How to pass Step 1 in 54 days

[twitter_follow username=”medicalce” language=”en”] Hello everyone,

I’d like to share my experience of passing Step 1 in September 2011 at my first attempt, after 54 days of revision. This may not be useful for many of you, as my sole aim was to pass the exam as I have already secured a subspecialty clinical fellowship in ophthalmology in the USA. I did not need a high score.



You may have already read my thread in this forum about passing Step 2 CS after 17 days of revision ( For those who haven’t, I am a board certified ophthalmologist in the U.K. I went to medical school in the UK, and graduated 11 years ago. I am of Asian origin and grew up in Asia. I have not done any general medicine or surgery for 10 years – only ophthalmology. I am taking the USMLEs for the reason I have highlighted in the first paragraph.



I took Step 2 CS in June 2011 and passed. I am due to take Step 2 CK shortly.



I was originally scheduled to take Step 1 just under six weeks following Step 2 CS. This was a very short period of time for the number of subjects that needed to be covered. I used the following RESOURCES:

  1. First Aid for Step 1 (2011 edition)
  2. USMLE World Qbank (2 months subscription)
  3. NBME self-assessment number 5

As I was short for time, I was forced to limit the number of books I used to just 1. I needed to be extremely focused and targeted with my revision. I agree with other forum posts about using more books for a higher score and if you have more time.




1. Days 1-37

As it’s been so many years since I did any general basic science work, I decided to revise by organ systems as this generally makes more sense to me as a practising clinician (even though I’m an ophthalmologist and not an internist or general surgeon).


Starting with the cardiovascular system in First Aid, I’d read through a chapter once (1/2 to 1 day), and then did the USMLE World Qbank questions on that system only. It was difficult trying to understand a lot of the First Aid information, as it is heavily summarised and assumes you already have an understanding of the topic from reading of other/larger texts. I took in as much as I could, and the Qbank is extremely helpful in filling in the missing links and with providing detailed explanation (e.g. of biochem pathways, etc etc). I then moved on to the next system. I would spend 3 to 5 days on each system in total. For each system, if there was a Qbank question relating to a basic science topic not covered within the …High Yield Organ Systems” topic, I’d take that opportunity to assimilate the relevant pages within the basic science …High Yield General Principles” in First Aid (e.g. embryology, microbiology, etc).


With regards to the Qbank, I used …tutor” mode only. In total, I did 1750 out of the available 2080-2100 USMLE World Qbank questions. I had the intention to go through all the questions twice, but I didn’t manage to even finish it once.


On average, I spent about 9 hours studying per day (more or less on some days as I was also doing some unrelated lab research at the time)


2. Day 38:

This was 2 days before I was originally scheduled to take Step 1. I did not feel ready, particularly as I still hadn’t revised and done the Qbanks for neurology, reproductive medicine, haematology, psychiatry and dermatology. To be certain, I took the NBME Comprehensive Basic Science Self-Assessment Form number 5. I got a score of 270, which is equivalent to a USMLE Step 1 score of 168, i.e. a fail! I decided to postpone Step 1 by 2 weeks.


3. Days 39-47:

I revised the rest of the topics I hadn’t covered as listed above.


4. Days 48-53:

I read through most of First Aid for the second time – most the Organ Systems chapters, and some of the High Yield General Principles (basic science) chapters.

I would recommend giving yourself at least 2 days more than I had done (I ran out of time) to read through First Aid again – I had to skim through some sections quicker and less thorough than I would’ve liked (e.g microbiology), and did not read some chapters again at all (e.g. embryology, psychiatry)


5. Day 54:

I read through Rapid Review and High Yield Images (in First Aid). This was very useful. This was my first time reading the Rapid Review section, and I wish I had done it once previously.


6. Breaks:

I took 3 full days off completely in those 54 days – days 6, 12 and 32.




I took Step 1 in August 2011.

This was undoubtedly the most unprepared I had ever been for an exam. I thought the questions were as tough as, if not tougher than the USMLE World Qbank. I managed to just about finish answering all questions in each of the 7 one hour blocks. However, for 2 or 3 of the blocks, I did not have time to go over any of the questions I had ‘marked’ for my own review. Time was extremely tight, and I wish I had practised a few timed blocks in USMLE World – the only one I had done was the NBME self assessment (which I failed 2 weeks prior).

This was an absolutely brutal exam, largely because I should’ve been better prepared. There were many questions with which I had absolutely no idea, and just had to guess. After the exam, I was certain I had failed and thus began planning towards to a re-sit.

To my delight and surprise, I passed Step 1 last week!



Step 1 is an extremely tough exam for those of us who’ve been out of medical school for a few years. However, it’s not rocket science. It simply requires a dedicated amount of time to acquire and retain the knowledge. The syllabus for Step 1 is clear, and there are ample resources. You need to streamline your resources based upon the score you’re aiming for. If your aim is simply to pass, then I am certain the limited resources and plan I used described above will suffice. If however, your plan is to get a high score (as would be the case for most of you), then you need to read around the subject more, add notes to First Aid and revise through that, and do more questions.

I hope everyone who’s about to embark upon Step 1 can glean something useful from my experience. Specifically, regardless of what score you are aiming towards, you can at least be confident of pass with less than 2 months of solid and very focused studying. You can then extrapolate how much extra time you’d need to get a high score.

Good luck![related_posts]

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