I am going to write a detailed composition regarding preparation for USMLE Step 1.

I am a final year
student at King Edward Medical University and I took my exam on June 10th. Final year is the year
before internship/ house job in Pakistan. I just got my scores: 99/266
Let me introduce some myths surrounding USMLE Step 1 which are especially prevalent within Pakistan;
I am not too sure about India because I heard their students typically appear in their final years.
Myth number 1: Do not appear for USMLE Step 1 within your graduation
Verdict: Baseless, illogical reasoning
Explanation: This is so prevalent in Pakistan its almost pathetic. One of the biggest concerns
surrounding our students is that Step 1 is a huge risk to be taken before graduation. Let me put it in
another way: Step1 would always remain a risk whenever it is taken, whether during or after graduation,
whether with a preparation of 4 months or a preparation 14 months. It is an unpredictable exam. Let me
reassure you that taking Step1 within your graduation would, 90% of times, result in a score that would be
substantially higher than when having taken after your graduation. Why? Its simple! You have a habit of
studying for prolonged time periods and you havent yet stepped into your professional field. Furthermore
what you have been studying all along during your medical studies is still fresh in your mind. Basic
sciences is something that troubles even the experienced doctors, let alone a mere young student. Its all
about finding the right tempo to study for extended time and when you enter the profession, that is
something quite troublesome. Take my advice: rather than wasting your time during your medical studies,
spend it swimming through Step1 recommended textbooks.
Remember you are in direct competition with medical students of US. They typically appear for Step1 at
the end of their 2nd year and Step2 at the end of their 4th year.
Myth number 2: You need clinical exposure to fully understand Step1s clinical vignettes
Verdict: Not necessarily!
Explanation: Remember US medical students dont have any clinical exposure leading up to their Step1
exam. While attending wards may help you understand the methodology leading to diagnosis and
management, you definitely do not need to wait till you acquire maximal clinical experience for Step1.
Most of the cases can be fully understood easily by simply applying knowledge of basic sciences you just
learnt. Radiographs and gross specimens can be practiced by simply getting help from the world wide
web and selected university department websites. Similarly heart sounds can be made available through
a simple Google search. You just need to be active enough to utilize the internet as an aid to your
studies. You would only be rarely tested for management of the patient, which is the primary focus of
Step2 CK and not Step1. In majority of occasions, application of knowledge of basic sciences is what is
expected of you.
Myth number 3: Cram, by heart, all of Kaplan series
Verdict: Wrong and time wasting!
Explanation: Let me begin by stating US medical students only rarely, if ever, turn to Kaplan for their
study. At a later stage of this article, I would lay out the recommended books for you. Kaplan definitely is
a good series but thinking that it lays out the syllabus content of Step1 for you is nonsense. Step1 does
not have a very well defined syllabus. The closest you can get is finding the syllabus release on
usmle.org for Step1. Instead of spending time cramming all of it, its more useful to concentrate on
selected areas more. You can totally skip out its Physiology book and replace it with BRS Physiology.
You can do the same to Pathology book and replace with Goljan. Youd need to supplement biostatistics
with high yield biostatistics. A lot of information written in Kaplan is vague, especially the Genetics part of
Biochemistry, and very rarely, if at all, tested. Some topics need more elaboration than whats published:
Cancer chemotherapy, Lysosomal storage diseases. Microbiology typically requires substantial usage of

Levinson to fully master the bugs. At a later stage, as stated already, I would lay out the books you need
to study for an efficient preparation.
Myth number 4: First read, Second read, third read, fourth read, Step1
Verdict: This depends!
Explanation: Remember everyone has his own way of studying. This sequential method typically follows
the Kaplan series and has little significant benefit. It is very rigid and cannot be modified. A lot of people
asked me repeatedly how many reads I have done. My answer was always the same: is the number of
reads the method to use to judge someones preparation? Thats the purpose of NBME sample
assessment. Dont let the number of reads fool you. Some people study fast and they find that spending
little time on everything gives them sufficient time to revise; others find the opposite to be true. This
means a person who has done 2 reads may be doing just about as good as another who has done 7
reads. Besides some subjects need more reads than others;pharmacology needs more commitment than
does anatomy.
Confused? I am too! When you try and follow number of reads rule, youd end up even more confused.
Solution? Try and find your own best method. If you get a good NBME score, this means youre doing
fine. For more info on NBME, read on.
Myth number 5: If you get less than a two digit score of 95, youre good as gone.
Verdict: Ignorance!
Explanation: While Step1 is very important, it is not the only thing required to judge a candidate.
Remember theres Step2 CK as well, number of attempts at Step2 CS, Electives, Research experience
etc. They all form part of what is known as a well rounded candidate. Not everyone gets a 99 at Step1
and those who dont must not lose their confidence. Step1 is an exam, just like every other exam and is
prone to causing mishaps and accidents in results. If that happens to you, I guess hard luck but should
you lose hope? Go and read the first article written by Dr: Umar on hope! Try and compensate from Step
2 CK or the best of all, research. Dont make Step1 a matter of life and death because its not worth it.
Myth number 6: Step 1 is all about concepts.
Verdict: and..cramming!
Explanation: Dont be fooled into thinking you dont have anything to learn in Step1!
Microbiology, Immunology and Pathology have far more knowledge that has to be learnt compared to
what you do in college, in addition to making concepts. By all means, make maximal attempts as learning
as much information as possible. If you dont know the virus names and groups, you cannot answer any
question based simply on concepts. Knowledge in Step1 is tested very rigorously, but it is typically very
cleverly disguised as they simply form a part of the multiple process thinking. Learn everything; dont
leave things out. Yes and that means you have to learn Ebola virus, Japanese Encephalitis Virus and
Lymphocytic Choriomeningitis Virus too!
Myth number 7: 70-80% of Step1 exam is full of Pathology
Verdict: Wrong!
Explanation: Its true that almost 95% of the exam has clinical vignettes that can be directly correlated to
Pathology however the subject matter that is being tested may not necessarily be pure Pathology. You
may be given a vignette on Ataxia-Telengiectasia but you may be tested on an immunological concept, or
a molecular biology concept. Now that the current USMLE exams are full of clinical vignettes (as stated
on the official usmle.org; number of questions in clinical vignette forms to be increased), you would find
this to be even more prevalent.

My purpose is to tell you to divide your attention equally amongst all subjects. 70-80% Pathology on exam
never means 70-80% time on Pathology and 20-30% time on remaining subjects. Infact Molecular
Biology is a dominant force. Step1 reflects current standards of medicine. You may infact realize that
spending more time on Microbiology than Pathology would be more high yield.
Myth number 8: Delaying the exam by a month or two would increase my score
Verdict: What makes you think the opposite may not happen?
Explanation: Read the verdict again, and again and again. Do you have any guarantee that you would
definitely not slack off, run the risk of forgetting important facts after breaking your study momentum and
decrease your score instead? Remember momentum and sustained effort are extremely important. When
you choose an exam date, stick to it. Try to carry your momentum straight uptil that date. Breaking your
rhythm would only increase your anxiety and make you forget important facts.
Myth number 9: My friend got a lot of virology in his exam; I must spend all my time studying
virology
Verdict: Fair enough, but isn't "all your time" a bit too ambitious?

Explanation: The issue here is that there is little uniformity within a Step 1 exam, and little comparative
value between Step 1 exams in terms of subject content, NOT standardized 2 or 3 digit score. For
example your friend just gave Step 1 about 2 weeks prior to your final date. He seemed to get a lot of
questions from virology and defense mechanisms (behavioural sciences). Should that make you think you
should spend your next 2 weeks till your final date studying with full force, these topics? This is a common
psyche of anyone who is about to take his or her exam, to rely a lot on what has already appeared. It's
fair enough, but you have to make sure you do not compromise the rest of your study. Step 1, as stated
already, is an unpredictable exam. You may be tested a lot, instead of virology, on mycology on a
disproportionately high scale i.e. far more questions than you might anticipate. When you go through Step
1 forums, you may see some people stating they got a lot of biochemistry but little anatomy, and others
attesting to the exact opposite.
You should always make an effort to study each and every subject in Step 1 with equal time and honesty.
As stated elsewhere, yes, there are subjects like Pharmacology and Microbiology that require
disproportionately more time but this is not because they appear a lot on the exam, but because of the
nature of these subjects that warrant consistent revisions.
If you can find any more myths, please discuss them in comments and Id include them here.
Now let me talk about the recommended books for you.
BOOKS:
Get all of Kaplan series. You may omit Physiology totally. You may if you like, also omit Pathology. Buy
the DVD lectures as well (remember the copies found in our country are illegal; if possible, they should be
bought at kaplanmedical.com). Heres a little run through the individual subjects:
Physiology:
All American students rely a lot on BRS Physiology. Its a fantastic book that focuses on the most high
yield content you need to know with all the necessary graphs. The problem with Kaplan is that it includes
discussion of quite a few topics that are not tested on Step1 e.g. Vascular Physiology. These are also
discussed in heavy details that entail a lot of time commitment. BRS Physiology has everything you need
to know in Physiology plus an additional chapter on Neurophysiology which is not discussed even in

Kaplans neuroanatomy.
Biochemistry:
Kaplan should suffice here. Infact Kaplan is a good book. Some topics need supplementation. You should
consider studying lysosomal storage diseases from elsewhere; first aid has details of all lysosomal
diseases. Listen to the lectures as well if you like. Dr. Lionel Raymon explains the concepts exceptionally
well.
Molecular Biology:
Again Kaplan should suffice here. Some American students consider studying High Yield Molecular
Biology. I got it and found it to contain a lot more information in excess of whats required. Other
American students think the 1999 version has just about enough info. But I dont trust an old book.
Sticking to Kaplan should suffice. Techniques should be referred from High Yield Molecular Biology as
they are poorly explained in Kaplan.
Genetics:
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. I have never heard LOD scores
being tested in Step1. Techniques of genetic analysis are very commonly tested but they havent
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. Dont underestimate
this topic!
Anatomy:
Neuroanatomy is good enough. High yield neuroanatomy is also a good book; I heard some Americans
studying it. I cannot recommend other texts as I dont know them. Remember it is extremely important
that you know the clinical scenarios very well, CT-scans, MRIs, and gross specimen. In this manner, High
yield is a very good book because it has many such illustrations and snaps. You should have a very good
orientation of the brain in all planes: sagittal, coronal and transverse! Using help from university
department websites can be of immense help. Search webpath on Google and navigate into the
Pathology department of Utah University.
Histology is written in a way youd forget as soon as you read. When you go through again, the same
happens. Third time isnt too lucky either. Here use High Yield Histology. At first glance this book seems
to be a lot more detailed than needed. But that detail isnt just histology. Its the bridging knowledge and
concepts that spans physiology, pharmacology, biochemistry and pathology! Try to find the original
textbook as there are excellent illustrations and photographs at end of every chapter.
Gross Anatomy is fair enough. But you may need help from major texts such as Snell to study the Pelvic
region which is disappointingly poorly explained in Kaplan.
Embryology is spread throughout Gross Anatomy. Its useful enough. Basic embryology needs
supplementation from other texts. I used a quick read through Langmans embryology to get a hang of the
initial development of the embryo. Most American students state First Aid embryology is good enough.
You can trust that opinion. You may also use High Yield embryology. But you can just stick to First Aid
here.

Behavioural Science:
When I first went through it, it looked out I didnt go through it at all and only had a dj vu that I did go
through it. On a serious note, its a pathetic book. Even when supplemented by lectures, it doesnt lose its
pathetic appeal. You will have to use High Yield Biostatistics to simply understand just what the hell is
going on around with all those lines and numbers and paranoid P-values.
Heres how I learnt my behavioural sciences. I used to study the explanations to behavioural science
questions in question banks. I used First Aid Q and A book. Explanations about respective questions
were well written and I would write them in a notebook and go through them regularly (number of reads
anyone, please?). Eventually I just got a hang of it all. The personality disorders, the defense
mechanisms, DSM manual etc. Kaplan is jittered with useful info and youd realize it once you study
schizophrenia (cram all of Kaplan, everyone raise your hands!). I had BRS Behavioural science but I
didnt use it. I didnt want to feel like an uncertified tester of all the books that are medical, just as I am of
all the different web browsers (Safari is the worst of all).
Heres a tip for you. Best way to learn behavioural science is to get a lot of questions incorrect in question
resources, and then diligently study the explanations and promise by God you wont underestimate this
subject again. ONCE you have done that, now you can rely on Kaplan. The only thing reliable is medical
ethics. Try and study the scenarios given in the two chapters. Some Americans suggest Medical Ethics by
Conrad Fischer. I didnt use it (I told you I dont want to be a unpaid tester of books!). Unfortunately it
seems that the American board examiners are extremely clever at finding just those special
circumstances for you, where youd eventually pick the wrong answer that happens to be both morally
and legally incorrect, even though you thought the contrary!
Guess what, you can safely skip that mammoth table about human development in Kaplan and simply
replace it with whats written in First Aid. Everytime I looked at that table, I was more worried in counting
how many milestones I achieved when I was a young boy rather than learning it. Not for a single time I
had to repeatedly remind myself I did have a hint of object permanence at age 1 but then
again..whats that?
Immunology:
Kaplan should suffice here. I didnt use the videos because I thought my concepts were clear courtesy of
Levinson. Strangely enough, the immune faculty was kind enough to write a continuous prose for us
rather than shoot bullets (points). Remember again that immunology techniques, similar to genetic and
molecular biology techniques, are very important and should be clearly understood and learnt. For
example KNOW the difference between ELISA and Western Blot very well! Diseases are very frequently
tested. When you supplement your study with First Aid Q and A book (Buy it!), immunology diseases
would become progressively clear. Stay loyal to Kaplan here; you dont have to spend too much time on
other books. Actually I did use Levinson occasionally especially for diseases. It takes time but its a
fantastic book written by a UCSF professor who is an authority in Microbiology and Immunology. At end
of Kaplan, there is an appendix detailing CD markers. Learn it by heart.
Pharmacology:
Use Katzung Board Review series here. Surprised? Im not. That is the best book. Again it is written by a
group of three UCSF professors who know whats needed for Step1. Some topics such as Chemotherapy
and Anticancer drugs are so important you have to study them in detail. Katzung is more than enough
detail and you can totally rely on it. Because Dr. Anthony Trevor is also a co-author of Kaplans
Pharmacology, there are some similarities between the two which means once you go through Katzung,
you can review Kaplan easily. You may consider annotating Kaplan with Katzungs points. They test each
and every drug, even Sitagliptin and Orlistat. Be careful studying Toxicology because it is important. You
will have to study it from katzung to know whats it all about. ANS and CVS drugs are definitely high yield.
It would help you writing some points on a notebook and repeatedly revising it. For example, write all

adverse effects of all anticancer drugs and keep going through it. Eventually youd start remembering that
pulmonary fibrosis is a prominent side effect of bleomycin and busulfan, Nephrotoxicity is not an issue
with Sirolimus and a combination of Didanosine and Zidovudine has a high incidence of neutropaenia.
Microbiology:
Here they go again. All of that written either in points form, or tables form. If you supplement it with
lectures, it ends up becoming a complete mockery of those little bugs. The bugs had to emerge resistant
to it and no wonder theyre doing it so well, both in real life and on our exams. It would seriously help you
if you just go and buy Levinson and just go through it atleast once. Some Americans recommend Made
ridiculously simple Microbiology and you may use it if you like to. I also went through High Yield
Microbiology but it didnt sustain my interest. Viruses need constant referencing with Levinson to simply
learn what haemorrhagic fever exactly is and what exactly is hand-foot-mouth disease. Parasites are just
sugarcoated in tables. Again, study from Levinson. You wont get the slightest hang of it from Kaplan.
Microbial genetics is written fair. Remember you have to learn the mechanisms of resistant to different
drugs, for example the acetyltransferase against chloramphenicol. You have to also learn which are
plasmids mediated and which are chromosomal mediated. Transposons, plasmids, lysogeny etc are all a
fair game and must be understood.
The case scenarios given at the end of Kaplan are slightly confusing but theyre a fair game as well. You
can actually replace them with similar scenarios and common causative agents written in Levinson.
Pathology:
Goljan appears to be the undisputed king here. You can also listen to Goljan lectures (remember their
possession is illegal! I dont know if they even officially release any lectures in first place). But you can
quite comfortably rely on its 3rd edition that spans not only Pathology but also bridging concepts to
Pharmacology, Biochemistry and Physiology which ensure active revision and repetition of these
subjects. Some American students say they also relied on the side notes given in the book especially just
a few days before the eventual exam and it was a massive help. This is a detailed book so make sure you
allocate enough time. Make sure to buy the original version so that all the micrographs and gross
specimens are clear.
Contrary to popular belief, Pathology doesnt make 70-80% of your Step1 exam as already explained
earlier in the Myths section. So dont allocate time in excess of whats required, that may compromise
your study of other subjects.
But you can also study Kaplans Pathology. Because I was studying Pathology alongside my medical
studies, I used Medium Robbins and annotated Kaplans Pathology with important topics. Make sure you
fully understand that studying Robbins alone would result in low Step1 scores. Robbins overemphasizes
topics that have little clinical value and understates the ones that are exceptionally high yield. Still you
may atleast like to go through it once (only if you are studying for Step1 during medical studies) to get a
grip on what Pathology is all about. Some students would suggest studying Big Robbins but again, you
need to know studying what material is higher yield. Big Robbins is typically for students who have little
else to do apart from studying. As you go through Kaplan, the point format may frustrate you so you may
want to revert occasionally to Medium Robbins to study topics like Pneumoconiosis in detail before
feeling confident about learning material from Kaplan.
Some people suggest BRS Pathology. I dont know about that. Its entirely up to your choice. Perhaps you
may want to use its illustrations, photomicrographs and gross specimens for supplementary study. Be
sure you also utilize Utah University Pathology Departments Webpath website.

OTHER BOOKS
First Aid is a favourite amongst American medical students. I only went through it twice but I found it to
be quite helpful. You may like to study it once early in your coursework and once later before the exam.
You can even go one step further and make it your primary book. In that case you may have to annotate
it and make up for the deficiencies in this book. In my opinion, it still has enough information to guarantee
a 99 on Step1 provided you study it comprehensively and carefully.
Kaplan medessentials is a similar book to First Aid. It has essentially all of the Kaplan series condensed
into a single book. Some Americans call it medsuperfluous. Its unnecessarily detailed at some places
and understated in others. Still it has the benefit of complementing your Kaplan textbook study. You may
use it if you like a very quick glance at a lot of information, typically arranged system-wise e.g.
Cardiovascular system. This helps you to save time flipping through different books in case you like to
apply a systems approach at some point during your coursework.
Step1 secrets is another rather useful book I encountered. I didnt study it all so I cannot comment but
based on others opinions, it has everything arranged neatly in a question-and-answer format and written
in simple language. Oversimplification is evident at a lot of places and requires rigorous supplementation
by more detailed textbooks. If a high 99 is not your aim or if you realize that studying simple textbooks
may ensure something like a 90-99 score rather than pursuit of a high 99 having to utilize detailed
textbooks and running the risk of losing score, thats the book for you. It has little of everything that should
benefit you in the actual exam. If nothing else works or you have run into anxiety, throw every other book
away even First Aid. Pick this book and just study it. It is written in a beautiful manner utilizing a very
student friendly approach and doesn't run aggressively amok anywhere. Studying this book alone
carefully can give you a 90+ score.
QUESTION RESOURCES:
You have the following question banks. They are discussed separately.
USMLE World:
It can be found at usmleworld.com. This question resource has consistently high ratings amongst
students and Americans love using it to supplement their study of First Aid. You can buy it for 100$ for
one month. Subscriptions greater than a month have substantial discounts. You can get their books but
theyre all pirated and illegal material. I would highly recommend buying this for a single month at least.
Typically this should be used to maximum effect about 1-2 months before your actual exam. Others
recommend using it as soon as possible but I have a different opinion. The explanations given in this
resource are the best amongst all others and some Americans actually solely rely upon the explanations
for their revision. If you start it late in coursework, you ensure adequate revision and security of keeping it
in memory. Questions typically use 2-3 step thinking processes and require good integration of concepts,
so its a tough question resource. My advice is to solve all questions and read their explanation
regardless of whether you get any question correct or incorrect.
KAPLAN Qbank:
This can be accessed at kaplanmedical.com. It is very expensive: 130$ per month and additional months
purchased have substantial discounts. You can get their books but again, thats pirated and illegal. They
dont release any textbooks. Americans dont prefer using this resource. Kaplan Qbank relies quite
extensively on knowledge given in their textbooks and at times, it feels they are exclusively focused on
specific knowledge pointers in their questions, rather than good integration of concepts as done by
usmleworld. Furthermore it has a habit of testing knowledge that is both Step1 irrelevant and not given in
recommended textbooks (not even in their own textbooks!). Overall I would recommend this Qbank. It has
the advantage of using Qtutorials (refer to their website), good media, good explanations and a huge
question resource. You dont have to attempt all of the questions given. Its preferable to use this
resource early in your coursework.

USMLErx:
This can be accessed at usmlerx.com. This is the least expensive of all qbanks with a single month
subscription at 70$. Instead of Kaplan you may want to utilize this resource early in your coursework. This
is the work of contributors of First Aid. So it heavily relies on info resource of First Aid. This can be an
advantage if you are using First Aid as well. Repetition of facts in first aid ensures adequate retention in
memory. However some questions may not correctly reflect the standard and format of current USMLE
exams and rely somewhat on typical case scenario facts and explanations. In addition, a lot more
questions directly test knowledge rather than careful integration of facts. Best utilized early in coursework.
First Aid Q & A book:
Similar to usmlerx. In fact they state questions are taken from usmlerx resource. It has 1000 questions,
650 organized systems wise and 350 organized into a full length exam with 7 blocks (remember current
USMLE has only 322 questions in 7 blocks). I used this book late in my study but I recommend using it
early. It may be a less expensive substitute to usmlerx questions resource as well. Explanations are good
and have cross referencing to First Aid text which may help your revision. Remember this is an official
First Aid release.
Mededia Qbank:
Surprised? Stay tuned for more updates in near future! I assure you this would be a very high quality
Qbank with MCQs according to the new format of more clinical scenarios and quality better than all
mentioned qbanks. I am working with Dr. Umar Tariq on it; it would be available online in a few months
times and would be entirely free of cost so you may start using this questions resource early or late in
your coursework depending upon your choice.
If you are interested in authoring MCQs for this Qbank, kindly contact me at dr.ayazmk@yahoo.com or
Dr. Umar Tariq and we would be happy to include you as a co-author/ contributor on submission of some
high-quality MCQs and would mention your name on the main book cover. I am sure it would prove to be
a big boost to your CV and provide help to your colleagues; the same reason I am doing it for.
The reason for its inception is to reflect the current trends in the USMLE Step 1 exam. Step1 is an everevolving exam; the examiners are very well aware of what guide-books and short-cuts students love
using. As an example heart sounds that appeared in previous Step1 exams could typically be resolved by
simply contemplating the question stem and not even listening to the sounds, as stated by some
examinees! Now you must have a sound knowledge of heart sounds. If you are as unlucky as I was, you
may get those varieties sometimes only cardiologists can decipher with a degree of confidence. Apart
from that, the examiners know that many students rely heavily on First Aid. By no means you can't get a
99 by studying First Aid alone, but this is to tell you that the style keeps evolving in order to maintain a
very high standard of this exam. Therefore we decided to make a brand new collection of questions
resource that would adequately aid your Step 1 preparation.
Wikitestprep.org:
This is a spin-off of Wikipedia with about 800+ questions free of cost, contributed by various authors.
Because there is little quality check and control over the type of questions, a lot more questions do not
reflect the USMLE style than questions that do. Integration of concepts is rarely tested. Since its free, you
may like to use it early in coursework but remember that some questions are factually incorrect, others
are vague and their explanations may not reflect high yield material.
NBME exams:
These exams can be purchased at NBME website for about 45$ each and has 200 questions each

arranged in 4 blocks. You may buy about 2 or 3 such exams, from a total of 7. It is very important to use
atleast one exam early in coursework and another late in coursework to gauge your performance levels,
strengths and weaknesses. In addition a projected 3 digit score is given to you at the end of your exam
that is highly predictive of your actual USMLE Step 1 score. NBMEs are also not reflective of current
USMLE style. Most questions are very easy making the marking very stringent and strict. But you have to
use these exams to quantitate your performance levels. I recommend buying 3. Use one early, another in
the middle and the last one late in your coursework to ensure adequate progression in your study.
USMLE World Self-Assessment forms:
They can be accessed at usmleworld.com and have a cost of 30$ each. They are two in number. When
purchased together, they cost 50$ in total. They have the added advantage of allowing you to study
questions you got incorrect or correct and read all explanations, over NBME which allows neither. Best
used late in your coursework and you should attempt to study all the explanations. There are 192
questions in each exam.
Kaplan Qbook:
This is an official release of Kaplan Medical. I did go through it randomly at first. It has various blocks of
50 questions each organized in a subject-wise manner (not systems wise). Unfortunately various
questions are again not reflective of current exam and are typically "easy". The most poorly composed
section is, as expected, Behavioural sciences. Two blocks of 50 questions each of absolute madness. It
follows the same philosophy of Kaplan's Qbank somewhat hinting more at retrieval of an examinee's
memory rather than integration of concepts.
GETTING STARTED WITH IT ALL:
You have the choice to study either during your medical studies or after your graduation. As I already
explained earlier, studying during your medical school is substantially better than after your graduation.
However USMLE is a difficult exam that needs honesty and time commitment. You cannot study this
exam for the fun or sake of it because that may seriously backfire with a very low score. Only sit this
exam once you are sure of your preparation. Using NBMEs is one way of assessing your preparedness.
In case you wished to appear in Step 1 during your medical studies but became very anxious or your
NBME score is not so good, your time wasnt lost! You can carry that knowledge over to studying for
Step2 CK as well during your final year. In that case you may begin to feel confident enough to give
Step2 Ck before your Step1 because you had already had some feel of how Step1 looks like.
The best way is to begin as early as possible in your medical studies. Study only good American
textbooks. I recommend you to study the following textbooks during your medical education:
- Snells Anatomy
- Snells Neuroanatomy
- Ganongs Physiology
- Lippincott Biochemistry and Molecular Biology
- Katzungs Pharmacology (Board Review Series)
- Levinsons Microbiology and Immunology
- Medium Robbins supplemented by Goljan, or even Goljan alone
(Medium Robbins = Robbins Basic Pathology)
- For behavioral science, you may have to rely on textbooks already stated above.
The textbooks above ensure you get a sound grasp on the subject in question. Using these resources
ensure youre automatically geared towards Step1 prep. Strictly avoid using textbooks authored in the
subcontinent as not one single such textbook lives up to the standard of the books above.

Heres a tour through a Step1 preparation.

First few months; getting started:

A lot of us subcontinent people use Kaplan. Americans get about 2 months off at end of their 2nd year,
and study Goljan, First Aid and Usmleworld.
You may need to use the videos. You dont necessarily have to listen to all these videos. You may form
good concepts but as soon as that happens, youd immediately forget later on. Using videos for
referencing again and again is time consuming and frustrating. A good detailed textbook is a very good
substitute. If grasping DNA synthesis from Kaplans biochemistry textbook is difficult, jump straight to
Lippincott. Unfortunately this cross referencing is something youd have to do extensively throughout your
Step1 study. So keep all the major textbooks readied.
First just go through the Kaplan. Understand, learn or not, is not a matter. Try to get a feel of what Step1
syllabus content is like. Next you may want to use video lectures to aid you in understanding difficult
concepts and also for the sake of simply touring through the Step1. In these first few months, use your
major textbooks extensively. Dont be afraid to open Snells neuroanatomy or Ganongs Physiology to
clarify difficult concepts. Once done, write them for your records somewhere. You can maintain a
notebook to serve that purpose. Alternatively you may annotate the Kaplan books. Choice is yours.
Doing all of that would take quite a lot of time. Be patient. Dont rush through your study schedule or try
jumping ahead. Do justice to all your subjects. Remember subjects like Pharmacology and Microbiology
require constant attention. This means that as soon as youre done with your first pass, try to immediately
jump back to these subjects and revise them. Dont limit these subjects to a mere 3 or 4 reads. Its
indefinitely high yield to do as many quick reads of these subjects as is possible. This ensures adequate
retention of facts in your memory. You dont have to use question resources at this moment.
So the initial stage of your study is simply quick pass through the syllabus content + careful pass through
selected and difficult topics with extensive cross referencing from major textbooks and maintenance of
important pointers in a notebook. Dont try to be a copycat and emulate others timetables. Find the right
solution to studying yourself.
Intermediate stage:
This stage introduces the question resources. As already stated, you can rely on Usmlerx or Kaplan
Qbank. Although you can find illegally printed textbooks to these question resources, they dont give you
the advantage of mixing your questions, making random timed or self-paced blocks and maintain a record
of used and unused questions. As soon as MedEdia releases its questions resources free of cost, you
may like to check it out as well.
My recommendation would be to use either question resource, and try attempting questions systems
wise. If you just finished a revision of Biochemistry, hit the questions. Read the explanations to all
questions, pick up a notebook and write the important facts in that. Go through those facts at regular
stages. This would especially help you, in Biochemistrys case, learn all the rate limiting enzymes and
hormonal and allosteric controls. Allosteric controls form an important testing component and is especially
tricky to understand, especially in the whole context of all metabolic pathways.
Use this approach and apply to all subjects. You dont have to attempt the whole question resource, but
make sure you do attempt at least a sufficient number of questions. At this stage you may use either
timed or self-paced mode.
At the end, try and attempt an NBME exam. This should give you an idea where you land and how far are

you from your goal. Depending upon your goal and the difference from your goal, you can modify that
final stage of your preparation in whatever manner you like.
Final stage:

Once again, quickly hit Pharmacology, Microbiology and especially Behavioural science and revise these
subjects. At least go through remaining subjects once but the aforementioned ones should be given
special attention to because of the ease with which they are forgotten. Remember now your momentum is
very important. If you remain consistent in this stage, you would drastically improve your final score. If you
take breaks or delay your exam, you would only end up wasting time.
Now is the time to start usmleworld.coms question resource. Americans at this stage do 2 blocks of 48
questions (46 in real exam) everyday and spend time reading all explanations. They supplement those
explanations into First Aid. You can try doing that too, to good effect. Mix in another NBME and/or Usmle
world Self Assessment forms which have already been referenced to above.
Heres an important point: IF your NBME score is far off from your goal, NOW you may contemplate
delaying your exam. Always aim for the very high, but you have to have a realistic appraisal of your own
intellect and ability. You must have both a very high goal, and a very realistic goal. Its only you who can
tell you what your abilities are. NBMEs usually are a very accurate gauge of your performance. What they
state is approximately what your abilities are.
Keep using First Aid also, especially towards the week leading up to your eventual exam. Make sure you
have been following CTs, MRIs, photomicrographs, gross specimens and X-Rays all along because these
are heavily tested. Keep focused on learning heart sounds as well. Last but definitely not least, all those
notes you made into your notebook, using your own familiar handwriting towards the end of your
preparation would most likely keep your anxiety levels in check. Do not even think about opening a new
book at this stage.
When youre done with your Kaplan, throw those books away and concentrate only on First Aid and your
own notes from Kaplan and question resource explanations in last two weeks.
In your final day, you may take a day off after a stressful spell that spanned several months. Make a list of
things you need to take. Check your permit, Prometric appointment, passport and National ID card.

Some tips about what to do during your last day and exam day:
I had the biggest misfortune of totally screwing up my sleep the very last day. It wasnt anxiety. It happens
sometimes to me that I cant go to sleep even after 4-5 hours and by chance, it happened the very last
night too. Eventually I took a pill of Bromazepam, slept for 4 hours, and went to the exam. The whole day
was a battle with drowsiness. Energy drinks did some trick but really, my first and second blocks were
almost sacrificed which must have led to reduction in my eventual score.
I would advise you to take a sleeping pill the last night and ensure a good nights sleep. This is critically
important before your exam that drowsiness doesnt take over. You can use energy drinks during the day
of your exam but make sure you have used them before to be sure they dont end up causing diarrhea
instead during the exam