The Ultimate USMLE Step 1 Framework

The 3-part gameplan for fast, efficient, and effective Step 1 prep.

Here’s what you’ll get from reading this post:

• My simple 3-step framework for organized USMLE prep

• Step-by-step instructions for executing each phase of the framework

• Confidence and clarity that your hard work will yield results

The USMLE Step 1 exam is arguably the toughest challenge standing between you and your dream of practicing medicine.

On the surface, it seems easy enough… Study and do questions - got it!

It’s never that straightforward, unfortunately:

"There are so many resources - which one is best for me?”

“They say do as many questions as possible - am I doing them correctly?”

“When do I use NBME exams - now or later?”

“Why aren’t my Qbank scores improving?”

It’s all pretty darn confusing, don’t you think?

The key to making your USMLE Step 1 preparation as easy as humanly possible is having a framework that is easy to understand and follow—no complicated study plans, minimal resources, and an easy-to-follow roadmap to help you get to where you want to be.

When students come to work with us at the USMLE Guys, they’re often already stuck, struggling, and looking for clarity.

I have good news and bad news.

The good news is that I’ve been doing this long enough to know what works and what doesn’t. This translates into a simple, crystal-clear roadmap that anyone can follow to pass the Step 1 exam.

The bad news is that even though I’m going to help you position yourself for exam-day success, it’s still going to require unwavering commitment and a willingness to work hard.

It's incredibly frustrating and endlessly confusing when you're not making progress despite following all of the 'recommendations' from colleagues, instructors, and online forums.

We don't want this... We don't need these headaches!

The exam is purposely made difficult for those who don’t know the material, meant to confuse the unprepared and destroy those who don’t take it seriously.

Therefore, it’s essential that we simplify your prep so you can master the information and ensure that you’re adequately prepared to tackle the challenging questions you’ll face on exam day.

As you read through the following mental framework, I recommend that you think of these as separate 'phases’—each with its own specific goals and criteria that should be met before progressing to the next.

Here’s how we’re going to format the rest of this tutorial:

• Outline the three parts of the mental framework

• Discuss the details of each component for clarity & understanding

• Explore the different ‘student profiles’ to help you figure out where you fit into the grand scheme of this plan

• Discuss how to use the 3-phase framework depending on your student profile

• Outline common challenges you might encounter along the way

Ready to simplify your life and accelerate your progress?

Great! Let’s get started.

---

THE 3-PHASE MENTAL FRAMEWORK:

I created the 3-phase mental framework to simplify things as you proceed with your exam prep.

At every moment from now until exam day, you’ll be in one of the following three phases:

Phase 1: The "Learning" Phase

Phase 2: The "Application" Phase

Phase 3: The "Assessment" Phase

---

Whether you’re just starting or you’ve been struggling for months, thinking in terms of phases and the phase you’re in will allow you to work with greater clarity and better understand what needs to be done and why.

As we discuss each phase, do your best to understand the what, why, when, and how for each (I’ll be very clear in making this obvious to you):

What is the goal of this phase?

Why am I using this particular phase?

When should I use this particular phase?

How do I best use this phase?

By framing your thought process in this way, it won’t matter which phase you’re in…

You’ll never again be lost and wondering what you should be doing, why you should be doing it, when you should be doing it, or how you should be doing it… See what I did there? 😎

Ok, let’s dive into the first phase - The Learning Phase.

---

THE LEARNING PHASE

What Is The "Learning" Phase?

As the name implies, this is the phase in which you learn the material.

Remember that while most of this phase will happen during your basic sciences years, you’ll always be slipping in and out of it depending on whether you’ve identified a new weakness or have to return to fix a lagging one.

This is the longest, most grueling phase of your entire Step 1 journey. Here, you’ll accumulate all of the knowledge needed to confidently and accurately tackle USMLE questions.

There is no shortcut for this phase!

If you’ve been out of school for more than six months, it’s likely that you’ll need to come back and spend more time in the phase.

Why Am I Using The “Learning” Phase?

You’re using this phase to accumulate knowledge - plain and simple.

If you’re struggling with any topic, subject, or concept, remember that the learning phase exists to address these problems.

It is your friend… It is here to help… Don’t try and speed through it.

When Should I Use The “Learning” Phase?

There are a few important times when you should use the learning phase, they are:

• During the basic sciences years

• As you find weaknesses while doing questions

• After NBME exams have identified weaknesses

• Any time you feel as though something is lacking

How Do I Best Use The “Learning” Phase?

It depends on where you’re at in the journey. It will differ from the basic sciences years to your dedicated Step 1 prep time.

Let’s take a look at how to get the most out of the learning phase based on both scenarios:

SCENARIO 1 - The Basic Sciences Years (Years 1-2 of Med School):

Think of this as the “all-out” learning phase, where your sole job is to dedicate yourself entirely to learning as much as humanly possible.

The basic sciences years are designed to put you in the ideal environment to maximize this goal.

Follow your school’s curriculum and get into the details.

This isn’t the time to worry too much about what will be tested on the Step 1 exam; if you put one hundred percent of your energy into learning as much as possible during the basic sciences years, you’ll cover the material tested on the Step 1 exam. Then, moving into your dedicated Step 1 prep should be a breeze—seriously.

SCENARIO 2 - Dedicated Step 1 Prep:

Your dedicated Step 1 prep aims to use all of the knowledge you’ve acquired during the basic sciences and apply it to practice questions.

As you use the different question banks (I recommend Amboss first and UWorld second), you’ll undoubtedly encounter areas of deficiency.

You will notice that specific topics, subjects, or concepts are still not quite as concrete as you’d believed - this is good - that’s what we aim to uncover in the dedicated phase. As world-renowned theoretical physicist Richard Feynman said:

As you encounter weaknesses or gaps in your knowledge, you should set aside a specific day(s) each week and a generous amount of time to deep-dive back into the areas that need your attention.

This isn’t a time for simple ‘review’… This is a quick visit to the ‘learning phase.’

An identified weakness during your practice questions requires your absolute, undivided attention. If you don’t commit to giving yourself enough time to dig into the weeds of the weakness, you’ll likely find, some time in the future, that you haven’t adequately addressed the problem; this creates more headaches down the road.

Understanding which resources to use is the final piece of the ‘learning phase’ puzzle, especially as it relates to ‘scenario 2’.

Before going into the details, I recommend that you try to keep things as simple and minimalistic as possible. Avoid accumulating resources—you probably won’t use most of them anyway.

One rule I follow is keeping things as simple and minimal as possible. Avoid accumulating resources—you probably won’t use most of them anyway.

Remember, when you're in this phase, you're here because you need to learn.

If you’re struggling with content, coming back into the learning phase requires using detailed resources like textbooks or video courses like Online MedEd (OME).

Aside from a robust, highly detailed resource that will provide you with enough information to help you fill the gaps in your foundation, I would recommend implementing additional resources on an as-needed basis and only when you’re using them to accomplish a specific goal.

Avoid using too many resources simply because you see others doing the same.

For example, it isn’t necessary to use Sketchy Micro or Pharm to pass the exam. However, if you find those resources to be extremely beneficial, then go for it—just don’t use them because you believe they are mandatory—they are not.

The learning phase is also NOT the time to skim First Aid (FA), especially not to improve your weaknesses. Skimming the FA is not the same as diving deep into and improving your weaknesses.

The FA is a review book designed to help you better recognize the information considered to be high-yield; it is not a tool to help you adequately learn information that you've either forgotten or failed to master during your basic sciences journey.

Sidenote: The microbiology section of the FA is quite robust and is probably close to sufficient for microbiology mastery - at least for the sake of the Step 1 exam.

Remember… This phase is designed to get you to a level where you can use your knowledge to answer questions accurately, precisely, and efficiently - a feat only accomplished if you know your information inside and out.

---

THE APPLICATION PHASE

What Is The "Application" Phase?

The "Application" Phase consists of taking your knowledge and applying it to questions - thus, it is coined the “application” phase.

Why Am I Using The “Application” Phase?

The reason for doing this phase is to determine how well you know the information that was covered throughout the learning phase.

When Should I Use The “Application” Phase?

Entering the ‘application’ phase requires adequately exposing yourself to the content covered on the exam.

There are two ways to know when you’re ready to exit the initial ‘learning’ phase and enter into the ‘application’ phase.

They are: