How to Study for Step 1 in 2022

USMLE^® Step 1 has long been regarded as the most important test that prospective M.D.’s and D.O.’s will ever take. If you are taking the exam in 2022, your score on Step 1 is the number-one factor that program directors will use to evaluate your application for residency (this is expected to change when Step 1 moves to pass/fail scoring in January 2022).

How well you do on the medical board exam depends mostly on making your Step 1 study plan, which includes designing your Step 1 study schedule, learning how to study for Step 1, and choosing the best Step 1 study resources for you. The exam covers a vast range of minutely detailed scientific knowledge and tests your ability to apply it in a medical context, so you will need to design your Step 1 study plan to optimize both memory retention and knowledge integration.

It will also be important to get as familiar with the Step 1 format as you can and to train with endurance and timing in mind. As with most standardized exams, it’s just as much about the test as it is about what you know.

Deciding how to study for Step 1 can be difficult, but as over 20,000 med students take the exam every year, there is a wealth of knowledge available about which Step 1 prep strategies work best. Whether you’re studying for Step 1 during first year or your testing date is just a few months from now, we’ll set you on the track for success with our Step 1 study tips backed by advice from a practicing M.D.

When to start studying for Step 1

It is most common to begin studying for Step 1 during your second year of medical school. However, some past examinees recommend that you begin preparing for Step 1 during your first year—if only enough to become familiar with which topics are covered on the exam while you’re learning them for the first time in lecture. There are good arguments for both:

Beginning study for Step 1 during first year...

• Lets you get to know the exam while pressure is still relatively low
• Helps you make connections between Step 1 content and what you’re learning in lecture
• Allows you to begin writing annotations in your Step 1 review book so you can more easily revisit that knowledge the following year

Beginning study for Step 1 during second year...

• Lets you focus on learning basics without getting distracted by Step 1 during first year
• Makes it more likely that your Step 1 study habits will have structure and consistency
• Ensures that the knowledge will be fresher in your mind on the day of the exam

How long to study for Step 1

Most medical schools have a six-week period dedicated to studying for Step 1 (commonly known as “dedicated”), but if you’re like most people, you’ll almost certainly want your Step 1 study timeline to begin sooner than your school’s dedicated Step 1 study period.

However, it is not recommended to begin spending multiple hours a day studying for Step 1 any sooner than six months before your exam date. There is an element of diminishing returns at play here.

When we asked Thomas Oswald, an emergency physician who earned his M.D. at the University of Utah, he told us that “roughly a five or six month study plan” worked well for him and allowed him to spend an average of two hours a day studying for Step 1.

On studying for Step 1 any longer than six months, he says, “There comes a time that you become so saturated with minutiae that you can only keep in your brain for so long. Plus, you still have to keep up with learning new material in lecture up until the study period. Step 1 demands that you are able to recall a lot of disconnected scientific facts from memory, but if you haven't seen the material in over six months, you’re not going to remember it as well.”

Depending on your personal study style, you may need as little as four weeks to study for Step 1. This will, however, mean exhaustingly lengthy study sessions, which tend not to be as beneficial as shorter, more spaced-out sessions.

“There were about 12 people in my class who were able to study for Step 1 in one month,” Oswald reflects. “If you’re that rare type who can just buckle down for eight to ten hours a day in the library, then one month might work for you; but if you want to study for a couple hours a day, you will need five or six months.”

Making a Step 1 study schedule

Your Step 1 study schedule should be planned around realistic, measurable goals that you have control over. You may not be able to predict how long it will take you to consistently meet your target score on USMLE^® Step 1 practice tests, but you can easily estimate how much time you need to work through a specific amount of practice questions.

However, the total length of time you spend studying for Step 1 will not have as much of an impact on your score as much as the total number of Step 1 practice questions you do, so the best Step 1 study plan will likely involve setting a target number of questions and then figuring how much time you need to work through them.

“My whole Step 1 study schedule was built around getting through an entire question bank twice,” Oswald says. “There were 2,500 questions in the bank I was using and it normally took me about an hour to work through 50 questions, so I figured it would take me about 100 hours to get through the question bank twice. From there, it was pretty easy to do the math to know how many months I’d need to meet my goal.”

Beyond the time it takes to work through blocks of questions, you will also need to account for the hours you’ll spend reviewing your answers—especially when you don’t know why an answer you’ve given is correct or when you have given an incorrect answer. In addition to reading answer rationales, it will be helpful to bolster your understanding of question topics by looking them up in a Step 1 review book.

Reviewing your answers and question topics will most likely take up a majority of your study time. Even if you’re spending an average of five minutes reviewing each answer, that can easily add multiple hours to your Step 1 study sessions

Of course, your Step 1 study schedule should account for days off so you can avoid burnout and maintain your mental health. Studying for Step 1 can be a gruelling experience, but your brain still needs to rest and your studying won’t be as effective if you are completely exhausted. No one can go on all cylinders all the time, so don’t demand that of yourself.

Allocating your Step 1 study time

You may decide to design a more detailed Step 1 study schedule around how much time you want to spend working within each content area tested on Step 1. The rates at which questions from each content area appear on the exam are listed on the USMLE^® Step 1 Content Description, so you might divide your Step 1 study time accordingly.

For example, since you can expect 44-52% of the questions on Step 1 to be about pathology, you might allocate more time studying that content area than, say, biochemistry and nutrition (14-24%) or biostatistics and epidemiology (4-6%). However, as low-yield material tends not to be covered in as much depth during lecture, you may want to give more attention to these areas to compensate for that.

It should be noted, though, that focusing your studies on one Step 1 content area at a time may be more beneficial when you begin studying for Step 1 rather than closer to your testing date. While it may be a good idea to target high-yield material or your knowledge gaps, the Step 1 exam does not present questions in any set order—so you’ll be better adjusted to the exam’s format if you shift to a more comprehensive and randomized approach toward the end of your Step 1 study schedule.

Then again, a comprehensive approach might work best for you from the very beginning, as it did for Oswald. “I didn’t divide my Step 1 study schedule by content area—I just worked with all of them at once,” he says.

How to study for Step 1

Putting your Step 1 study plan into action through intentional habits is every bit as important as designing and adhering to a study schedule. When possible, your study strategies for Step 1 should reflect the content and simulate the format of the exam as closely as you can manage—right down to the testing center environment and time limits.

Though Step 1 is entirely composed of multiple-choice questions, they require you to think in different ways in order to answer them. Some questions will ask you to recall scientific facts from memory, but most will ask you to apply scientific knowledge to problems that require multistep reasoning.

“When I took Step 1, less than half of the exam tested memorization,” Oswald remembers. “The majority of it is two-step reasoning. For example, they might give you a clinical vignette and then ask which detail is a risk factor for a specific disorder, but you’ll need to have figured out the diagnosis before you can do that.”

Memorization techniques are certainly an excellent way to keep facts and vocabulary fresh in your mind, but you should make sure to spend most of your time applying what you know rather than recalling it.

Step 1 study environment

Choosing the right study environment can have a positive impact on your Step 1 performance on test day. As testing centers are notorious for denying you the comforts you’re used to having at home, you might want to take a few weeks to adapt to a similar study environment so you can perform as well as you can in spite of the starkness.

“What helped most when I was doing Step 1 practice tests was to go to an environment that simulated a testing center—like a little, uncomfortable study desk in the library,” Oswald says. “I wouldn’t allow myself to have coffee, soda, or gum, or to have my own music playing. I just tried to recreate that testing experience as much as possible.”

Step 1 pacing strategy

Since the testing session for Step 1 is eight hours long and each block lasts 60 minutes, it is important to factor pacing into your Step 1 study strategy. The Step 1 exam has a total of no more than 280 questions divided into seven blocks of no more than 40 questions each. Ideally, you’ll want to get to a point where you aren’t spending much more than one minute answering each question.

Oswald’s Step 1 pacing strategy involved reading only as much of a vignette as he needed to give a correct response. “I’d jump straight to the last question in the question stem, and then read the answer choices,” he says. “Most of the time, you won’t need to read the whole vignette to know the answer—and most of the time, you won’t want to. There’s going to be a lot of skimming involved; if you read every word of every vignette, you’re going to run out of time.”

Since the Step 1 testing session is so long, you will more than likely experience fatigue toward the end of it. That’s why it’s a good idea to build your endurance by completing a few full-length Step 1 practice tests in the weeks leading up to your exam date.

Step 1 study resources

One of the most valuable study resources you can have is a current edition of the Step 1 review book, First Aid for the USMLE^® Step 1. Though there are plenty of great review books available (such as Pathoma, which has its own video lecture series), First Aid is consistently ranked as the most popular and trusted. The topics it covers are based on contributions from thousands of students who have taken Step 1, and it is updated each year to reflect the highest-yield content.

As with any Step 1 study resource, review books are best used in conjunction with other learning methods. A tried-and-true study technique is to use First Aid as a reference alongside question banks to ensure you have a thorough understanding of the topics you’re working with. When reviewing your answers, look up the question’s topic in First Aid and make annotations.

Many students who have taken Step 1 also recommend purchasing a copy of First Aid immediately before your first year of medical school, and to begin annotating topics in the book as you learn them in lecture. “I didn’t know a single person in med school who didn’t have a heavily marked-up copy of First Aid,” Oswald says. “It’s one of the best resources you can have.”

Step 1 question banks

Step 1 question banks (or Qbanks) are essential Step 1 study resources, and are a normal feature of most online Step 1 prep services. Qbanks for Step 1 are an excellent way to practice answering the types of questions that appear on Step 1, as well as to discover any knowledge gaps you have. They may also serve as the foundation on which you build your Step 1 study schedule.

Though everyone in your class may be required to purchase the same Step 1 question bank, you might want to consider working with one or two others in addition to that one.

Benefits of using multiple Step 1 Qbanks:

• Allows you to ramp up the difficulty of your Step 1 practice questions as you get closer to your exam date (Qbanks vary in difficulty)
• Ensures more thorough coverage of Step 1 content (Qbanks do not cover content in equal depth)
• Gives you more exposure to rare Step 1 topics (Qbanks may each have only a few questions on a rare topic—you’ll work with that topic more if you’re using multiple Qbanks)

Besides reviewing question topics and answer rationales with the help of a Step 1 review book, it is important to determine the reasons for any incorrect responses. Was there a gap in your knowledge? Did you misunderstand the question? Were you misled by a distractor? Being aware of why you chose a wrong answer can prevent you from making similar mistakes on the Step 1 exam.

Step 1 mobile apps

Unscheduled Step 1 study time is a great way to keep your head in the game, and Step 1 mobile apps make it easy to jump into a short, impromptu study session no matter where you are. Firecracker and Anki are popular options in this category, especially for their Step 1 flashcards. As with Qbanks, many online Step 1 prep services include mobile app access with a subscription.

“I used an iPhone study app,” Oswald says. “I could go sit on a bike at a gym and bang out a block of questions. On a camping trip, I could grind through 15-30 questions in the car. Even if you can’t follow your schedule exactly, you can still be consistent and keep the material relatively fresh.”

Step 1 audio lectures

If you need to give your eyes a break or you just want to switch up your mode of study, audio lectures on Step 1 material are an excellent way to do that. However, they’re best used as a supplement to more active modes of study that require you to apply your medical knowledge and problem solving skills.

Edward Goljan, M.D. is well known for his audio lecture series on pathology (the largest content area on Step 1). Though it was recorded in 2002, it is still lauded as one of the best Step 1 study resources out there. It is widely available via streaming services and other avenues online. “Goljan’s audio lectures were amazing,” Oswald remembers fondly. “I’d just have them playing in my car on repeat.”

If the lectures you attend in person are recorded (or if you have a way to record them yourself), you should not neglect these for the valuable Step 1 study resource that they are. You can review them more efficiently by using an audio player that allows for sped-up playback.

Step 1 practice tests

There is no better way to predict your Step 1 score than by your performance on Step 1 practice tests. This is especially important if you are studying for Step 1 in 2022 and taking the exam this year, since your performance will be reported as a numerical score. The exam will move to a pass/fail format in January 2022 at the earliest.

Though the minimum passing score for Step 1 is 194, you should be aware that residency programs typically have cut-off scores for Step 1 that determine whether they will grant interviews to applicants. These cut-off scores will differ depending on the specialty you plan to pursue.

While online Step 1 prep programs allow you to simulate taking Step 1 with their Qbanks, you should absolutely include the official NBME Self-Assessments among the practice tests you take because they are written by the same people who write the actual Step 1 exam. No other practice tests will give you a more accurate representation of what to expect on Step 1—both with regards to its content and how you are likely to score.

There are six forms of the NBME Step 1 Self-Assessment available, and though it’s up to you how many of them you take, you should take a different one each time to ensure you are only given unfamiliar questions (as will be the case on the real exam). It’s also a good idea to space them out rather than take them all in a short time frame; this way you can more accurately gauge your progress toward your target score based on the scores you achieve on the practice tests.

“I bought four of them and did one every six weeks in the time leading up to the exam,” says Oswald. “Use them wisely. Treat them like the actual exam and to take them in an environment that’s as much like a testing center as you can find.”

Another benefit of taking NBME Self-Assessments is they can give you insight into the topics that appear on Step 1 most frequently. “If you do enough practice tests, you start to recognize recurring themes in the medical conditions that the test writers like to ask questions about,” Oswald says. “There aren’t as many ‘testable’ topics as you’d think—there are too many gray areas in medical science and there can only ever be one right answer on Step 1. I remember Auer rods in hematology kept showing up a lot when I took it.”

The NBME has also recently started including answer explanations for correct and incorrect answers on their Self-Assessments, making this invaluable study resource even more useful.

Final thoughts

A carefully thought-out Step 1 study plan—including your study schedule, habits, and resources—will be the key to achieving your best Step 1 score. You’ve probably heard it before, but studying for the medical board exam is often compared to training for a marathon: it’s about learning to pace yourself and making incremental improvements over a long span of time.

Again, be sure to take care of yourself, conserve your energy, and make time to rest and recharge. It may be tempting to isolate too much, sleep too little, or to respond to the stress of Step 1 by overpreparing, but this can easily backfire in the form of burnout. “Set boundaries and don’t let it be all-consuming,” Oswald advises. “Don’t start too early in terms of your dedicated studying.”

Lastly, know that your peers in medical school can be your most valuable resource. The support and camaraderie of other people having the same experiences can get you through the toughest of times, so make it a point to reach out—find a study partner or organize a study group early on. It’s also never a bad idea to ask students in years ahead of you what worked best for them.

If you’re just beginning to study for Step 1, the USMLE^® Step 1 Practice Materials page is a great place to start.