How to prep for Step 1

The biggest mistake I see is treating Step 1 as something that starts in dedicated. It doesn’t. Dedicated is where you consolidate. The learning happens in the two years before it, and every week you spend building the foundation during MS1 and MS2 is a week you don’t have to cram later.

Step 1 is pass/fail now, and people hear that as permission to wait. I read it the other way. You still have to pass a long, broad exam, the material is the base for Step 2 and the wards, and failing is a real problem on a residency application. Starting early is how you make passing boring.

Starting early does not mean studying more hours. It means using the right resources alongside class from the beginning, so the foundation builds quietly while you’re doing what you’d be doing anyway.

If you only take one thing from this guide: Sketchy Micro, Sketchy Pharm and Pixorize Biochem, together, give you the essential foundation before serious Step 1 prep. Do them alongside your courses, not after.

• Sketchy Micro covers the bugs: what they look like, what they do, how they spread and what kills them. Microbiology is the most memorization-heavy part of the exam and the visual memory sticks.
• Sketchy Pharm covers mechanisms, adverse effects and interactions, which is most of what pharmacology questions test.
• I specifically recommend Pixorize Biochem. I know it covers far more than biochemistry, and that is part of why: it fills most of the gaps Sketchy leaves. Once you finish the biochem videos, go through the rest of its topic list instead of stopping there.

You don’t need to finish all three before you’re allowed to do anything else. Pair each one with the course you’re in. Most people find micro and pharm land better with Sketchy than with lecture slides alone.

Start questions as soon as you finish a foundation resource. Not when you finish everything, and not when dedicated starts.

• Finished Sketchy Micro? Start our microbiology and ID questions that week.
• Finished Sketchy Pharm? Start our pharm questions.
• Finished Pixorize Biochem? Start our biochem questions.

Questions are where recognition turns into recall. Watching a video makes the material feel familiar; a vignette makes you pull it out cold, in clinical language, with distractors. The gap between those two is exactly what you want to find out about early, when there’s time to fix it.

Do them in tutor mode at first, read every explanation including the wrong choices, and don’t worry about your percentage yet. Early on the score tells you almost nothing. The explanations are the point.

The resource list for Step 1 is short. The anxiety comes from everyone online having a slightly different one. Here’s the core:

• Foundation: Sketchy Micro, Sketchy Pharm and Pixorize Biochem, started during MS1 and MS2.
• Content review for weak systems: Boards and Beyond or Pathoma, picked for the areas where your questions show you’re weak, not watched end to end.
• Reference: First Aid, used to look things up and annotate. It is a map, not a textbook to read cover to cover.
• Questions: one main question bank done carefully, plus Rounds blocks by discipline as you finish each foundation resource.
• Spaced repetition: Anki if it already works for you. A premade deck matched to your resources keeps it manageable.
• Readiness: the NBME self-assessments and the free official practice questions on usmle.org.

What to skip: a second or third video series for the same subject, rewriting First Aid in your own notes, and anything you’re adding because someone said it raised their score. Doing fewer things all the way through beats sampling everything.

If the foundation is in place, dedicated is about volume and review: mixed timed blocks, reviewing every miss, and tightening the systems your questions keep flagging. Take a self-assessment early to set a baseline, then every week or two. Move the exam date if your practice scores aren’t where they should be. That decision is easier than a retake.

Protect sleep, take one real day off a week, and keep doing the things that keep you a person. You will learn more in a rested eight hours than an exhausted twelve.