Skip to main content

This page contains advice on preparing for board exams.

All that you really MUST know about taking board exams in medical school

Contributors: Matthew Cousins, Tyler McKinnish, Elizabeth Deans, and Billy Oslund

Step 1: FIRST and WORST. Stress can be your best friend or your worst enemy.
This is the longest and most difficult exam that you have ever taken. Your performance will also have important implications with regard to residency applications. You are nervous and concerned, and this is a good thing. Your concern should be channeled into efficient exam preparation. After you have prepared for the exam and done the work on the front end, own your preparedness. Use this to generate confidence on exam day.

Must use resources:
-FirstAid for the USMLE Step 1: Cover every section 2-3x, and spot study difficult material in detail.
-UWORLD: The best q-bank. Do all of the questions at least once (cover the right answers and the distractors).
-Pathoma (try to do this 2x). Consider taking notes in FirstAid to consolidate material.
-Do well in class, but do not try to study for Step 1 by comprehensively reviewing all of your notes. You can use class notes for targeted review, but they are generally not as high yield as board exam-specific resources. Some students take notes in FirstAid when they cover an important FirstAid topic in lecture.

Resources to consider:
– FirstAid for the Basic Sciences: General Principles and FirstAid for the Basic Sciences: Organ Systems.
-SketchyMicro and SketchyPharm.
-Microcards, Pharmcards, or other flashcard-based study aids.
-Pick your resources carefully, and ensure that you have a small enough number that you can use each of them fully (better to do 1 thing well than 6 things poorly). It is okay if your friends are using something different.
-Firecracker is good but only if you plan to use it for at least 6 months (best used starting day 1 of med school).

Other advice:
-The secret to this test and other board exams is pattern recognition.
-Generally, students feel least prepared for topics such as microbiology, biochemistry, and pharmacology, as these are topics that require memorization. Put in more time here. Consider Anki or other flash cards (paper/program). Review nightly. Focus more energy on things that seem to be tested often in UWORLD.
-Take several NBME practice tests during your study period. If you are not scoring at least 1 standard deviation above the failing score 1 week before your test date, DO NOT TAKE THE TEST!!!!
-If you do not feel that you can do this on your own, consider a prep course in a box (e.g. DIT), but be aware that these resources also require dedication and persistence (and cost $$$).
-Take LOTS of food on exam day (more than you ever think you could eat). Watch out for sugary things like Gatorade or candy (the high is followed by a crash). Use sugar carefully (perhaps just before the last section).
-Do not allow your perceived performance on one section of the exam to impact your performance on subsequent sections. Some sections are soul crushing nightmares for everyone. Put every section behind you as you move on to the next one.
-If you encounter a question that is particularly difficult or time consuming (e.g. murmur questions, ABG interpretation, etc.), guess quickly, mark the question, and return later to verify your answer.
-Do not try to study for more than 6 weeks in your final preparation period. You do not want to peak too soon.

General thoughts for all board exams.
-Having a plan is key. Invest time initially to plan what material/how many questions you will cover each day to ensure that you cover all of the material before the exam. Be flexible, but having a plan will help reduce stress.
-Every night during the 2 hour period before bed, stop what you are doing, and review all of the material that you found to be particularly difficult from the day. You are better at retaining information that you cover right before bed. Study most of the day; go about your evening routine; study; then go to bed.
-Exercise every day; eat regular meals; and sleep 8 hours a night every night.
-Do not try to study 90 hours per week. Data suggest that it is possible to study too much. 60 hours is enough.
-Take 5 minute stretch breaks every hour. Only 5 minutes.
-The most effective way to study is by doing questions. Your q-bank is therefore the most important resource that you will use. If you are using your q-bank properly, it should take a long time to review each test.
-FirstAid contains the minimum information that you need, but it does not work well in isolation. You should consider it a resource to aid memorization and a study guide but not a stand-alone resource.
-You will benefit immensely from covering the same material in different resources and from making connections between different concepts wherever they may be covered. For example, it is good to reference FirstAid when you are reviewing a difficult UWORLD question or when you are doing a Pathoma video and vice versa. Feel free to take notes in FirstAid as you move through other resources.
-A number of study schedules are provided below. The key is to make sure that you do what works for you. Multiple study schedules are available on the web (from UNC and from students at other institutions).
-Take days or half days off. Avoid taking more than one day in a row completely off.
-Make sure that you are actually studying when you are studying. Focus on the material. Ask yourself questions about what you just read (if you cannot answer them, then you must go back and review the material again). Reading ≠ studying.
-Studying for board exams is actually a process of learning in itself. You are learning how to assimilate large amounts of information. While a lot of this information is useless, a substantial amount of it will come in handy on the wards, serving as the foundation for your clinical education. You will be better able to make connections and understand what is going on around you, and your attendings and residents will notice.

Step 2 CK: More of the same.
This exam is a lot like Step1, but it is more clinically focused and therefore more relevant. Thus, a large fraction of the relatively meaningless minutia that has left your brain since you took Step 1 need not be reinserted. This exam is much like the shelf exams that you have been taking all year, except a bit more broad.

Must use resources:
-FirstAid for Step 2 CK, USMLE Step 2 Secrets, or Step Up to Step 2.
-USMLE WORLD: Do all questions at least once (cover right answers and distractors).
-At least 1 practice test from the NBME and/or UWORLD no less than 1 week before your test date.

Other advice:
-You probably do not need more than 2-3 weeks to prepare for this exam.

A note on timing:
-Make sure that you take the exam early enough that you can meet the deadline for graduation.
-It is possible to take the exam such that scores become available after ERAS submission. Program directors may ask you to submit scores later. Additionally, some programs will not review your application unless you have taken Step 2 CK/CS and have scores available. Check with programs and program websites as you plan.
-You are probably best prepared to take the exam at the end of your clerkship training. However, some students with high Step 1 scores may opt to take the exam later so that scores become available after interview offers have been made. If you did not achieve your target score on Step 1, you may want to try to impress programs with Step 2 CK by taking it early and achieving a high score.

Step 2 CS: Uniquely contrived. Speed is your friend, and excellent is the enemy of good enough.
This exam requires you to engage in a number of patient encounters. After each encounter, you are tasked with writing a patient note. You have 15 minutes for each encounter and 10 minutes to write each note. The patients will be less adept at acting than those that you see in the skills center during your preclinical training.

Must use resources:
-FirstAid for the USMLE Step 2 CS and/or USMLE Step 2 CS Core Cases.
-Practice with friends/family if you are apt to get nervous or if you do not perform well on/have not taken your comprehensive clinical exam. When you practice, use a timer for the interview and especially for the note writing. The most common reason for poor performance is running out of time.
-Be nice to the fake patients. Their acting may be so overdone as to seem sarcastic, but they will be reading your face for every smirk and counting off every time you don’t wash your hands, extend the leg rest, or ask them if they have questions. Kindergarten skills are the key.

Other advice:
-Wear gloves to do the exam. It is faster than washing your hands and harder to forget.
-Read the books. They tell you everything that you need to know. Also, watch the videos at:

A note on timing:
-These scores are slow to come back (~2 months). Be sure that you will have scores by the UNC deadline.
-You can take CS such that the scores are available after ERAS submission, but some programs may ask for them to be re-released. Generally, programs appear to be less concerned about CS scores.

Link to the above guide in word doc form.

Sample Step 1 Study Schedules (Microsoft Excel)

From the Class of 2017:

From other classes:

Note: The number of questions per set in UWORLD has changed over the years. Some of the study schedules may reflect this variation.