Step 1 Preparation and Experience

Step 1 266 – Comprehensive Write-up

Target audience for this post

I wish I had seen a post like this when I was starting step szn cause it would’ve relieved a lot of stress and anxiety. I hope it helps many of you out there. This post is for anyone who didn’t start Zanki/Lightyear/other decks from day 1 and never kept up with reviews. Scoring high despite not doing the latter, however, comes at a cost. That cost is working your ass off(going all in, working 8-10 hrs/day, all day everyday) starting ~6-7 months out. This also requires that you built a strong foundation of fundamentals and principles of thinking in your pre-clinical years. What I mean is: Not only did you learn everything properly the first time around, but are you actively making connections and seeing the bigger picture every time you learned something? Can you integrate concepts well, and apply them into clinical thinking?”. Keep in mind that a lot of what I did is only necessary if you want that 260+. The only issue is that Step 1 is so variable and is an any given day test. That said, the goal is to raise your floor so that the worst case scenario can still be a 250+. If at least 75% of this describes you, this write-up is for you. Let’s get it.


People love saying: “Stick to a few resources and do them well, do not try too many resources”. This is true, but I stepped that up a notch. I used as many resources as I possibly could and took the best parts of each resource to fill in my self-identified knowledge gaps. More to come on this below. The point is, if you want a 260+, you want to start off by identifying your weaknesses early and using however many resources you need to become an absolute expert in that subject. Again, this will all make sense when I talk about how I used specific resources below. Just to give one example: I was one month out from my test, and I was trash at reproductive path and I was also always forgetting the little details/etiologies/characteristics of the RTAs, ATN, and glomerulonephritides. One of my friends, who scored 250+, swore by sketchy path and said it helped him know all of path cold. So I went to sketchy path for renal and repro and immediately knew everything that I used to forget cold. Seriously, this one move worked wonders for me. This brings me to my next point.

The key to success on this plan is to constantly tweak and modulate your plan/study schedule. I would re-assess where I stood on a daily basis. Is what I am doing working? What types of questions am I missing? Is it subject based, or is it something else? What resources can I use just for that small area to become an expert in it? Basically, you’re going to need constantly re-evaluate and change your plans, and that is completely okay.

Next, know and understand who you are. Everyone is different. Please do not blindly follow someone’s advice when you know it goes against your philosophy or learning style. There are many different paths to success on this test, and you will only do well if you optimize your plan based on your own personal style. I have not seen anyone do the things I did, and I would always question myself and wonder whether I was royally fucking up. But no. Only you know what’s best for you, and find a way to learn all the resources in a way that you learn best.

Last but not least, everyone says Step is a memorization test, and it largely is. But, if you want to take it to the next level and kill it, it really helps to understand the in depth pathophys of everything and how it all connects together in the big picture. You need to be able to form connections between the things you are learning. This will help tons on hard questions where you need to reason. There’s obviously a ton to memorize on this test and I am not denying that. But I always told myself: Memorize as little as possible. If you learn something by brute force memorization, say goodbye to it unless you matured Zanki from day 1(which I did not). I forced myself to stop at every new fact I learned, and really understand the why behind everything. Is there some sort of connection I make to another topic I already know? If so, there’s a great chance this will stick in my head. So in a sense, you are still “memorizing” but it is actually going to stick in your brain now cause you took the time to actually process that information. I felt like this tactic greatly helped in both my pre-clinical school tests, and Step 1. That being said, there’s a ton of stuff like micro and pharm that need to be straight up memorized which sucks, but Sketchy and Anki can do the trick for those. Another thing that greatly helped me when I needed to brute force memorize things was making mnemonics. I had a knack for coming up with clutch mnemonics on the spot for things, and those really stuck in my head, so I would recommend that. Again, you’re going to have to memorize a lot, but make sure it isn’t blind memorization.



I go to a mid-tier US Medical School. We have non P/F number grading and ranks, so I went hard purely studying in house PPTs and not doing a lick of step. Our subjects in M1 were the basic sciences + Cardio and Neuro. Did not know anything about step at all during M1. Some ppl I knew were doing something called Zanki, to which I was like: “I got no time for that rn”. Lol. I would study as much as possible for in house, and then all other free time I had would be devoted to working out, hanging with my friends, playing basketball, and getting lit. Absolutely not a single thought about step. I used to always regret this, cause the in house tests and PPTs are just so out there and a lot of times there is not much overlap with Step 1 material. But after this whole process, in house material is what helped me get a lot of questions that others “have never seen before”. I worked very hard and did very well, ranking in the top 1% in both M1 and M2. I am inherently a lazy person who only works hard if there is a need to. If we were not graded, I would not be writing this post today with a 266 score. I also want to add: whatever your plan is for step, please enjoy free time in M1. You will regret it if you don’t. You will never get time like that again. Main point: In-house material differentiates the good scores from the great scores(most of the time)Second point: Enjoy M1 and don’t stress about Step so much. Save it for M2 cause you’re going to need to go hard. Save up that energy.

Summer after M1:

Research by day, chill by night. Thats all. Did not do a single thing for Step. Original plan was to start Zanki for Cardio and Neuro and keep up with reviews but I got too lazy and did not do any of that. Looking back, that summer was great, and in hindsight, it was okay that I didn’t do any step.


In my M2 year, the school wanted to add NBME exams to our testing. This was great for me because step was looming and it would be a great way for me to be forced to learn the material as well as possible to do well on the tests. The only problem was that our tests were now mixed in-house + NBME questions. So we had to study double. No lie, 1st semester M2 was crazy cause of that. I started doing Zanki for each organ module in M2 along with B/B, Pathoma, FA, Sketchy Pharm, and the USMLERx questions for that module. All while also studying all of the in-house material super in depth. In 1st semester M2, we had derm-ophtho, respiratory, GI, Renal, Biostats/Epi, and MSK/Rheum. My regret here is that I only did the Zanki in one-pass for each organ module as a study resource. Never did any reviews at all after we moved onto the next module. Lowkey regret this, cause any free time I had away from studying, I would use it to drink, chill with friends, or relax lol. I did very well in all the modules and learned everything very well. The problem was that I didn’t remember jackshit about anything I learned before cause I never did any reviews. I felt like I forgot all of Cardio, Neuro, Derm, Ophtho, Respiratory, GI, and Renal. I hated myself because all my friends and all of reddit seemingly had kept up with reviews. And now I was 6 months out from my test as Winter break approached. In hindsight, I realize that the good thing was that I had learned everything well the first time. Shit comes back quick the second time, so even if you feel like you don’t know anything or you forgot everything, trust that it’ll be okay.

M2 Winterbreak and beyond:

My plan was to relax and party during the first week of winter break because that would be my last taste of freedom for a while, and we had just come off of a school test. In the second week of winter break, I started sketchy micro and finished it right as second semester started. I used the pepper deck for micro. Yep you read that right, I never used lolnotacop. I would constantly second guess that decision of not doing it, but it ended up working out. My advice to you is to do lolnotacop because it is just a safer route.

After talking to many upperclassmen, and seeing reddit posts, I felt like my best bet was to start Uworld immediately and just learn the shit out of it. I was planning on making cards while doing Uworld and reviewing those cards daily. It was now January and my test was in June. We started our infectious disease module right after break which was perfect because I had just completed sketchy micro during break. But remember, there is also an in-house component of the test. But I told myself, that I had to go all in on step and couldn’t spend as much time on in house anymore. From then on till step, I would study step full time(atleast 8 hours/day) and then study for the in-house portions the last 2 days before the test. I started off in January aiming to be done with all of Cardio and Sketchy Pharm(with Pepper Pharm deck) by February. The resources I used for Cardio were B/B, Pathoma(supplemented with Duke Pathoma deck), Zanki Physiology(only one pass, no reviews). I purposefully didn’t do a pass of Zanki Path because I felt like I would see it all in Uworld, and I was doing the Duke Pathoma deck. Quick shoutout to the Duke Pathoma deck. Exceptional deck that is short, concise, and still fairly comprehensive of all of Pathoma. I really felt like I knew Pathoma in and out cause of this deck. Also it is not a cloze deletion deck like Zanki so it forces you to do more thinking. You may be wondering why I keep doing one pass of Zanki with no reviews. Well at this point, theres no point cause Zanki is too big to start 6 months out. Also I didn’t want to read FA as a book, so I was basically reviewing it in flashcard form. I would do 20 Uworld questions a day in cardio. I did it in non-timed tutor mode. Took 10 minutes per question and went super in depth into everything and made super detailed cards. Was extremely thorough with it. I continued with this approach through all of cardio, Heme/onc, and endocrine. I did heme/onc and endocrine after cardio because those were the 2 organ systems we were on during that time.

The time is now mid April. We are all home for coronavirus. My test is still schdeduled for June. I still have one more organ system left in school: reproductive. The big problem was that I had only reviewed 3 organ systems since January: Cardio, heme/onc, endocrine, and it was now mid-April. FML. I was highkey freaking out. I had 8 weeks left and I still had to do Neuro, Resp, GI, Renal, MSK, Reproductive, Derm, and all of basic sciences, biostats/epi, ethics, etc…..I was completely regretting my decision of going thru Uworld slowly from the beginning. I made a plan and schedule and gave myself 3 weeks to cover all the material I had left, and the remaining 5 to complete Uworld and do any other miscellaneous things. In those 3 weeks, I watched B/B, Pathoma, one pass of all the Zanki cards for each organ system, finished up ~20% of sketchy pharm that I had not done yet, and did pixorize for biochem/immune.


Yep, this is so great it gets its own section, and no I didn’t get paid to say this. Seriously this resource is gold. Boosted my score double digits from before to after it. And because of this, I never had to do Zanki for biochem/immune which are both fat decks. A lot of ppl don’t fuck with it, but I love this resource and lowkey believe it should be talked about like UFAPS/BB. Not much to say here, cause I can go on and on about it. Just do it, and thank me later. I used part of the pixy stix deck and part of the adytumdweller deck. Both are great, but I would recommend pixy stix cause it actually gets you to memorize the entire picture which is what you really need.


I got cancelled 5 weeks out. I had been working nonstop with no breaks since winter break. This couldn’t be happening to me. I had put it all on the line, and now it seemed I wouldn’t even be able to prove my worth. I missed out on all of life for 7 months, and all for what? What’s worse is most of my friends weren’t cancelled like me. Shoutout to Mamba and Jordan for helping me hang in there. The Jordan documentary came out around this time and he allowed me to enter an entirely different game mode. This was adversity that I would not let define or stop me. I was going to get thru this, and I was going to have the last say no matter what. There was no stopping me and there was no time to mope around in self pity and sorrow. Also shout-out to the entire r/step1 reddit community. Many of us were in the same boat and all the inspirational posts made me feel like I wasn’t in this alone. After around 2-3 weeks, a lot of spots started opening up again and now I was scheduled for early July. Just the feeling of being allowed to take the test felt so great to me.

For the last 5 weeks, I did 80 Uworld a day and finished 95% of Uworld. Finished with a 92% correct. Did not do anki at all the last 5 weeks. Literally woke up, did Uworld, reviewed, and went to sleep. That’s it.

Test day

I worked out the day before and went to bed at 11pm. I randomly woke up at 2:30 AM and could not fall back asleep. Was kind of nervous/stressed about only having 3.5 hrs of sleep but I had done too much to be stopped now. There was no way I was letting that screw me over. I came to the test center strapped with Monster, coffee, water, protein bars, and sandwiches. Taking a swig of monster after each section really helped me stay in the zone and not feel tired at all. I would recommend taking a short break after every section. Go to the bathroom during every break and take a small bite of food and drink something so you never crash or feel hungry during the test. Test felt like free120 mixed with the new NBMEs(like NBME22/23 especially). Did not feel like Uworld. By far harder than any practice test I took. Much harder than any of the NBMEs or Uworld. Came out feeling like I did my best, and performed to the best of my ability. So I was at least happy I did my best. But still was worried because my test was killer. As the days passed after the test, I got more and more worried that I didn’t do well. Easier said than done, but really just try not to think or worry about shit after cause its over. Just forget it and enjoy yourself. You just finished the hardest test of your life.

Practice Tests Scores

UW Percentage – 92% (1st pass)

NBME 21 (254) – 8 weeks out

NBME 22 (255) – 7 weeks out

NBME 23 (254) – 6 weeks out

UWSA1 (273) – 4 weeks out

NBME 18 (269) – 3 weeks out

NBME 24 (263) – 1 week out

Free 120 (92%) – 5 days out

UWSA2 (269) – 5 days out



This article originally appeared on Reddit, it was published here with the permission of the author.

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