# The Week Before Step 1

> What to do the week before USMLE Step 1: check you are above 68% on NBME 31, 32 and 33, then the Neil Randy PDF, the Mehlman High-Yield Arrows, the NBME Booster Anki with the NBME images, the FA Foundation Anki and Rapid Review. Bookmark what you don't remember: that list is your day before.

URL: https://drmarishasudani.com/week-before-step-1
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## Questions this guide answers

- **What should I do the week before Step 1?** First check the gate: you should only give Step 1 if you are above 68% on all 3 of NBME 31, 32 and 33. If you are, the week is recall, not new content. Do the Neil Randy PDF, the Mehlman High-Yield Arrows at 40 a day, the NBME Booster Anki system by system with the NBME images, the FA Foundation Anki system by system, and the Rapid Review section of First Aid. Bookmark every card you don't remember. On the day before the exam, you study only those bookmarks.

## Page text

USMLE Vault · Step 1 · The final week
The week before Step 1 (for procrastinators)
For IMGs with 7 days left who have been putting it off. By the end of this page you will know exactly what is enough , and nothing more.
By Dr. Marish Asudani · Published 22 October 2026
What should I do the week before Step 1?
First check the gate: you only give Step 1 if you are above 68% on all 3 of NBME 31, 32 and 33. If you are, the week is recall, not new content: the Neil Randy PDF, the Mehlman High-Yield Arrows at 40 a day, the NBME Booster Anki with the NBME images, the FA Foundation Anki and Rapid Review. Bookmark every card you don't remember. On the day before, you study only those bookmarks .
Last-minute? Simply scroll to the bottom of this article for the super high-yield things to do in the last minute →
Read this first If you've been putting this week off, it's not because you're lazy. Procrastination only happens when you don't have a vision, or when you don't know what to do and what is enough.
So I'm going to tell you exactly what is enough for this week. Checklists work: knowing exactly what to do. No new content, no new resources. Just the list my students run in their final week, in order.
1 rule before you start: you check the gate first. Then you open the list.
Students who did this
Real students, in their own words, on the exact tools in this guide. Tap to play.
Dr. Rana · Passed Step 1 An honest review of Vault Assessment
Lakshmi · Passed Step 1 An honest review of Vault Assessment
Try a free 3-day trial → usmlevault.com · no card needed
0
Before anything The gate: are you even giving it this week?
DO NOT SKIP
You should not be attempting your Step 1 if you haven't scored above 68% on NBME 31, 32 and 33 . All 3. Not your best of 3. And you should be finishing your blocks with time left on the clock.
If you've got those, this week is yours, and the rest of this page is your checklist.
If you haven't, this isn't your exam week, and that's fine. Fix the plateau first with Stuck at 62–65% , and if your date is already booked, use Reset in the Vault schedule . It tells you honestly whether your date fits. How Reset checks your date →
Not above 68% yet? Let the Vault re-check your date Set your exam date and hours in the Vault schedule. Reset tells you honestly whether the date still fits, and what to do each day until it does.
Open my schedule →
Those scores only count if you took them offline. NBMEs are always taken offline, timed, 20 questions in 30 minutes a block. The online version gives you 50 questions in 75 minutes, which feels comfortable and inflates your score by about 4 to 6%. An online 70% is not a 70%. Why NBMEs are always offline →
Not sure how to read your own scores? A trend beats a single number. 1 drop in a run of 68–73% is a bad day. 1 spike in a run of 63–65% is noise. How to know you're actually ready →
The 6 things to do this week
In this order. Anything new or anything you don't know while you do them, you bookmark it. That rule is further down , and it's the most important line on this page.
1
Non-negotiable · 2–3 days max The Neil Randy PDF
This is the biggest cheat code for the last week. People think Neil Randy is only biostats. He isn't. The PDF is his high-yield playlists in 1 place: every high-yield system, with the questions that go with it.
It takes 2 to 3 days at most. If you haven't done it yet, do it this week. No exceptions.
PDF Open the Neil Randy PDF in the Vault University usmlevault.com/university, with the Mehlman High-Yield Arrows.
2
Non-negotiable · 4 days The Mehlman High-Yield Arrows
160 up-and-down arrow concepts. Do 40 a day and you're finished in 4 days. The exam loves arrows: what goes up, what goes down, and why.
PDF Open the Mehlman High-Yield Arrows in the Vault University Arrows 1–40, 41–80, 81–120, 121–160. Same place as the Neil Randy PDF.
▶ Mehlman on how to use the HY Arrows PDF Watch once before arrow 1.
3
Weak systems first The NBME Booster Anki, system by system
⭐ HIGHEST YIELD
What it is: every NBME form, gone through topic by topic, with every topic written as a 1-line card, explained underneath, and sorted into the system it belongs to. It now covers forms 20 to 34, and the Free 120 has been added too. The line on the card is the line that comes back at you in a vignette.
Why this week: the real exam asks what the NBMEs ask. The NBME retires forms, not logic. So in the final week, you do the NBMEs again, as recall .
How: do it system by system, never form by form. For every system you feel weak in, run that system's Booster deck to the end.
The NBME images. Inside the Booster family there's the NBME Images Anki : every image asked in the NBMEs, from NBME 20 to 34, as flashcards. About 500 cards. This is the most important part of all of it, because the NBME repeats its images a lot in Step 1. Do it this week. The NBME Images Anki → Want a 12-minute warm-up first? Dirty Medicine: 40 High Yield Images for USMLE →
The NBME pharmacology deck. Every pharmacology question ever asked in an NBME, as flashcards. Do it after your pharmacology revision from First Aid. The NBME Booster, pharmacology only →
Open the NBME Images Anki Every image asked in NBME 20 to 34, as flashcards. Do it this week: the NBME repeats its images a lot in Step 1.
Open the images deck →
An NBME Booster Anki card in the Vault: 1 line on the front, the explanation on the back.
V Open NBME Booster Anki in the Vault usmlevault.com/anki · the Booster, the NBME Images and the pharmacology deck
▶ How to do Anki from the Vault My video: how to open the decks, flag a card and build a session.
The full explainer: The NBME Booster → how the cards are built, and why system-wise beats form-wise.
4
System by system · 5–6 days a pass The FA Foundation Anki
It just simply wraps up the entire First Aid . Every high-yield line of every page, asked actively, with the First Aid page number on every card. And that is basically what the questions in the exam ask.
2,499 cards in 17 system decks. At 400 to 500 a day, a full First Aid pass takes 5 to 6 days. Go system by system, with First Aid open beside you. If a card makes you hesitate, open that page and read a couple of lines above and below it.
Open the FA Foundation Anki, all 17 systems Every high-yield line of First Aid as a card, with the First Aid page number on every card. Start with your weakest system.
Open the deck →
Which deck does which job: Foundation versus Booster → The Foundation teaches you the book. The Booster teaches you the exam.
5
For your weak systems Frustrated re-reading First Aid? Don't read it. Recall it.
For every system you feel weak in, if you're frustrated reading the same First Aid pages again, stop reading and do that system's FA Foundation Anki instead. It's lines of the First Aid, recalled as Anki . Same content, but your brain has to pull it out, which is what the exam asks it to do.
6
A definite must The Rapid Review section of First Aid
The Rapid Review section at the back of First Aid is a definite must this week. You've read First Aid already. This is the fast pass at the back of it.
+
Every day, alongside the 6 Sketchy Micro revision, every single day
Sketchy Micro gets revised every single day this week, alongside the 6. In the last-month plan, days 30–31 add the 90-minute antimicrobials video, and day 32 adds the High-Yield Biostats PDF.
▶ Antimicrobials in under 90 minutes The single most important video on antimicrobials.
PDF The High-Yield Biostats PDF Every formula in 1 place.
✓
Tick them off Your week, on 1 list
Saved on this phone, so you can come back to it every day. Tick it only when it's finished.
Above 68% on NBME 31, 32 and 33, with time left in my blocks
The Neil Randy PDF (2–3 days)
The Mehlman High-Yield Arrows, 40 a day (4 days)
NBME Booster Anki for every weak system
NBME Images Anki, finished
NBME pharmacology deck, finished
FA Foundation Anki, system by system
Rapid Review at the back of First Aid
Sketchy Micro revision, every day
Everything I didn't remember is bookmarked
⏱
Pick yours Do you have the time, or not?
Be honest. If the week is full, you don't skip the list. You cut it down to the highest-yield things .
Tap the tab that matches your week
I have the time
I don't have the time
I have the time
Complete all of the bookmarks of your NBME Booster Anki .
Complete all of the bookmarks of your FA Foundation Anki . Going over all of First Aid and all of the high yield of the NBME Booster is what this week is for.
The Mehlman High-Yield Arrows, 40 a day.
Sketchy Micro revision, every single day.
The Neil Randy PDF, if you haven't done it.
If you have the time, Rapid Review.
I don't have the time
The NBME Booster Anki of NBME 28 to NBME 34, and the Free 120, which is now in the Booster too. All of them.
The NBME images, from NBME 20 to 34.
The NBME pharmacology deck.
Sketchy Micro.
The Mehlman High-Yield Arrows.
Rapid Review.
Why the NBME decks first? Because in the final week, the real exam just asks the NBME. So that's what you recall.
★
All week The bookmark rule: this week writes your day before
⭐ MOST IMPORTANT
While you do the NBME Booster Anki and the FA Foundation Anki , anything you don't remember, you bookmark. Anything new, or anything you don't know from the PDFs, you make a note of it.
That list becomes your final day, the day before . On the last day, you just do the bookmarks. Nothing else.
During the week: flag every card you got wrong or hesitated on.
On the day before: go through only the flagged cards. The ones you now remember, unflag. The ones you still don't, keep flagged.
Then again: go back through what's still flagged. The list keeps getting shorter, and you keep getting better.
Every Vault Anki deck has a Flagged filter: tap it and only your flagged cards come up.
How to pull only your flagged cards: Pick & Mix filters across every deck at once, by system, series or form, to only the cards you flagged or missed. Pick & Mix →
📅
The bigger picture Where this week sits in your last month
On the Vault's last-month plan , the final week is days 28 to 32, and nothing new goes in . This is how it's laid out:
Every day First Aid Rapid Review, plus the FA Foundation Anki or the NBME Booster Anki . Then the Mehlman Arrows and the Neil Randy PDF again. You've seen them once, so this pass is fast.
Days 28–29 Pharmacology revision from First Aid, then the NBME pharmacology deck.
Days 30–31 Sketchy for micro and the 90-minute antimicrobials video. Then the NBME Images Anki.
Day 32 The High-Yield Biostats PDF, then finish whatever is left of the images and pharmacology decks.
Day 33 The day before: your bookmarks only. The Final Day Protocol →
The full 33 days, from NBME 27 to the exam: The last month, day by day →
▶ How to Pass USMLE Step 1 in 2027, Part 6: the last month Chapter at 12:29. The bar, and what the last month looks like.
Last minute? (Step 1 edition) · the bottom line
The 4 highest-yield last-minute things
For Step 1, "last minute" means your final week and your final day. You don't learn anything new now. You recall. If you only do 4 things, do these, in this order:
The NBME Booster Anki . The NBME asks the same questions again, and the Booster is every form turned into 1-line cards, with the NBME images. How it works →
The Mehlman High-Yield Arrows. 160 concepts, 40 a day. In the Vault University →
The Neil Randy PDF. 2 to 3 days. In the Vault University →
Rapid Review at the back of First Aid.
"These are the highest-yield last-minute things that you can do to instantly get 15% to 20% more in your NBMEs and on your exam. They just increase your confidence to the next level ."
Your day before → The Final Day Protocol : your bookmarks only, books shut at 5 PM.
Your day-by-day plan
Want a day-by-day schedule that tells you exactly what to study next? The Vault builds it around your exam date.
Build my schedule in the Vault →
Want this week dated, around your exam?
…

## Source

USMLE Vault — https://usmlevault.com
Author: Dr. Marish Asudani

Updated: 2026-10-22