Tuesday, May 3, 2022

USMLE STEP1 just changed! You need to too!


On 26 Jan 2022, the USMLE Step 1 changed its score reporting format to Pass/Fail only. This means, that those who give their exam after this date cannot see their 3 digit score, and neither can anybody else (yes, not even PDs)

Students can now wrap the exam up faster and in a financially more efficient way. What's more, the humongous anxiety associated with it is finally out of the way, because passing the exam is very much manageable.

That being said, this change is by no means a reason to study half-heartedly, as the knowledge you gain in Step 1 is a foundation for your future journey.

So what exactly changes with this decision? And what should you do to adapt to this faster? Let us deal with some common questions that you may have at this point.

Q: UWorld, First Aid, Pathoma- how much of that changes?

UWorld stays

Pathoma, Boards and Beyond, other Qbanks- Si Opus Sit or ‘if the need occurs’

First Aid reduces to an annotation device

And ANKI comes in big time

Q: Okay.. elaborate on how we go about all of this!

 I would say that the entire focus of your preparation now should be solving MCQs only.

If I must say this in one line, it's UWorld, UWorld, UWorld!

  • Prepare retrospectively: use your QBank as a learning tool. UWorld percentages do not translate to your score, so ignore it. Each question presents information in a unique way, and your goal is to extract that information and apply it to similar scenarios. (Don't worry about memorization, believe me, they repeat concepts over and over)
  • Annotate in First Aid (FA): There's no need to take notes separately when such a beautiful compendium exists. FA already includes most of the factual information, so when you deal with a question explanation, you will hardly ever need to reiterate that fact for yourself. What is missing is the reasoning. Annotate the concept alongside the relevant text in FA. Write your interpretation of how the idea can be tested.
  • ANKI: Flashcards target the forgetting curve so it is a great way to remember dry facts. It works with concepts too, and you have the freedom to feed it whatever info you want. (Read till the end to find pre-made deck recommendations)
  • Pathoma: First 3 chapters (general pathology) and Hematology are sufficient. (Flashcards are also available for the same so you can save time on these videos)
  • Boards and Beyond: Biochemistry and Immunology videos are helpful if flashcards seem too vague. The rest are covered very well in their own deck.

Trust the process of active recall and spaced repetition. Our traditional study techniques are low yielding. Qbanks and flashcards force you to remember and apply these concepts and facts repeatedly, so you ultimately store them in your long term memory.

An Average timeline:

Time to complete- 6 months.

UW 1 block has 40 questions. Total questions- 3600+. Thus a rate of 20Q per day will take you 180 days to finish.

An Average day:

6-7 hours of study time (when you target 40Q per day)

1 block of UW (with a thorough review) can take anywhere between 4-5 hours.

Anki cards: 1-2 hours per day

Your speed will increase when you reach halfway through UW.

Q: How do we go from zero to solving UWorld? What if we are starting our medical school just now? Conversely, what if it's been too long since our basic sciences years of medical school? Is there a plan we can follow?

A: Situation 1- fresh into med school-

Concentrate on building concepts while studying for your med school exams. Starting ANKI Decks is your first priority. View your ANKI cards alongside the topics taught to you, and keep reviewing cards every day.

Test-taking acumen develops with practice so early incorporation of Qbanks is vital. If you are too far from your exam and cannot begin UWorld right now, buy a year-long/24-month long secondary Qbank like AMBOSS and USMLE-Rx. The AMBOSS library can supplement your class studies as well. Solving as little as 10 questions per day (and understanding each topic that comes your way) will reap massive results.

Refer to video lectures like Pathoma, Boards, and Beyond when you struggle with certain concepts. Watch these in the blank periods of the day to use time more efficiently.

The essence is to first finish your Questions and your ANKI cards for the day and then refer to additional material as time permits.

Situation 2- Already / soon-to-be graduates

Board style MCQs are clinical scenarios, so those of you who have clinical experience, just trust yourself and start solving questions. You will adapt to the style easily. Use UpToDate or the AMBOSS library to brief yourself about the topics that come up in your questions.

Use smaller, more concise ANKI decks to cover your lacunae. The same strategy of first targeting Questions and flashcards, and then referencing videos for specific topics applies.

Those comfortable can also go faster by solving more questions per day.

Q: So How do you carry your knowledge forward to step 2ck? Tips to store information in an efficient format?

  • Make your own ANKI flashcards
  • Annotate in FA
  • Collect pictorial information
  • Write down only complicated concepts separately that too in your own words (limit re-reading as it only builds familiarity)
  • Always store notes in a Q&A format so you are forced to do an active recall.

Q: The ANKI decks?

I'll end this post by mentioning a few pre-made decks, that you can use directly, to save time.

I am a firm believer in customization, so I used only concise, subject-specific decks/subdecks according to my strengths and weaknesses. I did these-

Concise decks:

  1. Pepper Microbiology and Pepper Pharmacology (based on Sketchy videos so you don't need to watch them separately).
  2. Duke's Pathoma
  3. Lightyear Immunology, Lightyear General Pharmacology
  4. Anatomy 100 concepts
  5. Zanki cardiac Auscultation sounds
  6. Soze (3000+ cards, has most subjects. I used it for Biochem, Genetics, Biostats)

But if you are someone who likes to stick with one/fewer resources, and have sufficient time at your disposal, you can try the more comprehensive decks, which cover everything. Each has at least 20k+ cards (I recommend you have at least 1.5-2 years before your exam, and ensure that you don't compromise your Qbanks while you tackle this huge number of cards)

These are the best ones out there:

  1. Lightyear (Boards and Beyond)

  2. Anking (includes Zanki)

I hope my experiences can make a difference in your study lives! I'd be happy to answer any questions along the way.

Happy Studying!

-Sania Thite


  1. By far the most practical approach I have read among the plethora of opinions .thank you for concise and high yielding advice.pls keep posting such blogs.waiting for the next one.

    1. Hey! Glad I could help. Thank you for your kind words!


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