USMLE STEP 1 Common Mistakes: How to Best Prepare for your STEP 1 exam?


USMLE STEP 1 Common Mistakes: How to Best Prepare for your STEP 1 exam?

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This post will go over the common mistakes that students make when they are preparing for their STEP 1 exam.

While the gold-standard resources for preparation for this beast of an exam are well known, guidance on the best way to utilize these resources is sparse. Additionally, posts on mistakes to avoid during Step 1 preparation are rare. During my experience preparing for the USMLE Step 1, and guiding juniors/ contemporaries in their preparation, I observed a few common themes.

This is the last year Step 1 will be a scored exam, so for those taking it this year, solid preparation is essential. I will begin by explaining general, thematic mistakes, and then move on to resource-specific mistakes. Finally, I’ll discuss a few oversights by students in their preparation, which are not strictly related to preparatory material. These tips & tricks could be the difference between an average score and an amazing one.

General STEP 1 Mistakes
Failing to do one’s due diligence before using resources


There are numerous posts online explaining what resources were used by high scorers. Most of these, however, do not explain the best way to utilize these resources. For example, while First Aid is a beautiful resource and a must-do, it is not a comprehensive review to understand the concepts you need to know for the exam. Similarly, I’ve observed IMGs attitude towards flashcards being either extreme love or extreme hate, and in most cases, the latter stems from a lack of understanding of how to use this unique resource.

My recommendation – spend a little time in your pre-dedicated period to understand what the resources are like, their optimum use, and plan accordingly.


Blindly following others’ advice

This applies to this article as well. At the end of the day, the USMLE is each one’s individual journey. Advice and guidance are crucial, but you have to figure out what works for you. You must take some time to figure out what your optimum style of learning is, and what resources work well for you, even if it is slightly unconventional

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Failure to analyze one’s weakness/ adjust according to self-assessments

The best way to score high is to have a high baseline in all subjects, rather than being extraordinarily strong in one or two, and weak in the others. As one moves deep into the dedicated period, one must tailor their preparation to target their weaknesses. UWorld gives you a fantastic depiction of what your strengths and weaknesses are. For example, I was weak at psychiatry and biochemistry, so in the last two weeks, a significant portion of my time targeted these subjects. On exam day, the representation of each subject is variable, so one must have well-rounded preparation.

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Memorization over concept-based preparation

You should focus on understanding the concepts of the information you are reading rather than just trying to memorize them. You can watch videos, search on Google, or have a quick read from a book if you are having a hard time understanding an idea. Try to understand the links across subjects. This represents a different challenge; for those coming from India, for example, where the focus in our medical school exams is long, essay-based questions requiring memorization. This new approach is something many initially struggle with.


Not spending enough time on media-based questions

Image/audio/video-based questions form a good proportion of the actual exam. Compared to text-based questions alone, these can be quite difficult without practice. I’ve seen many candidates reluctant to do targeted study for these types of questions, and as a result, their scores drop.

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Resource-specific STEP 1 Mistakes
First Aid (FA) STEP 1

Treating FA like a textbook – this may be controversial, but I believe this is the wrong way to approach FA. The strength of FA is that it summarizes what you must know for the exam. However, it is not the best resource to learn from. Therefore, use other resources to understand the concepts and FA to review and solidify the high-yield topics.

Doing multiple passes of UWorld in the dedicated period – UWorld is the gold standard resource for Step 1. However, the goal of doing UWorld should be learning how to approach questions in the right way, it is not to memorize all the information in the question bank. When you do a second approach soon after the first one, your percentages are falsely elevated, and you learn nothing new.

My recommendation – Take notes in an efficient way to review certain ideas you don’t know rather than review the whole question bank. Do a second question bank if you have time. In my opinion, AMBOSS is the next best question bank. This will further reinforce topics and prepare you for the multiple ways the same question can be asked.

Rushing through UWorld – The strength of UWorld lies in its explanations. They are incredibly well researched and well written. Regardless of whether you get the question right or wrong, regardless of your percentages, you must read the entire explanation and understand it. This is how you progress.

    • Reading too much into UWorld percentages – I have seen candidates be complacent, and take fewer NBMEs/ practice tests because they assumed that they were well prepared, based on their high UWorld percentage. UWorld percentages are not predictive of real-world performance.


These are great to lay the groundwork. However, in your dedicated period, there is no need to review the entire coursework. Candidates waste an inordinate amount of time re-watching the entire catalog, with minimal returns on score.

My recommendation – solve more questions; you learn from your mistakes. If you really feel like you’ve forgotten the topic, watch that specific video. There is absolutely no need to watch everything all over again, it is a low-yield exercise.


These mistakes generally stem from failing to understand how the system works .Blitzing/ going through reviews too quickly – with this, you may ‘finish’ your reviews for the day, but you haven’t actually utilized the principle of active recall. When you rush through the cards, rather than thinking about the question they are asking, you are using visual recall of the pattern of the flashcard to answer, i.e you are regurgitating the answer, not relearning the content.

My recommendation – take your time to do justice to each flashcard. There are add-ons available on the Anki online store to make sure that the pattern of the card changes each time you review it – this can help you really learn the card.

Not keeping up with reviews – Anki is a scientifically proven method that works only when you follow the algorithm. I’ve seen plenty say that it didn’t work for them, but that is because they failed to keep up with their daily reviews; they opened the app sporadically, and on seeing the piled-up cards, could not continue.

My recommendation – Anki is not a must-do. But if you do choose to embark on using the popular decks, please learn beforehand about how the algorithm works, and the best way to use it. The AnKing Youtube channel is fantastic for this.

Self-assessments (NBMEs/ UWSAs)

Not analyzing mistakes
– NBMEs and UWSAs are the gold standards. While it may be overkill to study all 160+ questions per exam, analyzing one’s mistakes gives you a huge benefit. You can broadly classify mistakes as (a) silly mistakes, due to exhaustion, overthinking, or impatience (b) failure to recognize what the question was asking (c) mistakes due to lack of knowledge, and (d) sufficient knowledge but failure to link different facts together. The approach to each type of mistake varies but identifying these mistakes can go a long way. Many candidates simply move on to the next NBME, only to repeat the same mistakes.

Not assessing early enough or frequently enough
– I’ve seen many candidates delaying taking their first NBME. This is understandable; the exam is huge, and anxiety is considerable.

My recommendation – take an NBME around 2 weeks into your dedicated period. This may give you confidence because you’ve progressed. It may also give you a reality check, and force you to think about changes in your approach. Either way, self-assessment is critical, and identifying mistakes/ weaknesses early on can drastically change exam-day outcomes.

Not purchasing NBMEs – I’ve seen a lot of people using ‘offline’ NBMEs, and simply finding out how many mistakes they’ve made. I think this is a big mistake – self-assessment is critical during your exam preparation; it can tell you whether you’re making progress in the right direction, whether you’re ready for the exam, and even what your weaknesses are.

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Other Mistakes During STEP 1 Preparation

Too long of a dedicated period

Some students take months or even years of dedicated time to study for their STEP 1. Try to balance the time you need to get your target score (if you take the exam scored) or pass (for STEP1 pass/fail) without burning out.


Not preparing for the STEP 1 exam day itself

  • Prior to Step 1, I had never given an exam that was more than 3 hours long. Step 1 is a whopping 8 hours. In addition to this, candidates may have to travel early in the morning, sometimes to a different city or even country. Without preparing for this grueling experience, candidates may see their scores drop.

My recommendations:

  • Take breaks during your NBMEs as if you’re in the actual exam.
  • Take 2 NBMEs (or 2 UWSAs) to make it similar to the actual exam.
  • Set your sleep cycle so that you function optimally from 8 AM to 4 PM. For example, I was in the habit of taking a nap right after lunch. However, I knew I couldn’t do this on exam day. So, I would force myself to stay awake till at least 4 PM.
  • Plan your food, drinks, and travel on the exam day well in advance.
  • Ensure you get a good night’s sleep. This is easier said than done, so please do your due diligence. If you’re planning to take a sleep supplement, please try it beforehand, do not try it for the first time on the night of the exam; this could be disastrous. The Dirty Medicine Youtube channel has a video with fantastic advice for food on exam day and ensuring you get a good night’s sleep.

Good Luck everyone!

By Vivek Bhat and Malke Asaad

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