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6 Burning Questions for USMLE Step 1 Studying During Your First Year of Medical School


With the FREE micro deck of more than 130+ Anki cards you will be practically BEGGING to get as many micro questions on your exam as possible.

You may feel that the first year of medical school is difficult enough without considering how you might be preparing for Step 1 of the USMLE.  However, as anyone who has scored well on the exam can tell you, the foundation for their success began long before their dedicated study period.

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

Here, I go through six frequently asked questions by first year medical students about how to best prepare for Step 1 during their first year, during the summer between first and second year of medical school, and in the period leading up to their dedicated study period. While some of these questions pertain specifically to first years, many of them are applicable to both first and second years, including those in their dedicated study period.

1) When should I start studying? I know many second years in my school say not to start too early because we will forget the information we study by the time it gets closer to crunch time, however, from reading your articles several times, something tells me that would NOT be your advice. 

This is a very loaded question. The advice that you are hearing from second years is very common, and stems from the belief that anything that you learn now, you’ll forget. As you well know, that is not true, when you have the powers of spaced repetition behind you, along with the Step 1 Anki cards that you purchased, which will help you to address the most common weakness is that students have in their preparations for the USMLEs.

My advice is that you don’t view studying for Step 1 as separate from studying for your classes. Regardless of the school, I found that there is a lot of overlap between class material and USMLE material than most people are willing to admit. The key is to recognize that most schools are testing you on rote memorization, and facts, while Step 1 will be testing you on the integration and application of information. The best news is that even though your school is presenting most likely disjointed information, you can still learn the pathogenesis to presentation behind the ideas, first by starting with the Step 1 Anki cards that you have, and by supplementing it with other resources that you have available to you. I found it much more important than the information that is presented to you in medical school is your own approach and attitude towards your learning.

2) Maybe you can tell us how to efficiently balance studying for step using anki while doing our coursework at the same time, in a reasonable way such that we don’t fall behind in our classwork because we are devoting too much time reviewing flashcards that are high yield for step.

This is one of the most difficult questions to answer. Most people that attempt to use spaced repetition of any kind, particularly any service or deck that starts with tens of thousands of cards, typically is quickly overwhelmed during their preclinical years, before they begin studying for Step 1. The reasons are many, but two of the main ones are that they treat their studying for USMLE as separate from their school studying, and they are either making or using too many cards.

First, as mentioned previously, I would treat your studying for school as part and parcel with your USMLE preparation. Second, focus on higher quality cards, like the ones that you have been finding in the Anki decks, rather than cards that take small amounts of information in each card, but have lots of individual cards. Decks that force you to memorize a lot of discrete facts will be more difficult for long-term attention, but they will also cause you to create an unnecessary number of cards.

Instead, if you focus on making fewer cards per day, like in the 40 to 50 card range, but focus on making integrated, applied cards, you will find that you should have enough time to both learn new information, while simultaneously keep up with everything that you have learned previously.

3) Should I be making Anki cards for my courses? If so, how do I review the older material after I begin a new block? I don’t see how I can feasibly make cards for the current block, review them each day, and also review old cards for previous blocks so that I can retain all of the material.

You may be wondering if you haven’t been using Anki from the beginning, how can you go back and learn other subjects that you haven’t covered in the past? The best news is that the cards have been set up to focus on the information the students are least likely to know, and most likely to struggle with on the USMLEs.

So let’s say that you covered cardiology and pulmonology during your first year of medical school, but didn’t start using Anki until your second year. I would first do the cards for whatever block you are on currently (i.e. do the renal cards if you’re studying renal), then go back and do the cards from your previous blocks for which you don’t have your own cards yet (i.e. go back and do the cardio/pulm cards once you’re done studying the renal cards). Then once you’re finished with my cards, you can tailor your own cards to whatever gaps there might be remaining that are specific to you. That way, you don’t have to be duplicate cards that I have already made, and can build off of the knowledge that you will gain from the cards from that particular section.

4) Should I be using FA beginning my second year in cohesion with my classes? How exactly should I be using it if I am not supposed to just read through it?

Use First Aid as a means of knowing what you should be learning along with their classes, like a target. Oftentimes, professors may not highlight the things that are most relevant for Step 1, and it is up to you to figure out which of the things are most Step 1 relevant. The best way to do this is to quickly scan through First Aid either right before or during the lecture, to make sure that you are getting the major points that are covered for Step 1. Then make sure that by the end of the day, that you have covered all of the major information in whatever relevant sections of First Aid there were.

5) I know you mentioned that you started with Kaplan Q bank, and tested yourself on your knowledge, and used Anki cards to retain the pathogenesis to presentation so that you would remember the underlying concept, so as not to get a question wrong on the concept in the future. Should I start using Kaplan Q bank starting the beginning of my second year, even if I haven’t covered all of the material yet (for example my MS2 yr covers path, pharm, behavioral science, etc)? If not, when exactly should I start using Q banks to do what you did?

I started the Qbank from Kaplan during the fall of my second year. I honestly didn’t do many questions during my second year, but it was useful to see how they were asking questions, since you can talk all day about what a USMLE question is like, but until you really see one, it’s not the same. I would try and do one full block of questions for every organ block you are doing, but do not feel overwhelmed if you can’t do many Qbank questions during your second year. I had finished 25% by the time I had begun my dedicate the study period, and that was more than enough.

6) Over this coming Summer, I was planning to devote an hour a day reviewing your STEP 1 Anki deck. Should I review the cards that I have not yet covered in class? Or should I just review the subjects that I have already covered my first year (e.g. micro, immuno, etc), and wait until I cover the other subjects during my school year?

Congratulations on your purchase of the Step 1 Anki cards! The Step 1 cards are set up to hit the information that you are least likely to know, and that I’ve found students struggle with the most on their QBanks, NBMEs, and USMLEs.

I would first use the cards to cover topics that you’ve already covered in class during your first year, and if you have time, you can use the cards for learning ahead on topics that you are going to cover later. There will be plenty of time to do those cards, however, so I would instead focus on consolidating your knowledge from your first year by using the Anki cards, and supplementing that information with your own cards to fill in whatever gaps might be remaining.

If you want ideas and how to best fill in gaps for things you don’t know, I would suggest the following article:

Nailing the USMLE Step 1 Fundamentals (#4 Helped Raise My Score to 270 from 236 First NBME Practice Exam)

Thank you again for the wonderful questions, and for your kind words. Best of luck with your preparations of the summer, and keep me posted on your progress!




With the FREE micro deck of more than 130+ Anki cards you will be practically BEGGING to get as many micro questions on your exam as possible.