Kaplan This qbank tests a lot of minutiae but I got several
questions on my exam correct because of the questions I saw here. This was also
my only place to see menkes disease (it is definitely in FA in the biochem section)
so you know it has been on the real thing before. The bank also does a good job of
giving you plenty of practice with the arrow questions for physiology. For
example the patient comes in with this disease, happens to x, y, z. It is also the
best for behavioral science and laboratory medicine. First do the diagnostic exam
to see where you are after two qbanks. Do it in tutor mode with all subjects and
organ systems selected. Write down the key concept at the end of the explanation
in your First Aid. Youll want to try to complete this by the end of April
During uworld and Kaplan banks read First Aid for a second time. Take the time
to find information that you missed in your first pass! Youll start to be surprised
by how much you missed and how much information is actually in First Aid.
Dedicated STEP study time:
So for this it really is up to the individual but this is how I did it and I dont think
many other people did it this way. I scheduled 5 weeks of dedicated study time. It
was a little more than the month that I thought I would need but it gave me the
ability to take one day off a week and also celebrate my MBA graduation and my
fiances birthday. During the time I thought that it was too much but now that I
have my score back I am happy with my decision on taking 5 weeks. So here is
what I would recommend based on that 5 week schedule. If you choose to do
something other than this it is fine, by this time you kind of know where you are
and where you want to go. I dont think any of the DIT or Falcon review courses

are worth it at this point either if you have followed this schedule from August.
Those are designed to help people pass STEP who havent been studying very
hard during second year.
Uworld Second pass. This time you want to set it up for timed and select all
subjects and organ systems. Review the entire test after you complete it. This
helps get you prepared for the real thing by getting your timing down and
working on your thinking process. You stop worrying about whether or not you
got a question right and just learn to try your best and move on. You know all of
the answers to this qbank so any question you miss means there is a fault in the
process you are using to answer the question. Find it and work on it. Sometimes
it is that you are thinking too much and other times its because you arent paying
attention. Find the right balance that allows you to function at your optimum
level. Try once again to finish this qbank in 4 weeks. It should be easier this time
since you arent writing everything down. Dont worry if you arent getting every
question right! I know of people who had a second pass percentage rate around
the 80% mark and still did well. The key is to figure out why you missed those
questions the second time around! I did my questions every morning.
Firecracker This is what I did in the afternoons. I know this is not how most
people use this program but based on my experience with it during first year this
is what I did because I knew it would work for me. I completely reset my account
so that I did not have any topics flagged. Prior to this I may have flagged about
40% of the topics with none from the organ systems section. I then did
approximately 50 topics a day so that I could finish flag everything within four
weeks. It is definitely a lot towards the end but this was my way of reviewing as
much as I could with spaced repetition so I wouldnt forget what I learned in the
first week by the time I took the exam at the end of the fifth week. I knew after
the Kaplan diagnostic exam where my weaknesses were so I did those sections
first to give myself the opportunity to see those cards the most. This may not be
for everyone but it definitely helped me with my microbiology, dermatology,
reproductive, and renal questions that were a relative weakness going in to
dedicated study time.
CBSSAs- DO THEM ALL! All of the ones online are around $50 and there are 6
so it is an investment but I saw several questions and pictures from these on my
actual exam. In my mind that in itself makes it worth it. Try to do one once a
week starting with the first week so you can have them done before your exam.
Dont stress too much about the scores you get. Most people I have talked to tend
to get a score a few points above their highest CBSSA. Also this is a great chance
to meet with a study group. Throughout my second year, I met with a group of
like-minded students that were dedicated to STEP studying at an early date. We
would meet once a week and answer 10-15 questions over an hour from a
question book and just discusses how we each arrived at the answer. We
continued this process by meeting up on Sundays to discuss the questions we
missed on the CBSSA. You dont get the correct answer for the questions you
missed if you choose extended feedback (you should choose this option, its $10

more but you only take STEP 1 once so its worth it!). You just get the question
and detailed statistics on the different subjects and organ systems. You can use
this to tailor your studying for the next week if you arent doing the Firecracker
method.
Last week before the exam: Do the two practice exams on Uworld, they are pretty
good but tend to overestimate your actual score. Try to focus once again on
limiting the number of mistakes you make in your thinking process. At this point
you know or have seen it all and it is just about minimizing stupid mistakes. By
that I mean mixing up biostatistics formulas or other simple questions that are
supposed to be the easy ones. You cant get the highest score youre capable of
without learning to do this. For example, on one of these practice exams was a
classic EXCEPT question. STEP isnt allowed to ask these questions anymore
but they have technical way of doing it. They give you a vignette and you have no
clue what it is. You look at the answer choices and see that you know four of them
but the other one is a mystery and youve never heard of it. The point of the
question is to know those more common four and exclude them based on the
information in the vignette so you can choose that one youve never heard of
before. If you are able to do that with good reasons for excluding each wrong
answer choice you are able to think like the question writers and that is the name
of the game! The other thing to do during this week is read through First Aid for
the last time. You have put a bunch of notes in there from all of the questions
youve answered. Use a fine tooth comb and find all the little details that you
dont remember. Dont worry if you are finding there is too much to First Aid and
you cant possibly know everything in there. Just by doing this youll get several
questions correct that you wouldnt have on your exam. I know because thats
what happened for me (do you remember what the dihydrorhodamine test is
used to diagnose? Chronic Granulomatous Disease and it is in First Aid!) A few
days before your exam do the free 138 questions given by the NBME. They are
good questions and a couple showed up on my exam.
Take the day off before your exam! You need to be in top shape for tomorrow and
not tired. Watch a movie, eat well, and get some good rest! Do whatever you have
to do to relax.
Wake up early on the exam day and get to your testing center early (like 30
minutes early). You dont want to add stress to the actual day. I ate some protein
(eggs and bacon) for breakfast. All I am saying is to eat something that will last
and keep your energy up for the exam. I also did 10 random questions and read
the rapid review section at the end of First Aid before I left. This helped me to get
in the question-answering mood and was a good overall review of commonly
tested items. Take plenty of food and drinks. Try to mix it up so you can eat
whatever you want (I took some sandwiches, crackers, and candy bars filling,
salty, sweet). I also took some 5 hour energy shots with me. I drank one before I
went in and then another in the afternoon. I know Im blatantly copying their ad
but I dont feel the crash with it as I do with coffee or cokes so that is why I
choose it over them. It kept my energy up and felt great the whole day. Try to stay

calm, cool, and collected. Dont over think and try to minimize your mistakes.
Manage your break time. They give you about 45 minutes of break time plus
whatever time from skipping through the tutorial. I did a little of the tutorial
because the auscultation on the exam allows you to move the stethoscope around
and change from diaphragm to bell unlike any of the other testing services. I
would get done answering all the questions around 20-15 minutes left in the
block mark and then review all of my answers for another 10 minutes so I would
have about 5-10 minutes after every block. I took a thirty-minute break for lunch
after the fourth block. I took slightly longer breaks in the afternoon because I
knew that I would be tired from answering all those questions earlier in the day. I
ended up using almost all of my time.
Congratulations! Youve just completed taking one of the most stressful exams of
your life! Go enjoy life and catch up with all those friends youve ignored for the
past month while youve been studying! It usually takes about 3 weeks to get your
results which will be posted to the same website where you registered for STEP 1.
They only release scores on Wednesday and will send an email saying your scores
will be uploaded later that day. If you take your exam during May/June they may
have a single date for everyone for a certain heavy testing period. For example,
when I took the exam all the scores from May through June 19th were uploaded
on July 9th. They usually post this information to their website if they are going to
do something similar during the time you take it.