For Jonathan Ramalho, scoring above the national average on the first two steps of the United States Medical Licensing Examination (USMLE) was a very big deal. The three-part exam, which assesses a physician's ability to apply knowledge and principles while demonstrating fundamental patient-centered skills, can be stressful and overwhelming.

“I began preparing for Step 1 during my second year of medical school,” explains the fourth-year Ross University School of Medicine student, who'll graduate in May and start his residency in June. “That early preparation allowed me to adjust to the way USLME asks questions, in comparison to medical schools tests. I purchased a question bank during my second year of medical school and periodically did practice questions.”

Planning is key

Ramalho, who has yet to take the final USMLE exam, advises students, “Spend some time studying, either with an online review course that provides videos in which high-yield information is consolidated and effectively taught. Do hundreds of questions—thousands, if you need to. Lastly, make sure you take an old USLME practice test online to make sure you're ready for the exam. They give you an estimated score that is roughly accurate.”

"According to 2014 performance data, the percent passing for Step 1 'repeaters' was a dismal 68 percent."

Francis Ihejirika, M.D., founder of PASS Program, Inc., says, “The main mistake I've seen the majority of students make in their preparation is that they attempt to simply memorize, rather than understand, questions from question banks, information from their basic sciences books or information from handouts. 

“Another student mistake is they focus so much energy on learning pathology, without first reviewing and mastering normal processes. These students are putting in the time and effort, but have not been shown the proper and most effective ways to learn, retain and recall the information.”

Don't be a statistic

According to USMLE 2014 performance data, the percent passing for Step 1 “repeaters” was a dismal 68 percent. Says Dr. Francis, “Many students who fail are forced to sit out of school for years, as they try repeatedly to pass the exams. Some of these students develop significant clinical depression and anxiety disorders.”

To avoid this outcome, he advises, “Start early with your preparation. Discuss with someone a solid plan for success, do practice questions each day as you are studying, speak to someone about which online question bank is the best and attend a preparation program, which will significantly increase your chances of success.”