USMLE Step 1 Prep: Everything You Need to Know Before You Start Studying
- Dr. Amin ali
- Nov 3, 2025
- 6 min read
Updated: Jan 6
The USMLE Step 1 is the first of three exams required for medical licensure in the U.S. It’s a Pass/Fail test that assesses whether you can apply core science knowledge to medical practice and understand the mechanisms behind health, disease, and therapy. The exam is one day long, divided into seven 60-minute blocks, with up to 280 questions.
In this blog, we will cover everything you need to know before you start studying — exam format, high-yield topics, study strategies, resources, and more.
The USMLE Step 1 is a computer-based, standardized exam that evaluates your understanding of the foundational sciences and your ability to apply this knowledge clinically.
Aspect | Details |
Purpose | Test basic science knowledge and clinical reasoning |
Focus Areas | Anatomy, Physiology, Biochemistry, Pathology, Microbiology, Pharmacology, Behavioral Science |
Format | Multiple-choice questions in clinical vignettes |
Outcome | Pass/Fail |
Think of Step 1 as a bridge between theory and clinical practice. It’s not just memorization; it tests your ability to reason through patient scenarios.
When Should You Take Step 1?
Timing depends on your background and study readiness:
Student Type | Recommended Timing | Notes |
U.S. medical students | End of preclinical years (usually 2nd/early 3rd year) | Ensure core subjects are covered |
International medical graduates (IMGs) | After preclinical coursework or focused review | Consider NBME practice exams before registration |
DO students | After preclinical years | Decide Step 1 vs COMLEX Level 1 based on residency goals |
Exam Format & Structure
Step 1 is 7 hours long, divided into 7 blocks. Each block contains 40 questions, with ~280 questions total.
Feature | Description |
Duration | 7 hours (7 blocks, 60 min each) |
Questions | ~280 multiple-choice, mostly clinical vignettes |
Content Weight | 50–60% pathology & physiology, 10–15% pharmacology, 10–15% microbiology, 5–10% biostatistics & ethics, 5–10% anatomy & behavior |
Pass/Fail Scoring
Step 1 is now pass/fail, which means:
You only need to demonstrate competence to pass.
Despite pass/fail, residency programs consider your knowledge and NBME scores for clinical performance.
Aspect | Details |
Scoring | Pass / Fail only |
Retakes | Allowed with specific time intervals |
Implications | Step 1 performance affects confidence, knowledge base, and foundation for Step 2 CK |
Registration & Cost
Complete registration after finishing your core review, not before.
How to Start Studying For The USMLE Step 1
Step 1: Assess Your Baseline
Step 2: Build a Study Schedule
3–6 months preparation recommended
Daily study time: 6–8 hours
Include practice questions, review sessions, and breaks
Step 3: Choose the Right Study Resources (Brocali Full Study System)
For students just starting their USMLE Step 1 preparation, Brocali offers a complete, all-in-one study system designed to cover every aspect of your learning journey. Instead of piecing together separate resources, Brocali provides a structured platform that includes everything you need:
Qbank: Access to thousands of practice questions with detailed explanations to master clinical reasoning.
Video Lectures: High-quality, Arabic and English video lessons covering all core subjects.
Books & Notes: Integrated summaries and references aligned with USMLE high-yield topics.
Flashcards & Visual Tools: Active recall aids, including Anki-style flashcards and visual mnemonics.
Custom Study Plans & 1:1 Coaching: Personalized guidance to optimize your study schedule and target your weak areas.
Watch Dr. Amin, founder of Brocali, explain how Brocali can be your all-in-one resource for USMLE Step 1 preparation.
Pass USMLE Step 1 the first time with Brocali — 93% of students succeed. Try it free and make it your go-to study system. click here to start
High-Yield Topics
Subject | Percentage of Exam | Study Tips |
40% | Focus on mechanisms, disease associations, and clinical correlations | |
15% | Understand mechanisms, not just formulas | |
15% | Learn drug classes, mechanisms, side effects, and interactions | |
10% | Focus on bacteria, viruses, fungi, and antimicrobials | |
10% | Enzyme pathways, metabolic disorders | |
5–10% | Images and diagrams; high-yield clinical anatomy | |
Behavioral Science & Ethics | 5–10% | Patient safety, ethics, epidemiology, biostatistics |
Spend more time on pathology and physiology, as they make up the majority of exam questions.
Study Techniques
Active Recall: Flashcards, Qbank explanations
Spaced Repetition: Review topics multiple times at intervals
Practice Questions: Brocali question bank
Full-Length Exams: Simulate testing conditions to track endurance and timing
Integration: Connect concepts across subjects (e.g., pharmacology + physiology + pathology)
Common Mistakes Beginners Make
Mistake | How to Avoid |
Starting too late | Begin planning and studying early |
Ignoring weak subjects | Identify gaps through self-assessments |
Passive reading only | Use active recall and practice questions |
Skipping mock exams | Take at least 2–3 full-length practice exams |
Neglecting wellness | Include exercise, sleep, and breaks |
Step 1 vs COMLEX Level 1
Exam | Purpose | Recommendation |
Licensure for MD programs | Consider if applying to competitive residency | |
COMLEX Level 1 | Licensure for DO programs | Required for osteopathic programs |
Taking Step 1 can increase residency opportunities, even if you already plan to take COMLEX Level 1.
Action Plan to Get Started
Key Things to Know Before Starting USMLE Step 1
Key Point | Why It Matters | Quick Tip |
Understand the Exam | Step 1 tests basic sciences + clinical reasoning | Focus on pathology & physiology first |
Start Early | Late preparation reduces success chances | Begin 3–6 months before your planned exam |
High-Yield Topics | Most questions come from core subjects | Prioritize pathology, physiology, pharmacology |
Active Study Methods | Reading alone is ineffective | Use Qbanks, flashcards, spaced repetition |
Practice Questions | Improves exam strategy and timing | Aim for daily Brocali questions |
Full-Length Exams | Builds stamina and tracks readiness | Take 2–3 NBME/Brocali practice exams |
Wellness Matters | Stress and burnout reduce retention | Sleep 7–8 hrs, exercise, breaks, mindfulness |
Study Resources | Choosing too many causes confusion | Stick to 2–3 trusted resources |
Time Management | Step 1 is long and intensive | Plan daily blocks + review + practice |
Retakes Are Costly | Multiple attempts are stressful and expensive | Only schedule the exam when fully prepared |
Frequently Asked Questions for USMLE Step 1
Do I need to finish all my preclinical courses before studying for Step 1?
Yes, ideally. Step 1 assumes you have a solid understanding of basic sciences, including anatomy, physiology, biochemistry, and pathology. However, if you are still finishing courses, you can start light review while completing your studies.
Can I rely on videos or notes alone?
Videos and notes are helpful for concept understanding, but Step 1 tests applied knowledge. Combine videos/notes with active recall and question practice for best results.
Should I memorize First Aid entirely before doing practice questions?
No. Use First Aid as a reference while practicing questions. Attempting questions first helps identify gaps and reinforces memory more effectively than passive reading.
How important is reviewing high-yield facts daily?
Very important. Step 1 exams reward frequent reinforcement. Use flashcards, spaced repetition, or summary sheets to review high-yield concepts daily.
How do I balance studying Step 1 with school or work?
Start with smaller, consistent study blocks (1–2 hours/day) if still in school.
Increase to full-time study during dedicated Step 1 prep months.
Use weekends or breaks for longer practice sessions.
Is it better to study by subject or integrated system?
Beginners: Focus on subjects individually first (e.g., pathology, physiology).
Later: Integrate subjects in clinical vignettes to simulate exam scenarios.
Do I need to take notes while using Qbanks?
Optional, but brief notes or flashcards for missed questions are highly effective.
Focus on why the right answer is correct and why others are wrong.
How often should I take practice exams?
Begin with baseline assessment before study.
Midway through prep: take 1–2 practice exams to check progress.
Final month: take 1–2 full-length exams to simulate real conditions.
Can I study Step 1 without a study partner?
Yes. Step 1 prep is largely individual. However, discussion groups or study partners can help with difficult concepts and accountability.
How do I decide my exam date as a beginner?
Choose a date 3–6 months ahead based on your schedule and progress.
Ensure your curriculum and Qbank practice are mostly complete before locking in a date.
What’s the best first week plan for a beginner?
Assess your baseline knowledge with a diagnostic test.
Outline your study schedule: subjects, daily blocks, review sessions.
Start with 1–2 hours of focused study per day, gradually increasing time.
Begin using Qbank questions and flashcards lightly to identify strengths and weaknesses.
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