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Step 1 Study Schedule for 250+ and Top Preclinical Grades

Prepare well now to set yourself up for success on Step 1 and beyond

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by Alec in Plan

The pace of med school is overwhelming. Professors come and go, each laden with dozens of PowerPoint slides. We are inundated with facts, with little emphasis on mastery. I spent hours pre-reading, only to find that the professors were using completely different material than what was in the syllabus. Even when I worked hard to really understand the material, I’d forget it the next week.

“What’s the point of studying for Step 1?” I thought. “I’m just going to forget everything.”

You may be tempted to memorize to pass your classes. You may be telling yourself, “it’s ok I’ll prepare for Step 1 later.”

“I just don’t have time to prepare for Step 1 and classes.”

However, you’d be making a mistake. USMLE Step 1 is the #1 ranked criterion by residency program directors in determining who gets an interview and who gets a rejection. Few if any residencies take preclinical grades into consideration. (Most med schools are pass-fail anyway).

The foundation for your Step 1 score occurs during the years leading up to your dedicated studying. Without proper preparations, no amount of cramming during the weeks before your exam will lead to a 250+ or even 240+.

More importantly, how much you retain from your preclinical years has a direct impact on your clerkship performance. Clerkship performance and Step 1 make up the bulk of what residency programs base their interview decisions on.

But how can you effectively study for classes while also preparing for Step 1? Here, you will learn how to use Anki to study for classes AND the most important exam of med school.

Preclinical Studying Principles Also Apply to Clerkships

This is the ideal Step 1 study schedule/plan for a first- or second-year medical student hoping to

  1. score 250+ on the USMLE Step 1, and
  2. ensure success for their future rotations/Step 2/residencys?

True, many students I tutor use this schedule to prepare for Step 1. However, ANY student preparing for ANY medical exam can use it. The experiences, principles, and approach apply to any medical trainee.

For example, this third-year used these principles to go from 168 on their first Step 1 NBME, to 261 on their Step 2 CK.

In this article, you will learn:

  • The weekly schedule former students have used to score 250s and 260s on Step 1;
  • Why my Stanford class failed at Anki, and how to fix it

Two Main Priorities for Effective Boards/Class Studying

First, let’s discuss the principles behind the schedule. As I’ve written before, a “study plan” without priorities is like a map without a destination.

In other words, reading First Aid until it’s covered in sleep-drool is neither a plan nor a schedule. It’s directionless.

Following “what medical students do” is a recipe for burnout and disappointing results.

Instead, to accomplish a huge goal, every single day’s actions must focus on that goal. Like my organic chemistry professor said: you the only way to eat an elephant is to go bit by bit.

Let’s discuss the two priorities followed by everyone I’ve ever met who has scored 250+ on Step 1.

(To read more about what your priorities should be for any med school exam, read this.)

Priority #1: Mastery, Not Memorization

My first year Stanford class attended a presentation on Spaced repetition and Anki. Everyone loved the idea of remembering things forever. (Need a refresher on Anki? Read the FAQ for Anki in medical school here).

However, while most students initially embraced Anki, most had quit by the end of the term.

Why? They focused on memorizing over mastering.

Many friends copied bits and pieces from professors’ PowerPoint slides. Even worse, some copied the entire slides. They could recall correctly the contents of their Anki cards but struggled to make sense of any of it.

Key: the most important thing when you start is not spaced repetition. It is learning how to master topics.

Read my guide on mastering Step 1 fundamentals.

In Yousmle Group Tutoring, we focus on “integration and application questions.” These questions force you to integrate and apply the material.

As a consequence, you can improve retention with fewer cards.

For example, most people memorized the differences between epidural and subdural hematomas. They know by rote the presentation, pathophysiology, as well as the susceptible populations.

To cover the vast amount of information, most people make lots of basic cards, like the one below. These cards are easy to remember, but you need a ton of them.

Making simple, flashcard-type Anki cards forces you to create tons of time-sucking reviews that won’t help your score

Making connections allows you to understand more with fewer reviews

Instead, let’s integrate and apply the information.

Most people memorize that ruptured bridging veins cause subdural hematomas. They also memorize the presentation. They memorize that subdurals are gradual (or asymptomatic), often evolving over weeks to months, but don’t understand why.

However, we can make tons of connections. The more connections we make between facts, the easier it is to remember/apply, and the fewer cards we have to make.

Ever wonder why subdurals present much later than epidurals? Veins have lower pressure than arteries. As such, venous bleeding seeps, whereas arterial bleeding shoots out.

Additionally, the mechanism of subdural bleeding explains who is vulnerable. Diminished brain mass creates longer distances for the bridging veins to travel. This stretching of the bridging veins creates tension. That tension predisposes venous rupture.

Thus, who tends to get subdural hematomas? Patients with dementia, alcoholism, or even low CSF volume.

Pathogenesis to presentation card

If I memorized these facts, I would have to make at least one or two cards for each point. This would create a large number of reviews for a single topic.

Instead, integrating and applying it means I can understand more with fewer reviews.

Are you tired of watching videos, then forgetting them the next week? If you’re a part of Yousmle Group Tutoring, the process of mastery and retention is simple. After each content module, I’ve created specific integration and application questions. Copy and paste these questions into your cards.

Now you can remember what you’ve mastered effortlessly.

For a sample lecture, check out to this sample module.

Priority #2: Make mastery + retention habitual

Once you’ve mastered a topic, you must learn never to forget it. You have time to learn everything once.

What does this look like?

Classes cover roughly two or three topics every day. Whether you attend class or watch lectures online, you must keep up.

Your aim: master the day’s topics, then turn them into Anki cards. Don’t just make simple rote cards like in my first example above. The more integrations you make, the better you understand it and the fewer cards you have to make.

Then, do all your old Anki reviews.

Every day, you will master new information, and remember the old.

Consider the short and long-term outcome of this approach. Most blocks run from several weeks to two months. By mastering each day’s topics, by the end of a month, you would have mastered more than 100 items. Each weekday, learn that day’s material, and on weekend days, you can catch up or learn new subjects.

Ever wondered what you should do with the many Step 1 topics not covered by your school? Use weekdays to master class material and weekends to cover the rest.

For subsequent blocks, continue to do all your old cards every day. Your goal? To never have to go back and relearn old topics. By doing your Anki cards daily, you are constantly reminding yourself so you never forget.

To accelerate your progress, you can use the Yousmle Step 1 Cards. It is full of efficient pathogenesis to presentation cards. By doing high-quality cards, will save tons of time, and learn the kinds of information that will actually improve your score.

Overall goal: minimize topics to master during dedicated study

You may be wondering what to do for the topics that you have covered but couldn’t make cards for. For example, I had developed a consistent rhythm by the end of my first year. However, I had not created useful cards for things I learned earlier. I had no reviews for biochemistry, cardiology, genetics, or other basic science topics.

If you haven’t made cards for every subject, what are you supposed to do?

Most people panic and try to cram everything in. For example, during their cardiology block, they may work to re-learn biochemistry. This is setting yourself up for failure.

You shouldn’t expect to master and remember every subject before your dedicated study.

Your current block is hard enough. In the words of my med school advisor: “Chase one rabbit, catch it. Chase two, catch neither.”

If you cover too much, you will only have a superficial understanding. Remembering old topics will be more challenging, as well.

(Read my article on how to use breaks to catch up on old topics).

Next, I will cover the ideal Step 1 study schedule for first- and second-years.

USMLE Step 1 Study Schedule for 1st and 2nd Years: General Principles

Weekly schedule: a typical week

Remember, your top priority is to develop a good daily rhythm of mastery and retention. With that in mind, here is a sample weekly schedule. My assumptions:

  • You have class all five weekdays.
  • You have two days of mandatory afternoon activities.
  • There are three separate classes in the morning.

Your school will likely have a different breakdown from this. However, the principles will remain the same.

Monday: morning class, afternoon activity/lab
  • 5:30AM Wake up/Breakfast
  • 6-8:30AM Old Anki Reviews
  • 9-12PM Class
  • 12-1PM Lunch
  • 1-5PM Mandatory School Activity
  • 5-5:30PM Dinner
  • 6-9:30 Finish Anki Reviews / Master 2-3 Topics from Class*
  • 10PM Sleep

*Days with mandatory afternoon activities are some of the most challenging. Focus on finishing your cards. If you can’t master everything, you can catch up later in the week.

Tuesday: morning class, afternoon free
  • 5:30AM Wake up/Breakfast
  • 6-8:30AM Old Anki Reviews
  • 9-12PM Class
  • 12-1PM Lunch
  • 1-5PM Master 3 Topics from Class
  • 5-5:30PM Dinner
  • 6-9:30 Remaining Boards-Relevant Material from Monday / Finish Cards
  • 10PM Sleep
Wednesday: morning class, afternoon free
  • 5:30AM Wake up/Breakfast
  • 6-8:30AM Old Anki Reviews
  • 9-12PM Class
  • 12-1PM Lunch
  • 1-5PM Master 3 Topics from Class
  • 5-5:30PM Dinner
  • 6-9:30 Remaining Boards-Relevant Material from earlier in week / Finish Cards
  • 10PM Sleep
Thursday: morning class, afternoon free
  • 5:30AM Wake up/Breakfast
  • 6-8:30AM Old Anki Reviews
  • 9-12PM Class
  • 12-1PM Lunch
  • 1-5PM Master 3 Topics from Class
  • 5-5:30PM Dinner
  • 6-9:30 Remaining Boards-Relevant Material from earlier in week / Finish Cards
  • 10PM Sleep
Friday: morning class, afternoon activity/lab
  • 5:30AM Wake up/Breakfast
  • 6-8:30AM Old Anki Reviews
  • 9-12PM Class
  • 12-1PM Lunch
  • 1-5PM Mandatory School Activity
  • 5-5:30PM Dinner
  • 6-9:30 Finish Anki Reviews / Master 2-3 Topics from Class
  • 10PM Sleep
Saturday + Sunday: Catch Up on Week’s Activities / Round Out Studies
  • 5:30AM Wake up/Breakfast
  • 6-9:30AM Old Anki Reviews
  • 9:30-12PM Catch Up / Master Topics Not Covered in Class
  • 12-1PM Lunch
  • Afternoon/Evening: Catch Up / Master Topics Not Covered in Class / Relax**

**use weekends to catch up on the week’s work. You can use the remaining time to cover Step 1 topics that are not included in your classes. For example, Stanford never covered amyloidosis, so it was up to me to learn that topic.

If you follow along in First Aid, you can cover the topics your classes miss. Make sure that by the end of the block, you’ve incorporated as many topics as possible within that block from First Aid.

Other Questions?

Wonder when (or if) you should work in a QBank? What you should do the night before a test? What it means to really master something? To read the most common questions students have about how to get impressive Step 1 scores while maintaining top preclinical grades, read the companion article here.

Concluding Thoughts

Your Step 1 (or Step 2) score is the product of your actions in the years leading up to the exam. Waiting until the last month or two to prepare is like deciding you’ll run a marathon next week. Too little, too late. The great news is that mastering what you learn, and doing Anki consistently, can lead to doing well in your classes AND Step 1.

But are you still overwhelmed by the idea of mastering the most important Boards-relevant material? And is it even harder to imagine making high-quality Anki cards to retain it forever? If so, I’d highly recommend the Yousmle Step 1 Anki cards. Not only do they teach you how to use the most important Boards-relevant topics, they’re already in the pathogenesis to presentation format for time-saving retention.

Now, you can study less, and master more for that impressive Boards score.

What do you think? How can you adapt this schedule to your current situation? Let us know in the comments!

Have you mastered microbiology yet??

Sign up to receive a FREE micro starter deck of more than 130+ Anki flashcards that I used to get >85% on microbiology on USMLE World. You'll be begging to get microbiology questions on your exam!

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