USMLE Vault · Step 1

Popular Step 1 study methods I would never use

Q: Which Step 1 study methods should I avoid?

Part 1, 4 popular ones: reading the entire First Aid once and then starting UWorld; doing UWorld on random mode from the beginning; leaving some questions of every system for random mode at the end; and reading the Sketchy PDF without watching the videos, or doing micro from First Aid without Sketchy. Part 2, 4 more: beginning with cardiovascular or biochemistry, doing Boards & Beyond for every system before UWorld, giving NBMEs online, and reading Mehlman's PDFs. Instead: understand First Aid system by system, then do that system's UWorld, every question, in system mode.

Your seniors swear by every one of these. I would never use any of them, and here's what I'd do instead.

By Dr. Marish Asudani · Published 22 October 2026

Which Step 1 study methods should I avoid?

4 popular ones. Reading the entire First Aid once and then starting UWorld. Doing UWorld on random mode from the beginning. Leaving some questions of every system for random mode at the end. And reading the Sketchy PDF without watching the videos, or doing micro from First Aid without Sketchy. Instead: understand First Aid system by system, then do that system's UWorld, every question, in system mode.

Already know Part 1? Jump to Part 2: 4 more methods I'd never use →

Read this firstEvery method on this page is popular for the same reason: it feels productive. You finish a book, you finish a block, you tick something off.

But feeling productive and scoring are different things. Every one of these feels like progress and quietly costs you weeks.

Part 1: 4 methods I would never use

Reading the entire First Aid once, then starting UWorld

This one is wrong. By the time you apply the early systems in UWorld, you've forgotten them, and you conclude you're bad at Step 1 when you simply used the wrong order.

You're not supposed to learn First Aid on the first go. Learning happens when you understand something first, then apply it, then recall it. So you understand First Aid system by system, and you go to that system's UWorld straight after.

How I read First Aid, page by page, with the First Aid Guide:

What to focus on, and a short video if the page needs one.
The concept walkthrough and the key takeaways.
"How is this tested": the common confusion on that page.
That page's MCQs. Then the next page.

Then Mehlman's videos for application, the FA Foundation Anki for recall, and only then UWorld.

▶How to use the First Aid Guide15 minutes. Watch it before your first page.

Read 1 system the right way, freeEvery renal page in the First Aid Guide: what to focus on, the walkthrough, and that page's MCQs.

Open renal free →

Renal p. 596 in the First Aid Guide: what to focus on, the ELI5s and the walkthrough.

Doing UWorld on random mode from the beginning

This is wrong too. UWorld is a learning and an assessment tool. It is not a first-pass resource. If you open it cold on day 1, you'll get 40-something percent, decide you're not smart enough, and give up. My own first block was 50%.

And random mode makes it worse. It feels productive, but every block jumps from 1 system to another, and nothing consolidates. When you do 1 system at a time, the reps stack on top of each other and the patterns lock in.

Instead: UWorld only after you've read, applied and recalled the system. Unused · your system only · tutor · untimed · blocks of 20, at least 2 blocks a day.

▶How to solve UWorld20 minutes. Watch it before your first block.

Leaving some questions of every system for random mode at the end

⭐ THE SNEAKY ONE

If you do this, you never complete the system. Those questions, and those marks, come back at the end. The topics in them are new, because you never did them. So when you finally do them on random, your scores drop, and you decide UWorld isn't useful at all.

Random mode can't fix this. It can't teach you something you never opened.

When a system is actually finished

Every UWorld question of that system is done (100% complete, not "most").
Every bookmark is traced back to its First Aid page.
Your last 2 blocks are above 65%.
That system's FA Foundation Anki is cleared.
The last block felt boring.

▶What to do before UWorld of each system15 minutes. For when your scores lag halfway through a system.

Reading the Sketchy PDF without watching the videos

That is the stupidest thing students ever do. The other version is doing microbiology from First Aid alone, without Sketchy.

The video is the lesson. The story is what comes back to you weeks later, when that organism shows up in a UWorld question and the whole sketch returns. The PDF is the lookup, not the lesson: you use it to check one image, not to learn the bug.

Instead, the WRWRT loop: watch the sketch at 1x, no notes → recall the whole story in your head → watch again only the gaps → read the Sketchy PDF for that organism → test with the micro MCQs on the Vault.

And the 4 resources that came off my list: Boards & Beyond (method 6 below says when it still earns its hours), Kaplan, USMLE Rx and Pixorize. Why they came off my list →

Part 2: 4 more methods I would never use

These 4 are just as popular, and just as expensive. More of the same in 10 IMG mistakes and 4 Step 1 hacks.

Beginning with cardiovascular or biochemistry

99% of IMGs begin with biochemistry, and then they quit, because biochemistry is just that difficult. The ones who skip biochem usually start with cardio, because it feels like the most important system. It isn't. Open your First Aid and it tells you itself: cardiovascular is 7 to 11% of the exam. Pharmacology and microbiology are roughly 20 to 30%.

So I would never start there. Micro and pharm first, then renal. Easy systems first (renal, respiratory, GI), so you build momentum. Cardio last, because it's the hardest. Biochem is a prerequisite, not an opener: it's split into small pieces, and each one lands right before the system that needs it.

Instead: micro and pharm (your first 9 to 10 days) → renal → respiratory → GI → … → cardio last, with each biochem piece slotted in just before its system.

Get the order built for youThe schedule puts micro and pharm first, renal next and cardio last, every biochem piece on its own day.

Build my schedule →

Doing the Boards & Beyond videos of every single system before UWorld

It used to be a must. Now it's not a necessity. The teaching was never the problem: none of it is anchored to First Aid. You finish a long video, then you have to find where it lives in First Aid yourself, and you end up with slides and a book and no idea which one to write your notes in. Doing that for every system before you touch UWorld costs you weeks.

When to use it

You're in 3rd or final year, with real time to build your basics.
You watch it against First Aid, with the same pages open.
Every extra point goes into the First Aid page, and you test that page's MCQs the same day.
Neuro and GI especially.
Or: 1 system whose UWorld still won't move after the method below. That system only.

When not to

You're a graduate, short on time.
Every system, start to finish, before UWorld.
Watched on its own, not anchored to First Aid.
As your first pass of a system.

Instead: the micro and pharm of the system → the First Aid Guide → Mehlman's videos → the FA Foundation Anki → UWorld. In my experience, that saves more than 100 hours of studying.

Giving NBMEs online

I would never do that. The online version gives you 50 questions in 75 minutes. It feels comfortable, and it inflates your score by 4 to 6%. You book a date on a number that was never real, and the pace you trained is not the pace of the exam.

Instead: offline, always. 10 blocks of 20 questions, 30 minutes each. Same conditions as the real exam, so the score is one you can trust. Review it the same day.

▶How to solve NBME blocksThe 2 passes inside every block of 20.

Want a full 14-block day?The Vault assessment: 14 blocks, 280 questions, the length of the real exam.

Take the assessment →

Reading Mehlman's PDFs

They are useless. The PDFs are chunky, and there's no repetition in them: you read a fact once and it's gone. People download every PDF, feel productive, and never improve.

The value is in his videos. He repeats the high-yield concepts again and again until they stick, and he teaches you how the NBME thinks: how it frames the stem, and how to eliminate the wrong options. A PDF can't do that.

Instead: that system's full playlist, in order, 1x, no notes, after you've read the system.

▶How to watch Mehlman Medical videos10 minutes, before your first playlist. ▶Mehlman · Renal playlistFull playlist, in order.