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USMLE Step 1 Guidance(99/266)

by Ayaz Mahmood

Salam everyone, let me start in the name of Allah who’s the greatest benefactor of all mankind. I am going to write a detailed composition regarding preparation for USMLE Step 1. I am a final year student at King Edward Medical University and I took my exam on June 10th. Final year is the year before internship/ house job in Pakistan. I just got my scores: 99/266

Let me introduce some myths surrounding USMLE Step 1 which are especially prevalent within Pakistan; I am not too sure about India because I heard their students typically appear in their final years.

 Myth number 1:Do not appear for USMLE Step 1 within your graduation

Verdict: Baseless, illogical reasoning

Explanation: This is so prevalent in Pakistan it’s almost pathetic. One of the biggest concerns surrounding our students is that Step 1 is a huge risk to be taken before graduation. Let me put it in another way: Step1 would always remain a risk whenever it is taken, whether during or after graduation, whether with a preparation of 4 months or a preparation 14 months. It is an unpredictable exam. Let me reassure you that taking Step1 within your graduation would, 90% of times, result in a score that would be substantially higher than when having taken after your graduation. Why? It’s simple! You have a habit of studying for prolonged time periods and you haven’t yet stepped into your professional field. Furthermore what you have been studying all along during your medical studies is still fresh in your mind. Basic sciences is something that troubles even the experienced doctors, let alone a mere young student. It’s all about finding the right tempo to study for extended time and when you enter the profession, that is something quite troublesome. Take my advice: rather than wasting your time during your medical studies, spend it swimming through Step1 recommended textbooks.


Remember you are in direct competition with medical students of US. They typically appear for Step1 at the end of their 2nd year and Step2 at the end of their 4th year.


Myth number 2: You need clinical exposure to fully understand Step1’s clinical vignettes

Verdict: Not necessarily!

Explanation: Remember US medical students don’t have any clinical exposure leading up to their Step1 exam. While attending wards may help you understand the methodology leading to diagnosis and management, you definitely do not need to wait till you acquire maximal clinical experience for Step1. Most of the cases can be fully understood easily by simply applying knowledge of basic sciences you just learnt. Radiographs and gross specimens can be practiced by simply getting help from the world wide web and selected university department websites. Similarly heart sounds can be made available through a simple Google search. You just need to be active enough to utilize the internet as an aid to your studies. You would only be rarely tested for management of the patient, which is the primary focus of Step2 CK and not Step1. In majority of occasions, application of knowledge of basic sciences is what is expected of you.


Myth number 3: Cram, by heart, all of Kaplan series

Verdict: Wrong and time wasting!

Explanation: Let me begin by stating US medical students only rarely, if ever, turn to Kaplan for their study. At a later stage of this article, I would lay out the recommended books for you. Kaplan definitely is a good series but thinking that it lays out the syllabus content of Step1 for you is nonsense. Step1 does not have a very well defined syllabus. The closest you can get is finding the syllabus release on for Step1. Instead of spending time cramming all of it, it’s more useful to concentrate on selected areas more. You can totally skip out its Physiology book and replace it with BRS Physiology. You can do the same to Pathology book and replace with Goljan. You’d need to supplement biostatistics with high yield biostatistics. A lot of information written in Kaplan is vague, especially the Genetics part of Biochemistry, and very rarely, if at all, tested. Some topics need more elaboration than what’s published: Cancer chemotherapy, Lysosomal storage diseases. Microbiology typically requires substantial usage of Levinson to fully master the bugs. At a later stage, as stated already, I would lay out the books you need to study for an efficient preparation.


Myth number 4: First read, Second read, third read, fourth read, Step1

Verdict: This depends!

Explanation: Remember everyone has his own way of studying. This sequential method typically follows the Kaplan series and has little significant benefit. It is very rigid and cannot be modified. A lot of people asked me repeatedly how many reads I have done. My answer was always the same: is the number of reads the method to use to judge someone’s preparation? That’s the purpose of NBME sample assessment. Don’t let the “number of reads” fool you. Some people study fast and they find that spending little time on everything gives them sufficient time to revise; others find the opposite to be true. This means a person who has done 2 reads may be doing just about as good as another who has done 7 reads. Besides some subjects need more reads than others; pharmacology needs more commitment than does anatomy.


Confused? I am too! When you try and follow “number of reads” rule, you’d end up even more confused. Solution? Try and find your own best method. If you get a good NBME score, this means you’re doing fine. For more info on NBME, read on.


Myth number 5: If you get less than a two digit score of 95, you’re good as gone.

Verdict: Ignorance!

Explanation: While Step1 is very important, it is not the only thing required to judge a candidate. Remember there’s Step2 CK as well, number of attempts at Step2 CS, Electives, Research experience etc. They all form part of what is known as a “well rounded candidate”. Not everyone gets a 99 at Step1 and those who don’t must not lose their confidence. Step1 is an exam, just like every other exam and is prone to causing mishaps and accidents in results. If that happens to you, I guess hard luck but should you lose hope? Go and read the first article written by Dr: Umar on hope! Try and compensate from Step 2 CK or the best of all, research. Don’t make Step1 a matter of life and death because it’s not worth it.


Myth number 6: Step 1 is all about concepts….

Verdict: and…..cramming!

Explanation: Don’t be fooled into thinking you don’t have anything to learn in Step1! Microbiology, Immunology and Pathology have far more knowledge that has to be learnt compared to what you do in college, in addition to making concepts. By all means, make maximal attempts as learning as much information as possible. If you don’t know the virus names and groups, you cannot answer any question based simply on “concepts”. Knowledge in Step1 is tested very rigorously, but it is typically very cleverly disguised as they simply form a part of the multiple process thinking. Learn everything; don’t leave things out. Yes and that means you have to learn Ebola virus, Japanese Encephalitis Virus and Lymphocytic Choriomeningitis Virus too!


Myth number 7: 70-80% of Step1 exam is full of Pathology

Verdict: Wrong!

Explanation: It’s true that almost 95% of the exam has clinical vignettes that can be directly correlated to Pathology however the subject matter that is being tested may not necessarily be pure Pathology. You may be given a vignette on Ataxia-Telengiectasia but you may be tested on an immunological concept, or a molecular biology concept. Now that the current USMLE exams are full of clinical vignettes (as stated on the official; number of questions in clinical vignette forms to be increased), you would find this to be even more prevalent.


My purpose is to tell you to divide your attention equally amongst all subjects. 70-80% Pathology on exam never means 70-80% time on Pathology and 20-30% time on remaining subjects. Infact Molecular Biology is a dominant force. Step1 reflects current standards of medicine. You may infact realize that spending more time on Microbiology than Pathology would be more high yield.


Myth number 8: Delaying the exam by a month or two would increase my score

Verdict: What makes you think the opposite may not happen?

Explanation: Read the verdict again, and again and again. Do you have any guarantee that you would definitely not slack off, run the risk of forgetting important facts after breaking your study momentum and decrease your score instead? Remember momentum and sustained effort are extremely important. When you choose an exam date, stick to it. Try to carry your momentum straight uptil that date. Breaking your rhythm would only increase your anxiety and make you forget important facts.

Myth number 9: My friend got a lot of virology in his exam; I must spend all my time studying virology

Verdict: Fair enough, but isn't "all your time" a bit too ambitious?

Explanation: The issue here is that there is little uniformity within a Step 1 exam, and little comparative value between Step 1 exams in terms of subject content, NOT standardized 2 or 3 digit score. For example your friend just gave Step 1 about 2 weeks prior to your final date. He seemed to get a lot of questions from virology and defense mechanisms (behavioural sciences). Should that make you think you should spend your next 2 weeks till your final date studying with full force, these topics? This is a common psyche of anyone who is about to take his or her exam, to rely a lot on what has already appeared. It's fair enough, but you have to make sure you do not compromise the rest of your study. Step 1, as stated already, is an unpredictable exam. You may be tested a lot, instead of virology, on mycology on a disproportionately high scale i.e. far more questions than you might anticipate. When you go through Step 1 forums, you may see some people stating they got a lot of biochemistry but little anatomy, and others attesting to the exact opposite.

You should always make an effort to study each and every subject in Step 1 with equal time and honesty. As stated elsewhere, yes, there are subjects like Pharmacology and Microbiology that require disproportionately more time but this is not because they appear a lot on the exam, but because of the nature of these subjects that warrant consistent revisions.


If you can find any more myths, please discuss them in comments and I’d include them here.


Now let me talk about the recommended books for you.



Get all of Kaplan series. You may omit Physiology totally. You may if you like, also omit Pathology. Buy the DVD lectures as well (remember the copies found in our country are illegal; if possible, they should be bought at Here’s a little run through the individual subjects:




All American students rely a lot on BRS Physiology. It’s a fantastic book that focuses on the most high yield content you need to know with all the necessary graphs. The problem with Kaplan is that it includes discussion of quite a few topics that are not tested on Step1 e.g. Vascular Physiology. These are also discussed in heavy details that entail a lot of time commitment. BRS Physiology has everything you need to know in Physiology plus an additional chapter on Neurophysiology which is not discussed even in Kaplan’s neuroanatomy.




Kaplan should suffice here. Infact Kaplan is a good book. Some topics need supplementation. You should consider studying lysosomal storage diseases from elsewhere; first aid has details of all lysosomal diseases. Listen to the lectures as well if you like. Dr. Lionel Raymon explains the concepts exceptionally well.


Molecular Biology:


Again Kaplan should suffice here. Some American students consider studying High Yield Molecular Biology. I got it and found it to contain a lot more information in excess of what’s required. Other American students think the 1999 version has just about enough info. But I don’t trust an old book. Sticking to Kaplan should suffice. Techniques should be referred from High Yield Molecular Biology as they are poorly explained in Kaplan.




The first three chapters are fine. Add another chapter from Genetics chapter of the Pathology book. The last three chapters are something of a lost sheep wandering aimlessly. I have never heard LOD scores being tested in Step1. Techniques of genetic analysis are very commonly tested but they haven’t explained it in a satisfactory way. This problem also arises in the techniques chapter of Molecular Biology section where irrelevant details hamper acquiring a good command of the actual subject. Studying these techniques from high yield molecular biology may be time consuming, but they are well explained and may help you get questions correct. Although technique methodology is not tested, knowing the techniques give you confidence in answering the question so study them in detail. Don’t underestimate this topic!




Neuroanatomy is good enough. High yield neuroanatomy is also a good book; I heard some Americans studying it. I cannot recommend other texts as I don’t know them. Remember it is extremely important that you know the clinical scenarios very well, CT-scans, MRI’s, and gross specimen. In this manner, High yield is a very good book because it has many such illustrations and snaps. You should have a very good orientation of the brain in all planes: sagittal, coronal and transverse! Using help from university department websites can be of immense help. Search “webpath” on Google and navigate into the Pathology department of Utah University.


Histology is written in a way you’d forget as soon as you read. When you go through again, the same happens. Third time isn’t too lucky either. Here use High Yield Histology. At first glance this book seems to be a lot more detailed than needed. But that detail isn’t just histology. It’s the bridging knowledge and concepts that spans physiology, pharmacology, biochemistry and pathology! Try to find the original textbook as there are excellent illustrations and photographs at end of every chapter.


Gross Anatomy is fair enough. But you may need help from major texts such as Snell to study the Pelvic region which is disappointingly poorly explained in Kaplan.


Embryology is spread throughout Gross Anatomy. It’s useful enough. Basic embryology needs supplementation from other texts. I used a quick read through Langman’s embryology to get a hang of the initial development of the embryo. Most American students state First Aid embryology is good enough. You can trust that opinion. You may also use High Yield embryology. But you can just stick to First Aid here.


Behavioural Science:


When I first went through it, it looked out I didn’t go through it at all and only had a déjà vu that I did go through it. On a serious note, it’s a pathetic book. Even when supplemented by lectures, it doesn’t lose its pathetic appeal. You will have to use High Yield Biostatistics to simply understand just what the hell is going on around with all those lines and numbers and paranoid P-values.


Here’s how I learnt my behavioural sciences. I used to study the explanations to behavioural science questions in question banks. I used First Aid Q and A book. Explanations about respective questions were well written and I would write them in a notebook and go through them regularly (number of reads anyone, please?). Eventually I just got a hang of it all. The personality disorders, the defense mechanisms, DSM manual etc. Kaplan is jittered with useful info and you’d realize it once you study schizophrenia (cram all of Kaplan, everyone raise your hands!). I had BRS Behavioural science but I didn’t use it. I didn’t want to feel like an uncertified tester of all the books that are medical, just as I am of all the different web browsers (Safari is the worst of all).


Here’s a tip for you. Best way to learn behavioural science is to get a lot of questions incorrect in question resources, and then diligently study the explanations and promise by God you won’t underestimate this subject again. ONCE you have done that, now you can rely on Kaplan. The only thing reliable is medical ethics. Try and study the scenarios given in the two chapters. Some Americans suggest Medical Ethics by Conrad Fischer. I didn’t use it (I told you I don’t want to be a unpaid tester of books!). Unfortunately it seems that the American board examiners are extremely clever at finding just those special circumstances for you, where you’d eventually pick the wrong answer that happens to be both morally and legally incorrect, even though you thought the contrary!


Guess what, you can safely skip that mammoth table about human development in Kaplan and simply replace it with what’s written in First Aid. Everytime I looked at that table, I was more worried in counting how many milestones I achieved when I was a young boy rather than learning it. Not for a single time I had to repeatedly remind myself I did have a hint of object permanence at age 1 but then again………..what’s that?




Kaplan should suffice here. I didn’t use the videos because I thought my concepts were clear courtesy of Levinson. Strangely enough, the immune faculty was kind enough to write a continuous prose for us rather than shoot bullets (points). Remember again that immunology techniques, similar to genetic and molecular biology techniques, are very important and should be clearly understood and learnt. For example KNOW the difference between ELISA and Western Blot very well! Diseases are very frequently tested. When you supplement your study with First Aid Q and A book (Buy it!), immunology diseases would become progressively clear. Stay loyal to Kaplan here; you don’t have to spend too much time on other books. Actually I did use Levinson occasionally especially for diseases. It takes time but it’s a fantastic book written by a UCSF professor who is an authority in Microbiology and Immunology. At end of Kaplan, there is an appendix detailing CD markers. Learn it by heart.




Use Katzung Board Review series here. Surprised? I’m not. That is the best book. Again it is written by a group of three UCSF professors who know what’s needed for Step1. Some topics such as Chemotherapy and Anticancer drugs are so important you have to study them in detail. Katzung is more than enough detail and you can totally rely on it. Because Dr. Anthony Trevor is also a co-author of Kaplan’s Pharmacology, there are some similarities between the two which means once you go through Katzung, you can review Kaplan easily. You may consider annotating Kaplan with Katzung’s points. They test each and every drug, even Sitagliptin and Orlistat. Be careful studying Toxicology because it is important. You will have to study it from katzung to know what’s it all about. ANS and CVS drugs are definitely high yield.


It would help you writing some points on a notebook and repeatedly revising it. For example, write all adverse effects of all anticancer drugs and keep going through it. Eventually you’d start remembering that pulmonary fibrosis is a prominent side effect of bleomycin and busulfan, Nephrotoxicity is not an issue with Sirolimus and a combination of Didanosine and Zidovudine has a high incidence of neutropaenia.




Here they go again. All of that written either in points form, or tables form. If you supplement it with lectures, it ends up becoming a complete mockery of those little bugs. The bugs had to emerge resistant to it and no wonder they’re doing it so well, both in real life and on our exams. It would seriously help you if you just go and buy Levinson and just go through it atleast once. Some Americans recommend “Made ridiculously simple” Microbiology and you may use it if you like to. I also went through High Yield Microbiology but it didn’t sustain my interest. Viruses need constant referencing with Levinson to simply learn what haemorrhagic fever exactly is and what exactly is hand-foot-mouth disease. Parasites are just sugarcoated in tables. Again, study from Levinson. You won’t get the slightest hang of it from Kaplan. Microbial genetics is written fair. Remember you have to learn the mechanisms of resistant to different drugs, for example the acetyltransferase against chloramphenicol. You have to also learn which are plasmid mediated and which are chromosomal mediated. Transposons, plasmids, lysogeny etc are all a fair game and must be understood.


The case scenarios given at the end of Kaplan are slightly confusing but they’re a fair game as well. You can actually replace them with similar scenarios and common causative agents written in Levinson.



Goljan appears to be the undisputed king here. You can also listen to Goljan lectures (remember their possession is illegal! I don’t know if they even officially release any lectures in first place). But you can quite comfortably rely on its 3rd edition that spans not only Pathology but also bridging concepts to Pharmacology, Biochemistry and Physiology which ensure active revision and repetition of these subjects. Some American students say they also relied on the side notes given in the book especially just a few days before the eventual exam and it was a massive help. This is a detailed book so make sure you allocate enough time. Make sure to buy the original version so that all the micrographs and gross specimens are clear.


Contrary to popular belief, Pathology doesn’t make 70-80% of your Step1 exam as already explained earlier in the Myths section. So don’t allocate time in excess of what’s required, that may compromise your study of other subjects.


But you can also study Kaplan’s Pathology. Because I was studying Pathology alongside my medical studies, I used Medium Robbins and annotated Kaplan’s Pathology with important topics. Make sure you fully understand that studying Robbins alone would result in low Step1 scores. Robbins overemphasizes topics that have little clinical value and understates the ones that are exceptionally high yield. Still you may atleast like to go through it once (only if you are studying for Step1 during medical studies) to get a grip on what Pathology is all about. Some students would suggest studying Big Robbins but again, you need to know studying what material is higher yield. Big Robbins is typically for students who have little else to do apart from studying. As you go through Kaplan, the point format may frustrate you so you may want to revert occasionally to Medium Robbins to study topics like Pneumoconiosis in detail before feeling confident about learning material from Kaplan.


Some people suggest BRS Pathology. I don’t know about that. It’s entirely up to your choice. Perhaps you may want to use its illustrations, photomicrographs and gross specimens for supplementary study. Be sure you also utilize Utah University Pathology Department’s Webpath website.





First Aid is a favourite amongst American medical students. I only went through it twice but I found it to be quite helpful. You may like to study it once early in your coursework and once later before the exam. You can even go one step further and make it your primary book. In that case you may have to annotate it and make up for the deficiencies in this book. In my opinion, it still has enough information to guarantee a 99 on Step1 provided you study it comprehensively and carefully.


Kaplan medessentials is a similar book to First Aid. It has essentially all of the Kaplan series condensed into a single book. Some Americans call it medsuperfluous. It’s unnecessarily detailed at some places and understated in others. Still it has the benefit of complementing your Kaplan textbook study. You may use it if you like a very quick glance at a lot of information, typically arranged system-wise e.g. Cardiovascular system. This helps you to save time flipping through different books in case you like to apply a systems approach at some point during your coursework.


Step1 secrets is another rather useful book I encountered. I didn’t study it all so I cannot comment but based on others’ opinions, it has everything arranged neatly in a question-and-answer format and written in simple language. Oversimplification is evident at a lot of places and requires rigorous supplementation by more detailed textbooks. If a high 99 is not your aim or if you realize that studying simple textbooks may ensure something like a 90-99 score rather than pursuit of a high 99 having to utilize detailed textbooks and running the risk of losing score, that’s the book for you. It has little of everything that should benefit you in the actual exam. If nothing else works or you have run into anxiety, throw every other book away even First Aid. Pick this book and just study it. It is written in a beautiful manner utilizing a very student friendly approach and doesn't run aggressively amok anywhere. Studying this book alone carefully can give you a 90+ score.




You have the following question banks. They are discussed separately.


USMLE World:

It can be found at This question resource has consistently high ratings amongst students and Americans love using it to supplement their study of First Aid. You can buy it for 100$ for one month. Subscriptions greater than a month have substantial discounts. You can get their books but they’re all pirated and illegal material. I would highly recommend buying this for a single month at least. Typically this should be used to maximum effect about 1-2 months before your actual exam. Others recommend using it as soon as possible but I have a different opinion. The explanations given in this resource are the best amongst all others and some Americans actually solely rely upon the explanations for their revision. If you start it late in coursework, you ensure adequate revision and security of keeping it in memory. Questions typically use 2-3 step thinking processes and require good integration of concepts, so it’s a tough question resource. My advice is to solve all questions and read their explanation regardless of whether you get any question correct or incorrect.



This can be accessed at It is very expensive: 130$ per month and additional months purchased have substantial discounts. You can get their books but again, that’s pirated and illegal. They don’t release any textbooks. Americans don’t prefer using this resource. Kaplan Qbank relies quite extensively on knowledge given in their textbooks and at times, it feels they are exclusively focused on specific knowledge pointers in their questions, rather than good integration of concepts as done by usmleworld. Furthermore it has a habit of testing knowledge that is both Step1 irrelevant and not given in recommended textbooks (not even in their own textbooks!). Overall I would recommend this Qbank. It has the advantage of using Qtutorials (refer to their website), good media, good explanations and a huge question resource. You don’t have to attempt all of the questions given. It’s preferable to use this resource early in your coursework.



This can be accessed at This is the least expensive of all qbanks with a single month subscription at 70$. Instead of Kaplan you may want to utilize this resource early in your coursework. This is the work of contributors of First Aid. So it heavily relies on info resource of First Aid. This can be an advantage if you are using First Aid as well. Repetition of facts in first aid ensures adequate retention in memory. However some questions may not correctly reflect the standard and format of current USMLE exams and rely somewhat on typical case scenario facts and explanations. In addition, a lot more questions directly test knowledge rather than careful integration of facts. Best utilized early in coursework.


First Aid Q & A book:

Similar to usmlerx. In fact they state questions are taken from usmlerx resource. It has 1000 questions, 650 organized systems wise and 350 organized into a full length exam with 7 blocks (remember current USMLE has only 322 questions in 7 blocks). I used this book late in my study but I recommend using it early. It may be a less expensive substitute to usmlerx questions resource as well. Explanations are good and have cross referencing to First Aid text which may help your revision. Remember this is an official First Aid release.


Mededia Qbank:

Surprised? Stay tuned for more updates in near future! I assure you this would be a very high quality Qbank with MCQs according to the new format of more clinical scenarios and quality better than all mentioned qbanks. I am working with Dr. Umar Tariq on it; it would be available online in a few months times and would be entirely free of cost so you may start using this questions resource early or late in your coursework depending upon your choice. 

If you are interested in authoring MCQs for this Qbank, kindly contact me at or Dr. Umar Tariq and we would be happy to include you as a co-author/ contributor on submission of some high-quality MCQs and would mention your name on the main book cover. I am sure it would prove to be a big boost to your CV and provide help to your colleagues; the same reason I am doing it for.

The reason for its inception is to reflect the current trends in the USMLE Step 1 exam. Step1 is an ever-evolving exam; the examiners are very well aware of what guide-books and short-cuts students love using. As an example heart sounds that appeared in previous Step1 exams could typically be resolved by simply contemplating the question stem and not even listening to the sounds, as stated by some examinees! Now you must have a sound knowledge of heart sounds. If you are as unlucky as I was, you may get those varieties sometimes only cardiologists can decipher with a degree of confidence. Apart from that, the examiners know that many students rely heavily on First Aid. By no means you can't get a 99 by studying First Aid alone, but this is to tell you that the style keeps evolving in order to maintain a very high standard of this exam. Therefore we decided to make a brand new collection of questions resource that would adequately aid your Step 1 preparation.

This is a spin-off of Wikipedia with about 800+ questions free of cost, contributed by various authors. Because there is little quality check and control over the type of questions, a lot more questions do not reflect the USMLE style than questions that do. Integration of concepts is rarely tested. Since it’s free, you may like to use it early in coursework but remember that some questions are factually incorrect, others are vague and their explanations may not reflect high yield material.


NBME exams:

These exams can be purchased at NBME website for about 45$ each and has 200 questions each arranged in 4 blocks. You may buy about 2 or 3 such exams, from a total of 7. It is very important to use atleast one exam early in coursework and another late in coursework to gauge your performance levels, strengths and weaknesses. In addition a projected 3 digit score is given to you at the end of your exam that is highly predictive of your actual USMLE Step 1 score. NBME’s are also not reflective of current USMLE style. Most questions are very easy making the marking very stringent and strict. But you have to use these exams to quantitate your performance levels. I recommend buying 3. Use one early, another in the middle and the last one late in your coursework to ensure adequate progression in your study.


USMLE World Self-Assessment forms:

They can be accessed at and have a cost of 30$ each. They are two in number. When purchased together, they cost 50$ in total. They have the added advantage of allowing you to study questions you got incorrect or correct and read all explanations, over NBME which allows neither. Best used late in your coursework and you should attempt to study all the explanations. There are 192 questions in each exam.

Kaplan Qbook:

This is an official release of Kaplan Medical. I did go through it randomly at first. It has various blocks of 50 questions each organized in a subject-wise manner (not systems wise). Unfortunately various questions are again not reflective of current exam and are typically "easy". The most poorly composed section is, as expected, Behavioural sciences. Two blocks of 50 questions each of absolute madness. It follows the same philosophy of Kaplan's Qbank somewhat hinting more at retrieval of an examinee's memory rather than integration of concepts.  



You have the choice to study either during your medical studies or after your graduation. As I already explained earlier, studying during your medical school is substantially better than after your graduation. However USMLE is a difficult exam that needs honesty and time commitment. You cannot study this exam for the fun or sake of it because that may seriously backfire with a very low score. Only sit this exam once you are sure of your preparation. Using NBMEs is one way of assessing your preparedness. In case you wished to appear in Step 1 during your medical studies but became very anxious or your NBME score is not so good, your time wasn’t lost! You can carry that knowledge over to studying for Step2 CK as well during your final year. In that case you may begin to feel confident enough to give Step2 Ck before your Step1 because you had already had some feel of how Step1 looks like.


The best way is to begin as early as possible in your medical studies. Study only good American textbooks. I recommend you to study the following textbooks during your medical education:


Snell’s Anatomy

Snell’s Neuroanatomy

Ganong’s Physiology

Lippincott Biochemistry and Molecular Biology

Katzung’s Pharmacology (Board Review Series)

Levinson’s Microbiology and Immunology

Medium Robbins supplemented by Goljan, or even Goljan alone

For behavioural science, you may have to rely on textbooks already stated above.


The textbooks above ensure you get a sound grasp on the subject in question. Using these resources ensure you’re automatically geared towards Step1 prep. Strictly avoid using textbooks authored in the subcontinent as not one single such textbook lives up to the standard of the books above.


Here’s a tour through a Step1 preparation.


First few months; getting started:


A lot of us subcontinent people use Kaplan. Americans get about 2 months off at end of their 2nd year, and study Goljan, First Aid and Usmleworld.


You may need to use the videos. You don’t necessarily have to listen to all these videos. You may form good concepts but as soon as that happens, you’d immediately forget later on. Using videos for referencing again and again is time consuming and frustrating. A good detailed textbook is a very good substitute. If grasping DNA synthesis from Kaplan’s biochemistry textbook is difficult, jump straight to Lippincott. Unfortunately this cross referencing is something you’d have to do extensively throughout your Step1 study. So keep all the major textbooks readied.


First just go through the Kaplan. Understand, learn or not, is not a matter. Try to get a feel of what Step1 syllabus content is like. Next you may want to use video lectures to aid you in understanding difficult concepts and also for the sake of simply touring through the Step1. In these first few months, use your major textbooks extensively. Don’t be afraid to open Snell’s neuroanatomy or Ganong’s Physiology to clarify difficult concepts. Once done, write them for your records somewhere. You can maintain a notebook to serve that purpose. Alternatively you may annotate the Kaplan books. Choice is yours.


Doing all of that would take quite a lot of time. Be patient. Don’t rush through your study schedule or try jumping ahead. Do justice to all your subjects. Remember subjects like Pharmacology and Microbiology require constant attention. This means that as soon as you’re done with your first pass, try to immediately jump back to these subjects and revise them. Don’t limit these subjects to a mere 3 or 4 reads. It’s indefinitely high yield to do as many quick reads of these subjects as is possible. This ensures adequate retention of facts in your memory. You don’t have to use question resources at this moment.


So the initial stage of your study is simply quick pass through the syllabus content + careful pass through selected and difficult topics with extensive cross referencing from major textbooks and maintenance of important pointers in a notebook. Don’t try to be a copycat and emulate others’ timetables. Find the right solution to studying yourself.


Intermediate stage:


This stage introduces the question resources. As already stated, you can rely on Usmlerx or Kaplan Qbank. Although you can find illegally printed textbooks to these question resources, they don’t give you the advantage of mixing your questions, making random timed or self-paced blocks and maintain a record of used and unused questions. As soon as MedEdia releases its questions resources free of cost, you may like to check it out as well.


My recommendation would be to use either question resource, and try attempting questions systems wise. If you just finished a revision of Biochemistry, hit the questions. Read the explanations to all questions, pick up a notebook and write the important facts in that. Go through those facts at regular stages. This would especially help you, in Biochemistry’s case, learn all the rate limiting enzymes and hormonal and allosteric controls. Allosteric controls form an important testing component and is especially tricky to understand, especially in the whole context of all metabolic pathways.


Use this approach and apply to all subjects. You don’t have to attempt the whole question resource, but make sure you do attempt atleast a sufficient number of questions. At this stage you may use either timed or self-paced mode.


At the end, try and attempt an NBME exam. This should give you an idea where you land and how far are you from your goal. Depending upon your goal and the difference from your goal, you can modify that final stage of your preparation in whatever manner you like.


Final stage:


Once again, quickly hit Pharmacology, Microbiology and especially Behavioural science and revise these subjects. At least go through remaining subjects once but the aforementioned ones should be given special attention to because of the ease with which they are forgotten. Remember now your momentum is very important. If you remain consistent in this stage, you would drastically improve your final score. If you take breaks or delay your exam, you would only end up wasting time.


Now is the time to start’s question resource. Americans at this stage do 2 blocks of 48 questions (46 in real exam) everyday and spend time reading all explanations. They supplement those explanations into First Aid. You can try doing that too, to good effect. Mix in another NBME and/or Usmle world Self Assessment forms which have already been referenced to above.


Here’s an important point: IF your NBME score is far off from your goal, NOW you may contemplate delaying your exam. Always aim for the very high, but you have to have a realistic appraisal of your own intellect and ability. You must have both a very high goal, and a very realistic goal. It’s only you who can tell you what your abilities are. NBMEs usually are a very accurate gauge of your performance. What they state is approximately what your abilities are.


Keep using First Aid also, especially towards the week leading up to your eventual exam. Make sure you have been following CTs, MRIs, photomicrographs, gross specimens and X-Rays all along because these are heavily tested. Keep focused on learning heart sounds as well. Last but definitely not least, all those notes you made into your notebook, using your own familiar handwriting towards the end of your preparation would most likely keep your anxiety levels in check. Do not even think about opening a new book at this stage.


When you’re done with your Kaplan, throw those books away and concentrate only on First Aid and your own notes from Kaplan and question resource explanations in last two weeks.


In your final day, you may take a day off after a stressful spell that spanned several months. Make a list of things you need to take. Check your permit, Prometric appointment, passport and National ID card.


Some tips about what to do during your last day and exam day:


I had the biggest misfortune of totally screwing up my sleep the very last day. It wasn’t anxiety. It happens sometimes to me that I can’t go to sleep even after 4-5 hours and by chance, it happened the very last night too. Eventually I took a pill of Bromazepam, slept for 4 hours, and went to the exam. The whole day was a battle with drowsiness. Energy drinks did some trick but really, my first and second blocks were almost sacrificed which must have led to reduction in my eventual score.


I would advise you to take a sleeping pill the last night and ensure a good night’s sleep. This is critically important before your exam that drowsiness doesn’t take over. You can use energy drinks during the day of your exam but make sure you have used them before to be sure they don’t end up causing diarrhoea instead during the exam.

My experience with Step 1 preparation:

I started at the beginning of my fourth year. I was confident because I had the fortune of having studied good textbooks in preference to local ones. I started as usual: Buy Kaplan textbooks and the Video lectures. But I didn't use all the video lectures because quarter-way through I realized that although they are helping me solidify my concepts, they are of little value in revision. I listened to Dr. Lionel Raymon's biochemistry lectures, Dr. Anthony Trevor's Pharmacology lectures, and Dr. James' Neuroanatomy lectures. I may have listened to others too somewhat, but I don't clearly remember. All these mentioned lectures were the works of genius people indeed and by all means, you should listen to what they have to say about their subjects. You may elect to skip the other lectures.

As I have stated in the ideal preparation above, cross-referencing to good textbooks is important and I felt the need always to do that. From February through June, I managed to cover some subjects atleast once (Pharmacology, Biochemistry, Anatomy), others twice (Microbiology), still others only less than half (Immunology, Pathology) and remaining none (Physiology, Behavioural sciences). You can try this same methodology with the exception of including Behavioural sciences in the "twice" category with Microbiology. So much for a "first read" I guess?

In July I managed to cover some major portions of usmleworld questions resource especially microbiology and pharmacology. This helped strengthen my knowledge of these subjects. Later I finished my first pass through Physiology and Behavioural science (I told you I developed a deja vu right after studying this!).

I would cover Pathology text with my medical studies in fourth year. For example, when they had a class test, I'd study Goljan and Medium Robbins. 

Time passed and I started wasting time too. Perhaps I realized that attempting the Step1 at end of my fourth year was overly ambitious. It would have been very realistic if I started in 3rd year, which is why if you are a student in 3rd year, by all means start your exam preparation! Till November I had managed another pass at least once through most subjects, with the exception of Physiology and Behavioural sciences (yet again). In November I picked up First Aid and went through it in 2 weeks. I registered for NBME form 3. I attempted it on November.....27th I think (right after that was Eid-ul-Azha day). My score was projected 244. I realized that this was very decent, given that I had yet to seriously cover behavioural sciences and Physiology also.

After that, time for my professional exams at end of fourth year arrived. ENT, Eye, Community Medicine and Special Pathology were the subjects and I somehow managed a third position and distinction in Pathology. The latter was significant because it motivated me once again for Step 1. But this exam had seriously upset my rhythm and because my first ward in final year was a maternity duty (day and night for 2 weeks = no time for Step 1 prep), I lost my way. This was why I stated how important is your study momentum when taking into the final date. I somehow managed to pick myself up, had to spend substantial time applying for electives and finally started seriously in April. I finalized my date for June 10th, and immediately started covering Physiology and Behavioural sciences which I had neglected (and I'd advise you to not do as I did).

In that time I also went through Katzung board review pharmacology and some part of Levinson, especially Parasitology. I also immediately revised all of Pathology which I hadn't touched ever since I gave my fourth year exam. All of a sudden it turned into a hi-octane study mode. Cursing myself for wasting time, I gradually navigated my way through immediate revisions, and then picked up First Aid Q and A book. I attempted all 1000 questions and wrote a majority of explanations in my notebook. Afterwards I went through that once, especially revising the behavioural science explanations. This really helped me immensely. Now it was already May 12th. I picked up first aid and finished it in next 8 days. I had attempted Usmle world self-assessment form 1 on May 18th and my projected score was 256. Needless to say, I felt more relieved than happy that the break in my tempo didn't destroy my hopes. Then I picked up usmleworld once again and navigated my way through it studying the majority of explanations, and combining with the very final quick revision of kaplan series. This continued on into June.

On June 5th, I attempted the second usmle world self assessment form online. My projected score was 265+. Usmleworld doesn't give a score beyond 265 so it states it as 265+ instead. I was happy. In the final few days I went through explanations to the exam questions I just gave and my own notebook. I'd occasionally open a few books but I would advise you against it, to guard against unnecessary anxiety induction. Then the final day came, I arranged my things together: Passport, permit, ID etc, went and bought snacks, a sandwich, and energy drinks. At 9:30 PM I went to bed. I thought I fell asleep at 10PM only to wake up moments later. Sleeplessness continued till late night at 3AM when I finally took Bromazepam and went to sleep for good. But the damage was done, and damage continued into the first block of my exam. Second block suffered as well but after that, through sheer willpower I fought with my drowsiness and the exam and eventually finished it.

Moral of the story? A good night's sleep before your exam!

The exam really was very much like what described it as. 46 questions per block, framed into clinical vignettes more so than not so. At some stages I felt that questions were unnecessarily stretched with clinical information. Exam has increased in difficulty overall, and timing did become an issue for me especially in the first block where I had to resort to guesswork towards the end but this was more attributable to my sleep problems rather than the exam itself. The new Mededia Qbank is designed to, therefore, reflect this trend and style. I will not write what topics were tested or what was the distribution of subjects and I strictly advise you not to do that either. The repercussions include ban from taking USMLE exam for a limited number of years! So don't disseminate exam information anywhere, even under the veil of anonymity internet provides you!


Word of special thanks:


First of all, all thanks to God. Second to parents.


The journey started when Dr. Umar Tariq explained to me how getting started with Step1 might bring some good fortune. That happened at the very start of my fourth year. I thought this sounded too cool. Then I got started on it. Who knows I might not even have started if he didn’t tell me to? True words of inspiration. The first person who stated the true words of guidance that was honest and sincere. The only senior at that time who encouraged me to gear up for Step1 and now I am happy to carry out that legacy.


Going through the preparation, I got in contact with another senior Dr. Mustafa Mumtaz. He also encouraged me to give it as soon as possible. His contribution was really important for me because he introduced the NBME concept to me and explained how it helps in measuring up the candidate potential. He also gave me many other tips about the exam for which I am very thankful. I would also like to carry that legacy and guide the juniors just like that, in a positive and encouraging way, the same way he did to me.


My brother, Dr. Ather (not a medical doctor; PhD), also had contribution in keeping me motivated about my eventual goal. Later I also got in contact with Dr. Hassan Aziz and Dr. Sultan Mahmood which helped me carry over my preparation.


If you are lucky enough to get seniors and friends like these, no one can bet against you going 270+ in Step1. Good luck in the pursuit of your ambitions.


If you have any comments that you want added to this article, please write them in the comments below.




 hello.m a 4tH year MBBS

 hello.m a 4tH year MBBS student in indian pvt college.

here we  do not read our entire tesxtbooks but instead read n learn importanr topics ..the ones have been asked in last 10 years in proffessional exams.n this much readin helps us obtain a good score in exams.

so i we have to read,understand n cram each and every topic in kaplan....????? or we could just just do important topics or diseases that are more prevelant and clinically important...?????

please help.

the new qbank?? when will it be out?


Thanks for writing this amazing account. I wanted to know when will the Mededia Qbank

be out? And how will I be able to access it? My third year of MBBS just started this August..I wasted august but will start my prep for step 1 in full swing in september 2012 IA. When would you suggest would be a decent time to take the step 1? 

Please guide me thanks.



i am a Indain student pursuing my 3rd year in medicine at TBILISI STATE MEDICAL UNIVERSITY,GEORGIA.
I want to take USMLE or PLAB or any exams that can assure me my PG study in any country such as US Canada UK Australia or Germany.
I want to have some advise from experts who can guide me through.
Please help me.
I would be very grateful.
Thank you.
Please help me i am very confused.


Dear Ayaz, i m 4th year medical student of  LUMHS jamshoro.
As i m in fourth year I study my pathology from guljan with medium robins and listen lctrz  and I hav studied texts which u hav mentioned in article,for my 1st and 2nd professional I want to start my preparation for step 1 for that I hav bought  kalpon review books and dvds lectures for my study and what do u think is there any other books to buy.?
 My major problem is that i m  confused about the order of subjects to start my study and which subjects I should place first and others in last in my time table.?? Is there any plain or order that I should follow...plz explain me that in detail....ihav not gone thru the Q boks like UW and Q banks yet.
And i hav decided to giv my step 1 exam after my final year exam before my house job bcz now I have passed  more than half of my fourth year.

Simple and detailed article..thank you Ayaz bhae.

Ayaz bhae i m 4th year medical student of  LUMHS.
I  want to sart my step1 preparation from now after reading your inspiring  article... Thanks.
As i m in fourth year my progrees is that till now i have not refered any usmle tested material with my text during  my studies  except pharma from katzng review, microbiology half from levinson  and anatomy from snals anatomy and  i study my pathology  from guljan with medium robins and listen lctrz on internet for making concepts. These are the  books i have studied which u hav also askd in your article....but i m totally confused that how to set my mind for steps preparation ...plz help ihav never gone thru the Q boks like UW and Q banks etc..!!!!
Du to some personal problem i hav decided to giv my step 1 exam after my final year exam befor my house please help in making my schedule..?? I m not cuming to the point that  how to start my other subjects revisions ( except pathology bcz that is subject i m studng now days) as i hav bought kalpon review books and dvds lctures. i dnt know the order of subjects  to start like from which subjects should i  start from now and which subjects i should place in  the last of my time table....plz explain me that in detail.

For that i wil be thankfull to you for ever.

Thank u for detald explantn.

Ayaz bhae I m 4th year medical student.i want to start my preprtns of step1 with my heart and soul frm now..yet i hav nt solved any Q bookS but i refer guljan for my patho with medium robins..i m confused abt my next step for steps preprtn!!plz help..??? I m confused abt my previous subject which i hav stdeyd in 3rd and of first prof.??how shuld i make my schedule of stdng other subjects excpt patho which is in my hand..and i hav bought kaplon dvds..plz help me in making my subject schedule from now..i dnt want to wast my time any more and i M interested to giv my step exam after my finl year exams bcz i think i hav nt any couple of revions of my text that could help me in steps exam before my graduatin..what do u think for me that how can i do my best from now and plz do tell me abt books from which i shuld start my prepration..???

The path for a weak student.


I'm a student who made it through by cramming on the last day and forgetting everything in a couple of days. What's worse is that I used local review books and took advantage of a weak examination system by doing questions that repeated in the actual exam by going through almost every past paper I could. 

My question is that for the first pass what's the best way of going about it? Text books? Kaplan+Lectures?

The latter is what most people suggest, but like you mentioned already lectures aren't something that are easily accessible for review. Is the Text book + Kaplan note method viable?

Let's take physio to be the topic to start of with. Guyton with Kaplan should do the trick I'm thinking but how should one go about it? The chapters don't really go along with each book.

And how long should one take in this "learning phase"? 

not confident enough to give in 4th year!

salam ayaz bhai
                       inspirational article!!! but still i have got a feeling that i cant get a good score if i do it in 4th year..and one thing more which is very important..our seniors and colleagues..they dont encourage us to do it in 4th year..they say that do it after ur graduation..everyone discourages...need some help!!

you need to be confidant for what you are doing

i  had  the  same  problem,everybody  discouraged  m,though  i  started my  prep  in  2nd  year  on  and  off,bt  due  to  no  support  i  left  the  plan  for  after  graduation.i  would  suggest  you  'you  need  to  be  confidant  for  what  you are  doing,and  what  are  your  imbitions.what  i  faced  was  a  lot  of  discouragement.if  you  are sitting  and  waiting  for  others  big  words  it  means  you  are  not  much  stronger  to  make  yourself  ready  for  exam  at  your  own.afterall  i  am  done  with  it  even  before  its  all  upto  you.make  your  mind  and  do  with  have  all  guidance  at  this  forum  seniors.

i have 3 questions to ask

Salams Ayaz Bhai hope u doin well,

i actually have 3 questions to ask you:

1.Im thinking to start my usmle step 1 prep from july inshALLAH after my term exams and im a 4thyr student.please guide me what subject should i start first with and so on.

2.Secondly,im like zero right now in a sense that i forgot quite a things i studied in previous please telme how much time should i give to each subject daily as u should know that here we have annual system of examination instead of semesters.

need help

i m from private med colg of khi juz given my final year mbbs xam... i want to know abt material of usmle?? n can i give step 2 ck be4 step 1 cuz i juz hav given final year xam?? any suggestinz?? plz tel me kaplan is enuf ? or hav 2 read text bookz fm start 2 end?? ppz do rplyy

Query regarding Rechecking

Hi,I got 98 two digit score on step 1.

Thats way less than what i expected.

My question is: Are there any risks involved in sending for RECHECKING??

Jizzakallah Ayaz bhai.

great job.

I am a 4th year student. All i need to know is,can i rely solely on goljan for professional exams too? 


Aoa..I am a student of 3rd yr MBBs in a pvt medical college... I ve some Q's for u.(some are unrelated 2 the topic anyways)

1) Do a pvt medical clg degree and studies effect our carrier..??

2) its better 2 give step1 in 4th or 5th year??

3)USMLE or AMC...??? which ones better??


Dear Ayaz Bhai ,  Thank you

Dear Ayaz Bhai ,

 Thank you for such a wonderful description , its a great help indeed . Sir , i am a final yr student intending to give my step 1 in december , sir I have a few questions .

1) I have just started seeing kaplan videos , they take alot of time and i am worried i might not be able to finish them all , which subjects videos do you think are i should definitely watch ?

 2)  My seniors told me that usmle step 1 exam is similiar to GRE pattern and so as you keep solving the blocks the computer analyses how youwere in the previous block and increases the difficulty of the subsequent blocks ? and then while scoring it compares how many difficult Qs you were able to solve as compared to others . Is this true ? or is it that a set of 322 questions are made and the no of questions correct determine your score ?

Thank you

I have a couple of

I have a couple of questions:

1. The major chunk of your preparation was during the 4th year of your medical college...i was wondering considering so little time which is available, did you regularly attend college wards other than eye and ent?

2. Did you medicine specifically for Step 1 exam? Is it required?

Thank you!

I hope you have many more future successes!

Very informative article,

Very informative article, Jazakallah. Would the grades in graduation matters while choosing for the specialty of your choice like cardiac surgery neurosurgery etc? And would they matter much for residency?

thanks for your kind words...

umar's picture

thanks for your kind words... no it does not matter...

I am very busy these days and won't be replying to anymore queries. Apologies for any inconvenience and thank you for your understanding. All the best.

Hey! I loved dis article. I

Hey! I loved dis article. I am a first year student at dmc and i m planning for usmle.. How eary do u think i shud start? Some of my batch mates have already planned for the end of 2nd yr. Is it too early? And what is da exact importance of electives?

how many of the NBME exams

how many of the NBME exams did you take? You mentioned form 3 and the USMLE world assessment exams but did you utilize all the NBME exams or just 1?

CV for electives


   one question,when applying for electives,what do the selectors want out of a good candidate?

 1) USMLE? i heard that not all unis require this in the US.Any ideas about canada?Do ppl even go to canada for electives?Ive heard they're very close-close about letting in foreign students

2)CV? what wud they look 4 in my CV?Stupid as it may seem to ask-Do they count debates,writing competitions,societies? Im in KEMU,and i guess spws would do for community service.What about the rest?There;s SARD too.

 3)med school grades?

  in short,getting a good elective(or even AN elective) depends on what?

 AND the attendance issue? Dont u think lectures at KEMU are a total waste of time? esp. in the basic sciences?Ive been asking  this question frm a lot of seniors,and the replys alwayz vague-do they really give 10 marks per subj. for attendance or is it rely a fake sword over our heads?

 I'm really thankful to u for all ur help,


Dear Anonymous, please

ayaz's picture

Dear Anonymous, please consider introducing yourself as this would be appreciated.

Some medical students do their electives in Canada, particularly McGill university but the people I personally know have a Canadian citizenship. You have to ask the electives coordinator to get a better idea.

CV is not given too much importance but electives programmes usually ask for a CV to be attached. Places like Mayo Clinic and NIH need a strong CV that is usually reflected in your personal statement. Your CV is improved by activities strictly related to the medical profession only, such as publications in renowned medical journals, clinical experience and references.

Likely medical school grades may not matter too much, but Mayo Clinic looks forward to these. Most programmes now need USMLE Step 1 and the score may be a strong factor in influencing selection.

For attendance issue, please contact your colleagues in your institution.





 this is a wonderful post indeed and very informative.i am kinda confused as i have graduated and the confusion is stuck as in to go for house job first or give steps ....... can you please help regarding this


I might have helped you

ayaz's picture

I might have helped you better if you had better introduced yourself and your immediate future plans regarding house job and exam preparation.

It is entirely upto you if you want to do house job and study for step 1. This would be an overambitious plan. My honest suggestion is that you skip on house job, and prepare for the exams and have december as your deadline.


thanks for taking the time to write this!
its almost like reading some chapters in some step 1 books/ but better... real

read ur thread.. and got some concepts.. here is my summary can u help me.. 

could u check it out.. and let me know what u think.

Order first
Start Kaplan Q bank for the 3 above
Kaplan for the above

kaplan notes 09-10 plus DVD
HY neuroanatomy
kaplan Q book
annotate from the begining to FA

Kaplan plus DVD
Dont know about BRS physio??? what do u think
Annotate FA 
Kaplan k book..

Kaplan plus DVD
Dont know if i should read HY mole bio ... 1999 edition?? what do u think

kaplan plus DVD
annotate in FA
CMMR dont know about these, read lots of posts about this but also read about kaplan.. so dont know if i should u this or kaplan what do u think?

Path (most important)
Goljan RR plus Audio
dont know if i should read at least 1 time kaplan and see its dvd some say barone is great as well.. what do u think
FA of course
what do u think robbins review path???

kaplan plus dvd
flashcards kaplan

behavioral (im an IMG)
kaplan plus dvd
BRS .. what do u think?
conrad fischer book 100 cases
kaplan q book

Kaplan Q bank
while reading for the 1 and 2 time

USMLE world i hear its gold standard
so i want to do 100% of all Q

Doctors in trainning for the last 15 days.. what do u think

for what i read in your thread i think im getting to much resources.. do u think i should cut some away ?
i want to ace.. i want a university program of an affiliated program for IM


about the time ... dont know i guess 6 months

Good planning but I am not

ayaz's picture

Good planning but I am not sure about Doctors in Training Programme. Americans have mixed feelings about DIT but they typically like it because it's much cheaper compared to Kaplan Medical.

6 months is a good timeline. You should definitely cut on some resources because they would only eat away your time. You have no need to do Kaplan Qbook. Omit it entirely. You can replace the Kaplan physiology completely with BRS Physiology. What's CMMR? I don't think you need any other resources other than Kaplan for microbiology, and Levinson as a reference book. For behavioural sciences, you don't need BRS. Your best preparation would be from Qbanks. Do not read HY Molecular Biology in its entirety. Just read what you don't understand from Kaplan. That's all. Good luck.

ayaz bhai khuda apko aur

ayaz bhai khuda apko aur bulande de , apne kitna kamal ka guidance diya jiska zhavab nahee. achaa apka bahut shukriya kyunke is guidance ka mujhe bahuut fhayada pahucha hai.

 thank you very much , and once again congratulations, i want you to give guidance on step 2 ck preparation , do you agree .     please do it.

Thankyou for the kind

ayaz's picture

Thankyou for the kind feedback. As soon as I give my Step 2 CK, I would upload another detailed guide.

simply classic

simply classic


hi,im afraid if i wont be able to get good score...

actually i was not a very good student during last now in my 4th year.

tell me what should i do to give away my tention:(

Start preparing early and

umar's picture

Start preparing early and study well. Your USMLE scores dont rely on your medical school grades!

I am very busy these days and won't be replying to anymore queries. Apologies for any inconvenience and thank you for your understanding. All the best.


hey ayaz how many times did you go through each you your Qbanks before you felt ready?

Just once through Uworld and

ayaz's picture

Just once through Uworld and First Aid Q and A. Qbanks take a lot of time when read with explanations.

Hi,     i am currently in the


    i am currently in the last leg of 3rd yr,mbbs dng ent,ophthal,comm med.I ahd started usmle-1 preps,but couldnt do it this year due to some personal reasons.

i have thot of taking it in the beginning of dat a good time to take it??is a period of 3months suffficient??do the usmle steps have to be taken in order?

does this timing of the exam have any bearing on the chances of getting into a study program??i am also interested in taking up an elective.

it highly varies from person

umar's picture

it highly varies from person to person but if you really work hard... it is certainly doable!

I am very busy these days and won't be replying to anymore queries. Apologies for any inconvenience and thank you for your understanding. All the best.

NBME assessment

Hi Ayaz

I am giving my exam on the 6th of Oct and had a few queries. I had some confusion regarding the NBME's as to which ones to give? and also what is ur view that some forms eg 5 and 6 are harder while 1 to 4 are a little easier? I took two online nbme's form 3 and form 6 and scores were similar except that it was little less in 6 compared to 3. So is that normal considering the difference in difficulty or its a sign to work harder!.

Really appreciate it if you could guide me through this one!



taking a year off to study for usmle step 1 and 2...

hey hi there,

i've got a small doubt regarding the timing of the usmle steps. is it true tat people who are fresh out of med school and apply immediately for residency are given preference over the others who take a year off to study and give their application. given tat both get same scores and are in somewhat similar standing...ll the freshie get more preference?

or in other words ...does it reflect bad on ur cv if they find tat u had taken a year off after med school to study for usmle steps???

yes they are preferred... yes

umar's picture

yes they are preferred...

yes it is not appreciated if u have taken year or years off to prepare for steps...

I am very busy these days and won't be replying to anymore queries. Apologies for any inconvenience and thank you for your understanding. All the best.

wat wud u recomend for a 3rd

wat wud u recomend for a 3rd yr student whose tryng 2 get thru their exams but wants 2 keep the door open for usmle prep....... to put it simply

for pharma: lipincot, mini kat or big kat

for patho: do u recomend guljan at this stage

n is ther ny point studyng forensic at all :P

Pharmacology = Board Review

ayaz's picture

Pharmacology = Board Review Katzung

Pathology = Goljan and associated texts as reviewed in the article.

Yes studying forensic is important to pass your professional exam. Good luck!

i want all the CDs ov kaplan

i want all the CDs ov kaplan lectures-pls if u know where to buy them?

plus i want to buy goljan video lectures also?

Goljan, I think, only has

ayaz's picture

Goljan, I think, only has audio lectures. Both can be bought from any local bookshop in CD/DVD format. 

Congratz for an inspiring

Congratz for an inspiring insight.

I have these Qs:

1.How did u manage ur attendance in ur university-i mean did u miss any classes?

2.Where do we get complete set of KAPLAN VIDEO LECTURES?

Kaplan video lectures can

ayaz's picture

Kaplan video lectures can possible be had, legally, from and they are quite expensive. Otherwise any medical bookshop would have them in DVD format and you can simply buy them.

Attendance was always an issue so I had to manage studies with it. I missed a substantial portion of attendance towards the final date of exam.


First off i'd like to tahank you for taking the time to write such a detailed post, perhaps the most detailed one i've read thus far ( and believe you-me, that i've read many). Your words really make me want to just grab a book and start, and Inshallah score as well as you did. I don't have much to add for now since i have not begun, but it seems like you know what you're talking about. Thanks a lot for letting us in on such a wonderful journey of yours. Very well deserved grade. Cheers!!!!!!


phew.....that was really inspiring.....though I have a pharmacology test tmrw but feel like studying Goljan somehow :)

excellent work....

sir congrats on your

sir congrats on your achievement and thanks for guiding in detail.i am a student of 2nd year and have started preparing for step 1.problem with me is that i am not regularly studying the kaplan series.sometimes even its fortnight gap after which i open them again.whem i start studying then i waste a lot of time in cursing myself for being distracted and for lack of punctuality.what should i do to come out of this situation and for gearing me up towards the goal.seeking for your reply.bye!

Dear Visitor

ayaz's picture

Consistency is important in preparation for Step 1. You may note that a consistent preparation may take not more than 6-7 months and still produce a very good result but a non-consistent preparation can span more than 2 years and still be fruitless. Because you are preparing with your medical studies, this'd be a challenge. You should not force this upon yourself. Take it easy and dedicate only about 4-5 hours per day for Step 1 study. There's no use rushing things and deciding, for example, you'd finish it at end of your 2nd year. Let a sample NBME or USMLE World Self-assessment exam decide when you're finally ready to tackle it.

As long as you're consistent yet steady (only 4 hours per day) with your preparation, there shouldn't be any problems. Good luck!

thank you very much sir for

thank you very much sir for giving me a direction to follow.thanks alot.

Very good indeed

Hi everyone, 

First of all many congrats to you ayaz !! Very well done indeed.

I agree with almost everything you have said. I took my step 1 in November last year and got the same score. I was then at the beginning of my 5th year.

However, one thought that i do not agree with is that giving your step 1 before graduation has no effect on your score. I strongly believe that clinical experience helps a lot. 

I can only say for myself but during my exam i was solving majority of questions based on my clinical rotation experience in psychiatry, obs/gyne, derma, anesthesia, and pediatric rather than from the kaplan series. I think could have done a little better if i had given it after my graduation i think. 

The scores from our school also show my point. Last year, majority those who took step 1 before graduation scored in the range of 236 - 266. This year the scores after graduation went as high as 274. This is true for every year. The highest scores for the last few years have always been above 270. 

The reasons for this are common sense in my view. Firstly, you are totally focused on Step1 after grad with no rotations to divert your attention. Secondly, and more importantly, you have done your medicine and surgery rotations.

Although USMLE says that STEP 1 is a basic science exam but there were a lot of clinical scenarios in my exam. Even this year they have increased the percentage of cases which will be presented as clinical vignettes. Although i believe that any case they present can be solved just on the basis of basic science knowledge but after gaining clinical experience some questions are already ingrained in your spinal cord like a reflex. This saves a lot of time for the more difficult questions i believe. It also makes you more confident answering the clinical vignettes since you come across most of these situation before.  

That being said, i still think that step 1 should be given not only before graduation, but preferably before the final year elective rotations since these days almost all of the university programs require it. Even the pd's that i have talked to during my US electives place a higher value on giving step 1 before graduation since their own students do that. This makes a lot of difference especially if you will be applying in the more competitive fields such as ent, radiology, rad-onc, plastics, neurosurgery etc.

In an unrelated context the above, i strongly believe that everyone should use goljan during their preparation including the audio lectures series by the same author. It greatly helped me, and i can remember that there were at least 10 odd questions which were exactly what he discussed in his lectures. In the book, some important things could easily be skimmed over because it is already too condensed. Listening to the lectures makes sure that at least the most important things stick. And i would seriously advise people not to read the patho kaplan even once. Its better to read goljan once instead of doing kaplan two times.

Anyways, that was what i think. Everyone has a different method of studying and i would advise them to stick to what works for them. Number of reads do not matter. Any one who has followed the 3 read method knows that you end up reading the same concept at least 10 times.

Dear Jamal

ayaz's picture

Thankyou for your valuable insight and a second opinion. While it is true that clinical insight may be helpful in attempting questions, I was talking in favour of American medical students who give their Step1's before their clinical rotations start. Like you mentioned, giving Step 1 in graduation would eliminate the "time since graduation" factor and help you concentrate on other things, like research, after your graduation. It is also very true that a lot of questions these days incorporate complex clinical scenarios, with some questions going as far as asking management plans in a typical Step 2 fashion.

I strongly agree and would reinforce your point about Goljan. Kaplan Pathology, just like Physiology, can be totally skipped in favour of Goljan, however like I did using Kaplan's Pathology during my medical studies, this can be an alternate as well. I annotated my Kaplan with important points from Medium Robbins which certainly my professional exams but may not have had a very strong bearing in Step 1 exam.


great work Ayaz !

First of all Congratulations for getting a wonderful score on step 1. You really worked hard to achieve this score . Also we are all thankful to you for giving a valuable guidance regarding step 1 preparations. I would like to know if you reviewed the whole katzung or just the questions given at the end of each chapter ? And regarding levinson is it worth to go through it once after kaplan and FA microbiology. ?

Thanks a lot for your help.

Dear Visitor

ayaz's picture

I reviewed almost all of the text written in Katzung Board Review book (NOT the major textbook!). The same goes with Levinson. Cross references are important to reinforce facts written in Kaplan. For example, as I stated in my article, topics such as Dengue Fever and Haemorrhagic fever are better appreciated and realized when studies from Levinson rather than Kaplan where only a superficial description may not be adequate to answer a few questions given on USMLE Exam.


Hi Ayaz!!

First of all COngratulations on getting such an awesome score. Reading your prep indicates the level of hard work and focus u put in for the exam and u totally deserve it! I am in the middle of my prep and ur detailed explanation really helps! Thanks a lot for sharing all this with us..

 ALL the very best for your future endevaours!!



i am a third yr student at

i am a third yr student at lmdc. i was actually curious as to when should i take the exam. i was thinkin abt after fourth yr profs.what do u think?i have yet to start my preparation.please guide me i am very confused. i know in the end it is my own decision according to the way i am able to prepare but what do u think would be the most appropriate timing for taking the exam?please reply soon

The most appropriate time

ayaz's picture

The most appropriate time would be just before your fourth year examinations. It would be difficult managing the preparation in final year.

The final decision would be based on your score in NBME assessment exam. If your score is within your goal, you can decide to immediately register with ECFMG and complete the verification process.

When you register at ECFMG and complete the form and payments, you are required to get a verification form attested by your university's dean. When you send it back to ECFMG, they typically require a month to complete the process. Once done, you get your permit which you can use to book a date.

So if you think November 2011 is the intended time for appearing in Step 1, you may give an NBME 2 months prior. If you decide to appear, pick the triad of months: november-december-january. Now you have two months in which to complete the verification and book a date.

So start preparing if you like. Don't rush over things; let NBME decide your fate. You don't have to register for Step 1 at the very earliest because there are very few candidates in Pakistan who take it.

First of all Ayaz bhai i

First of all Ayaz bhai i would love to appreciate this  extremely elaborate explanation of each and every aspect of the STEP1 exam, you provided us with, as far as i am concerned.

  I wanted to discuss a myth (well i want u to give a verdict!) here regarding USMLEWorld which alot of ppl praise. I am currently in my 3rd year and have started preparing for the exam. I was looking forward to buying this bank. What my thought is that, doing questions of the usmleworld bank and reading all the explanations of my wrong answers would lead me into a way of solving questions and reasoning for them in a more "STEP 1 exam" way which might even help me in solving the real ones when i take the test.

                   Now what people I have talked to are saying is that i shouldn't be doing that as this would make me unable to evaluate myself at the end of my preparation when i am all set to take the real thing. They say that i should leave the bank for the end to help me evaluate for the test.

          I would really admire it if you could clear up this opinion and tell if it would be of any good if i use it as early as now (in my 3rd year) to read the explanations and as a result try studying in a way that the STEP requires me to study.

Thankyou for highlighting this issue

ayaz's picture

USMLEworld is a better Questions resource when compared to others that are currently available in the market. While your decision to use this during this stage of your preparation is not flawed at all, the general recommendation is that you should maximally utilize this qbank towards the final stage of your preparation.

In my article I have mentioned this same thing when discussing the stages of preparation. Because virtually every American medical student uses Usmleworld within the final 2 months of preparation, along with First Aid and Goljan, I decided to translate this into a general recommendation since this is a time-tested and student-approved method.

Here is an alternate for you. You may, if you wish, decide to use Kaplan Qbank or USMLErx (or a little later, Mededia Qbank) at this stage of your preparation. They aren't bad at all and should give you a general feel for the Step 1 examination. Because USMLEworld somewhat relies more than these Question resources on concept integration, you may benefit more when you have a sound grasp of the knowledge in Step 1.

Another alternate for you is to attempt about half of USMLEworld qbank by purchasing it online. They allow you to maintain a record of used and unused questions. So by the end of your preparation, you'd be wishing to utilize the remaining unattempted questions.

If you decide to purchase the usmleworld "books" (remember they don't officially release their questions in print), it would be a bit difficult to maintain records of used and unused questions. By doing this qbank now, you'd actually be following my lead because as you can read in my experience section, I did the same! But make sure you go through a major portion of this qbank again in the last month of your preparation! Read the explanations thoroughly.

Do as you like and do what suits you best! You don't have to limit yourself to others' opinions strictly because that'd seriously limit your flexibility in Step 1 preparation. Good luck and if you have anymore questions, don't hesitate to ask!

Thanks Ayaz bhai for the

Thanks Ayaz bhai for the reply. Another difficulty that I face is, constructing a proper time table for the STEP prep.  Because this preparation requires devotion, it is really hard to provide that, as one is going through alot in other time consuming activities like class tests, send ups and prof exams. As i am in my 3rd year now, i havent been able to make up a proper time table to give to the STEP study, yet. 

                      I would really appreciate if you could just put up a general time table of some sort, for people in my situation, to stick to.

You don't have to necessarily

ayaz's picture

You don't have to necessarily construct any timetables. Consistency is far more important than following a stringent study schedule. At third year, I would advise that you spend atleast about 4-5 hours of dedicated study each day. You may wish to take the sunday off and relax. The only meaningful long-term break that would occur is your professional exam so you have to make sure that before it arrives, you have had a long term study commitment with Step 1.

Cover Microbiology and Pharmacology towards the end of your third year. This way your professional exam preparation would not get compromised and should the need arise, you can also switch to studying local textbooks for the exam.

Bravo and well done.Superb

Bravo and well done.Superb article.keep it up and good luck in future.

Gud job done !!

@ ayaz ...thats awesome man, its gud to see such a detailed n grippy article frm a recent step 1 taker..!! ..  'll definitely make my way easier

what a mind blowing

what a mind blowing article,hats off man ..U rockzz dude.

2 ayaz

Dude.. ..u dun realize wat a treatise u'v written down!! absolutely mind blowin!


Ayaz our article duly explains your score in the exam. MashaAllah you have covered it so well that i advise it to be placed on the KEMU website and all relevant places as a career counsel.

MashaAllah you have made us all proud. Prayers for you.

plz highlight on biostatics

plz highlight on biostatics subject that hw much contributions of questions of biostatics in step1exam??

Relative contribution varies

Relative contribution varies in the actual exam. You may see that some Step 1 exams have about 20-30 Biostats questions whereas others have about only 5-10. This is no reason to not give enough time for biostats study. I recommend a thorough study of High Yield Biostatistics. This is bound to help you not only in Step 1 exam but also later on in your research work.

very superb article!! really

very superb article!! really ,u guys  gives us gud planning of study n selections of step1 books in thz article!! i m exicited to wait ur mededia Qbank,hopefully it ll soon launch!!! i just started my step1 study....this article sloved my confusion regarding myths of some books n subject also,hopefully ... wel thaks n plz keep it up!!

The " BEST ARTICLE " i have

The " BEST ARTICLE " i have ever read about Step1 exam !!

@ Ayaz - You deserved it and you have crammed it !! Congratulations !!

congrats ayaz grt achievement

congrats ayaz

grt achievement

thanx a lot dude !!!!

usama's picture

wow !!! datz really awesum experience .. thankyou SO muCH !

Usama Bin Tahir

AOA.I am a student of 4thyear

AOA.I am a student of 4thyear AIMC.I wanted to know can i give step2 ck in final year when iwill be planning to go for electives for 2 months without passing step1.Will it be appropraite like this

You can do that

ayaz's picture

As I stated in my article, if you are accustomed to what Step 1 is like, you can most certainly give Step 2 CK before Step 1 in your final year. This is wise because your final year syllabus is more or less, quite similar to what is to be expected for Step 2 CK. Again whether or not you are prepared would be judged by how you fair in Step 2 NBME practice assessments. If your scores are within what you wish to achieve in Step 2, you can register with ECFMG and select a triad.

There are a lot of bridging concepts and syllabus contents between Step 1 and Step 2 CK.

well done man! what a

umar's picture

well done man! what a well-written account of usmle step 1 guidance... have not read such a detailed guidance anywhere myself.... this would even help me in my prep.... good job!

I am very busy these days and won't be replying to anymore queries. Apologies for any inconvenience and thank you for your understanding. All the best.

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