Elliott Campbell MD, Dermatology Resident at Mayo Clinic, Pastest question writer and high-scoring candidate, shares expert advice on how to devise an effective USMLE Step 1 study schedule.

Leading up to Dedicated - when should I start?

Studying for USMLE Step 1 (and all major board examinations) doesn’t just start during your Dedicated study period. This gives many students anxiety as they feel the need to specifically start studying for Step 1 in first year. The truth is that it is a balancing act – excel in school and be mindful that this information will be tested through…a test!

What I mean is that you must train your brain to frame information into differentials, which is how board examiners structure their questions. To do this, you have to know the information cold and integrate knowledge using a question bank, such as Pastest, throughout medical school. Every time you encounter a practice question, the writers have created a differential diagnosis which trains the brain to differentiate these entities. Training your brain to think in this manner early on will pay dividends on test day. So no, you don’t need to come up with a Step 1 study schedule during your first year. Rather, start utilizing the resources to learn the information in a way that will translate into not only clinical excellence but also high marks on boards.

How long should I take for my Dedicated?

Most second-year students will have a period of time without any classwork, termed the “dedicated study period”. To determine how long you should take, it is important to reflect on how much preparation you have put in prior to this period, as well as your goals. If you have put time into your course work but have not spent a significant amount of time using a question bank, it may be wise to take 12 weeks. If you have already gone through a question bank and have dedicated time throughout your second year with Step in mind, eight weeks is the maximum. Remember that you want to give yourself adequate time but not too much time. Burnout is real, and you will start to forget the information you learned at the start of Dedicated (more on this later). One last rule: once you pick a test date, try to stick with it. Unless you are on an upward score trajectory on your NBME practice tests AND haven’t reached your target score, it is better to take the test as planned.

Structuring your Dedicated Schedule

This is critical. Just like you have learned how to learn in medical school, it is important to learn how to learn for Step. This starts with a thoughtful and detailed plan of action (the Dedicated Schedule). I have shared my thoughts on how to structure Dedicated with many students and have received positive feedback once results have returned. There should be nothing “random” about this schedule.

Step 1 (determine your speed)

Ultimately, your goal will be in terms of number of completed questions. Ambitious students will complete two full passes through their chosen question bank. Those wanting to excel but not dominate will complete a full pass and then re-attempt those they got incorrect. Completing a single pass is likely enough to pass. You will want to determine how much time it takes for you to complete a question, process the information, and reference other study materials (First Aid, Sketchy, etc.). To do this, take a 20-question test, untimed, on tutor-mode. You can get an idea of how long your first pass will take based on this. Students take about two-thirds to half the time per question on the second pass. Regardless of whether you have already completed one pass through your bank or not, you will only have time for a single pass during your Dedicated. It is better to take your time through each question rather than trying to rush.

Step 2 (study time per day)

Determine how many actual study hours you can perform per day. This does not include eating, essential responsibilities, and recommended break time (hopefully with some form of exercise).

Step 3 (interval spaced repetition)

Break your content into categories by system and then identify the number of questions in the question bank per category. Determine the amount of time per category total. You will then divide that into several sessions and evenly space them throughout your Dedicated (interval spaced repetition is key). Give yourself two to four hours in the morning to review content in that category prior to starting questions. I highly recommend First Aid for this.

The following example will be based on an eight-week Dedicated Schedule. This student has determined that it will take six minutes per question. Two weeks prior to the exam will be discussed later and only a few categories are displayed for simplicity.

Practice Exams - how/when/what should I take?

It is imperative that students take multiple NBME full length practice tests throughout their Dedicated. These will monitor your progress, point out areas of weakness, and provide insight into the style of true Step 1 questions.

Here are a few hints related to practice tests:

1. Take the first test toward the beginning of your Dedicated (first two weeks). This may freak you out but remember that you have to start somewhere (it’s okay if it’s not the score you want).

2. Give at least seven full study days between these tests. You want to track improvement and it takes at least seven days to see improvement.

3. Avoid taking one within seven days of your test. It will only freak you out and is of little benefit.

4. Review your tests in detail!

5. Take these tests like they are the real deal. Should be at the same time as your Step, in a quiet environment, and timed (do not take the untimed version).

6. Do not plan to study anything else that day. This will take the entire morning and reviewing the answer choices in the afternoon. Hopefully you will get some time to rest in the evening (these are exhausting).

7. Don’t let these dictate your study schedule. Keep to your schedule, even if you do poorly on a certain system. There will be time during the last two weeks (see ahead) to focus on these areas for improvement.

Two weeks before the exam

You are almost to the finish line! Take a deep breath. You should hit each system during this time. Only plan on completing half the number of questions per day (double your predicted time per question). This will allow for overflow and increased time reviewing content (First Aid time).

Block off three days. You will thank yourself later. Try to forget these exist (don’t “plan” on using these when not meeting your goals early on). This will be used for several reasons:

1. Brushing up on your worst subjects (as deemed by the NBME practice tests).

2. Spill over from days you didn’t meet your question goals.

3. Reviewing any notes you have accumulated for brute memorization or other study materials.

The day before the exam

This really depends on your personality type. If you are a person who can relax, DO IT! If you are a type-A person like me and relaxing would cause more anxiety, brush up on a few details throughout the day.

Some other helpful hints:

1. Don’t try to go to bed way earlier than you usually would. You will likely not be able to get to sleep and not being able to sleep will freak you out (leading to very little sleep before Step!).

2. Don’t hit a question bank that day. You can brush up on some details for memorization if you please.

3. Reach out to loved ones, get some good vibes going.

4. If possible, try to exercise. It’s good for the brain.

Hope this proves useful and thanks for reading!

Elliott

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