USMLE Tips Consolidated

People often overlook the necessity of planning. Planning is an essential element of success, whether you are planning a trip or planning a career path you would never get out there and just “wing” it. If you do “wing” it for the USMLEs you will surely be disappointed. There are many tips all over the internet about the right model for studying for the USMLEs (a.k.a. the Boards). Here I will consolidate suggestions, add my perspectives with a little help from my friends, to help better prepare you. Understanding what’s on the test and how to prepare for it is a key first step to your success.

 This article is being sectioned as follows:

  • Components of the Exams
  • Study Habits
  • Study Material

Components of the Exams

The USMLEs are 3 separate exams in 4 parts:

  • Step 1
  • Step 2 CK (Clinical Knowledge)
  • Step 2 CS (Clinical Skills)
  • Step 3

 Here is a brief summary of each exam.

Step 1

Arguably the most difficult of the exams this test is comprised of 325 multiple choice questions; this computer based exam takes a full day (8 hrs.). This exam is generally taken after the 2nd year of medical school when you have completed your basic science courses. The content covered on this exam includes all of your basic sciences in an integrated fashion:

  • Anatomy
  • Biochemistry
  • Microbiology
  • Pathology
  • Pharmacology
  • Physiology
  • Immunology
  • Genetics
  • Aging
  • Behavioral sciences
  • Biostatistics and epidemiology
  • Nutrition
  • Molecular and cell biology

Step 2 CK

Taken generally in your 3rd or 4th year of medical school, this exam focuses on your ability to apply clinical knowledge. This exam is also a computer-based one day exam comprised of 350 multiple choice questions.

Step 2 CS

Already out for several years, this exam is vastly different than any other. This exam tests your ability to apply your clinical skills in mock scenarios with “standardized patients.” This is also a one day exam and is regimented. You will have 12 patient cases (encounters) each allotted 25 minutes (15 minutes for patient interaction and 10 minutes for documentation). You will be scored on the following 3 metrics:

  • Communication and Interpersonal Skills (CIS)
  • Spoken English Proficiency (SEP)
  • Integrated Clinical Encounter (ICE)

Step 3

This exam is given over 2 days and is generally taken after graduation. The exam is a multiple choice and tests your ability to apply clinical science to patient care.

Study Habits

As mentioned earlier, a little advanced planning for your study schedule each day will keep you focused and save you valuable study time. You need to treat studying like your job: regiment it and you will succeed. Don’t wake up each morning and then decide what your game plan will be for that day, as this indecision will just waste precious time. Knowing in advance what activities you will engage in and when (i.e. reading, QBank, making flash cards, practice tests), will help minimize lost time during transitions.

I don’t care what anyone else tells you, preparation for your exams (particularly Step 1) begins the moment you set foot into medical school. How you ask? Simple: when reviewing your coursework in any of the basic sciences you can add targeted QBank into the mix.

However, for most folks that can be a little overwhelming. So, make a 6-8 week schedule that includes meals and socializing and time to take care of yourself. Let’s face it…you can only isolate yourself for so long before going a little crazy. You will need to account for breaks, meals and full practice exams. As you go along, and you see something is not working, modify the global schedule not just the day’s events. This is now your daily “work schedule.”

The best way to overcome anxiety is preparation. Preparation means familiarity with a particular subject. So, in preparing for an MCQ exam, it makes sense to familiarize yourself with MCQs.

  • Take a practice test early to see your strengths and weaknesses. We recommend at least 1per week over the course of 8 weeks. Chart your progress. It’s important to make these practice tests timed and equally regimented to the actual test as it prepares your body for the real thing.
  • As you master a subject…move on. Spending time focusing on areas in which you are struggling will only improve your results.
  • Find a partner(s) to study with. Motivate each other.
  • Breaks in your study day are a must so aside from meals make sure you include at least 30 minutes of exercise. Your body will thank you. Every hour or so get up and shake “it” off. When you get the crick in your neck or other bad sensations your body is telling you to MOVE!
  • Create a study space – the best space is a table or desk. This is best found in the library or study hall. If you room is your option, make sure you stay clear of distractions and the bed.
  • Set boundaries – Keep family and friends away during your study time. You wouldn’t bother your friend while at work would you? Probably not, so if you consider this your work, setting boundaries will be easy. Leave your phone away from your study space. This is a bad distraction. If there is a global calamity I’m certain you will find out.
  • Be true to yourself – Only you can tell how much effort you need. Are you memorizing facts or do you understand the matter? Understanding = long-term memory. Passively reading a book is not effective. Repetition is the key to understanding.
  • Block studying – I have never been an advocate of this as the real world does no present itself in a block format. However, for test preparation all bets are off. Consider a portion of your week studying in a block format, meaning take a subject and watch videos, read and do sample MCQs on that subject only. Beware, Step 1 requires an integrated approach and so you will also have to know how each basic science subject connects.

The USMLEs are difficult exams so don’t beat yourself up if your struggling. Test anxiety might get in the way but it is best to ensure a good night’s sleep the night before the exam. Wake up earlier, fresh and energized to ace that exam. With proper preparation and focus, you will be prepared and confident when you walk in on test day.

Study Material

It is important to say that no one method is sanctimonious. The best approach is to view each venue as a supplement to another. While your budget has much to say about what you choose, don’t settle for the commercial courses because of the “name,” choose one based on their outcomes. This will make your studying whole. The major venues include:

  1. Prep Courses - They offer structured lectures and preparation materials. For those who learn best through this classroom style learning this is a good supplement. You may also want to consider saving a few bucks and enroll in a live-online course. Some medical schools offer prep courses as part of the curriculum. Avail yourself of the opportunity to take them. Some courses are offered by well-known companies like Kaplan, Medquestreviews, and Doctors-In-Training.
  2. QBanks – These are essential for USMLE prep. They offer hundreds of MCQs in varying formats with explanations. There are some freebees that can get you started as well as inexpensive starter options from USMLE and NBME. But do NOT rely on them. Comprehensive proprietary QBanks will need to be purchased as a subscription.
  3. Study Guides – “First Aid” is known as the Step 1 bible. Use it!

Final pearls:

  1. Create a study plan – Stick to it. Don’t get distracted.
  2. Make time for yourself – Exercise daily.       Also, like residency you need 1 in 7 days free from patient care; here you will need 1 day off from studying. If you don’t take care of yourself you will burn-out quickly. Pick a day and make it part of your schedule.       This will help you mentally stay the course.
  3. Proper planning, focus and preparation – Remember: Knowledge x Effort = Results.

 Good luck!


As always, comments and suggestions are welcomed.  If you have an idea for future topics please share and we can collaborate.

Michael Farca served as a residency program coordinator for the Department of Medicine at one of the largest training programs in the country.  He became the Department Administrator with continued oversight of the residency program, 2 primary site fellowships and 3 rotating fellowships.  Michael has dedicated over a decade to graduate medical education and is board certified in Teaching Administrators for Graduate Medical Education (C-TAGME).

*Disclaimer - Michael is an entrepreneur and operates an observership program and offers USMLE and Internal Medicine Board review materials.