USMLE® Step 1 is a cumulative assessment of the knowledge gained during the first two years of medical school. While the exam shifted from the traditional three-digit score to a pass-fail system, it remains the first meaningful hurdle medical students encounter on their path to residency. The first challenge lies in learning the vast amount of content on the exam because everything you’ve been exposed to during those first two years of medical school is fair game!
Due to the sheer volume of information that can appear on the USMLE® Step 1 Exam, a comprehensive study plan is essential. A useful study plan includes new content, repetition of material, and a healthy amount of practice questions. Fortunately, Osmosis.org has done the legwork for you. Here’s a quick primer on how to use the Osmosis quiz tool to conquer Step 1 (as well as COMLEX 1 for the osteopath learners out there)!
The Benefits of Quizzing
Practice questions are the foundation of Step 1 preparation. To do well on Step 1, it’s super important to both complete and review practice questions. It’s worth repeating that reviewing practice questions is as important, if not more important, than completing practice questions.
When completing practice questions, learners must use active recall and problem-solving skills to answer correctly. Osmosis quizzes provide immediate feedback to check your knowledge in real time. Studying with quizzes allows you to practice using test-taking strategies and gives you the opportunity to identify flaws in your question approach long before test day. Once you’ve completed a set of questions, the next step is reviewing the completed quiz.
When reviewing completed questions, you’ll benefit from the use of spaced repetition, which is an especially effective way of retaining information for the long term supported by compelling evidence. For example, Anki is effective because of its use of spaced repetition, which adjusts the frequency of card exposure based on user-rated difficulty, ensuring that you review challenging content more often while reviewing easier topics less frequently.
While Anki is a powerful learning tool, I recommend creating your own cards, which requires you to engage with the material and articulate concepts in your own words, strengthening both your understanding and retention of the material. Taking this approach leverages the original purpose of Anki: helping you review information you’ve already encountered. So, while pre-made Anki decks are convenient, they also come with the challenge of adapting to someone else’s writing and learning style, which can cost you time and patience.
Strategies for Effective Quizzing
While all learners should complete and review practice questions, how often and how long you need to study depends on the individual. Some learners do their best with just a few questions every day, while others excel when they study hard during the weekdays and take weekends off. There’s no universal answer to that question. Ultimately, the optimal study plan is the one you can stick to while maintaining your health and well-being.
Using the Osmosis USMLE Step 1 study schedules is a great place to start. Reviewing past study plans for difficult exams before Step 1, such as the MCAT, can also help identify personalized and unique approaches to studying.
Incorporating Quizzes into a Study Schedule
When studying for Step 1, completing questions and reviewing them (notice a theme yet?) makes up the majority of your study time. Additionally, practice questions will likely be the most energy-intensive portion of your daily studying. We recommend taking test questions at the start of your study day to ensure you have the energy to perform your best. Reviewing questions tends to require less mental energy, so it’s reasonable to hold off on reviewing until later in the day.
An effective daily study plan might look like this:
8 AM to 11 AM: Complete two to three full practice question sets.
11 AM to 12:30 PM: Break for lunch.
1:00 PM to 3:00 PM: Review completed questions from the previous day, an example of spaced repetition.
3:30 PM to 5:00 PM: Content review or new content exposure, which can be videos, reading, Anki, podcasts, group studying…you name it!
To be clear, this is an example of a study schedule rather than a recommendation. It does include unscheduled time, so make sure to include scheduled time for breaks. In addition to supporting your overall well-being, scheduling breaks also reflects the Step 1 exam day when you choose the timing of your breaks.
Later in your Step 1 dedicated study period, it’s also wise to increase the total number of questions you complete daily to build up your mental stamina for test day. For students who prefer a more specific study plan and want to explore additional tips on acing the exam, Osmosis is here to help.
Tracking Progress and Adjusting Study Plans
An advantage of using practice questions to study is that it’s easy to track your progress. There’s a range of variables worth monitoring, including your percentage of correct questions, your scores on practice USMLE Step 1 exams, and the number of questions you’ve completed per day (up to a point). It’s important to track these variables as an overall positive trend over time instead of looking for a linear positive trend. In other words, while you’ll want to see improvement in your performance and scores, it’s common for your progress to fluctuate up and down rather than steadily increase. For those worried that tracking such trends may lead to overthinking, dropping the lowest practice test performance as an outlier can be helpful, as we all have off days.
If you notice that your progress is slowing or declining, the first thing to consider is mental exhaustion. While your anxiety may be telling you that you have to push through, the best step when progress slows is to take a break. We know that convincing medical students to step away from studying can be difficult. But trust us, knowing when to take a break is an essential skill to have as a medical professional.
After the break, we recommend mentally rehearsing how you approach practice questions. Often, deficits in question performance are due to test-taking patterns that may impact performance on practice questions. These patterns tend to become more prevalent as mental exhaustion builds. By becoming aware of your test-taking patterns to understand when you’re refreshed versus when you’re tired, you’ll significantly improve your study performance without adding a lot of study time to your schedule.
How to Use Osmosis Quizzes
If you don’t have one already, take a moment to create an Osmosis account (we offer a free trial period so you can decide if Osmosis is right for you). Accessing Osmosis quizzes is as simple as clicking on the sidebar menu under “Questions” (See Figure 1).
Once you’re in the Questions section, the Osmosis quiz builder will prompt you to select the exam you’re preparing to take. It will invite you to choose the topics you’d like to review, personalizing your study session to present the exact content you want to review (see Figures 2 and 3).
It’s also worth noting that you can choose between a set of new questions, questions you’ve previously answered incorrectly, or a mix of both. Doing this allows you to focus on new content exclusively or to complete questions as a form of review.
Taking Next Steps to Unlocking USMLE Step 1 Success
Practice questions are the foundation of a well-planned USMLE Step 1 study plan. Completing and reviewing practice questions allows for a perfect blend of active studying, spaced repetition, and specific practice for test day. Practice questions also allow you to identify areas to focus on when utilizing other resources for Step 1, such as First Aid.
For learners who currently use practice questions or the Osmosis quizzes, we invite you to leave your tips and suggestions in the comment section below. Let us know if there are other topics you’d like us to cover or if you have questions regarding this guide.
Wishing you all the best in your studies—stay motivated and keep pushing toward your goals!
References
- (n.d.). Background. AnkiWeb. Retrieved February 18, 2025, from https://docs.ankiweb.net/background.html
- Yuan X. (2022). Evidence of the Spacing Effect and Influences on Perceptions of Learning and Science Curricula. Cureus, 14(1), e21201. https://doi.org/10.7759/cureus.21201
- Yang, B. W., Razo, J., & Persky, A. M. (2019). Using Testing as a Learning Tool. American journal of pharmaceutical education, 83(9), 7324. https://doi.org/10.5688/ajpe7324
- Jape, D., Zhou, J., & Bullock, S. (2022). A spaced-repetition approach to enhance medical student learning and engagement in medical pharmacology. BMC Medical Education, 22(1), 337. https://doi.org/10.1186/s12909-022-03324-8
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