Class of 2027

Step 1 Guide
2024-2025
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Table of Contents
INTRODUCTION ........................................................................................................................ 4
GETTING STARTED .................................................................................................................... 4
How to study ................................................................................................................................................. 4
What to study ................................................................................................................................................ 4
When to study ............................................................................................................................................... 4
When to take the exam with score targets ................................................................................................ 5
EUSOM Step 1 expectations ....................................................................................................................... 5
WHAT TO EXPECT: STEP 1 LOGISTICS ....................................................................................... 6
Step 1 Scheduling Permit ............................................................................................................................ 6
On Test Day ................................................................................................................................................... 6
Moving your Step 1 Test Date ..................................................................................................................... 7
Exam Structure .............................................................................................................................................. 8
ACCOMMODATIONS................................................................................................................. 9
Accommodations for Step 1........................................................................................................................ 9
Accommodation Timing .............................................................................................................................. 9
STEP 1 STUDYING: M2 Year and Dedicated .............................................................................. 9
Step 1 studying during M2 .......................................................................................................................... 9
Step 1 studying during dedicated ........................................................................................................... 10
CONTENT REVIEW ................................................................................................................... 10
CONTENT REVIEW: RECOMMENDED RESOURCES (organized alphabetically) ......................... 11
AMBOSS ..................................................................................................................................................... 11
Anki Flashcards .......................................................................................................................................... 11
Boards and Beyond ................................................................................................................................... 12
Clinical Key ................................................................................................................................................. 12
Crush Step 1 Podcast ................................................................................................................................ 12
Dirty Medicine ............................................................................................................................................ 12
Divine Intervention Podcast ..................................................................................................................... 12
Firecracker by Lippincott .......................................................................................................................... 13
First Aid for the USMLE Step 1 ................................................................................................................. 13
Goljan Pathology Lectures........................................................................................................................ 13
HyGuru ........................................................................................................................................................ 14
Medbullets Step 1...................................................................................................................................... 14
Med School Bootcamp ............................................................................................................................. 14
MedSchoolBro ........................................................................................................................................... 14
Mehlman Medical ...................................................................................................................................... 15
Pathoma ...................................................................................................................................................... 15
PHYSE Biochemistry Map ......................................................................................................................... 15
Pixorize ........................................................................................................................................................ 15
Randy Neil for Biostats .............................................................................................................................. 16
Sketchymedical .......................................................................................................................................... 16
USMLE Scholar Rx ...................................................................................................................................... 16
STRATEGY OF QUESTION: QUESTION BANKS (QBanks) ......................................................... 17
Question Format ........................................................................................................................................ 17

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Finding your question rhythm .................................................................................................................. 17

Practice, practice, practice........................................................................................................................ 17
Question Banks for Step 1 ........................................................................................................................ 18
ENDURANCE OF EXAM: PRACTICE TESTS .............................................................................. 19
Practice test quantity and timing ............................................................................................................. 19
Assessing value of practice question blocks .......................................................................................... 19
Practice environment ................................................................................................................................ 19
Practice test resources .............................................................................................................................. 20
STRUCTURING STUDY SCHEDULES ......................................................................................... 21
Ordering and balancing time on topics.................................................................................................. 21
Sample study schedules ........................................................................................................................... 21
FINDING BALANCE AMID THE STRESS .................................................................................... 22
FEELING STUCK? ..................................................................................................................... 23
CREDITS AND ACKNOWLEDGEMENTS.................................................................................... 25

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INTRODUCTION

Medicine and the MD program should be seen as a sequence of marathons, not sprints. The
Foundations phase of Emory’s curriculum is the start of your first marathon culminating with the
completion of the USMLE Step 1 examination. Your second undertaking is the Applications Phase with
the USMLE Step 2 exam being the finish line. As in all challenging pursuits, you must start with a plan
of action; this guide is to help you create such a plan.
As you begin to study in earnest for Step 1, choosing the appropriate study materials and study
strategy will be crucial to your success.
The Emory School of Medicine Center for Holistic Student Success (CHSS) is here to support you
in this journey through individual Step 1 planning, group workshops, and this annually updated Step 1
guide meant to provide an outline of suggested resources, strategies, and answers to frequently
asked questions.
Please read this document thoroughly as many answers to your questions lie herein.

GETTING STARTED

How to study
Keep in mind, no single approach to studying is right for everyone. First, have faith in your current
and established study strategies. Next, seek advice from a variety of other students, faculty, and
alumni. CHSS including learning specialists, Dr. Hairston, and EUSOM tutors will then help you to
create an individualized plan and check-in with you along the way.
There will be some trial and error that comes with the Step 1 preparation process, and we are here to
support you as you navigate.

What to study
Not surprisingly, it is easy to overwhelm yourself by using too many resources. This guide will
help you develop a plan and choose what is right for you.
When considering resources, be sure to ask other students’ opinions before purchasing for yourself;
many can be quite expensive. CHSS will host a workshop at the beginning of 2024-25 academic year
to expose you to students’ favorite resources, who they work best for, and how to combine resources
to give you a holistic review prior to the exam.
Remember, if studying from certain resources in a certain way guaranteed a “pass,” it would have
been readily known long ago and multiple resources would not be available. Do not equate a high
price with a high score. (See Content Review for more information).

When to study
Study materials outlined in this guide can be used both during the curriculum and during dedicated.
How, when, and to what degree you use them varies based on what you personally need as a
student. Together, with the use of this guide, support from CHSS, faculty, small group advisors, and
others, you will find what works for you and be ready for test day. Just breathe and believe; you have
support on this journey. (See Structuring Study Schedules section for more information).

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When to take the exam with score targets

Most students will use on average 6-8 weeks of focused, dedicated study time to prepare for the
Step 1 exam. EUSOM provides students approximately 10 weeks of dedicated study time from
November-February each year. Your readiness to take Step 1 will be based on a combination of your
NBME practice test scores and your personal circumstances (i.e., mental / physical wellbeing, life
events, etc.).
NBME Score Targets: Passing at least two NBME practice exams with a minimum score
of 65% indicates a 96% chance of passing within the next 2 weeks.
Please see the USMLE Step 1 guidance sheet from NBME based on CBSSA scores here. Please work
with the CHSS to assess readiness to give you the best possible outcome. (See Practice Tests section
for more information).

EUSOM Step 1 expectations

The deadline for completing Step 1 is 3 weeks prior to starting the Application phase. In 2025, the
application phase starts on March 3, 2024, so the last date to complete the Step 1 is February 10th to
remain on-cycle in your academic progression in the MD program.
Integrations 1 and Orientation (end of February) are required of all students entering the Application
phase. A delay in taking Step will delay your start of Applications.
To guide your decisions, please see the following chart, outlining the 2024-25 EUSOM MD student
USMLE Step 1 Test Timing and its impact on academic progress.
If a student takes Step 1… They will begin clerkships… Which means…

On or before Feb 10th Mar 3rd On-time

Feb 11th - Mar10th Mar 31st 4-week delay

Mar 11th - Apr 7th Apr 28th 8-week delay

12-week delay
Apr 8th - May 12th Jun 2nd
Graduate with class of 2028

Delay the start of clerkships until Graduate with the class of

After May 12th
March of 2026 2028

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WHAT TO EXPECT: STEP 1 LOGISTICS

Step 1 Scheduling Permit

In September 2024, you will begin the process of registering for Step 1. Dr. Hairston will send you an
email with detailed instructions.
• Match names: When you sign up for the USMLE Step 1, provide your name as it is written on
your Driver’s License or other form of ID acceptable to USMLE). If you have had a name
change, please work with NBME, USMLE, Emory, and the registrar to be sure your name is
correct across systems.
• Pick a testing window: You will select a three-month window within which you would like to
test. Make sure to make the first month the month you intend to take the test. If you plan to
take it January 15th, make your testing permit for January, February, and March. This gives you
more time if you need to move your date.
• Get verified: MD student affairs, currently Mary Kaye Garcia and Zachy Farrell in OMESA, will
check the NBME site every day to approve students’ enrollment at EUSOM.
• Certificate of Identification (CIF): Complete and submit the CIF to Emily Generally, Senior
Program Coordinator, in the CHSS. There will then be a verification process to validate you as a
EUSOM student and finalize your registration.
• Once you are registered, you will receive a scheduling permit via email from the NBME.
• Thereafter, you can choose your test date.
• Please see When to take the exam with targets and assess your test readiness before spending
money on a test date. As mentioned, it is expensive to reschedule your test date. The CHSS will
help you to assess but we do not recommend everyone scheduling in October unless finances
are not a concern. Instead, wait until you have a baseline and progress score to assess how
many weeks you will need.
• EUSOM will expect all students to have a test date officially in the NBME system no later than
January 1, 2025. Please note, students applying for accommodations cannot schedule a date
until they receive a decision on their accommodation request. Do not forget, EUSOM Step 1
expectations as you are deciding.

On Test Day
• Documents: You must bring the scheduling permit you receive via email to the Prometric
testing site on the day of the exam. (Be sure to open the link and print the actual scheduling
permit). You must present this permit along with an unexpired, government‐issued photo
identification with your signature (e.g., current driver’s license). Your first and last names on
the photo ID must exactly match the first and last names appearing on the scheduling permit.
• Break time: Step 1 is a test of endurance. There are seven, one-hour blocks of 40 (or fewer)
questions; eight hours are allotted to complete the test. Forty-five minutes of break time is
automatically allocated. In addition to the exam blocks, the test begins with a 15-minute
tutorial. However, the tutorial is identical to the one online. It is best to complete the tutorial
online prior, skip it on test day, and take those 15 minutes as additional break time. This
allows you to begin with 1 hour of break time, which you may take between sections at any
point during the day. Also, if you finish an exam block early, the remaining time is added to
your break time.

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• Use of breaks: Some students complete a couple of sections at a time and then take a
prolonged break, while others choose to take a five-minute break at the end of each section.
Choose what helps you increase your test taking endurance. Proceed with caution when
looking things up in between sections – doing so may end up stressing you out. If your testing
center allows the use of a cell phone during the breaks, you can call a friend or loved one
during the break to keep you grounded, if that works for you.
• What to bring with you: Water bottles in a clear, transparent container without labels are
allowed into the exam room as well as unwrapped, unbottled medications (pills) like pain
relievers or cough drops (unwrapped); place pills/cough drops in a clear Ziplock bag. You are
also allowed to bring your own set of earplugs. Consider wearing pants without pockets to
minimize time spent doing the security check upon entering the exam room after breaks.

• Lockers: You will also be assigned a locker that you will have access to during your breaks, so
you can bring snacks and lunch with you to the testing center. However, please note that some
Prometric testing centers (e.g., Smyrna) have lockers that are only 1 foot x 1 foot, which are not
large enough to fit a full-size backpack (wall hooks are available to hang bags next to the
lockers as well).

• Note: You will be able to access any notes/study materials/devices during the breaks, but we
strongly recommend that you use your break time to breathe and prepare for the next block.

Moving your Step 1 Test Date

If you are not yet passing your practice tests consistently, you may decide to push back your Step 1
date. Please see section on EUSOM Step 1 Expectations.
Review the USMLE costs associated with moving your Step 1 test dates below.

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Exam Structure
Step 1 is a one-day examination divided into
seven, 60-minute blocks and administered in
one, 8-hour testing session. The number of
questions per block never exceeds forty. Exam
questions will not exceed 280. For every exam,
an unidentified 80 questions are new and
being validated thus they do not count toward
the overall outcome of the exam.
As you start your study plan, the following
tables show the exam structure weighting by
content areas.

Tables 1 (right), 2, and 3 (below) are slicing

the Step 1 exam in three different ways—
percentage items by (1) system, (2) physician
tasks, and (3) discipline.

This information can be helpful to you in

mapping out how many study days you will
spend by content area in relation to their
weighting on Step 1.

For a very detailed USMLE Step 1 Content Guide, visit:

https://www.usmle.org/sites/default/files/2022-01/USMLE_Content_Outline_0.pdf. This guide can
provide additional insight into every detail and subject area covered.

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ACCOMMODATIONS

Accommodations for Step 1

If you are planning on applying for accommodations for USMLE Step 1, please plan to meet with Dr.
Christen Hairston at the beginning of your M2 year to discuss and plan timing for applying.
Typically, Step 1 accommodations are granted to those with a long history of receiving
accommodations. We will work with any student interested in applying to send in the best possible
application. Sending a thorough and early application is the best approach. For more information
on requirements to apply for Step 1 accommodations, please see https://www.usmle.org/step-
exams/test-accommodations.

Accommodation Timing
The application for accommodations is extensive and requires many forms with appropriate
signatures, medical documentation, and a personal statement. Plan to start gathering these items in
July and August of your M2 year. There is about an 8-week waiting period from when you submit
your application to when you receive notification of your approved accommodations, and you will not
be able to sign up for a test date until those are received. Note that NBME accommodations may not
match your accommodations as granted by Emory Department of Accessibility Services (DAS). If this is
the case, you can appeal the decision, but this will lengthen your process and hinder your ability to
schedule the exam. CHSS will work with you through the process.

STEP 1 STUDYING: M2 Year and Dedicated

Step 1 studying during M2

Step 1 studying during the Emory SOM curriculum can and should reinforce what you are already
studying. In other words, Qbanks or other sources can be used to reinforce curricular knowledge as
you learn material during your Foundation courses.
The amount of time you designate for additional Step 1 studying during the curriculum should be
guided by the amount of time you have available to study after completing your course activities.
Please do not allow your studying for Step 1 to hinder you from passing a course. Remediating a
course after summer break usually means completing the remediation at the beginning of dedicated.
If this happens to you, keep in close contact with Dean Hairston for support – you are not the only one
who has been through this!
Emory School of Medicine’s curriculum is preparing you for Step 1. What you CAN do during the
curriculum is constantly reinforce your content knowledge, layer, and interleave1 concepts, and
frequently assess and reassess your areas of strength and weakness.

1
Interleaving is the mixing of subject content to interlace concepts and make connections. This differs from
blocked studying in which you study one topic without moving on to a new topic until the review is complete on
that one.

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Step 1 studying during dedicated

Dedicated studying will require content review, improving how you approach questions, and
increasing your individual endurance for a long, strenuous examination.
As such, this guide is organized around three domains for Step 1 preparation:
1. Content Review
2. Question Strategy (QBank)
3. Improving your test-taking Endurance

The following sections of this guide will target each of these three areas and the resources available to
you as you navigate improving each dimension.
As you begin, ask yourself:
• Where am I strongest in these three areas?
• Do I feel strong in content but weaker in how I approach questions?
• Do I get exhausted in long exams and need to improve my endurance?
• Do I feel like I need to start from scratch and review content in absolutely everything?

This will differ for each individual, but based on where you are at this moment, we can create a plan
customized to your greatest areas of strength and weakness. Your time and energy are limited; the
more strategically you plan for Step 1 the less stressful the experience can be.

CONTENT REVIEW

When approaching Step 1 studying, it is helpful to first identify your content areas of greatest
strength and weakness.
Content review needs to be engaged and active – not passive. The more passive, the less likely you
will retain the information. The most active work is through UWorld questions and using them to
guide what you do and do not know. Once you are aware of your areas of great weakness, you can
engage with content videos, online resources, questions, and beyond to resolve them. This is an
iterative process and requires regular self-evaluation.
Together, we can map a plan for how and to what degree you review content but know content
review will be an essential part of your Step 1 dedicated review process.

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CONTENT REVIEW: RECOMMENDED RESOURCES (organized alphabetically)

This guide is not an endorsement of one product over another, nor should one believe that the higher
the price, the higher the quality. We are, however, including only popular resources that have helped
students succeed, and we are listing them to guide you in your choices.
2024 pricing is provided in green.
A note for students who come from lower-income backgrounds or who are nervous about the
additional costs associated with these resources: you do not have to spend a lot of money to be
prepared for Step 1! In this list, there are many free resources that will help you be fully prepared to
take this exam. If you feel especially nervous or concerned, please reach out to fellow students and
CHSS – someone will be able to help you create a study strategy that is both successful and
affordable.

AMBOSS - https://www.amboss.com/us
• Full Qbank access is in addition to the monthly membership; $149 for 1 month; $189 for
3 months; $229 for 6 months; $299 for 12 months.
• Includes content review using unlimited library access, Anki add-on and smart study tools, as
well as interactive medical imaging with overlays. Includes “phrasionary, table quizzes, charts,
radiological images with overlays, videos, SmartZoom samples and other images that illustrate
key points on different topics” all on a digital platform.
• Includes 2,700+ Step 1 questions, and with your subscription you also have access to 3,200+
Step 2 questions, 3,700 Shelf questions, and 2,000+ Step 3 questions.

Anki Flashcards - https://apps.ankiweb.net/

• Android and Mac version: FREE; iPhone app version: $25
• Some students use flashcards extensively, and others never use them.
• For those who benefit from flashcards (e.g., a quick review of material prior to bedtime or first
thing in the morning) this is a popular option.
• For students who choose to use Anki, continuously keeping up with cards from previous units
can help minimize the amount of content review that is necessary during dedicated.
• Different Anki Decks to Consider
o Zanki offers a Step 1 specific deck using First Aid prompts.
o AnkiHub has a $5/month subscription and a “pay what you can” scholarship
subscription that syncs with V12 cards and new sketchies/other third-party resources,
including Sketchy, Pathoma, B&B, etc.
o One of our members of the class of 2026 has provided an AnKing deck for preclinical
courses.
o The following decks are commonly used (and can be found online): AnKing, First Aid
2020 Rapid Review, Anatomy Step Clinical Correlations
o 100 most important Concepts Anki Deck.apkg

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Boards and Beyond - https://www.boardsbeyond.com/

• Subscriptions range from $24 for one week to $399 for 2 years.
• $399.00 - 2 Years | $349.00 - 18 Months | $249.00 - 1 Year | $199.00 - 6 Months |
$149.00 - 3 Months | $89.00 - 1 Month | $24.00 - 1 Week
• Step 1 resource includes 447 videos, PDF copies of the slides, and Qbank of 2,300 questions.
Covers content review and Qbank with one subscription.

Clinical Key - https://proxy.library.emory.edu/login?url=https://www.clinicalkey.com/

• Offered FREE through Emory Health Science Library
• Clinical Key is an online database to search conditions, treatments, drugs, books, journals and
more related to clinical practice. A great content review resource for clinical overviews, drug
monographs, calculators, drug class overviews, and guidelines.

Crush Step 1 Podcast

• https://open.spotify.com/show/1zRYlByLLzgpXMkeUPQKW1?si=f0a8d14eb07447f7
o FREE Podcast
o It feels very much like the First Aid.
o They just read the facts aloud. No real explanation.
o Only high yield information.

Dirty Medicine - https://www.youtube.com/c/DirtyMedicine?app=desktop

• Offered as FREE YouTube videos
• Conceptual review of one or more concepts that are similar, this resource helps you discern
the ways in which they are different with mnemonics. Known for excellent biochemistry videos.
• DM also offers extensive coverage of high yield drug classes and images. High Yield images
are updated; DM YouTube playlist.
• Pay special attention to their social sciences/ethics videos, as they teach you about the unique
way the USMLE asks ethical questions.

Divine Intervention Podcast - https://divineinterventionpodcasts.com/category/usmle-step-1/

• Offered as a FREE Podcast
• Highly recommend listening to episode 37 – Preventative medicine to review risk factors
and trends prior to Step 1 test date (27 minutes)
• Focuses on high yield concepts. This podcast allows you to choose specific topics to
supplement learning deficits. Because it is a podcast, it can be listened to during commutes,
while running errands, or even during exercise.

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Firecracker by Lippincott
https://www.wolterskluwer.com/en/solutions/lippincott-medicine/medical-education/firecracker
• For the full MD Firecracker deck: $150/year and up; 7-day FREE trial
• Offers several “bundles” for Step 1 review which include various additional (and more
expensive) options; the most popular of which includes First Aid citations and a collection of
topics, flashcards, and test questions which reference material from Pathoma and
Sketchymedical

First Aid for the USMLE Step 1

• First Aid 2024 is $51.89
• First Aid is available for FREE when a student becomes a member of the American
Medical Association (AMA) which costs $20 a year or $68 for 4 years. You will also get
the FREIDA residency database and other wellness tools.
• The book is separated into the following sections:
o Section 1: Guide to Efficient Exam Preparation
o Section 2: High Yield General Principles
o Section 3: High-Yield Organ Systems
o Section 4: Top-Rated Review Resources
• Students often read relevant sections of First Aid throughout the first three years (especially
second year).
• Many students make notes directly into First Aid; while others choose to hole-punch the pages
and put them in a binder, combining class notes and high yield information gleaned from
UWorld questions into one source.
• As valuable as it is, First Aid is not recommended as a stand-alone resource. It is great for a
high-level, high-yield overview of target areas for review.

Goljan Pathology Lectures

• Offered as FREE Audio lectures on the web or Spotify Podcast as “Daddy Goljan
Lectures”
• This resource provides a comprehensive pathology review for high-yield content in a way that
integrates multiple disciplines. It has become one of the most popular resources for concept
connection and crucial for review throughout the year. Because it is an audio podcast, it can be
used for passive learning at regular or increased speeds (up to 3.5x on Spotify) during
commutes, while running errands, or even during exercise.
• In particular, the Neoplasia lecture felt particularly high yield for a last-minute review. The
recordings provide a fast-paced, high yield review and help with important word associations
for commonly tested concepts. His lectures bounce from concept to concept (but also connect
topics in ways that other resources do not) which helps train your brain for the exam.

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HyGuru - https://hyguru.teachable.com/p/usmle-step-1-pass-fail-course
• USMLE Step 1 Course: $196
• HyGuru, Dr. Rahul Damania, is a former critical care fellow at Emory School of Medicine. His
course was utilized by quite a few of the members of the class of 2026 and they appreciated
his high yield reviews and how this resource incorporates practice questions after every video.
• Focuses on integrated organ systems. “HyGuru's comprehensive USMLE Step 1 course
augments the pathophysiology in the free NBME Top Concepts with the relevant physiology
and pharmacology. Integrated with immunology and biochemistry, this course provides a
high-yield, integrative overview of each organ system.”
• HyGuru also provides free recordings of many sessions on YouTube including systems based
and pharmacology lectures.

Medbullets Step 1 - https://step1.medbullets.com

• Offered as a FREE Podcast on Spotify or for Peak Subscription $98 for 6 months and
$175 for 1 year.
• Presents Step 1 questions/topics as short “bullet-phrase” style reviews with a clinical vignette
afterwards. It is available both as a podcast and an online question and content repository and
is a thorough source to quickly review specific topics. It functions especially well as a quick
overview on memorization-heavy concepts like metabolic disorders.

Med School Bootcamp - https://bootcamp.com/med-school

• QBank (2,000+ questions, included in the price); 1 month ($49); 1 year ($199); 2 years
($349)
• Med School Bootcamp offers review materials in all content areas, from the basic sciences to
the organ systems.
• Many of the videos are accompanied by questions to cement the learning.
They have USMLE-style questions, along with benchmarks to suggest when students might be
ready to take the exam.
Great resource for anatomy, as well as imaging (a lot higher yield than gross anatomy on Step
1).

MedSchoolBro - https://medschoolbro.com/collections/usmle-guides
• USMLE Step 1 Rapid Review Guides, starting at $29.99
• Free USMLE Study Pack Resource too - https://medschoolbro.com/collections/free-resources
• PDF, Anki Deck, Hard Copy Available
• High-yield study notes designed for passing the USMLE. With effective memory techniques /
mnemonics (as seen in MedSchoolBro's videos) to maximize retention. Every detail is
purposefully included to ensure you focus on essential information, avoiding any time wasted
on low-yield material.

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• This guide seamlessly integrates various disciplines within specific pathologies and disease
processes. Unlike most resources that separate subjects into distinct chapters, such as
anatomy, physiology, or pharmacology, this approach fosters a more comprehensive and
interconnected understanding of each topic.

Mehlman Medical - https://mehlmanmedical.com/

• Offered as FREE High Yield documents, learning modules, self-assessments, and pre-
recorded lectures.
• Additional services offered for a fee (Anki decks - $44 - $70, Tutoring packages - $185 -
$10,800).
• Would strongly encourage reviewing the “HY Arrows” document
(https://mehlmanmedical.com/hy-arrows/) to solidify key pathophysiology and work through
pathways in your head to solidify your understanding. Self-assessments are very high yield.

Pathoma - http://www.pathoma.com/
• PathomaFree version is FREE and does not include the textbook or all videos.
PathomaPro starts at $84.95 and offers the textbook, and 3-, 12-, or 21-month
subscriptions to videos for every chapter of the book.
• Pathoma offers a Step 1 review, and this resource covers high-yield pathology information for
all organ systems in shorter videos. For those who prefer reading, the Pathoma textbook may
be faster than reviewing the videos. The textbook has many color images like those on Step 1
and 2.
• Chapters 1-3 include very high yield topics about cancer, immunology, and topics that you
may have not reviewed since the healthy human modules.

PHYSE Biochemistry Map

• Offered as a FREE resource
• Biochemistry Map.jpg
• Analyze biochemistry questions using the visual to conceptualize the biochemistry map.

Pixorize - https://pixorize.com/
• Medicine and USMLE Complete 1 year for $249, Biochemistry $150 for 1 year,
Pharmacology $150 for 1 year, Immunology $150 for 1 year.
• A visual mnemonic series for biochemistry, microbiology, immunology, and pharmacology.
• Recommended primarily for useful mnemonics on biochemistry as a long-term memory tool.

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Randy Neil for Biostats -

https://www.youtube.com/playlist?list=PLuyQGqW98Zlsm4MInaD2LJCub8i9D3pms
• Offered as a FREE YouTube videos
• Dr. Neil’s videos cover everything you need to ace every biostats question on Step 1
• He uses USMLE-style questions to make biostats intuitive and easy to remember.

Sketchymedical - https://sketchymedical.com/
• $299.99 for 6 months; $399.99 for 12 months; $599.99 for 24 months
• A visual mnemonic series for microbiology, biostats / epidemiology, physiology,
pathophysiology, anatomy, biochemistry, pharmacology, and microbiology.
• Sketches “help you create a memory palace by associating medical topics with memorable
visual elements.”
• Students have noted that Sketchy Micro supplements the Emory curriculum and provides
helpful memory tools for USMLE questions.
• If possible, beginning Sketchy Micro specifically during the infectious disease module creates
a solid foundation for starting your dedicated study period. Additionally, Sketchy
pharmacology is a helpful resource to begin early as it includes many high-yield medications
and explains the body system(s) they work in. Watching these videos and completing the
corresponding Anki cards (information below) help solidify this knowledge for both Step 1 and
clinical rotations.
• Another strategy that has worked for some students is aiming to watch one Sketchy Micro and
one Pharm video a day starting at the beginning of the M2 year. That way, you can learn a few
facts a day at a slower pace. You do not have to keep up with this schedule every day, but it
can be helpful to get a head start.

USMLE Scholar Rx - https://www.usmle-rx.com/

• $149 for one month, $199 for 3 months, $329 for 6 months, $399 for 12 months, $449
for 24 months, $499 for 36 months; special discounts may be available for purchases of
3+ month subscriptions.
• Emory School of Medicine offers USMLE Scholar Rx Step 1 subscription FREE for the
Foundations phase as part of the curriculum. USMLE Scholar Rx has five different resources
in one—Rx bricks, Step 1 Qmax, Flash Facts, Express Videos, and Digital First Aid. Their
question bank for Step 1 was created by the authors of First Aid.

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STRATEGY OF QUESTION: QUESTION BANKS (QBanks)

Question Format
Step 1 questions all follow a specific formula. Please see
https://www.youtube.com/watch?v=ov8UhrB64sw for a quick overview of the NBME question
structure. Also, access last year’s Deconstructing Step-Like Questions Workshop from Klevi Golloshi,
MD, Class of 2024.
Your clinical vignette test taking strategy matters. Students have opportunity to improve how they
approach questions each and every day.

Finding your question rhythm

As you are going through Step 1 questions, give each question consideration, but if you are unsure,
pick an answer and move on or skip the question and plan to return to it. A subsequent question may
help to trigger the answer to a previous question that you skipped. There may be what you find to be
easier questions at the end of the block, so you do not want to run out of time.

Practice, practice, practice

Question Banks are a valuable resource to improve the speed and effectiveness by which you
reinforce content and improve your test taking ability.
By practicing question types, you can also improve the ways in which you can (1) identify distracters,
(2) see what the question is truly asking, (3) work through the best possible answer, (4) choose it and
(5) move on. It is both an art and a science.

Qbanks can play various roles in your studying:

• During courses, Qbanks can reinforce newly acquired knowledge through questions.
• During dedicated, Qbanks can be used to:
o Reinforce content review through spaced repetition and learning from missed
questions.
o Give you a 360° view of how questions are asked around certain concepts.
o Improve timing per question.
o Give you a pattern of question types you are missing to see if you are able to improve
blind spots.
o Simulate testing environment.
o Improve endurance of exam taking through the gradual addition of question blocks
over time
• For content review purposes, you may consider single-subject or single-system blocks on tutor
mode, namely in areas of great weakness.
• To improve your strategy of question, endurance of the exam, and synthesized knowledge
across systems and subjects, your goal is always to move from single-system blocks towards
mixed, timed blocks, even if you do so in a stepwise approach.

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To optimize Qbank use:

• Identify ways to gain optimal benefit from this essential resource for your own personal
learning style.
• Integrate high yield topics gleaned from questions and reading answer explanations into your
own list of high-yield topics for additional review (i.e., Anki cards, First Aid annotation, Excel
spreadsheets or other creative way you have identified).
• Review incorrect questions. Should you read the explanation for each answer option for every
question? For the sake of efficiency, probably not. Rather, read the explanation for any answer
option you get wrong, “guessed right” or considered as possibly correct.
• Plan to do a set number of questions per day during dedicated study time. While it is true that
there is an advantage to completing as many questions as possible, be sure you do not rush
through questions at the expense of learning from the questions.
• Reflect on your strengths and weaknesses regularly. Compare your equated percent correct
(EPC) by practice test to measure your progression in areas in which you have been putting
your energy.

Question Banks for Step 1 (organized by recommended question banks)

1. UWorld - www.uworld.com
30-day ($319), 90-day ($439), 180-day ($479) or 360-day ($559) subscriptions.
Emory School of Medicine provides a 6-month subscription during second year to the UWorld
3700 + question bank. (If necessary, any renewal costs are the responsibility of the student).

2. AMBOSS - https://www.amboss.com/us
Full Qbank access is in addition to the $14.99 monthly/$129 yearly membership; $149 for 1
month; $189 for 3 months; $229 for 6 months, $299 for 12 months.

3. USMLE-Scholar Rx - https://www.usmle-rx.com/
QMax (2300 questions) - 1 month ($129); 3 months ($159); 6 months ($249); 12 months ($299);
24 months ($349); special discount pricing may be available on 3+ month subscriptions.
Emory School of Medicine offers USMLE Rx Step 1 subscription for first- and second-year
medical students as part of the curriculum. Students who choose to use it further may purchase
on their own.
USMLE Rx has five different resources in one—Rx bricks, Step 1 Qmax, Flash Facts, Express
Videos, and Digital First Aid. Questions, videos, and flashcards with First Aid integration
produced by the authors of First Aid.

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ENDURANCE OF EXAM: PRACTICE TESTS

Taking practice tests is the best way to improve your endurance for an 8-hour exam. For each student,
they will need to build their endurance through smart test-taking strategies and planning.
It is recommended to plan practice tests when it can be optimal for your own personal learning. Speak
with CHSS and small group advisors to decide how many and when practice tests make the most
sense for you.

Practice test quantity and timing

• Minimum: At least 3 practice tests at the beginning, middle, and end of dedicated.
• On Average: Students take approximately 7 practice tests before taking the official Step 1
exam. Students often take many more over the course of their Step 1 journey. Every other
week is ideal to provide enough time to show progress from efforts.
• High: Some students will decide to take a practice every week. I always remind students it
typically takes two days to do a practice exam—one to take it and one to review it. If you take all
the NBME, Free120s, UWorld, and Scholar Rx practice exams, you will complete approximately
14 practice exams.

Assessing value of practice question blocks

Reviewing material repeatedly through questions also helps to consolidate information and helps with
retention. A low score may lead to undue anxiety while a high score may contribute to a false sense of
security. Do not get fixated on your UWorld block score. Instead, focus on doing your best each
block and using what you missed to guide what you will focus on learning. It is with practice exams
that you improve your endurance and time management skills. The equated percent question
produced by the practice tests is much more indicative of test readiness than the UWorld block
percentage correct.

Practice environment
When taking a practice test, ensure your testing environment simulates the test site as closely as
possible. You may want to consider taking a practice test at the Prometric test site. Details are at
https://proscheduler.prometric.com/scheduling/testInformation. Within your 90-day eligibility period,
Prometric offers a practice session with a brief tutorial section and three, one-hour blocks of
approximately 40 multiple-choice test items each. Upon completion, a printed percent correct score is
provided. The opportunity to become familiar with the testing site may help decrease anxiety on the
test day. Contact your local Prometric Testing Center for costs.
For those who do not choose to use a Prometric practice space, it is important you still simulate your
testing environment when taking practice tests. An optimized test site will need to be a quiet place
with no interruptions or excessive noise – likely outside of your home. This might be the library, a
reserved classroom, or other reserved, quiet space with “testing in progress” posted on the door.
Note that your actual testing site may not be 100% distraction free. There will be people walking in
and out of the room, and some students have reported issues with AC in the past.

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Practice test resources

EUSOM students recommend fully completing a single question bank rather than switching between
multiple. EUSOM provides 6-month UWorld subscription that includes 3 UWorld self-assessments,
as well as 2 NBME in-person or self-assessments. All other practice tests will be purchased at the
student’s expense. These expenses were included in students’ cost of attendance for the 2024-25
EUSOM academic year.
• NBME Comprehensive Basic Science Exam (CBSE)
Four blocks of 50 questions practice exam (Only administered by the medical school at
$59/student)
• NBME Comprehensive Basic Science Self-Assessment Exam (CBSSA)
Four blocks of 50 questions practice exam. ($60)
• NBME Free 120 (Free)
There are 2 versions: old and new. Both have relevant questions. Note that in addition to the
2021 (old) and 2024 (new) versions, there may be a 2022 version floating around that has
significant overlap with the 2024 version. If using a PDF, make sure to check the year. The
NBME Free 120 includes several examples of long question stems which are representative of
the length of long question stems on the actual Step 1 exam. This is a great resource to
practice your timing, but it is advised to wait to take the NBME Free 120 until ~1-2 weeks
before your actual exam date.
It is also helpful to review the concepts tested in the NBME Free 120 (as well as the concepts
tested in the USMLE Practice Examinations) in detail given those topics could be asked in
another form on the actual Step 1 exam. Unlike the CBSSAs, you will not receive any kind of
score report or predictor of how likely you are to pass. Once you finish the exam, it will only
report the percentage you got correct without the ability to review your answers. There are no
explanations provided. It can be helpful to pair the Free 120s with a third-party explanation,
such as this one from Boot Camp: https://bootcamp.com/blog/new-free-120-nbme-step-1-
explanations
• UWorld
Four blocks of 40 questions practice exam (included in EUSOM UWorld 6-month
subscription).

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STRUCTURING STUDY SCHEDULES

Following a study schedule will help you to stay on track. That being said, you may not reach all the
goals you set out to meet in the beginning. Be flexible, adapt throughout, do not beat yourself up,
and move on. Include several flex-days for “catch-up” or more time on a particular topic. Allow more
time for review toward the end of dedicated study time; reviewing material helps with retention and
more rapid recall during the exam itself. It is easy to get stressed and to ignore the importance of
food, sleep, exercise, family, and friends if you get behind schedule. A daily routine helps to maintain
mental health and decrease burnout.

Ordering and balancing time on topics

Begin with your weaker topics and/or those more heavily emphasized on the exam so that you can
schedule accordingly to allow more time for these topics. To guide the stratification of your topic
areas, please see Tables 1, 2, and 3 on page 8 in this guide for the percentages of items by systems,
physician tasks, and disciplines. Also see “How to Study” on page 4 to further identify how to balance
your strengths and weaknesses in each topic. Please know this is not necessarily an effortless process,
so please reach out to the CHSS to help to identify those strengths, weaknesses, and the best
approach for you to balance your study plan.

Sample study schedules

• Additional tips and sample schedules are FREE at https://firstaidteam.com/schedules/
• Many students also like Blueprint’s Med School Study Planner for a daily Step 1 study
schedule.
o FREE (https://blueprintprep.com/medical/med-school/study-schedule).
o You enter all the resources you will use, the time you have before the test, and it gives
you a daily schedule. If you do not finish something in one day, it rolls over and updates
daily.
• Your mentors and student success resources can support you in outlining your Step 1 schedule
for dedicated as well as throughout the curriculum.

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FINDING BALANCE AMID THE STRESS

• Follow your energy flow. Schedule the most challenging part of your study day when you are
most alert (i.e., are you a morning or evening person) and schedule accordingly.
• Study environment: Find a good place (or places) to study. What setting is least distracting
and absent of anxiety-triggers? Home, library, school, coffee shop, etc. For some, varying your
place of study is the best strategy. For others, they find their “one place” of study and make it
their primary site.
• Silence your notifications. Turning off all phone and computer notifications will aid in your
ability to concentrate. Plan to check your phone and email at specified times as part of your
study schedule.
• Do not be an island. Humans need connection and dedicated study time can be very
isolating. Make sure that you are engaging with others in some way throughout the entire
dedicated study time. This can include connecting with family and friends who know nothing
about Step but know the best way to support you, and/or venting with your medical school
friends who are going through the same thing. Near peers who have completed the exam will
also be on campus and are typically happy to get together and provide some advice or
support if needed. What is important is paying attention to what your needs are socially during
this time. If explaining what you are going through with a family member is exhausting, then do
not do it. If venting with your med school friends is getting you down, then step away. It is
about knowing yourself and your needs.
• Study partners: Many students benefit from a study partner. For example, plan to meet with a
classmate to review a topic (e.g., ask one another questions, present a topic to one another,
find a white board, and give “lectures” to one-another, etc.). You could also time your study
breaks concurrently and take a walk together outside.
• Time off from studying: A study schedule must include breaks. Time off makes for more
effective study. Take at least one full day off a week (i.e., one full day, two mornings, or two
afternoons). Schedule a five-minute break at least every 45 minutes as this simulates the testing
scenario and is also proven to improve retention. Go outside for breaks, when possible, to get
fresh air and sunshine.
During a break, remove yourself from any study materials and do your best to truly relax – no
flash cards or podcasts on the treadmill. It is better to study 8 “good hours” than 12 “non-
productive hours.” Respect your limit and stop studying.
Do not sacrifice your health; make time to exercise, meditate, hydrate, refuel with nourishing
food, engage in your spiritual life, and soak up some sunshine. A session of physical activity
every day is good for your body, mind, and soul! If you feel like you have hit a wall studying,
not feeling well mentally, or just need a break, do not be afraid to take an extra day off
completely (outside of the one that you may have scheduled). Be forgiving and flexible with
yourself and your timeline.
• Sleep: Get on a sleep schedule that will model the wake time on test day. Practice like you
play.
• Comparing self to others: There will always be someone studying more than you (and less
than you). While you should listen to the advice of others, you know yourself best and the
way(s) in which you are most productive studying. Do not be stressed by how other people are
studying — be confident and do what works best for you. Do not place blanket trust in Reddit; it

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is advisable to avoid it altogether. There are many different things that people will say to do
but might not work well for you.
• Additional study time: Avoid the urge to push back the test date. There comes a point in
time where additional study is counterproductive. Although the thought of an additional week
of study time may be tempting, be confident in your ability and in the effectiveness of your
study schedule. Changing the test date can negatively impact your confidence and contribute
to anxiety. You will never feel totally prepared; most students “peak” at 5-6 weeks of dedicated
study time.
• Reach out to Emory School of Medicine resources. You are not alone in this journey—it takes
a village—and we are here to support you! Please feel free to reach out to:
o Christen Hairston, Ph.D., Associate Dean of Student Success, Center for Holistic
Student Success
o Emily Generally, MSM, Senior Program Coordinator, Center for Holistic Student
Success
o Rana Van Voorhis, MS, Learning Specialist, Center for Holistic Student Success
o Small Group Advisors
o Stacy Higgins, MD, Associate Dean of Student Affairs, Clinical Services at
smhiggi@emory.edu
o EUSOM Tutors via https://med.emory.edu/tutor
o CAPS Embedded Psychologists
• Waiting for your score. After completing Step 1, your score will be available two to four
weeks after your exam date. Scores arrive on Wednesday mornings. Administration will have
access at 8:00 a.m., and you will receive an email between 11 a.m. and Noon. If you have failed
the exam, someone (typically Dr. Hairston or Dr. Higgins) will text/call you to let you know the
results and strategize next steps. If you have passed the exam, Dr. Hairston will reach out via
email or text to congratulate you. It can be nerve-racking to wait for the results of the exam.
Just know that there are people there to celebrate and support you, whichever way the result
goes!

FEELING STUCK?

Hitting a plateau in your scores is normal. While your UWorld score should increase over the weeks of
studying, individual question blocks are not directly predictive of your NBME/Step 1 performance. It is
totally normal to get 60% on one block and 40% on the next. UWorld is a learning tool. (See
Assessing value of practice question blocks)
Ideally, your NBME scores should increase by ~5 points every 1-2 weeks. If after several weeks (2+
weeks) you feel like your scores are not improving, reach out to the CHSS for help.
Some possibilities:
• If you are burnt out, you might need to take a couple of days of break to recharge. Do not feel
guilty – if you keep going it will not be effective. It is better to take a couple of days off
studying and get back to it with a refreshed mind, body, and spirit.
• Make a list of concepts that you are missing consistently and gear your studying toward your
weaknesses.

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• Alternatively, sometimes a plateau in scores may be due to test-taking skills rather than
content. It may be useful to go through your incorrect questions, either by yourself or with a
peer to see if there are patterns you can identify (i.e., changing your answer last-minute,
missing an "except/not etc.” in the prompt).
• Take a step back to make sure you have a consistent framework for approaching questions. It
may be worthwhile to watch a video about test taking strategy (AMBOSS, HyGuru, USMLE
GUYS, etc.) to see if there may be a strategy that works better for you. Keep in mind that there
are a variety of approaches, and it is okay if the first one you find does not end up working for
you. Do not be afraid to switch it up.
• Join fellow Emory students for studying. Studying for this exam can be very isolating, and
sometimes sharing or hearing others express those feelings can be helpful.
• Connect with a Step 1 tutor from the Emory School of Medicine Tutoring Program. These
tutors can help you identify areas of weakness, review content, be a sounding board for
picking a test date, and improve test-taking skills.
• Reach out to the CHSS to chat about what you are noticing.
• You do not need to make big decisions on your own!
• If you need to move your test date or revamp your study schedule, reach out to a few people
to hear their opinions. Getting input from a combination of students and faculty will help you
make informed decisions.
• Connect with friends, family, or whatever support system you rely on, during your break/break
days to get you out of the Step spiral. Perspectives and experiences outside of your everyday
studying can go a long way in recharging your battery.
• At the end of the day (regardless of how you perform on this exam), you are going to make it
to the other side and will be a doctor someday! This process can be extremely overwhelming
but know that you are not alone in these feelings. Reach out to your near peers if you need to
vent or just want a listening ear.
• If you are struggling with your mental health, reach out to administrators and in-house CAPS
counselors. These are tools that medical students can benefit from during dedicated, which
can sometimes be intensely isolating and anxiety-provoking. When the going gets tough, just
remember, as Dr. Hairston says, “We can do hard things!”
o CAPS: https://counseling.emory.edu/
o Mental Health and Wellness @ SOM: https://med.emory.edu/education/center-for-
holistic-student-success/student-counseling/index.html

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CREDITS AND ACKNOWLEDGEMENTS

The original version of the Step 1 Guide was written by Paul Catalana, MD, MPH and Christen
Hairston, Ph.D. for University of South Carolina School of Medicine Greenville. It has been updated
specifically for Emory University School of Medicine MD students preparing for the USMLE Step 1
examination by Christen Hairston, Ph.D. and reviewed/edited by Gordon Churchward, Ph.D.; Susan
Orr, M.Ed.; Klevi Golloshi, MD; Onyie Eze (CL2025); Caroline Chivily (CL2025); Cassidy Golden
(CL2025); Stacy Higgins, MD; Erica Brownfield, MD; Jen Spicer, MD; Samantha Steigerwald (CL2025),
Julia Shuford (CL2026); Maxwell Richardson (CL2026); Meghan Acheson (CL2026); Cherise Thomas
(CL2026); David Kulp (CL2026); Sarah Touponse (CL2026); Kasthuri Nair (CL2026); Robert Blakes
(CL2026); Mina Milosavljevic (2026); Christopher He (CL2026); Jillian Rankin (CL2026); Anna
Pulminskas (CL2026); Bryan Medilien (CL2026); Alex Abdollahzadeh (CL2026); Ian Kusher (CL2026);
Bill Eley, MD, MPH, and Emily Generally, MSM.

Updated 6/27/2024