USMLE Step 1 study guide: resources to ace the exam

Disclaimer: This article is based on my personal experience with these resources. Using the resources outlined here, I was able to score 260+ on Step 1. Your mileage may vary.

As First Aid is the bible for Step 1 preparation, I will be discussing study resources based on the structure used by First Aid. This article is essentially a walkthrough of First Aid and the resources you can combine with it to make sure you do your best on Step 1.

The book is divided into 2 sections: 1- General Principles

2- Organ Systems

I’ll be using this structure and discussing relevant resources for each chapter in those sections.

General Principles (1st half of First Aid):

1- Biochemistry:

This is the 1st chapter in First Aid and includes biochemistry, molecular biology, cell biology, and genetics. This is one of those chapters that you’ll either love or hate. If you had a good grasp of these topics during your BS, then this chapter shouldn’t be all that intimidating. I started Step 1 preparation after graduation and it had been a long time since I had studied any of the topics, but by exam day they were easy points mostly thanks to the resources I used outside of First Aid.

The resources I’d recommend for this chapter are:

Boards and Beyond: Dr. Ryan does a great job of going over these topics, highlighting important clinical tie-ins along the way. These tie-ins are probably the most important part of studying this section because this is how you’ll be tested. You’re not going to be asked what the 3rd step of the catecholamine synthesis pathway is, but you will be asked about an enzyme deficiency in this pathway and its sequelae. B&B does a great job of focusing on these topics, although it does go a bit overboard every now and then.

Pixorize: This one is for those visual learners out there. As someone who dreaded the idea of studying biochemistry, these sketchy-style videos were incredible in helping me keep those biochemistry pathways and enzyme deficiencies in the back of my head come test day. This resource is one of those nuggets I stumbled upon and made a HUGE difference in my prep and how comfortable i was with the biochemistry material on exam day.

2- Immunology:

For this chapter, First Aid and Uworld questions were more than enough. Pathoma also does a great job of explaining a lot of the concepts you’ll need to know in immunology in chapters 1-3 of his book. These should be more than enough to get all the immunology questions on test day.

3- Microbiology:

This is one of those topics that you’ll have to know cold. There’s not much you can do outside of memorizing the bugs and their treatments. I didn’t use First Aid for microbiology, but if you do, I’d recommend you add the following to your First Aid readings:

Sketchy Micro: To make your life MUCH MUCH easier, I’d recommend using Sketchy Micro. In a word, Sketchy takes those pesky memorization heavy topics like microbiology and pharmacology, and turns them into colorful, easy-to-digest sketches. Symbols are tied to different bug characteristics and might carry over from one sketch to another when bugs share these characteristics. By recalling the picture, you’ll have an unworldly superpower of remembering even the tiniest of details.

Yes, it works best for visual learners, but I would encourage everyone to at least give it a go, even if you don’t consider yourself a visual learner. It takes 90 pages of straight memorization from First Aid and break it down into a number of short 5-10 minute videos that you can incorporate into your studies regardless of what you’re studying. Let’s say you’re studying cardiology this week, you can watch a few Sketchy videos on your break time, during lunch, before bed, whatever works for you. This will save you a bunch of time rather than dedicating a study period specifically to microbiology.

Anki: There are a bunch of pre-made decks out there for USMLE step 1, and I would recommend using the ZANKI deck which includes a microbiology section. Much like sketchy, this will allow you to break up your microbiology studying over a long period rather than dedicating a specific study period for it. We talked about spaced-repetition and Anki in this episode of our podcast.

Using Sketchy and Anki in tandem will make microbiology one of the easiest topics on exam day rather than one of the most dreaded. The stuff you learn here will also help you throughout your career.

4- Pathology:

The Pathology chapter in First Aid does a great job of summarizing all the basic pathology you’ll need to know for your exam. I would recommend you also do chapters 1-3 of Pathoma as they’ll make it much more digestible. You’ll be able to answer so many questions on exam day by just watching chapters 1-3 of Pathoma. I would also recommend you watch them once again in the week leading up to your exam. Yes, they’re that important.

5- Pharmacology:

If it’s been a long time since you’ve gone over pharmacokinetics and pharmacodynamics (yuck, I know), then I would recommend the Basic Pharmacology chapter from Boards & Beyond. This covers all the topics discussed in the First Aid chapter in a very straightforward, yet detailed manner.

6- Public Health Sciences:

I would also recommend the Boards & Beyond Biostats and Epidemiology videos for this chapter too. The videos are around 2 hours long and do a great job of covering all the topics discussed in FA.

If you want a quick refresher, I’d recommend these 2 Youtube videos: - https://www.youtube.com/watch?v=75pQPB1RF50 - https://www.youtube.com/watch?v=VMI9UuNqoGI

Organ Systems (2nd half of First Aid):

The basic structure shared by First Aid chapters in the Organ Systems section is as follows:

- Embryology

- Physiology

- Pathology

- Pharmacology

Whether you’re studying cardiology or endocrinology, they will all follow the same structure. Therefore, we will discuss the resources that could help you in each section of the organ systems chapters.

You’ll start noticing an underlying theme to the resources used: UFAP. That’s short for Uworld, First Aid, and Pathoma. You will certainly have to go outside of these resources at times, but these should be the backbone of your studying.

1- Embryology:

Thankfully, this isn’t a heavily tested subject. You will get a few embryology questions here and there on test day, but these will be relatively straightforward and easy to get points.

First aid and Uworld: The 1-2 page summary of embryology in every First Aid chapter is a great guide on what you need to know for each organ system. The material covered in First Aid and tested in Uworld is enough, but if you would like to learn more about the embryology of each chapter, I’d suggest using Youtube if you feel inclined to do so.

2- Physiology

If you’ve ever read the physiology section of First Aid, then you’ll already know how hard it is to study a conceptual topic like physiology from First Aid. It’s hard to learn physiology from bullet points. If you can get away with it, then fine. If you feel like you need another resource to help make sense of things, I recommend one of the two following resources.

Costanzo Physiology: This book does a great job of explaining physiology concepts. The chapters are long, but once you read it, you’ll understand why. The author does a great job of making physiology simple. It will take you a day or more to get through each physiology chapter, but it’s definitely worth it. Remember, you don’t have to spend hours memorizing physiology, and no one expects you to. But this is one of those resources you do a quick read of at the beginning of a new organ system that will make your life much easier. Once you understand physiology, then pathology and pharmacology start making a lot more sense. The time you spend brushing up on physiology will save you time when studying pathology and pharmacology, and will make you much more prepared to answer questions that aren’t necessarily directly discussed in First Aid.

BRS Physiology: If Costanzo Physiology chapters are too long for you, then you’re in luck. The author of this book is also Linda Costanzo, so you can think of this book as a summary of Costanzo Physiology for the USMLE. This would make more sense if you’re short on time or just need a quick refresher if your physiology knowledge base is good.

3- Pathology:

The Number of resources out there for pathology are limitless. Finding the right resource for you is very important because a huge chunk of the exam is made up of pathology and pathophysiology questions.

First aid and Uworld do a great job of covering the exam material, but there are other resources you can use to bolster your knowledge.

Pathoma: This resource is priceless. Pathology concepts are broken down in detail and simplified in ways that have you scratching your head sometimes. There are videos for every organ system and the way Dr. Sattar explains everything will have you hating the way you were taught pathology in medical school. Yes, he’s that good.

Anki: Another thing you could add to your study schedule is Anki, specifically the pathology section of the Zanki pre-made deck. This will help you review the information you need to know over long stretches rather than having to go back to a textbook.

Boards & Beyond: Some people also recommend Boards & Beyond. I didn’t use B&B in organ systems because I didn’t feel the need to. Uworld, First Aid and Pathoma do a tremendous job of helping you get those questions right on exam day, and I honestly don’t think you need more in terms of reading.

4- Pharmacology:

Just like microbiology, pharmacology is a memorization-heavy topic. You’ll need to know indications, contraindications, drug-drug interactions, and side-effects.

There are a lot of drugs to know, and unfortunately, you’ll have to memorize them.

First Aid and Uworld do a great job of showing you what you need to know and simplifying things a little.

Anki: If you want to make sure that these topics are fresh in your head, then the pharmacology section of the Zanki pre-made deck will help you tremendously. The flash cards go over all the important things you need to know, allowing you to memorize them over time.

Sketchy pharmacology is another resource you could use. Although I swear by Sketchy Micro, I don’t think their pharmacology videos are up to par. The videos are sometimes unnecessarily long (≈30 minutes) with too much going on in the sketches for them to be realistically memorable. There are a few gems among these videos, so I would recommend you maybe try watching videos for the drugs you just can’t memorize using the resources mentioned above.

Note: Psychiatry is the only organ system that doesn’t follow this structure as there is no embryology or physiology for obvious reasons. For psychiatry, Uworld and First Aid are more than enough to answer any questions you might encounter on test day.

With Step 1 moving to a pass/fail grading system, your life just got a lot easier and you won't need to kick into as high a gear as students in the past have had to. Hopefully, these resources can help make things even easier where you can just pick and choose the resources based on your needs.

Good luck!