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First-Year Step 1 Study Plan: 6 Burning Questions Answered

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by Alec Palmerton, MD in Beginners, Plan

Medical school is challenging enough. Are you supposed to create a first-year Step 1 study plan, as well?

The short answer: yes!

The foundation for high Step 1 scores begins long before your dedicated study.

The most successful ways to prepare, however, are not what you would expect. They are not what many of your seniors have told you.

Here, I go through six first-year Step 1 study plan questions. I address how to prepare best:

  • For Step 1 during the first year
  • During the summer between first and second year, and
  • Leading up to your dedicated study period.

Some of these questions pertain specifically to first years. Many apply to any preclin, including those of you in your dedicated study period.

Also, some of the questions assume you are already using Anki/spaced repetition. If you are unsure of what Anki/spaced repetition is, check out this article here.

If you are looking for guidelines on productive Step 1 study, check out this article.

First-year Step 1 study plan: when to begin?


I have your Step 1 Anki cards, but when should I start studying for Step 1? Many second years say not to start too early because we will forget the information by crunch time. However, from reading your articles several times, something tells me that would NOT be your advice. 

The general advice for first-year Step 1 study plans: don’t study for Step 1!

It stems from the belief that anything that you learn now, you’ll forget.

Thankfully, that is not true. Spaced repetition is efficacious, especially with the Step 1 Anki cards that you purchased. The Step 1 cards will help you address common weaknesses. They will also give you a template for making your cards (more later).

The best first-year Step 1 study plan? Don’t view studying for Step 1 as separate from studying for your classes. Regardless of the school, Step 1 and class material overlap a lot.

Most schools test rote memorization and facts. Step 1 tests the integration and application of information.

The best news is that even though your school may present disjointed information, you can still learn the pathogenesis to presentation behind the ideas.

What is pathogenesis to presentation? It’s how you should be learning if you are tired of memorizing details without understanding the concepts behind them. If you can understand a disease’s presentation from its pathogenesis, you do better in less time. You can read more about pathogenesis to presentation here.

The Step 1 Anki cards will save you time in three ways. First, I’ve integrated the information for you, so you can spend your time learning, not culling through UFAP trying to understand each disease. Second, with spaced repetition, you won’t have to waste any more time re-learning information. Finally, you will accelerate the learning process by using my cards as an example when making your own.

Remember: your approach is much more important than how your school presents the information.

Balance Step 1 Anki with coursework

How do I balance Step 1 Anki studying with coursework? I’m worried about devoting too much time to reviewing flashcards I’ll fall behind in my classes.

Spaced repetition overwhelms many first and second years. Decks with tens of thousands of cards are most likely to overwhelm you.

Anki/spaced repetition can derail a first-year Step 1 study plan in three ways.

  1. You view Step 1 studying and school studying as separate (see above).
  2. You believe Step 1 is all about memorization.
  3. There are too many time-sucking low-yield reviews.

To overcome these obstacles, treat your coursework studying as synonymous with your USMLE preparation.

Second, focus on higher quality cards. The Anki decks concentrate on concepts and integration. As a consequence, you need fewer reviews and recall more.

If I break a topic into many short cards, each of those cards is simple to remember. However, these simple cards create two problems.

  1. Each card exists in a vacuum. The reviews will be harder to remember if I can’t relate facts to each other. Plus, in Step 1 questions on integration/understanding, I will struggle.
  2. Without integration, I must create many more cards.

Focus on making fewer, high-quality cards per day. 40-50 is a reasonable start. Cards that integrate and apply deepen your learning. Plus, fewer cards accelerate review time.

How to do Anki for old blocks

How do I review the Anki cards for older material after I begin a new block? It is challenging to make/review cards for the current block while keeping on top of the previous material.

The ideal first-year Step 1 study plan involves mastering new material and retaining old.

Doing your Anki reviews for the current block while making new cards is daunting. The challenge is to keep up with the old reviews, as well.

The key is to make fewer, but higher quality cards. Let me give you an example.

If I memorize every third line from a PowerPoint, I may have 50+ cards from each lecture. To keep up with this, I’d have 800+ daily reviews in no time.

Low-quality reviews are an enormous time drain.

Instead, set a limit for new cards that you make for each lecture. This forces you to focus on high-yield information and integration.

First Aid: when to start

Should I use First Aid in conjunction with first-year classes? How should I use it if I am not supposed to read through it?

Rumor has it that First Aid was first made by asking students what was asked on their Step 1. Then the authors wrote notes so that future students could answer similar questions.

Why is this relevant to your first-year Step 1 study plan?

Because reading First Aid alone is very confusing.

Instead, use First Aid as a target.

Professors may not highlight the things that are most relevant for Step 1. Instead, it is up to you to figure out which of the items are most applicable to Step 1.

To do this, scan through First Aid either right before or during the lecture. Make sure to blanket the significant Step 1 points. By the end of every class, master the material in First Aid relevant to that class.

Read more about the best practices for First Aid for Step 1 here.

When to begin QBanks?

You mentioned that you started with Kaplan Q bank to identify your gaps. You used Anki to retain the pathogenesis to presentation to get future questions right.

Should I start using Kaplan Q bank at the start of my second year? I’m worried because I haven’t covered all the material yet. If not, when should I start using Q banks to do what you did?

My first-year Step 1 study plan involved no QBanks. Instead, I started the Kaplan QBank during the fall of my second year.

My goal was to peek around the corner and see what was ahead. Many pre-clinical professors would say things like, “this is high yield.” Or “you need to know this for Boards.” But I had no idea if they were right.

I also didn’t know the Step 1 question format.

You can talk all day about what a USMLE question is like. But until you see USMLE-style questions, it’s not the same. I did one full block of problems for every organ block we covered our second year.

Don’t feel overwhelmed if you can’t do many Qbank questions during your second year. I had finished 25% by the time I began my dedicated studying. That was more than enough.

Summer Yousmle Anki integration

This coming Summer, I was planning to devote an hour a day reviewing your Step 1 Anki deck. Should I use the cards that I have not yet covered in class? Or should I focus on the first-year subjects (e.g., micro, immunology, etc.)?

Save second-year work for your second year. Instead, use the Step 1 cards to shore up your most significant first-year weaknesses.

Let’s say I had ten first-year and ten second-year subjects. If I tried to learn all 20 during the summer, I would fail. Even trying to re-learn my ten first-year topics would be overwhelming.

My summer Step 1 study plan was different. I knew that mastery takes time. I could only learn a limited number of topics during dedicated studying. Thus, my goal was to limit the number of things I had to learn during this period.

First Year Step 1 Study Plan Summer Yousmle Anki

Summer plan: use the Yousmle Anki cards to turn your biggest weaknesses into strengths

During the summer, I focused on mastering my three weakest first-year topics. These were genetics, embryology, and respiratory. My goal was to learn these so well that I wouldn’t need to cover them again during my dedicated study.

Then during Thanksgiving/winter break, I’d learn two more weaknesses. (You can find the Winter Step 1 study plan here). I chipped away at my gaps until only a handful remained.

Because I also kept up with my second-year classwork, my weaknesses diminished. In creating more and more strengths, I had a manageable amount of work for dedicated study.

In the same way, you can use the Step 1 cards to strengthen your weakest topics. The Step 1 cards will teach you fundamental knowledge. Because they use spaced repetition, you will spend less time reviewing it.

You should also start with a QBank during the summer. I would recommend Kaplan, to save UWorld for dedicated studying. As in my above response, use the Kaplan QBank to identify your gaps and preview the Step 1 format.

Then, create your own cards to fill in remaining gaps.

If you want ideas to fill in your gaps, I would suggest this article.

  1. Nelson says:

    Hello Alec,

    I’ve been a subscriber for a while and in general find your website useful, but I’m having an issue that you don’t explicitly address in any of your articles. I messaged you privately but you said (I’m assuming auto reply) that I should post on the website so here I am.

    You said in another article that learning from the First Aid is very difficult/impossible and that one must understand the why and not just the what of things. Since First Aid just gives you a collection of facts it’s not the best resource to outright learn. I’m assuming the same applies to most/all other review books out there.

    My education in my school hasn’t been all that great and I’ve made it worse by not applying myself more to my independent studies previously. So I wanted to ask you, how would you suggest approaching the learning of material? How would you suggest filling the knowledge gaps that I have? I bought your Anki decks a while back and while I find them very well made after trying to use them I found myself spending hours every day trying to do the normal 20 cards because I just didn’t know what the cards were talking about. I have a fair amount of USMLE books and other textbooks but there’s so much to cover that I just don’t know how to tackle it.

    I want to learn a lot of the things I’m supposed to know but don’t to my lack of effort in the past. I want to actually learn those (many) concepts instead of memorizing them. If you could please give me some advice as to how to approach this problem I’d really appreciate it.

    Thank you for your website and all you do and I look forward to your response.

    1. Yousmle says:

      Great question! I’ve addressed this question before, particularly here:

      If you have any other questions, let me know!

  2. Love says:

    Hey Alec,

    Great article. I’ve loved this blog and it’s been incredibly helpful during my 1st year. Anki has been amazing. I did really well 2nd semester because of it. Could you do an article focusing on qbanks? (Kaplan and UWorld). Also could you discuss how you integrated them into studying during the school year and could you give pointers on how you approached a questioned you had gotten wrong and turned it into a flashcard. I feel that sometimes reviewing a TLE takes a really long time. Thanks so much in advance

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.