Step 1 Preparation and Experience

178 –> 242 in Two Months (with Data) in Step 1

Hopefully this helps someone.


  • Courses
    • My medical school has a 1.5 year P/F pre-clerkship curriculum that’s not Step-based
    • Did pretty well in most courses (85+) except Anatomy (barely passed)
    • Went to class every day except when I physically couldn’t
  • Step Prep
    • Did not use any Step decks; only used in-house Anki decks made by upperclasspersons/peers
    • Used Sketchy Micro for every block and Pathoma/B&B whenever I needed help on a topic
    • Was really bad at using FA or USMLERx; did not use Costanzo either
  • Finished
    • All of Sketchy Micro
    • a Neurology clerkship
    • a Family Medicine clerkship (without taking the shelf)


  • Data
USMLE World (UWorld) % and Practice test Scores over Time
4/4: pre-dedicated baseline | 5/18: start of dedicated | 80% on Free 120
hours spent studying per day | 17.8h/528.9h were pomodoro breaks (3%)
in hours
  • Logistics
    • Goal was 240
    • Did not use any kind of score predictor before taking Step. Just did it and got 234 😛
    • Used Notion as my task manager; can’t recommend this app enough and it’s free if you’re a student!
    • Used Clockify, a Chrome extension that works with Notion to keep track of time spent on tasks and a built-in pomodoro timer (figure 2)
    • Used Webtime Tracker, a Chrome extension that tracks the amount of time you spend per website (figure 3)
    • Used AnKing Step 1 deck, 100 Concepts (Dorian) Anatomy deck + PowerPoint, and Rapid Review deck
  • Schedule
    • Made master schedule with how many UW blocks I needed to do each day to finish a week out. Started with just 1 block/day and steadily increased to 3 blocks/day; 3 blocks/day is absolutely horrible so I would recommend starting with 2 blocks/day
    • Wanted to take a practice test every week and then increase in frequency the last 2 weeks
    • Built in time to finish Sketchy Pharm and Pathoma
  • UW
    • Random & timed from the very beginning
    • Got 37% on the first block and freaked out but it got better 🙂
    • Spent 2h on average reviewing every block. Started at 3h, went down to 1.5h, realized that I was rushing, and re-equilibrated to 2h again
    • Whenever I missed a question, I would find it in Anki and flag it. I then made a filtered deck with all of my flagged cards. Unfortunately, I didn’t get to do many of them but finding the cards and reading about the topic in context of other similar cards was useful in and of itself
    • Got through UW once plus a handful of incorrect blocks; found that it was less helpful because I didn’t finish the Anki for all the questions I missed so I just kept making the same mistakes and that was taking too long
  • Anki
    • Made many filtered decks for missed questions and for all the topics that I knew I needed to review
    • Only rated ~8,000 cards; just didn’t have enough time
    • AnKing really is a great deck; wish I did more of (or any of) it during pre-clerkship because, obviously, it would’ve helped a lot
  • Practice NBMEs/UWSA
    • Made a conscious decision to use some of the free retired NBMEs due to monetary reasons
    • Followed the results of this Cureus article for which new NBMEs to take based on R2 value
    • Tell me why I had no idea that the UI of the actual test would actually look exactly like UW???
    • For me, I always felt I did worse than my score. I skipped every question that I didn’t know the answer to right away which was half of the block most of the time. I flagged every question I wasn’t sure about which was like 3/4 of the questions I skipped and would almost alway run out of time before I get to look at them again. That made flagging obsolete basically. If this sounds like a bad test taking strategy, it probably is. I think I just got better at eliminating wrong answers, making my best guess, and trusting my gut over time #gestalt
  • Other resources
    • Used B&B and Costanzo on topics I needed extra help on
    • Got answers for Free 120 from Ben White
  • Home stretch
    • During the last couple weeks, I made a “To Review” column in Notion of topics I knew I was still shaky on. Didn’t get through everything but I definitely tried
    • Used 100 questions that appear on every NBME to guide my targeted review as well
    • Looked at the 100 concepts PowerPoint
    • Did a power read of FA
    • Rewatched Pathoma Ch 1-3
    • Replicated a full-length test by doing 3 blocks after UWSA2 while wearing a mask
    • Made sure to heavily review questions I missed on the Free 120
    • Did the Rapid Review deck
    • Reviewed formulas; this was not necessary at all because I didn’t have to use a single formula on the exam
    • Listened to Goljan on my drive to my testing site which was in another city
    • Did 5 incorrects the morning of and got super lucky because one of them showed up on my exam 😀

Aftermath & Takeaways

Having dedicated during a pandemic and an ongoing sociocultural revolution was one of the greatest mental challenges that I’ve experienced. Part of it was my own doing. I have horrible impulse control so I had to be apart from my SO, delete all social media apps, and use website blockers. After 4 weeks, this became unsustainable. Reconnecting with people close to me and the world at large, as well as the things I enjoyed was crucial for my mental health. What also helped was moving my test date back after getting a 210 two weeks out. I just didn’t feel ready and I knew I needed more time.

The test itself was like the Free 120 > UWSA2. Felt great during the first 4 blocks then got served by the last 3. There were quite a few WTF questions. If you didn’t know, you can look at whatever resources you want during your breaks, including your phone. I took a break after every block and that was incredibly helpful. I probably missed some stuff. Either way, it’s over! On to r/Step2.

Edit: oh, and if anyone wants an instrumental playlist with 600 songs comprising of math rock, post-rock, future bass, EDM, lo-fi, folk, acoustic, etc., making this helped me a lot



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