How I Scored a 257 On USMLE Step 1

Note: This is a guest post from Mike Frazier who writes at Medical School Insider.


If you are a second year medical student, there is one thing on your mind at this time of year: Step 1. For me, there was nothing quite as scary as preparing for that test or walking into the testing center that day. But, there are things that you can do to help calm your anxiety and get your best score possible.

Set a Goal
In my opinion, before you start really preparing for the USMLE exam, you should have a couple of things clearly in mind: where you are with your score and where you want to be. To determine where you are, you need to take a USMLE Step 1 practice test. Our school gave us one that we took as a class. Your school might do the same. You might be scared by this score. I know I was (208). But, it’s good to know where you’re starting from.


A passing score on Step 1 is 188. The national average score on USMLE Step 1 is 221. The most competitive specialties have average USMLE Step 1 scores of around 240.

So, before you start studying, set your goal. If you are trying for a less competitive specialty, your USMLE Step 1 score won’t be as important and you might be shooting for average or just above. Nothing wrong with that. If you’re going for orthopedic surgery, you had better hit the books! Probably the best resource for what you need to do to match into particular specialties can be found here, the NMRP’s report on “charting outcomes in the match.” It goes into volunteer, research and other activities as well as Step 1 scores for different specialties. The first pages of First Aid for the USMLE Step 1 have information about average Step 1 scores for different specialties. If you know what specialty you want, you’ll have a good target for your score. You can also find this information on the Careers in Medicine website under specialty information.

If you’re not sure what you want to do, you’ll want to score as high as possible. I wasn’t too sure going into the test, so I set a high goal of 245. That way I wouldn’t be kept out of any specialty based on my score. I needed to spend plenty of time studying, especially since my first practice test said I was at a 208!

Start Studying Early
Looking back, I wish I would have been using the resources I used for my USMLE prep throughout first and second year. That way when it came time to prepare for the test in earnest, I would have been more familiar with the resources. That said, it worked out ok without doing that, so don’t get too stressed out if you’re looking at your prep materials for the first time now.
Our school gave us about two months to really study for Step 1 (meaning we didn’t have any classes scheduled during that time). I would recommend starting relatively serious study starting in January of your second year and really serious study for 2-3 months before you take the test. That should give you enough time to get your best score.

Choose the Right Resources
Choosing the right resources will depend partly on your learning style, but there are a few that are must-haves.

  • A Question Bank

There’s always the debate about whether Kaplan or USMLE World is the better question bank. In my experience, USMLE World was absolutely the best resource that I used for my USMLE prep. USMLE World gives you the opportunity to take tests on the exact same program that you will use on the actual USMLE exam. This was comforting to me since I knew how to mark questions for review, how to look up lab values and do the other tasks that might have been foreign to me had I not used USMLE world. I imagine Kaplan does the same thing, but that was helpful.

The thing that impressed me most about USMLE world was how similar the questions on the USMLE review were to those on the actual USMLE exam. When I came to the USMLE exam, I really felt as though I was just taking another set of questions from USMLE world. In this way, I felt that it was the best USMLE prep that I did.

Also, the explanations of questions on USMLE World were great. They give detailed explanations of why the right answer is right and why the wrong answers are wrong.  I learned five or six important concepts that tested on Step 1 from one question and its explanation. This made USMLE world a very efficient study tool.

I don’t say this for very many things, but First Aid for the USMLE Step 1 is a must-have for your Step 1 prep. You will likely see some of your classmates using this book throughout their first and second years of medical school. I thought that my classmates were nerds for doing this. But, looking back, this was a great way to start USMLE prep.

First Aid is essentially a very condensed version of most of the things you’ll learn in your first and second year of medical school (at least the material that will be covered on the USMLE exam). The more familiar you are with First Aid, the better off you will be when you start using it for your formal USMLE prep. If you use this book during your curriculum, you’ll be able to have a summary of the things you’ve learned, as well as seeing what might not have been covered by your school that is covered on the USMLE exam.

This book is similar to First Aid in that the material is condensed into bullet points. However, it has more information about the “why” of diseases than First Aid. It gives great explanations about pathophysiology and this material is stressed heavily on Step 1.

These are the only resources that I used for my Step 1 prep. As you can probably tell, I study more on my own. Also, I learn best from practice questions. If this is not your style, then this strategy is probably not a good fit for you. If you work better in groups, make sure you find a group that will help you learn the material well. Also choose a group that doesn’t stress you out. You want your time to be spent in the most efficient way for you and stress generally makes learning harder.


How I Used These Resources

  • USMLE World
    • What I bought from USMLE World. I purchased a 6 month subscription to the USMLE World QBank. In retrospect, I would have probably purchased a shorter subscription. I thought that I would have time to start doing questions before my school let out to give us time to study for the Step 1, but I really didn’t. So, I would recommend buying the QBank for the amount of time you have committed solely to your USMLE review (probably 2-3 months). I also purchased two practice tests, but only ended up doing one of them. Our school also gave us a practice test before we were given time off for USMLE study.

I spent a lot of time answering questions and reviewing them near the end of my USMLE review period, but only got through about half of the QBank. In my opinion, if you really study the answer explanations provided by USMLE world, you’ll be able to master the concepts covered by the USMLE exam without having to do all of the questions. That was my experience, anyway. Obviously, however, the more you do, the better prepared you will be for the exam.

As far as how your QBank score correlates with your final score, UWorld questions tend to be a little harder than the actual test. I was scoring in the high 70s on my question blocks before I went into the test and ended up with a 257. My overall was about 60%, but my percentages were getting much higher on each question block the more questions I did.

    • My study strategy with USMLE World. As I said before, at first I thought I would start studying the questions before my protected USMLE review time. As it turned out, I really started studying USMLE world about when I started my official USMLE prep.

I took one of the practice tests at the beginning of my USMLE prep to help find out about where I was. This is a good idea to help you know how close you are to your goal. UWorld gives you a breakdown by topic of how you did so that you can target your studying to areas that need the most work. After this test, I spent my time studying in First Aid USMLE and in Goljan Rapid Review Pathology. After I would finish a section in one of these, I would go through questions about that section in USMLE world. I really started doing the questions more (about 2-3 question blocks per day) during the last month of my studying. This was, for me, the most helpful part of my USMLE prep.

Again, the way that I learn best for tests is by taking practice questions and studying the answers. This is why USMLE world was such a great tool for my USMLE prep. If you study style is different, this may not work as well for you.

  • First Aid
    • There are helpful figures in First Aid USMLE and mnemonics to help you memorize things. I found the organization of the book very helpful in my USMLE prep. First Aid USMLE breaks the huge amount of information you need to know for the big test into categories that make sense for your study. You will learn about immunology, endocrinology, pharmacology, the cardiovascular system, the renal system and all other important information for the USMLE exam. Again, the information is condensed in First Aid USMLE, so you may need to supplement the information with things from the internet or other books if you have bought them. The bottom line is: First Aid USMLE has what you need to know for the test.
    • Don’t sweat the biochemistry. One tip I have is to not spend a ton of time on the biochemistry section of First Aid. Understand the key steps that have to do with certain diseases (e.g. what does lead poisoning or B12 deficiency affect), but don’t try to memorize full pathways that don’t have specific clinical relevance. I spent a lot of time on this and saw very few questions on the test. My classmates had the same experience.
    • My study strategy was as follows: get through the book twice in depth before my test. I tried to finish about 2 weeks before my actual test date. That was combined with my studies with USMLE World and Goljan Rapid Review Pathology.
  • Goljan
    • My study strategy was the same for Goljan’s book as it was with First Aid USMLE. I tried to get through the material in the book twice and know it well about 2 weeks before my actual test date. I would use the material in this book to compliment and supplement the material in First Aid USMLE. For example, if I was reading about endocrinology in First Aid, I would also read about that in Rapid Review Pathology.

My Schedule


Month 1-2: Monday to Friday I would read a new section in First Aid USMLE and the corresponding section in Goljan’s book. I would read new material in the morning (around 6-8am), new material in the afternoon (1-3pm) and review the material from the day at night (7-9pm). Those hours might go a little longer on some days. The night review would sometimes include USMLE World questions on the related topics. On Saturday I would review the things that I had studied in the previous days. This would include USMLE world questions about the topics.

In the middle of this I also took the USMLE world practice test and found that I was around 220. This was encouraging since it was about what I needed for psychiatry, but lower than my goal of 245. So, I had to keep working on my USMLE prep!

Now, this was the ideal schedule for me and didn’t always happen just like this. I would sometimes get tired of reviewing material or wouldn’t have enough time to do USMLE World questions at night or whatever. This was my ideal. You can set your own dates for reviewing your material. I wanted to finish by 2 weeks before my test date. I would also take breaks at times during my studies to go play basketball, run, or take other breaks. I study a lot better when I take breaks between. You might be different.


Month 3: This is where I started transitioning to doing more USMLE world questions. I had finished most of First Aid USMLE and Goljan by this point, so it was more just doing questions. Usually I did 2 sets per day and started studying at the same hours with the same breaks. It was what worked for me. With having a family, it worked well to do studying before the kids woke up, during their naps, and after they went to sleep.


Test Day: I scheduled my test day for the middle of June, a couple of weeks before rotations started on July 1st. Looking back I wish I would have done it a week earlier. That last week probably made very little difference on my score but took a week away from vacation that I would have loved to have before starting rotations my third year of medical school. So, my advice to you would be to take it at the beginning of June.

On test day, make sure you bring snacks and food. It’s a very, very long test. I would also recommend taking all of your breaks. I would run around the building, do push-ups or do other things to keep my body and mind refreshed. That might just be my thing, but if I sit for too long I start going crazy!

So, with all of this, I was able to surpass my target score of 245, with a 257 which I was very happy with. Again, this is what worked for me and may not work as well for you. But, USMLE World, First Aid USMLE and Goljan Pathology are top notch resources no matter your study preferences. You may also want to work with groups to help each other learn the material. At any rate, best of luck! And remember, although important, Step 1 isn’t everything. Programs look at a lot more than just this score, particularly your transcript and letters of recommendation. Good luck!

14 thoughts on “How I Scored a 257 On USMLE Step 1”

  1. Wow! Thanks for all of this information. I am heading into medical school and I really appreciate your “wish I should ofs.” Hind sight is 20/20 and I appreciate the clear picture from someone up ahead.

  2. thanks dude..that was very much refreshing….could u plzz update about usmle step 2 also….i’m about to take these steps..

  3. thanks, im planing to take my first step soon, and looks like we have the same method of study! thank you for advises

  4. Thank you so much for this. I really appreciate it. I was just wondering when did you take your first practice test?

  5. We’re a gaggle of volunteers and starting a brand new scheme in our community.
    Your web site provided us with helpful info to work on. You have done an impressive job and our whole neighborhood
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