What to study first for USMLE (United States Medical Licensing Examination) Step 1?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 23, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

To begin studying for USMLE Step 1, start with the foundational sciences: anatomy, physiology, and biochemistry, as they form the basis for understanding more complex medical concepts. When considering the most effective approach to studying for the USMLE Step 1, it's essential to prioritize the subjects that lay the groundwork for all other medical knowledge.

  • Anatomy should be the first subject to tackle, focusing on major organ systems and their structures, as understanding the physical layout of the body is crucial for comprehending how it functions and responds to various conditions.
  • Next, move on to physiology to grasp how these systems function, including adaptations to exercise, stress, pregnancy, aging, and renal and pulmonary abnormalities, as highlighted in the training guidelines for clinical cardiology 1.
  • Then, delve into biochemistry, which is vital for understanding cellular processes and metabolism, and recognize the importance of dietary, renal, and hepatic function, as well as geriatric influences on drug therapy, as noted in the context of pharmacology education 1. After establishing this foundation, progress to pathology, pharmacology, and microbiology, using high-yield resources and question banks to assess understanding and identify weak areas. Key subjects to focus on include:
  • Pathology, to understand disease processes
  • Pharmacology, to learn about drug interactions and therapies
  • Microbiology, to comprehend infectious diseases and their treatments By following this structured approach, individuals can build a strong knowledge base and effectively connect basic science concepts to clinical scenarios, which is essential for success on the USMLE Step 1 exam.

From the Research

Preparation for USMLE Step 1

To prepare for the USMLE Step 1, it is essential to understand the exam's content and format. The exam primarily measures knowledge about foundational sciences and organ systems 2.

Key Factors for Success

Several factors can contribute to success on the USMLE Step 1, including:

  • Using USMLE-specific question banks, which have been shown to be positively correlated with performance on the exam 3
  • Taking practice examinations, such as the National Board of Medical Examiners (NBME) Comprehensive Basic Science Self Assessment (CBSSA), which can help assess exam preparedness 3
  • Pre-clinical grade point average (GPA), which has been found to be associated with higher subject exam scores among students who took Step 1 4
  • Preparation for the exam itself, which can help develop crucial skills such as compassion and empathy 5

Curriculum and Performance

Research has shown that there is a relationship between students' perceptions of the adequacy of their curriculum and their performance on the USMLE Step 1 examination 6. Students who felt that their curriculum was adequate were more likely to perform well on the exam, while those who identified deficits in the curriculum were more likely to struggle.

Study Resources

Some studies suggest that certain resources are superior for exam preparation, such as USMLE-specific question banks 3. Additionally, practice examinations like the NBME CBSSA can help students assess their preparedness for the exam.

Pass/Fail Scoring

The shift to a pass/fail scoring format for the USMLE Step 1 has raised questions about how this change will impact student preparation and performance 4. Some students may study more or less for the exam depending on the scoring format, and the impact of this change on student outcomes is still being studied.

Recommendations for Study

Based on the available evidence, students preparing for the USMLE Step 1 may want to consider the following:

  • Use USMLE-specific question banks to prepare for the exam 3
  • Take practice examinations to assess their preparedness 3
  • Focus on developing a strong foundation in the sciences and organ systems 2
  • Seek out additional resources and support if they identify deficits in their curriculum 6

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.