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For IMGs who have started Step 1 prep more than once and stalled. No shortcuts, no tricks with the exam software.
By Dr. Marish Asudani · Published
4 of them, and all 4 are about order. 1: never start with cardiovascular or biochemistry; start with micro and pharm, then renal. 2: do UWorld system-wise, never on random mode, and finish every question of that system. 3: stop worrying that you're forgetting, and finish each system in 6 to 7 days with the same loop: First Aid with the First Aid Guide, Mehlman, FA Foundation Anki, then UWorld. 4: watch Mehlman's videos, not his PDFs.
Read this firstMost IMGs who quit Step 1 quit because they begin in the wrong order. Not because the content is too hard.
They open the biggest, scariest system first. They open UWorld before they've read anything. They save questions for "later". They read Mehlman's PDFs and wonder why nothing sticks. Then they decide Step 1 isn't for them, and they quit.
None of those are discipline problems. They are order problems, and order can be fixed in an afternoon. Here are the 4 fixes I'd give you on day 1.
99% of IMGs begin with biochemistry, and then they quit, because biochemistry is just that difficult. Don't make that mistake. 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 not one of the most important systems. Pharmacology and microbiology are roughly 20 to 30% of all questions on Step 1 on any given day. So that's where you start: micro and pharm first, then renal.
Free micro and pharm PDFs, in the Vault UniversitySketchy and the High-Yield Pharm PDF, free, in 1 place. This is where your day 1 starts, not cardio, not biochem.
Open the free PDFs →Micro and pharm (your first 9 to 10 days) → Renal → Respiratory → GI → Reproductive → Endocrine → Immunology → Heme-Onc → MSK → Derm → Psychiatry → ANS → Neuro → Cardio, then biostats and ethics.
The biochem pieces slot in on the way: nutrition before GI, carbohydrate and fat metabolism before endocrine, cellular, molecular and amino acids before immunology, genetics before ANS and neuro. Easy systems first, so you build momentum. Cardio last.
Read next: Sketchy Micro in 6 days · Pharmacology in 48 hours · where the 7 biochem pieces go · the full timeline
UWorld is a learning resource. It is not a resource you do once at the end, and it is not a first-pass or second-pass thing. You do it once, and you do it in system mode, because you're learning and assessing how much of that system you understand and retain.
Random mode 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.
And finish every question of that system. The 30% you "save for random" was never saved. It was never opened. Those are the topics that show up brand new during revision, when there's no time left to learn them.
Unused questions · your system only · tutor mode · untimed · 20 questions.
Halfway through the system's questions and not consistently at 65 to 70%? Stop. Go back to that system's Mehlman and FA Foundation Anki, then carry on.
▶What to do before UWorld of each system15 minutes. Watch it if your scores lag after half the questions.Read next: the RPSR method · when is a system actually finished? · the study methods I would never use
Every IMG worries that by the time they finish neuro, they've forgotten renal. So they slow down, re-read, and finish nothing. Stop. Try to complete each system within 6 to 7 days, using the same loop every time.
Forgetting isn't the problem you think it is. In 2 to 3 days of this loop, you attack the same First Aid pages 4 to 5 different ways: you read them, apply them, recall them, and then test them. And every new system revises the micro and pharm you already did.
Here is the exact breakdown, using renal:
About 6 to 7 days a system, 10 systems: roughly 70 to 80 days for First Aid and UWorld of every system.
Start where nobody quits: renal is freeOpen the renal First Aid Guide with its micro and pharm pills, page by page. Day 1 of the loop above, at no cost.
Open renal free →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 on usmlevault.com/schedule →
Read next: Renal, start to finish, in 6 days · the First Aid method · every system guide
The PDFs are chunky, and there's no repetition in them. You read a fact once and it's gone. In the videos, he repeats the high-yield concepts again and again until they stick.
And he doesn't just teach you the answer. He teaches you how the NBME thinks, how the stem is built, how the options are built, and how to rule out every single option. That elimination skill is what moves your score.
Read next: how to use Mehlman
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