How to Get a 250+ On the USMLE Step 1

Everyone uses the same resources, works hard and is smart. What are the variables that differentiate a mediocre score VS a rock star/ residency landing score?

We are all medical students. By MS2 we have all learned routine medical A&P, path and pharm. As medstudents we are already professionals of taking tests and memorizing trivial facts. But the USMLE does a great job at separating good medical students (the pack in the middle of the bell curve) from people who get what the board exams require!
This is the champion round of medical school testing and it is delivered with different game rules than professor written exams – so we have to tweak what has worked for us previously.
There are 2 requirements beyond medical school knowledge in order to get a big USMLE score.
#1:Spend time on high yield board specific trivia till you can twist it and recognize it        inside and out.
#2: Learn how to decipher and reason through NBME USMLE questions.
Johnson et al completed a study across 3 medical schools to compare resources, study time and USMLE step 1 score. Shockingly most curriculums, MCAT, class rank, confidence, amount of time spent in board prep etc had no correlations with Step 1 score! Here are the only significant correlations between board prep and score: # of practice questions completed, UWORLD and FA.
According to my experience and this study – spending time in the most high yield resources and gaining the skill to understand board questions will make the difference on your score results. Here is how I propose to turn these two variables your way!

Variable 1: TIME spent on the RIGHT things.

Variable 2: Skill of deciphering board questions.

Variable 1: TIME spent on the right things.
To be excellent at both our variables requires time. But how should you use your prep time?
I asked people coming out of the exam, “What would you do if you had 2 more hours?” – the most common answer was, “Read FA one more time!”
You simply HAVE to know a crap ton of information for this exam and it takes enormous time to know it all. BUT according to the data in the study by Johnson et al across 3 medical schools taking USMLE there is no correlation between QUANTITY of study time spent vs scores. So if its not quantity what is it?
My goal is to help you not waste a second of golden study time. Every moment you put toward board study should bump that number up a few decimal points. If you are still opening old ppts or Robbins path to learn “tough” topics – the you are losing because you aren’t using time appropriately.
 Here’s the magic formula. Variable 1 = Time Management = Resources x Schedule
The KISS method. (Keep It Simple Stupid)
  • FA
  • UWORLD Question bank. (either 2x or add another Qbank)
  • A Question Journal (or some sort of log)
  • >2 Practice tests
  • Only 1 resource for each topic. e.g.  Sketchy for Micro, Pathoma for Path. NO MORE.
WHAT! Thats not magic! Everyone has those!
YES, The resources we have are phenomenal! This is all I used. Everyone I know who did well used these. Every SDN and Reddit thread boasting 270’s settles on this same list! You’ve got the tools! (They call it UFAP) Uworld, FA, Pathoma, – those alone will get you EVERYTHING you need to blow the exam out of the water…I believe you have to add Sketchy for micro so UFAPS it is!
We already know the basic medical knowledge – these just help us become experts with the board specific facts!
Good Schedule formula = Allocate time x Limit distractions
I believe that whoever allocates his time the smartest (aka time management) wins the BIGGEST scores. I distributed my study time across topics based on these two guides to get the most bang for my buck.
  1. The blueprint of the USMLE (gives you the percent of questions assigned to each topic on exam, found on the NBME website)
  2. What your analytics say you need to work on

Makes sense: what’s on the exam + what I personally struggle with = what I should be working on. NOTHING ELSE.

I designed/used a program that used data from these guides as well as FA page numbers to help allocate my time properly. In 2017 I gave this program to 12 people and 6 emailed me back that they used it and were shocked to score higher than their goal. Read why its important to study this way. See/buy my program!  *Wait and use my big special offers below!*

Making a smart and good schedule that you can actually keep has been the #1 variable in exam scores for me through the years. Wasting time with distractions during this board season is deadly to your future. Studying the wrong thing for even 1 day is deadly to your future.  Read how I make that kind of schedule.

Variable 2: Skill of deciphering NBME USMLE style questions. Someone can memorize every word of FA but if they haven’t seen that fact twisted into the most awkward deceitful questions of USMLE then FA is USELESS trivia. Use question banks to learn this skill. The same study as above (across 3 medical schools taking USMLE) found that the number of practice questions completed correlated to score. Factors like IQ, review book, quantity of time spent etc didn’t correlate to score changes. Interestingly, using UWORLD (specifically) DID correlate. Read my post about how to properly use and log questions. 
In short – I used one Qbank (USMLE-RX) to learn topics during my topical review. This was used nonrandom in topical order to cement the memory of the high yield info I was learning in a clinical, question format. bonus – this qbank follows FA pages.
 Next I used UWORLD to learn the skill of questions while adding valuable high yield info.  UWORLD was always done in blocks of 40, timed, random to practice test taking skills. The most important part is the test review. While reviewing I assessed my test-taking skill, timer mistakes, misunderstood questions and last of all – knowledge. I kept a log and journal and reviewed this nightly. I go into this more in depth here.
So keep your resources! The difference in USMLE scores is HOW you use those resources. Thats where I come in. I’m here to help you use your resources correctly.  Learn about my Time Management methods and how I use Questions Banks to get more bang for your buck out of them. Lastly – I created a program complete with web apps and all my tutoring videos to set you up with my own time management and question journal programs that I created over years of formulas fine tuning. Last year we had a beta group of 30 students use it and our average USMLE Step 1 score was 8 points above the mean and this was a group of students who were struggling with their practice tests and study prep for months a even years prior!
Now this year we are in full swing!
For those of you reading my article and from my personal website I have a BIG offer!
My schedule system FREE! AND if you purchase my program I will give you 20 minute free 1:1 session where we set up your game plan for success and make sure you are all ship shape for blowing this thing out of the water even better than I did!!

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