As one of the most challenging and important tests a medical student will ever take, the USMLE Step 1 exam can be intimidating. However, with a lot of studying, the application of some helpful hints, and lots of practice answering different types of questions, you can excel. Learn more about the exam, the question types, and how to reason through the answers in today’s blog.
What is the USMLE Step 1?
The USMLE Step 1 is the first of three licensing exams that medical students must prepare for and pass to become physicians in the United States. Score reporting has recently shifted from a three-digit score to a pass/fail format.
How long is the exam?
This computerized exam is an eight-hour testing session administered in one day. At the start of the exam, there is an optional 15-minute tutorial and 45 minutes allotted for break time. There are a total of seven sixty-minute blocks. Although the number of questions in each block may occasionally differ, there are never more than forty questions per block.
Break time can be divided as the test taker sees fit. Some take a break after each 60-minute block, while others do two or more question blocks back-to-back before taking a break. It is important to note that if the 15-minute tutorial is skipped, those 15 minutes will also be added to the break time. Overall, the entire exam has a maximum of 280 questions.
What’s tested on the USMLE® Step 1?
The content tested on the USMLE® Step 1 is focused on the basic sciences as well as physician tasks and competencies, which are the core of what medical students learn during their first two years of medical school. More specifically, the exam content includes the following disciplines:
- Anatomy
- Aging
- Embryology
- Physiology
- Biochemistry and Nutrition
- Genetics
- Biostatistics
- Epidemiology
- Behavioral Sciences
- Immunology
- Microbiology
- Molecular and cell biology
- Pathology
- Patient Care
- Pharmacology
- Communication and professionalism
What types of questions appear on the USMLE Step 1?
All of the questions on the USMLE® Step 1 are multiple choice questions in which you must choose the best answer. Rather than basic recall-level questions, the majority of the questions are two-step questions. These are questions where the test taker must correctly ascertain multiple points about the case before they’re able to arrive at the correct answer.
For example, a case may present a patient with the signs and symptoms of pneumonia; instead of simply asking for the diagnosis of pneumonia, a two-step question may ask about the most likely pathogen involved in this patient’s infection or about the most likely imaging findings on this patient’s chest X-ray.
There are also questions with images that may include a photo of a patient with a particular finding, an ECG, X-Ray, MRI, CT scan, or a histology slide for interpretation by the test taker. In addition, there are multimedia questions where you must listen to different lung sounds, heart sounds, or view a video of a patient displaying particular signs during a physical exam. Lastly, there are linked questions, where multiple questions may be asked about the same case in sequential order.
Remember, you won’t be able to go back and change your earlier answers for the case as you progress through the linked questions!
What are some general tips for multiple-choice questions?
There are a few strategies to employ when approaching the multiple-choice questions that appear on the exam. You may be presented with a long question that seems overwhelming. However, by looking at the last sentence, you’ll know what question you’re being asked, enabling you to pick out the most critical information to help you select the correct answer.
Make use of the highlighting tool and notes section; it can help you keep track of the pertinent information from the vignette so that you do not have to reread the question stem multiple times.
When looking at the answers, cross out the options you know are incorrect. If you get stuck between two answers, try to reason through why each answer is correct. There will always be one answer choice that makes the most sense to the clinical scenario being presented to you.
Another great tool to use is the marking tool. Unsure of a question? Mark it and come back to it. It’s easy to lose track of time when you’re trying to work through a very difficult or confusing question. Instead of losing time on one question and possibly having to rush through others, mark the question and come back to it later. Remember, all of the questions are worth the same amount of points. Focus on gaining as many points as possible by giving each question an appropriate amount of time.
Speaking of time, make sure to keep track of the timer that’s ticking away while you work through questions. Ensure that you have enough time to answer all of the questions and review your answer choices before time is up.is up.
How to approach two-step questions?
The purpose of two-step questions is to prevent rote memorization from being the primary study strategy employed by students. For example, a question may provide you with a clinical scenario and request the pathophysiology behind this situation. If you can’t determine the correct diagnosis, you can’t select the best description of the underlying pathophysiology. You must reason through two steps to get the correct answer. A helpful way to work through these multi-level questions is to break them down into parts. Look at the clues in the vignette to determine what question you must answer first. That will ultimately lead you to answer the question that awaits you in the last sentence of the question stem.
How to approach imaging questions?
Imaging questions can often seem daunting when preparing for USMLE® Step 1. The good news is that the information you require to answer the question is often found in the vignette, and the image will only reinforce your answer choice.
There will be times when choosing the best answer relies primarily on the image being presented to you. The question banks and practice exams that students use to prepare for this exam are a great way to get exposed to different images and recognize patterns that will make them easier to decipher on test day. Be sure to review the various resources and images presented very carefully.
How to approach multimedia questions?
The best way to approach multimedia questions is to practice listening to different heart and lung sounds as well as observe videos of physical exam findings. Osmosis has a robust library where you can listen to these sounds and receive an explanation as to their cause, location, and associated conditions. Some questions include videos of physical exam findings that you can also review while studying. Remember, vignettes may provide you with clues to arrive at the answer before you click on the multimedia. Use both the vignette and the multimedia to determine the correct answer.
What resources are helpful to study for the USMLE Step 1?
There are many resources to choose from when studying for the USMLE® Step 1, and it can be easy to try to adapt another successful test taker’s methods and resources during your test prep. However, your individual learning style is the most important thing to consider when studying for this exam. Regardless of your learning style, question banks are vital when preparing for this exam to learn concepts and reinforce knowledge.
In addition to Osmosis, commonly used resources include First Aid, UWorld, Pathoma, SketchyMedical, Picmonic, and Boards and Beyond. Osmosis offers flashcards,videos, and questions and can help you generate a study schedule.
The National Board of Examiners also provides practice exams to test your knowledge and identify strengths and weaknesses before test day. Make sure to allocate time to take and review practice exams to help you get a feel for how concepts may be presented on test day and pinpoint areas that need improvement.
Most importantly, focus on the resources that work best for you, such as spaced repetition through flashcards, to keep the facts and concepts you study fresh.
There’s a lot to consider as you prepare for the USMLE® Step 1. The great news is that there are plenty of helpful tips and tricks to help you excel on test day. Check out this Ultimate USMLE® Step 1 Study Guide to get more insight on this exam.
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