Step 1 Study Guide

Zach Berman, 2014

Some background: This plan was developed as a plan that LJ sent Mike. Mike modified it and then sent
it to me where I played around with it, taking advice from Mike, David, Kyle, and Dennis. A lot of credit
goes to those guys. I also, would like to thank Mark Layer for sitting with me on the beaches of California
as we hammered out the stressful final details.

For reference: I got a 163 on the practice exam you can take in December and ~225 prediction test
before starting studying. I am by no means a savant. (Our average was well over 260 as a group).

Materials:
1) First Aid for the USMLE (FA)
2) Pathoma
3) Uworld question bank
4) Lange Pharm Flash Cards
5) Wikipedia
6) OPTIONAL: MIcro Flash Cards (I used these the first 2-3 weeks then switched over to FA completely)
7) OPTIONAL: DIT videos for first time through FA (I thought it was helpful to slow me down and gives a
few more mnemonics) - would definitely not use this as a major resource

If its not on that list dont get it. I want to make that really clear. IF ITS NOT ON THAT LIST DONT GET
IT. All but 4-5 of the questions on my test could be answered with just those resources. A lot of people get
themselves into trouble by using waaaay too many resources and not spending enough time with any one

Method:
Before diving into the plan, I want to share what was going through my (and others) minds when
developing this strategy.

First, questions. If you do over 2,500 questions you are pretty much guaranteed at least a 235 (per DITs
info packet). This needed to be a major part of our plan.

Second, pathology. I decided to use Pathoma over Goljans rapid review and I would do it 1,000x over.
There were quite a few questions during the test where I heard Dr. Satar's voice in my head answering
the question. There is some give here on that decision but Pathoma is an amazing resource.

Third, Pharm/Micro/Biochem. They are indistinguishable in my mind. On the actual test these questions
are the easiest in my opinion; they are also the questions that will separate you from the rest of the pack.
They ask very straightforward questions, for the most part 1 step reasoning (pretty much unheard of on
the rest of the test). ie. A patient has postauricular lymphadenopathy, what is the bug? Or a patient comes
in with vague nausea vomiting and a high serum Proponyl-CoA level. What co-factor are they
missing? There is really no way of knowing that unless you straight up memorized it; this is why most
people hate Step 1 (MAKE THIS YOUR STRENGTH!!!!!)

So we targeted these fields with memorization in mind. No concepts to learn - just facts. You either know
it or you don't. Can't really reason your way into an answer like you can for physio.

Fourth, and for me the most pivotal. Do it somewhere where you know few people. When I was studying
there were quite a few Fridays and Saturdays where I would stay in my house and study. I was in a small
village, where I didn't know anyone and therefore, didn't get depressed when I didn't go out and the rest of
my friends did. A lot of my peers had problems staying motivated while their friends finished their first
rotation or would go out and get beers on a Friday. Med students are the masters of delayed gratification!
(you will be happy with your score even if you have to sacrifice a few going out days).
Other tips:
1) Exercise/Relaxing/Stress relief - 1.5 hours a day minimum. For me that was 60 minutes+ of running
and the rest of walking. (I think I ended up running around 350 miles while studying) . I broke my study
day in half with this. I loved it.
2) Food EAT REAL FOOD!!! Nothing from a box or has all sorts of crap in it - your brain will thank you
3) Sleep - there is absolutely no reason why you should have FEWER than 8 hours a night. Realistically
this might be the last time you can get 8+ hours ago the rest of med school.
4) Clothes - I forget where I saw this advice but I agree with it 100%. Put real clothes on every day.
Jeans/T-shirt etc. Wearing sweatpants every single day will make you lazy.
5) Coffee - both Mark and I (avid coffee drinkers) went cold turkey the last month. I would recommend not
using caffeine, you become dependent on it quickly and withdrawal headaches are horrible. (Optional)

The Plan:
The plan is set up for 7 weeks duration and is broken into 3 parts.
Part 1: The initial gathering of information (3 weeks)
Part 2: The reinforcing of said information (2 weeks)
Part 3: Building the endurance for an 8 hour test (2 weeks)

Part 1:

Note: My days started at 7am.

Weeks 1-3:

Morning 1 hour pharm flash cards, 1 hour micro flashcards/FA chapter every single day!!!! This is a
recurring theme. I spent the first 2-3 hours of every morning using nothing but flash cards or the
micro/biochem section in first aid. I made sure to do 1 hour micro and 1 hour of pharm during this
portion.

Then 8 DIT videos in the order they wanted them to be done. Alternatively you can do ~0.75-1 section in
First Aid (ie. GI, Neruo, Cardiac, etc).

Noon: Lunch/Exercise/Shower.

2pm: Then 1 to 2 chapters in Pathoma (watching video and taking notes in book) - we went in order and
didn't try and match it up with First Aid/DIT. Some days our pathoma would be on cardiac while our
FA/DIT was based on GI. Dont try and match them up; learn from our mistakes it was way too hard and
added a lot of stress.

4:30pm: 2 sets of Uworld quesions (96 q total a day) of whatever DIT/FA was on. Dont worry about
taking too many notes or annotating your first aid completely. A set should take you no longer than 1.5-
2 hours tops. If youre taking longer than that you are spending too much time on each question.

8 hours of sleep.

Doing this every day for the first 3 weeks you would have finished DIT (all of First Aid) and Pathoma (for
the first time). Additionally, you will surprise yourself with your newly acquired solid understanding of
Micro and Pharm.

We took a practice test at this point - NBME 11. Four weeks from the test and scored 255. It is scary how
much you learn in those first 3 weeks. Its as if you didn't know medicine beforehand.

Part 2:
Weeks 4-5: Still do 1 hour of Pharm and 1 hour of Micro but now add 1 hour of biochem. Yes the
first 3 hours of every morning was spent doing these 3 things.
I used these 14 days to do the 14 or so chapters in First Aid again during the rest of the morning session.
Note: if you didnt use DIT just repeat your FA plan from Part 1.(Systems Based: So Cardio,renal, pulm,
etc don't do the Pharm section/biochem section etc, you get that 1 hour every single day already!)

Noon: the lunch plan with running stayed consistent form part 1.

The afternoon was spent WATCHING the pathoma videos and not even looking at the book.( Now you
have used this resource as an written/visual resource the first time through, and again as a pure visual
resource the second time through wonder what the third time through is going to do? This gives your
brain 3 completely distinct reference points for all of the information in that book! Because the information
is presented in 3 different ways your brain has to store it in 3 different places (pseudo-science or not).

In afternoon/night I would finish all of the sections on Uworld for the subject that I was studying that day
(ie whatever I didnt finish from the first 3 weeks). So by the end of week 5 you have done 100% of
UWorld and another complete pass through FA/Pathoma as well as COUNTLESS times through
micro/pharm/biochem.

We took another practice test - NBME 13. Three weeks from exam I scored a 261 (slow growth not as
much as I was expecting)

Step 3:
Weeks 6-7: This is where things get a little crazy. Mark threw out the idea of trying to do ALL of UWorld
again in 2 weeks - and being crazy, we did it.

Morning was still spent 3 hours for micro/pharm/biochem.

The rest of the day (pretty much from 3pm on) was QUESTIONS.

Reset UWorld and start over from the beginning and do 1 complete topic a day. (THIS IS BYFAR THE
HARDEST PART OF THE STUDYING PERIOD. The benefit - you will be used to doing ~200 questions
when you are already a little fatigued from the morning) IF YOU DO THIS, I CAN PROMISE YOU, AT
THE END OF THE REAL TEST YOU WILL NOT BE TIRED!

As a note: some fields like Cardiology have over 200 questions. So yes, you might do 200+ questions in a
day. It sucks but doing all of the questions over again was one of the BEST ideas that we had.

In total: we were around 5,500 questions for all of studying. 3x through FA and 3x through pathoma as
well as 20-30x through micro/pharm/biochem. You will know the Kreb-cycle better than Kreb did.

Day before the test: We traveled to Laguna Beach 45 miles away(where we took our test) spent the day
going over the last chapter in First Aid which is little last minute reminders. Went to dinner with my Aunt
and went to sleep. It might take you a little longer than expected to fall asleep the night before.

Overall result: ~270

If you have any questions please feel free to ask ([email protected]). This is an intense plan
for sure, but do the work and you will get the score!

Hope for the best!