USMLE Step 1:
The biggest problem with Step 1 is the amount of information to cover and memorize. The only way to succeed in retaining such amounts is through spaced repetition. Hence you see the extreme number of passes over First Aid (FA) and the UWorld Question Bank (UW).
The number of FA passes mentioned below doesn’t take into account any reading of FA I used to do for the university exams.
I usually recommend people to plan way in advance. When planning your studying schedule, start from the exam date and go backwards, giving yourself a reasonable amount of time to go over everything you want. This is always the best way to plan (just like for university exams but on a much larger scale). Don’t forget to include catch up days in your plan (free days to catch up to your plan), because unfortunately, however reasonable a plan is, it is very difficult to follow it perfectly.
As you will see in the plan below, the number of study hours should increase gradually. Just like physical training, you need to build stamina and endurance gradually in order to gain the ability to study for hours on end close to your exam date.
The most difficult thing about the USMLE Step 1 is the long and draining preparation, not the test itself. Once you go through months of prep solving thousands of Step 1 style questions, the exam itself is doable. Try to keep that in mind.
Some have asked me about finding motivation to study, and the reality is that nothing I will say will give you enough motivation to study for months. You must find your own reasons. Literally sit down with yourself and think about the reasons you want to do the Step 1, and answers like to do residency in the US are not enough, go deeper than that, and convince yourself that this is what you want to do, and you’re not just doing it because everyone else is. In the end, it is important to have your intentions or niyyah well-defined, and whenever you do anything with the right intentions for the right cause Allah will make it easy and reward you upon your efforts.
This is my personal timeline with minor modifications for clarity.
FA 1st pass: Priority is getting familiar with the concepts in FA using extra resources if necessary (e.g. pathoma, youtube, google, khan academy, BRS physiology, Kaplan, etc.). The objective is to understand any new or difficult ideas mentioned in FA with minimal memorization. Timeline: 3-4 months during academic year. [Approx. 12-15 pages a day, 3 days a week]
FA 2nd pass: Increased emphasis on memorization while revisiting the different ideas in the book. Timeline: 5 weeks during the summer (can also be done 10 weeks during the academic year). [Approx. 20 pages a day 6 days a week during the summer OR 10 pages a day, 6 days a week during the academic year]
UW 1st and FA 3rd passes: For the next 6-7 weeks, I was doing UW for the first time and FA for the third time, dividing my days between both (details in the comments below). Timeline: 6-7 weeks during the summer. a. UW 1st pass: Answering mode: tutor and untimed. Finished systems first, then went on to basics (didn’t do the questions randomly). Example: Under any system (say Gastro) I would choose: Anatomy, Embryology, Histology, Physiology, Pathology, Pathophysiology, and Pharmacology (basically following how the chapter was organized in First Aid). I would leave out the remaining subjects under Gastro (e.g. Biostatistics, Microbiology, Biochemistry, etc.) to be done separately later on according to First Aid’s basic subjects' chapters after finishing the systems. Once I solved a question, there were one of 5 scenarios: - Answered the question incorrectly. Repeated under “incorrects”. - Answered the question correctly by chance or without confidence. Marked for repetition. - Answered the question correctly with confidence, but wanted to repeat for: 1) a very nice question that really challenged my thought process, 2) some concepts were very nicely described in the explanation and I wanted to read it from there again, or, 3) the explanation summarizes multiple diseases in a very nice manner, and I wished to read it in the same way again. Marked for repetition. - Answered the question correctly with confidence, and apart from a small idea that is new, I felt comfortable with the question, explanations and concepts described. Wrote that new idea in my FA/Created UW flash cards. Did not mark or repeat the question. - Answered the question correctly with confidence, and after reading the explanations I felt comfortable potentially answering similar questions in the real exam without going over the same material again (usually the explanation to these questions are covered in FA). Highlighted in FA. Did not mark or repeat. b. FA 3rd pass: Familiar with most concepts by now, trying not to leave a page without having it memorized. [Approx. 60 questions and 15 pages a day, 6 days a week]
UW 2nd pass: I only repeated the marked and incorrect questions (as described above, which for me added up to around 1800 questions). Timeline: 3-4 weeks during the summer. [Approx. 100 questions a day, 6 days a week]
FA 4th pass: Last review. Brushing up on the knowledge and rememorizing the dry facts one last time. Timeline: 2 weeks. [Approx. 50 pages a day, 6 days a week]
As you can see, the bulk of studying was done throughout the summer break. Based on the experiences I have witnessed; I believe that summer studying is much more productive and valuable compared to studying throughout the academic year.
As you can see in the timeline above, I believe that for most students, 4th year and the summer between 4th and 5th year are the best time to dedicate your studying for Step 1, with the exam ideally being at the end of the summer. If possible, DO NOT WAIT TILL THE SUMMER AFTER 4th YEAR TO START. Your studying likely will continue to drag along throughout 5th year.
Recommendation: Every time you start reading FA, start reading from the systems then read the basics. Rationale: we are much more familiar with the systems than we are with the basics. This allows us to read through and understand the systems a lot faster than the basics. The faster pace gives us a confidence boost as we finish more than half the book before having to go over the dry and somewhat unfamiliar basics [the order I used to follow with minor changes every pass, keeping in mind that I always wanted to go over the things I am weakest in towards the end: Basic pathology > Systems from strongest to weakest ending with neurosciences and psychiatry > Basic pharmacology > Immunology > Biochemistry > Microbiology > Public Health].
Recommendation: Read FA cover to cover 1-2 times before starting UW. This is an arguable point as many of my successful colleagues have approached integrating UW differently. Rationale: FA is the primary resource that contains most of the information required to perform well on Step 1. UW is an exceptional resource that allows you to understand some of the hidden FA concepts and adds to the knowledge provided by FA. Without knowing the content of FA (by going over it 1-2 times), how will you know what to do with the plethora of information provided in UW? You will find yourself writing down notes from UW and later realizing that these notes are already mentioned in FA, thus, wasting valuable time.