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How Long to Study for USMLE Step 1 Pass-Fail

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by Alec Palmerton, MD in Plan, Step 1 Pass-Fail

Now that it’s pass-fail, how long should you study for Step 1? And if you’ve been preparing for a while, why is it taking so long? Getting ready for Step 1 now that it is pass-fail has changed people’s approach, including how much time to apportion to Step 1 vs. Step 2 CK. Most people no longer devote most of their time to Step 1, leaving Step 2 CK to chance.

In this article, you will learn:

  • How to 10x your knowledge so you can study for Step 1, Step 2 CK, and shelf exams simultaneously,
  • A simple framework for solving life’s difficult questions,
  • An easy way to ballpark how long your Step 1 studying should take,
  • Why do people often spend much longer studying for Step 1 than they anticipate (sometimes months or even years!),
  • What to do if you can’t get your score to improve, and
  • Much more

Table of Contents

How Long to Study for Step 1 Depends on Your Approach

Let me pose a question to you. If you want to 10x your knowledge, which approach would NOT work?

  1. Master 10x more every day
  2. Study 10x longer
  3. Improve retention by 10x

You would be right if you guessed that studying 10x longer would not lead to you knowing 10x as much. In other words, many people study for months – or even years – for Step 1 but can never pass.

Thus, before discussing how long to study for Step 1, HOW you prepare for Step 1 should be the question you ask first.

How Much Is the Maximum You Can Know?

You can use a simple equation to know the maximum you can master. It is:

Maximum Amount Learned = Amount Learned per Day / % Forgotten Per Day

In other words, if I learned three pages of First Aid per day, and forgot 10% of all the things I’d learned previously every day, then:

Three pages learned per day / 10% forgotten per day = 30 pages learned maximum

In other words, I would top out at about 30 pages worth of First Aid learned. I reach this limit because the amount I’m learning daily (3 pages) equals the amount I forget (also three pages).

From this equation, it becomes evident that to increase my knowledge by 10x, I’d need to either:

  1. Learn 10x more per day, or
  2. Forget 1/10 as much

As we’ve discussed, it IS possible to improve your retention by 10x. For more on this, see the article on Med School Anki here. As you will see, retention is one of the most critical ingredients for studying for Step 1 in the shortest time possible.

Inverting the Question of How Long to Study for Step 1

A favorite approach of ours is “inversion.” To invert means to solve a problem backward. For example, Charlie Munger, Warren Buffett’s business partner, famously said, “All I want to know is where I’m going to die, so I’ll never go there.”

Let’s say I wanted to open a successful lemonade stand. The traditional approach would be to try and find the secrets to running a successful business. An inverted process, however, would be to ask, “what could I do to make a lemonade stand that was sure to fail?” and then do the opposite.

So if I wanted to know how long to study for the USMLE Step 1 so I pass, let’s start with inversion. Let’s ask, “how could I study so that it would take forever to study for Step 1 and I would still never pass?” Then we will do the opposite.

How to Study for Step 1 So Passing Takes Forever

You can probably come up with your list for how to make your Step 1 studying stretch forever. Mine would look something like:

  • Never understand a single thing that you are learning,
  • Forget everything,
  • Rush yourself,
  • Feel lots of pressure,
  • Be anxious and burn yourself out,
  • Never sleep,
  • Try and do everything by yourself and never learn from others’ mistakes

How to Study for Step 1 So You Can Pass in the Shortest Time Possible

To figure out how to pass Step 1 in a hurry, then invert:

  • Whatever you learn, you learn well,
  • Maximize your retention using spaced repetition,
  • Take your time,
  • Forgive yourself, and don’t take every setback as a sign you’re a failure/not good enough,
  • Do things that give you flow,
  • Get 8 hours of sleep on a consistent schedule,
  • Learn from others’ mistakes

This list is not exhaustive. And we’ll discuss later a couple of critical elements to studying so you can pass Step 1 faster. However, next, we’ll focus on how to estimate how long to prepare for Step 1 now that it is pass-fail.

Start with an NBME

To know how long it will take to reach a destination, you need to know:

1) How far away that destination is, and
2) How fast you can move toward it

Once you know those two things, you can figure out how long it will take to arrive.

To estimate how long to study for USMLE Step 1 pass-fail, figure out:

Because of pass-fail Step 1, the NBME does not give out a 3-digit score for tests in the passing range. Instead, estimate your score with the CBSSA (NBME) Score Converter.

How Many Points Can You Expect to Improve on Step 1 Per Month?

I have an equation I use to estimate how much someone’s score will improve:

Score improvement = Mastery Retained x Question Interpretation / (Burnout x Anxiety)

In other words, you can improve your score by either:

  • Mastering more per day along with forgetting less (Mastery Retained)
  • Improving your ability to “translate” the vignette (question interpretation) and/or
  • Addressing burnout/anxiety

As a rough estimate, if you’ve been studying for a while, you can assume roughly a 10-point improvement per month if you’re learning well.

Often, people who haven’t done a lot of USMLE-style questions will see their scores improve faster in the first few months. This increase is because they will have more “low-hanging fruit” like learning popular USMLE topics, working on question interpretation, or seeing how they test specific popular subjects.

Concluding Thoughts

Knowing how long to study for the USMLE Step 1 pass-fail is simple but not easy. To estimate how long to prepare for USMLE Step 1 pass-fail, figure out:

As we discussed, the list of things to do to minimize this process includes:

  • Whatever you learn, you learn well, focusing on mastery vs. memorization, and question interpretation
  • Maximize your retention using spaced repetition,
  • Take your time,
  • Forgive yourself, and don’t take every setback as a sign you’re a failure/not good enough (addressing anxiety and burnout),
  • Do things that give you flow,
  • Get 8 hours of sleep on a consistent schedule,
  • Learn from others’ mistakes

And if you’d like help navigating Step 1 – and how to study less for Step 2 CK while being better prepared – set up a free consultation.

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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.

Subscribe
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