Case Western Reserve University
case western reserve university



Suggested Study Timeline for USMLE Step I


William Bligh-Glover, MD, Chairman, Content Committee

With thanks to Marcia Wile, PhD, Robert Haynie, MD, PhD, and C. Kent Smith, MD, for their assistance.

  1. The first thing to do: relax. The process for getting into residency is long and multi-factorial. I am not suggesting that you treat the USMLE Step 1 cavalierly, but there is more than one part of getting into residency. Also, doing poorly on the USMLE Step 1 should not scuttle your application if the program strongly desires you. However, a poor performance on the USMLE Step 1 may be used as an excuse to not rank you if the program doesn't really want you. Obviously, the best course of action is to do well. The Society Deans and I have received several requests for a course (like Kaplan) that is tailored for the USMLE. Case University Medical School does have such a program; it is the curriculum of the first two years. At the Step 1 symposium, the four students who spoke recommended that students study for the USMLE Step 1 as they are studying for our curriculum. I concur. As Dr. Wile has pointed out, the best predictor of USMLE performance is performance on the comprehensive examination. Now, for the nuts-and- bolts.
  2. Beginning now through January of Year 2. Self-Assessment. Review your subtest scores from the Year I Comprehensive Examination. Figure out where you are weak or had trouble, and review that material. Maintain a balance, don't go overboard studying for the USMLE and ignore the Second Year curriculum. If you need guidance, contact me, Dr. Wile, or the Society Deans. In addition, suss out the USMLE. You can download the information on USMLE Step 1 from its Website:; Review the USMLE Step 1 Content Outline. Correlation of your weak points and strong points using the USMLE Content Outline and your performance on the subtests related to that content on the Year I Comprehensive Examination will allow for some more directed review.
  3. January to May: Begin daily USMLE study, using the USMLE questions. I would start with a constant 30 minutes a day in January, and gradually increase the time and amount of questions answered. By May, you should be up to 350 questions in two hours. When I took the USMLE, I met weekly with like-minded people and went over questions. We went through a chapter at a time, then reviewed the answers and made sure we figured out the reasons behind the answers. Dr. Wile suggests using resources with recent publication dates (2003 and 2004). Practice tests should be diagnostic; don't flip back and forth to the back of the book, approach the questions as if this was the exam. When reviewing the answers, look for areas of strength and weakness, and then study the material where you're weak and review areas of strength. I found flash cards to be helpful, some people work better with summary sheets or what have you. It is wise to read the material, analyze it, and then make the cards, whatever from memory. This improves retention and really enforces learning rather than copying.
  4. Take practice tests before the exam. Take practice tests as if they were the real thing; this familiarizes you with the process, the environment, and the procedures. As the Marines say, "you fight as you train." Training in the environment that you need to perform in will minimize any nasty surprises when the real thing happens. Aim for a minimum of two 350-question tests taken in an 8-hour period: 420 minutes for actual tests; 60 minutes for lunch, breaks, etc.
  5. Graphical timeline
    • Now through New Year's
      • Review Year One
      • Determine weaknesses and strengths
      • Seek help from school resources
      • Go to class
    • January-March
      • Begin systematic USMLE study
      • Concentrating on questions
      • ~ 30 minutes/day every day
      • Keep going to class
    • April
      • Continue systematic USMLE study
      • Concentrating on questions
      • ~ 60 minutes/day every day
      • Keep going to class
    • May
      • Continue systematic USMLE study
      • Concentrating on questions
      • ~ 120 minutes/day every day

      Take at least two practice exams as if they were the real thing.
      Keep going to class

    • June
      • Take the exam successfully