Step-by-step prep for Step 1

By Loren Deutsch

If you’re an M2, you may be prepping for Step 1 right now, one of the licensing exams necessary for medical practice. It’s an important exam to say the least, and for most medical students, it provides a gateway to clinical training. 

Medical students approach Step 1 knowing it plays a pivotal role in their medical education. and readiness for clinical training. While Step 1 is now reported as pass/fail, it remains a high‑stakes exam, one of the highest, and sets a standard for future test preparation.

Below is an overview of our top 5 Steps for Step 1 prep. They are evidence-based and provide opportunities for success. So the goal is simple but demanding: take Step 1 once, pass with confidence, and move forward prepared for the challenges of M3. Each of the steps is adaptive, so you can use them for future NBME Shelf Exams, Step 2, and Step 3.  If you have questions, we’re happy to answer them.

• Pretest and error analysis – Start with a pretest to establish a baseline score from which to measure progress, then complete an error analysis to clarify reasons for incorrectly answered questions, and prioritize the highest-yield, lowest-achieving content for daily preparation. Make sure you’ve registered for your 3-month eligibility window, and if you’re applying for test accommodations, have done so.
• Design a daily workflow for test prep – Incorporate targeted learning and practice questions with measurable goals to assess comprehension and immediate recall, along with maintenance blocks of used questions to hone test-taking skills and maintain and enhance achievement outcomes. Make sure to track progress.
  • First half of test prep – Complete targeted questions from the highest-yield topics at 70% or above. Use a review/redo strategy if achievement is lower. Complete twice-weekly maintenance blocks and a half-length self-assessment to track progress. Your score should start to improve.
  • Second half of test prep – Complete targeted questions from the remaining content categories at 70% or above. Complete daily maintenance blocks of used questions, and complete a weekly, half-length self-assessment and a weekly full-length assessment for progress tracking. Don’t forget to do a full-length post-test.
• Backfill knowledge gaps – Whether you use Anki or First Aid, ChatGPT or Sketchy, MindGrasp or an actual textbook (we like Symptom to Diagnosis by Stern, Cifu, and Altkorn), you need a resource to address knowledge gaps and a process for backfilling them. For the record, we like Symptom to Diagnosis. It really helps with clinical decision-making.

We left out some important information about self-reflective strategies. And we think they’re crucial; they address questions and skills about time management, use of test accommodations, quelling test-taking anxiety, and so much more. However, they deserve their own space and a separate blog post. So stay tuned! 

If you need test prep support right now, contact us, and don’t forget to check out the new Step 1 format, effective May 14, 2026.