All You Need to Know Before You Start Studying for USMLE Step 1

Preparing for USMLE Step 1 can feel overwhelming—especially for international medical students who must balance their university coursework with high-stakes exam prep. This concise guide explains what Step 1 tests and how it’s delivered, surveys the most useful types of study resources, recommends the best timing and balance for non-U.S. students, clarifies the real implications of the move to Pass/Fail, and ends with a practical summary of how Brocali can support your preparation.

What is USMLE Step 1? — Purpose & Format

Purpose: A single–day, computer-based exam that assesses whether medical students understand foundational medical sciences and can apply them to clinical problems relevant to safe patient care.

Format:

• ~ 280 multiple-choice questions

• 7 blocks per exam day

• Each block ≤ 40 questions

• 1 hour allotted per block

• Total exam time: Up to 8 hours (includes tutorial time and scheduled breaks)

Figure 1. Exam sections breakdown. 

Quick tip: practice block-length testing early (timed blocks + scheduled breaks) so the day’s logistics don’t surprise you.

Best tools & sources to study 

There’s no single “magic” resource — the effective strategy is a small, consistent set of complementary tools you actually finish and use.

Core resource types

• Interactive lectures or recorded video series — for structured explanations and high-yield concept walkthroughs. Good video series turn dense topics into logical stories.

• Concise review textbooks/libraries — a single, well-organized review book (and a short pathology/pathway-focused text), or an online medical library (Figure 2), is useful for one-pass consolidation and rapid review.

• Visual aids — diagrams, flowcharts, and clinical correlation images to turn lists into cause → effect stories.

Figure 2. Necrosis article from Brocali’s online medical library.

Active practice

• Question banks (QBanks) — use Qs for active recall, pattern recognition, and learning how Step-style vignettes are written (Figure 3).

• Practice assessments / mock exams — periodic full-length or block-based assessments to gauge readiness and guide study priorities.

Figure 3. Medical question from Brocali’s online QBank.

How to use them together

• Pick 1 core textbook/online library, 1 primary video source, 1 QBank, and your flashcard system. Consistency beats collecting dozens of resources.

• Use question performance to drive targeted review (don’t passively reread everything).

When is the best time to start? (for international medical students)

Formal, dedicated preparation: best started after finishing the second year of medical school — once you’ve covered the bulk of basic science courses. That’s when you can realistically convert foundational knowledge into Step-style reasoning.

Early familiarization (during early study years):

• Light exposure to USMLE content and formats (sample Qs, short video lectures, overview books) can make later intensive study more efficient.

• Early familiarization is not the same as full-time preparation — it’s low effort, high familiarity.

Balance is crucial

• Always prioritize your home university coursework, homework, and exams. Your medical school grades and foundational learning matter for long-term competence and residency applications.

• Treat Step 1 prep as supplemental until you can commit to a dedicated study block. Poorly timed full-time Step study that compromises university performance creates unnecessary risk.

USMLE Step 1 is Pass/Fail — So what?

What changed: Step 1 scoring moved from a numeric score to Pass/Fail reporting. Previously, students often engaged in very long, score-focused study periods — sometimes at the expense of their university courses — because numerical Step 1 scores were heavily used in residency screening.

Why this matters

• The change aimed to reduce excessive stress and to rebalance training priorities.

• A common misconception: “Pass/Fail means I should study less.” That’s incorrect.

Reality check

• Pass/Fail removes the pressure of a single numerical cutoff but does not reduce the knowledge required. Passing Step 1 still needs a solid foundation in basic sciences and serious, focused review.

• Many students underestimated the exam’s demands after the change. Among first-time takers, pass rates for international medical graduates showed a decline after the switch to Pass/Fail (example trend among IMGs):

  • 2019 — 82%

  • 2020 — 87%

  • 2021 — 82% (year of change)

  • 2022 — 74%

  • 2023 — 72%

Interpretation: the decline suggests some candidates reduced study intensity or misjudged what was required; Pass/Fail lowers exam-score anxiety but does not replace disciplined, concept-based preparation.

Practical takeaway: treat Step 1 as a high-stakes competency check — plan deliberate study, use questions to measure readiness, and schedule practice assessments that mimic test conditions.

What Brocali offers — an integrated Step 1 solution

Brocali is a medical education company that packages the full study ecosystem so you don’t have to juggle too many separate providers.

Comprehensive services

• Live group sessions

• 1-on-1 tutoring with Brocali’s doctors

• Peer-to-peer mentorship

• USMLE-style question bank

• Module-based assessments and evaluation exams

• Question practice workshops

• Step 1 learning videos

• Review articles and Step-focused flashcards

• Academic planning and progress checkups

• ECFMG application assistance (optional)

• Technical & academic support

• WhatsApp study group access

• Certificate on completion

How Brocali fits into your plan

• Use a single, coordinated course to avoid overloading with dozens of disparate resources. Brocali’s model is to combine teaching + practice + academic planning so you can follow a clear, measurable study path.