Advice from 10 Students Who Scored 250+ on USMLE Step 1

It’s officially springtime, and you know what that means – it’s board season (for us Vitamin D deprived second year medical students).

First Aid is our bible. UWorld blocks will (or should) take the place of Fortnite. We’ll watch Sketchy in favor of Netflix. And Dr. Sattar will become our new best friend. (This is hyperbole… you should still make time for leisure).

Anyways, as the famous saying goes: “A goal without a plan is just a wish”. I believe that was from Michael Scott. When formulating a plan of any sort, it is always wise to seek the advice of elders – people who have “been there and done that”. Throughout the past year, I have enjoyed reading posts about peoples’ Step 1 experiences in which they share a comprehensive breakdown of how they achieved a certain score on the UMSLE Step 1 exam. I find these posts extremely insightful, and at times, inspiring. I’m sure many of you feel the same way.

So, I thought it might be a cool idea to “interview” a handful of medical students who have conquered and destroyed Step 1, scoring a 250 or above. How did they do it? What resources did they use? How did they use them? And what advice would these students impart to someone currently preparing for the big test?

(Click here to read my personal Step 1 Experience and how I scored > 250)

One last, but very important, comment before reading: a 250 is an awesome score, yeah. But that does not mean you have to hold yourself to the standard of 250. It is an arbitrary number. Each and every person has different goals. Take pride in your work, do the best you can, and don’t compare yourself to others.

Scroll down below to read the experiences, study strategies, and advice of 10 students who have scored over 250 on the USMLE Step 1 exam. I have received more than 10 submissions, but for the sake of brevity, I will post a Part 2 (and perhaps Part 3) with more submissions in the near future.


About: clockwerksly, US MD, average student
Score: 253 USMLE Step 1
Practice Tests: CBSE, 2 months out, 165 NBME 17, 4 weeks out, 219 NBME 16, 3 weeks out, 225 UWSA1, 1.5 weeks out, 255 UWSA2, 1 week out, 249 NBME 18, 2 days out, 244
Dedicated Time: 7 weeks

UWorld (1.5x): Used only during dedicated. Did all blocks random, timed and then reviewed all explanations taking notes in a notebook or looking up info in First Aid or my Anki deck. First pass finished with 77%. Did not get through all incorrects.
First Aid (1.5x): Started looking at it the summer before M2. Read relevant chapters based on curriculum block and annotated with additional info or explanations from Pathoma and Boards & Beyond. Used as reference during dedicated.
Pathoma (1x): Watched the relevant videos during organ systems in M2 and then finished up any systems I missed from M1 during the first 2 weeks of dedicated. Reviewed with flashcards.
Sketchy Micro (2x): Watched once during M1 for the system block and made a second pass during dedicated. Used a mix of Zanki, Pepper, and own cards to review.
Sketchy Pharm (1x): Most helpful resource for me as it taught both physiology and pharmacology. Watched some videos during M2, finished watching during dedicated. Used Zanki cards to review.
Sketchy Path (0.5x): Primarily watched when bored during dedicated. Some videos were really good (cancer videos), others not so much so if you’re strapped for time I would focus on other resources.
Boards & Beyond (.75x): Watched relevant chapters during M2 focusing on any topics that were not covered in Pathoma or Sketchy. Annotated First Aid while watching videos although during dedicated I just focused on watching the videos.
Anki: From summer throughout M2 made a master deck that consisted of cards from Zanki, Bros, and my own. During M2, I’d do cards from this master study deck just to review, roughly 50-100 review cards every other day. During dedicated, I did bursts of cards such as reviewing a system deck (Cardio for example) over the course of 3 days and making custom decks on topics I struggled with on UWorld blocks.

Favorite non-UFAPS Resource: Zanki was a godsend and saved so much time from having to make my own cards from scratch.
General Advice: I’d say the only additional piece of advice I can offer is learn the stuff well the first time. There were systems I never really looked at during dedicated outside of UWorld because I felt I had learned it well the first time by going to lecture and supplementing with Step resources. Also I recommend having a study buddy to keep you honest, bounce questions off of, and help stay sane.
What you’d do differently: Wish I had known about Pathoma, Sketchy and Boards & Beyond earlier so I could’ve incorporated them into relevant systems during M1. Those first few weeks of dedicated were really rough trying to get through stuff I easily could’ve done during prior semesters. If you can do a single pass through all the video resources by interspersing relevant videos during your curriculum, you will be much better off than I was come dedicated.


About: Onethirtyseven, US MD
Practice Tests: Pre-dedicated baseline 225; during dedicated: 242; 255; 258
Dedicated Time: 3.5 weeks

Resources: Before dedicated i did Goljan while driving, and Pathoma when at home. I made both of those into a single anki deck highlighting important concepts and concepts that i was weak on. I reviewed those maybe once a week. When dedicated started i did 120 UWorld questions a day. 40 in the morning, 40 after lunch, and 40 in the evening. I made a tentative subject schedule (eg biochem, cardio, pathology) and would watch videos from Doctors in Training (only if i was weak, did about 40 percent of the videos skipping microbiology and pathology). During the day i made anki cards sporadically on topics i was weak on. I used Microsoft word to take screenshots of important photos and used image occlusion for those. Sketchy for microbiology while adding notes to FA from it. I did not do a premade anki deck as i found them to be very bloated.

Favorite non-UFAP(S) Resource: Goljan Audio
General Advice: Learn anki early in medical school and get good at it. Learn things properly – don’t memorize anything that you can’t explain.
What I’d Do Differently: I wouldn’t do anything differently


About: slknights, US IMG (China), started below average & ended above average/top of class level. Check out his Instagram page (
Score: 251
Practice Tests: NBME 17: 213 06/01/17, 213; NBME 18, 07/16/17, 228; UWSA1, 08/04/17, 258; UWSA2, 09/22/17, 254
Dedicated Time: 16 weeks

Major:  First Aid: 2015, 2016, 2017(x3) – First Aid for the USMLE Step 1 Q&A – USMLE Rx Qmax – UWorld: 1 pass + redid all marked/incorrect – Pathoma: ~2 passes over 1 year – SketchyMicro: 1st pass @ 1x speed, 2nd pass @2x speed
Minor (little bits of each to help when major resources weren’t enough to get it through my head):  Youtube (Osmosis/Lecturio/Khan Academy/others) – sometimes other people explained stuff more succinctly than the resources above, especially in terms of physio.  Google/wikipedia – For those weird tidbits that I don’t know about. Picmonic – When I still couldn’t remember. Dr. Najeeb – When I really was coming from nothing. Kaplan Medical videos – Really only used for embryology and gross anatomy, as well as if I couldn’t understand a specific topic.

Favorite Non-UFAP (or Sketchy) resource: Youtube (Osmosis, Lecturio, Khan Academy)
General Advice: Don’t give up no matter what. This is not a challenge that anyone gets through without some sort of difficulty, so remember that things will get better for you too. It’s all about getting back up again and kicking another block in the ass.
What you’d do differently: I wish I wasn’t so paralyzed by the idea of the exam early on, so that I could have done it earlier. That would have made things easier for me in my future. I should have believed in myself more.



About: Alyssa Ehrlich, US M.D., above average student. Founder of USMLE Pro Step 1 tutoring services. Check out USMLE Pro Facebook (@usmleprotutors) and Twitter (@usmle_pro) pages.
Score: 262
Practice Tests: NBME 13 (4/14/2017): 230 NBME 15 (4/25/2017): 255 NBME 16 (5/12/2017): 263 NBME 17 (5/15/2017): 248 NBME 18 (5/16/2017): 240 UWSA 1 (~5/18/2017): Don’t have recorded, but I think it was a 266 UWSA 2 (~5/20/2017): Don’t have recorded, but I think it was a 272
Dedicated Time: 7 weeks

Resources:  Pathoma (1X) – watched videos and took brief notes in the book. All 6 NBME comprehensive basic science self-assessments under standard pacing (took screenshots so I would have access to the ones I got correct as well). I spent A LOT of time searching the internet and cross-referencing with First Aid and UWorld to understand every single NBME question. UWorld (1x) with all blocks done in Timed (not tutor), random mode (72% correct), as well as both UWorld Self-Assessments. I read all UWorld explanations (for correct and incorrect, and the entire explanation) for every question. I also made my own Anki cards for every UWorld and NBME question I got wrong, cross-referencing the relevant sections of First Aid as I did so, and putting in screenshots from FA, the NBMEs, and UW into my cards. I reviewed the cards every day (made around 1,000 cards and was reviewing around 200 a day by the end). I skimmed First Aid in the 3 days before my exam (I basically never opened the physical book before then). I also re-reviewed all my screenshots from the NBME practice tests in the last few days before my exam. I never used any premade Anki decks, or any other resources than those mentioned above. I didn’t study for Step 1 during pre-dedicated period (except for maybe reading a chapter or two from Crush Step 1 here or there to prepare for certain class exams), but did take Step 1 after 3rd year clerkships (and thus had already taken all my shelf exams).

Favorite Non-UFAP (or Sketchy) resource: My own Anki cards and the NBME self-assessments
General Advice: I think the biggest thing people need to do differently is spend more time reviewing the NBME self-assessments. I do online tutoring for Step 1 and Step 2 CK (see, and I spend a lot of time going over those self-assessments, and my students have found it really valuable, and it’s clear in the improvements in their practice test scores that doing this really helps (my take is that excelling on Step 1 has a lot to do with test-taking technique and learning to answer NBME-style questions; this is definitely teachable, and it’s equally important to memorizing the key content). Don’t get so caught up on UWorld percentage and instead focus on learning from the questions they get wrong; it’s okay if you get a lot of questions wrong as long as you learn from them. Finally, active studying approaches (like making your own flashcards) lead to much better information retention than just reading or watching videos like BNB, so I highly recommend making your own cards that are targeted to what YOU don’t know (the premade decks have WAY too many cards), and limiting the time you spend on passive resources like just reading First Aid (even if you’re taking notes too, this doesn’t help much) or watching videos.
What you’d do differently: I would have taken my first NBME sooner (a few weeks before my dedicated period started) to motivate me earlier in my studying (I ended up having to do a lot of catch up in the last few weeks of my dedicated because I had fallen behind). I would have spent even more time on the NBMEs and potentially made Anki cards for all the questions. I would have started skimming First Aid a couple of days earlier (say 5 days before my test rather than 3) because it was stressful to have to read it all in 3 days.


About: Bailey, US MD, above average (but definitely not top of class)
Score: 253
Practice Tests: Baseline of 203 on NBME at the start of dedicated.
Dedicated Time: 6 weeks

Resources: Uworld- 1 pass + my incorrects First aid- Skimmed through once then only as a resource if I didn’t understand Uworld or wanted more info Pathoma (lecture with book)- one time through during blocks, then one time through during dedicated Sketchy pharm and micro- one time through during blocks, then one time through during dedicated Anki- Zanki (I think one time through? Idk, 400/day) plus had my own deck called “Step shit” that I would add anything I didn’t know when I was running through Uworld that I reviewed at the end of every day. Cram Fighter- Literally saved my ass by making my entire schedule for me so I stayed on topic and focused.

Favorite Non-UFAP(S) Resource: Like I mentioned previously, I loved Cram Fighter. Obviously, all of the CBSE practice tests. I took all of those.
General Advice: Honestly, the biggest thing is to review early, not like a dedicated study, but just like 10 review questions/day to keep you fresh on old material during your blocks. Don’t study for longer than you are actually productive for. I started off my step schedule planning to study 10 hours a day, but realized the last hours were useless because I wasn’t retaining anything. I ended up doing about 7 from then on.
What you’d do differently: I probably wouldn’t have wasted 60 bucks on CBSE19, which was soul crushing. I think I also would have done some more review during my blocks.


About: Qcount, non-traditional US MD who has a grad degree and worked as a research scientist before medicine. I had a below average MCAT (29), but was at roughly the 75th percentile during pre-clinical classes (my school is pass/fail unranked).
Score: 259
Practice Tests: Baseline score of 221 on NBME 13 at the start of dedicated.
Dedicated Time: 6.5 Weeks

UWorld (1x): 20% complete before dedicated, weeks 1-3 1 block per day, weeks 4-6 2-3 blocks per day. All blocks were timed random. I Took handwritten notes (this was key for my success!) on every question/possible answer choices, and reviewed these notes in the week before my exam. My first pass average was 72%.
Boards & Beyond (1x): 20% complete before dedicated, finished the rest during weeks 1-3. Re-watched some of the cardiology videos.
First Aid (1x): 0% complete before dedicated. 1 pass during weeks 4-6. Highlighted every word as I read to make sure I wasn’t skimming over anything.
Pathoma (2x): 50% complete before dedicated, finished the rest during weeks 1-3. Read the text 1x during weeks 4-6. I took notes while I watched the videos.
Sketchy Pharm (0.75x)/Micro (0.3x): Watched during fall of M2.
Goljan Audio (1x): Listened on my walks to and from campus during the fall of M2. Somewhat dated, but great for integrating concepts.
USMLE-RX Qbank (0.3x): Did questions that paralleled in-class material.

Favorite Non-UFAP(S) Resource: Boards & Beyond was a key resource for me, and I would recommend it to anyone who learns well from videos.
General Advice: Develop a plan to build confidence leading up to your exam day. I specifically saved UWorld self assessment 2 as my last practice test since it is relatively accurate but also is slightly generous with the score (as opposed to NBMEs which tend to under-predict). I also graphed the average of the past 10 days of UWorld blocks to help remind myself that I was trending the right way even if I happened to score poorly on one block.
The questions on the real exam were most similar to UWorld questions, with long stems and multiple steps required to get to the answer, they were not similar at all to NBME questions. I felt terrible after I finished the test, and pretty flat for the next few days. I knew I passed, but beyond that I had no idea what my score would be. So if you feel this way, don’t worry!
What you’d do differently: Use flashcards to help myself memorize specific aspects of biochem and micro that never found a good logical framework for (for example which viruses are encapsulated vs. naked, ssRNA vs dsRNA, + vs – sense, etc). I would also make a pass through First Aid following along with class material during M1 and M2.


About: lxodes, Australia FMG, top of class
Score: 261
Practice Tests:
NBME 16 – 200, 7 months out; UWorld 1st Pass – 89% (Tutor & untimed); NBME 13 – 252, 21 days out; NBME 15 – 255, 18 days out; NBME 17 – 252, 16 days out; UWSA 1 – 277, 14 days out; NBME 18 – 261, 11 days out; UWSA 2 – 264, 9 days out; NBME 19 – 257, 7 days out; Free 120 – 88% 3 days out
Dedicated Time:
3 weeks

Resources: UFAP (UWorld 1 pass + just started 2nd pass), FA organ systems (casual reading), Pathoma (1 pass), Najeeb (1 pass in 1st few years of med school & made notes), B&B (during dedicated – didn’t finish), Sketchy, USMLE Rx (1 pass), Little bit of Toronto notes & FA step 2 CK

Favorite Non-UFAP (or Sketchy) Resource: Najeeb
General Advice: Repetition helps info stick – Whenever you see nuggets of info write it down or put it in anki.
What you’d do differently: Complete all anki brosencephalon & B&B – Use anki more – to put any bits of info from reading into anki along the way.


About: 11JulioJones11, US MD, above average student
Score: 263
Dedicated Time: 5 weeks

Resources: During dedicated UFAP- 3 passes of FA and Pathoma organ blocks and 5 passes of FA general principal chapters, UWorld x1 + wrongs. Pre-dedicated during classes: All of bros anki, sketchy videos, boards and beyond prn, and about 3500 questions between Kaplan and Rx (I did about 70 questions a week for a year).

Favorite Non-UFAP(S) Resource: I thought the Bros deck was by far and away the most important resource I used (I did zanki pharm though). Overall I liked bros better than Zanki, it was far shorter and had everything you needed, it really isn’t that old.
General Advice: Study longitudinally and put in a few hours a week during the school year to give yourself a foundation for dedicated. Also do as many different questions as you can, it can be expensive but you only get one shot at this.
What you’d do differently: I didn’t do all the NBMEs or review my missed questions, there were nearly identical questions on step from old NBMEs. Its worth seeing as many of those as possible cause it can get you free points.


About: US MD, top of class
Score: 261
Practice Tests: UWSA2: 234 (6 weeks out); NBME 17: 250 (2 weeks out); UWSA1: 260 (4 days out)
Dedicated Time: 6 weeks

Resources: I finished UWORLD before dedicated and re-set it the first day of dedicated. I read first aid once before dedicated. I read/watched pathoma twice before dedicated. During dedicated I did uworld once, then did the marked questions when I ran out of new questions. I read first aid twice while sometimes following along with DIT videos. I also used sketchy micro for bugs I had a hard time remembering. I used Robbin’s review book of questions (only the first 10 chapters). I read pathoma 3 times during dedicated.

Favorite Non-UFAP(S) Resource: Robbins review
General Advice: The first day of dedicated, I took an NBME practice exam to set a base line (234). Then every day I did 40 Uworld questions, mixed-untimed-tutor mode. Then I’d read half an organ system from first aid and a pathoma unit from another organ system. Somethings I would try to memorize but others I would try to understand very well. At the end of the day I would do another 40 uworld questions. You will finish going through first aid in about 4 weeks this way. At this point I took an NBME (250) to check my progress, this is what I called my initial peak. Next I did the same thing over again but in a more concentrated fashion (whole first aid chapter in one day, along with 1 pathoma unit and 80 uworld questions). after finishing Uworld for the second time at week 6, I took another NBME (260), which was my second peak.
What you’d do differently: Eat healthier food during the exam. I felt sick because I ate too much junk food.


About: uncle-herniation, US MD school, top of class
Score:  252
Practice Tests: School’s CBSE (~4 months out, before Repro block): 205; NBME 13 (5 weeks out, taken as a baseline): 217, NBME 17 (3 weeks out): 240; NBME 18 (2 weeks out): 246; NBME 19 (1 week out): 234; UWSA 1 + 2 (4 days out, taken back to back): 273 and 262, respectively
Dedicated Time: 5 weeks

UWorld (1x): Untimed, random. Took notes on incorrect questions and tried to review these when I had time. Average was ~80% when I finished.
First Aid (2x + classes): I paralleled material from classes with First Aid throughout the months leading up to Step 1 and did another 2 passes during dedicated.
Pathoma (1x + classes): As with First Aid, paralleled class material with Pathoma. In retrospect, I found Pathoma to be much more useful during dedicated than any other time. Relatively concise and really nails down the high-yield points of pathology.
Sketchy Micro (2x + classes): Used this during classes as well, and again during dedicated. I felt pretty confident with most micro questions because I had hammered Sketchy into my head. I also did not neglect the Microbiology chapter of FA and did image searches of esoteric parasites and protozoa, which turned out to be helpful.
Boards and Beyond (1-2x): I wasn’t able to watch all of the videos because I didn’t discover this resource until 1/3 of the way through classes, but wished I had found it earlier. Dr. Ryan explains things in a way that makes it easy to draw connections across disciplines, which is obviously super helpful for building a strong foundation for Step 1. As others have said, the Biochemistry videos are really great.

Favorite non-UFAP(S) Resource: Boards and Beyond
General advice: Try to do well in classes and really learn the material well the first time. You will thank yourself when dedicated rolls around and you are essentially reviewing topics that you have already mastered.
What I would do differently: Start Boards and Beyond from day 1.


Click here to read my personal experience and journey to scoring >250 on Step 1.

I would like to thank each and every person who contributed to this post. I will be posting a Part 2 in the near future, so check back periodically.

If you enjoyed this post and would like to read more stories, musings and advice on medical school, click here.

To stay updated on the latest posts – follow me on Twitter @JordanSoze



  1. Advices like these from top scorers are plenty. There is nothing to learn from them due to the fact that they were top scorers to begin with. Most of them had higher scores before dedicated than majority of students right before the exam lol. This is why I think what would be really helpful for majority who struggles – advices from those who were below average or even top bottom of class and yet they made it to pass exam and some even scored above average. That would be a true wonder and something to learn about and to relate for many of us.


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