THE  FINAL  USMLE  PREPARATION    
STRATEGY  YOU  WILL  EVER  NEED  
 
 
 
 
 
 
 
  
Copyright  ©  USMLE  Success  Academy  
 
You  may  print  and  distribute  this  document  to  friends  and  colleagues  as  
long  as  it  is  kept  in  its  original  format.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 PREFACE  
 
 
We  were  not  going  to  write  this  guidebook,  simply  because  the  contents  
within  it  are  the  result  of  years  of  trial,  error,  testing,  and  tweaking.    We  
thought  the  results  of  our  years  of  effort  should  be  restricted  to  our  
students,  to  those  who  decided  to  join  us  at  The  Academy  for  their  
USMLE  Step  1  preparation.    However,  as  we  move  forward  and  continue  
to  grow  by  leaps  and  bounds  on  a  weekly  basis,  we  know  that  the  right  
thing  to  do  is  to  help  as  many  students  as  possible,  by  answering  the  
question  we  literally  are  asked  several  times  per  day:  How  do  I  study  for  
the  Step  1  exam.  
 
We  get  emails  coming  in  every  single  day,  with  that  exact  question!      
 
I  cannot  stress  enough  just  how  many  hours  and  years  of  hard  work  
have  gone  into  testing  our  USMLE  preparation  strategy  –  1000’s  of  
hours.    If  you  troll  the  USMLE  forums  these  days,  you  will  see  a  generic  
response  to  this  ever-­‐so-­‐important  question  asked  mainly  by  foreign  
students  from  India  and  the  Caribbean,  mainly  telling  students  to  use  
Kaplan  and  some  question  bank.      
 
Personally,  when  I  was  in  medical  in  the  Caribbean  earlier  this  century,  I  
received  absolutely  terrible  advice  from  my  school’s  administration  on  
how  to  prepare  for  the  hardest  exam  of  my  life.    How  do  I  know  it  was  
terrible  advice?    Because  when  I  took  an  NBME  (for  the  first  time)  just  
days  before  my  attempt  at  the  Step  1  exam,  the  results  were  absolutely  
horrifying.    The  advice  I  received  (from  a  non-­‐MD),  was  to  ‘Do  as  many  
questions  as  you  possibly  can…  Up  to  10,000  questions  should  be  done  
before  writing  your  exam).    I  thought  “OK,  I’ll  do  that  and  get  a  260”,  but  
this  simply  does  not  work.    Doing  question  after  question  without  a  plan  
does  absolutely  nothing  to  help  you  achieve  that  illustrious  99  on  the  
exam.    Sure,  questions  are  an  integral  part  of  your  preparation,  but  only  
when  approached  strategically  and  with  a  proper  plan-­‐of-­‐action.    
 
I  was  ashamed  to  have  to  postpone  my  Step  1  exam…  Not  only  was  it  
personally  embarrassing,  but  I  already  had  an  illustrious  Psych  rotation  
set  up  in  Chapel  Hill,  North  Carolina,  that  was  the  opportunity  given  
only  to  those  who  were  deemed  ‘exceptional  students’  by  the  faculty  
and  administration.    Not  only  did  I  let  myself  down,  I  let  my  clinical  co-­‐
ordinator  down…  But  here’s  the  thing…  She  was  the  one  who  gave  me  
the  very  vague  and  non-­‐directional  advice  that  put  me  into  this  position  
in  the  first  place.  
 
I  realized,  after  delaying  my  exam,  that  this  was  NOT  about  them,  it  was  
about  ME…  Why  was  I  being  rushed  into  clinicals  when  I  clearly  wasn’t  
prepared??    Why  squander  away  any  chance  I  have  at  attaining  a  
Residency  position  when  I  wasn’t  ready?    So  equipped  with  this  
epiphany,  I  decided  to  start  my  Step  1  preparation  from  scratch…    
 
I  did  well  in  the  Basic  Science  classes.    I  was  known  as  one  of  the  hardest  
working  students  in  class.    And  I  don’t  share  this  with  you  to  brag,  not  in  
the  least.    In  fact,  if  you  knew  me,  you  would  know  that  I  am  not  one  to  
boast,  I  prefer  being  the  strong  silent  type.    But  I  tell  you  this  so  you  
realize  that  simply  being  a  good  student,  with  solid  basic  science  grades,  
and  a  strong  work  ethic  will  not  automatically  translate  into  a  great  Step  
1  score.    Once  we  start  preparing  for  the  USMLE  Step  1  exam,  we  are  all  
starting  with  a  clean  slate,  and  how  well  you  do  is  not  necessarily  based  
on  your  current  knowledge,  but  rather  based  on  how  you  approach  this  
exam.  
 
I  compare  the  Step  1  exam  to  a  marathon.    You  may  be  in  good  shape,  
you  may  hit  the  gym  regularly,  you  may  even  be  a  casual  jogger,  but  
unless  you  are  implementing  a  specific  training  regimen  for  that  
marathon,  you  are  likely  to  come  up  short.    The  Step  1  exam  is  a  
marathon,  both  in  preparing  for  it  and  actually  writing  it!    It  is  tough,  
exhausting,  and  the  process  is  downright  cruel.    But,  we  all  have  to  do  it,  
and  it  is  a  right  of  passage  for  each  medical  student.    Great  pride  comes  
with  getting  over  the  hurdle,  just  like  great  pride  comes  to  those  who  
are  able  to  withstand  the  cruel  and  punishing  training  for  a  marathon.  
 
So,  when  I  realized  I  was  going  to  fail  based  on  my  NBME  exam  (which  
by  the  way,  my  school  never  taught  me  about),  I  joined  a  popular  
preparation  program  in  the  Mid-­‐west,  an  investment  that  I  paid  over  
$5500  for.    I  figured  if  anything  could  help  me,  this  would  be  it.    So  I  
hopped  on  a  plane  and  headed  to  the  program.    I  quickly  realized  that  
this  program  was  NOT  for  me…  I  value  my  time  more  than  anything  else  
in  this  life,  and  I  really  did  not  appreciate  wasting  a  couple  hours  of  
every  full  day  of  lecture  listening  to  our  teacher’s  life  stories,  anecdotes  
on  life,  and  musings.    Not  to  say  the  program  itself  wasn’t  useful,  it  had  
its  moments,  but  what  took  a  8  hours  to  get  through  everyday  could  
have  been  taken  care  of  in  only  a  couple  of  hours  per  day,  leaving  me  
with  real  time  to  prepare  and  study.      
 
So  I  left,  locked  myself  in  my  hotel  room  for  several  weeks,  and  started  
reaching  out  to  the  best  of  the  best  students  on  the  UMSLE  Forums.    I  
searched  night  and  day  for  success  stories  from  students  like  myself,  I  
compared  and  contrasted  preparation  ideologies,  and  eventually  put  
together  what  I  believed  to  be  the  best  series  of  steps  that  needed  to  be  
taken  in  order  to  achieve  a  score  putting  me  into  the  elite  level  of  test-­‐
takers.    The  only  way  to  actually  test  out  this  strategy  was  to  put  it  into  
action  –  and  that’s  what  I  did!  
 
Fast-­‐forward  a  couple  of  years…    
 
I  met  Dr.  Stavros  in  our  4th  year  of  Clinical  rotations  in  a  South  Side  
Chicago  hospital.    We  were  immediate  friends,  and  soon  began  small  
Step  1  tutoring  sessions  with  students  who  had  yet  to  take  the  exam.    
We  prepared  high-­‐yield  lectures,  and  we  taught  them  our  strategy  for  
success.      
 
This  became  quite  popular  and  it  soon  consumed  lots  of  our  time,  and  
we  simply  couldn’t  keep  up  with  the  demand.    Eventually  students  
started  offering  to  pay  us  to  continue  with  our  tutoring,  and  although  
we  were  in  medicine  to  help  the  patients,  we  soon  realized  the  value  we  
could  offer  to  other  students  who  were  following  in  our  footsteps.    As  
students  came  and  went,  we  started  to  see  amazing  scores!    This  was  
immensely  rewarding  for  us,  and  with  that  The  Academy  was  born.    As  
we  continued  to  help  students,  we  tweaked  the  original  strategy  that  I  
developed  on  my  own  while  locked  in  that  hotel  room  in  Illinois  back  in  
2007.    We  combined  a  lecture  series  comprised  of  approximately  100  
hours  with  our  detailed,  step-­‐by-­‐step  strategy  for  achieving  enormous  
success.      
 
Since  we  officially  launched  The  USMLE  Success  Academy  in  2009,  we  
made  minor  tweaks  and  changes  to  our  preparation  strategy  in  order  to  
boost  scores  even  more.    At  this  point  in  time,  the  strategy  is  perfected!    
Students  who  follow  our  lectures  and  our  success  strategy  are  achieving  
amazing  scores,  every  single  time,  no  matter  how  weak  of  a  student  they  
were  in  the  past,  no  matter  which  Caribbean  school  they  came  from,  no  
matter  how  many  failures  on  the  Step  1  they  come  to  us  with  –  they  
always  score  well  with  our  strategy.  
 
Now,  because  we  are  being  asked  several  times  per  day  about  the  ‘Best  
way  to  prepare  for  the  Step  1  exam’,  we  are  going  to  lay  it  all  out  for  
you  here  today.      
 
Now,  let  get  started.    Keep  in  mind,  what  you  are  about  to  read  is  not  
just  a  recommendation  that  you  should  try,  it  is  not  something  to  pick  
and  choose  ideas  from…  It  is  our  tested  and  proven  formula  for  a  great  
score  on  your  USMLE  Step  1  exam.  
 
Let’s  get  started!  
 
 
 
 
 
 
 
 
 
 
 
 
 
To  your  success,    
 
Dr.  Paul  &  Dr.  Stavros      

 
 
 
 
 
 TOOLS  NEEDED  FOR  THE  USMLE  PREPARATION  STRATEGY  
 
 
In  order  to  best  prepare  yourself,  you  need  the  right  tools  at  your  
disposal.    Below  I’ve  outlined  a  few  things  you  should  have  before  even  
starting  your  preparation,  so  that  as  we  move  through  the  plan,  you  
have  everything  right  at  your  disposal.  
 
 
What  you’ll  need:  
 
1.  Excellent  review  notes  
 
Excellent  review  notes  come  from  one  of  two  sources.    They  are  either  
created  by  you  through  carefully  moving  through  your  basic  science  
notes  and  combining  all  of  the  high-­‐yield  information  into  a  neat  
document,  or  they  come  from  following  a  review  program  that  tackles  
the  high-­‐yield  information  in  great  detail.    Please  realize  that  ‘study  
guides’  such  as  the  First  Aid  or  even  our  USMLE  Step  1  BIBLE  are  not  
comprehensive  review  notes,  they  are  only  review  guides  that  tell  you  
what  is  considered  to  be  high-­‐yield.    You  should  be  able  to  look  at  the  
First  Aid  and  be  able  to  discuss  the  topic  inside  in  great  detail  –  simply  
memorizing  the  information  in  any  study  guide  will  leave  you  falling  
well  short  of  the  knowledge  base  you  need  to  succeed.  
 
2.  USMLE  World  Question  Bank  
 
Through  the  years,  I’ve  tried  all  of  the  more  popular  question  banks  out  
there,  and  I  can  say  with  complete  confidence  that  USMLE  World  is  the  
superior  product  on  the  market.    A  1-­‐2  month  subscription  to  USMLE  
World  is  all  you  will  need.  
 
3.  NBME  Examinations  
 
In  order  to  get  the  most  accurate  feedback  of  your  progress  as  you  move  
through  our  success  strategy,  you  are  going  to  need  to  use  NBME  
examinations.    Many  students  don’t  like  the  fact  that  they  have  to  spend  
some  money  for  these  exams,  but  keep  in  mind  that  these  exams  are  
made  of  real  USMLE  questions  that  are  being  used  today.    What  this  
means  is  that  the  level  of  difficulty  that  this  exam  presents  to  you  will  
give  you  both  an  accurate  assessment  of  where  you  stand  and  it  will  
give  you  a  great  look  at  the  level  of  difficulty  that  you  can  expect  on  the  
real  USMLE  exam.    Each  NBME  is  $45,  which  is  a  very  small  price  to  pay  
for  the  valuable  information  and  feedback  that  you  will  take  away  from  
each  one  you  take.    Please,  embrace  these  exams  and  be  prepared  to  
take  anywhere  from  2-­‐5  of  them  throughout  your  preparation,  as  it  will  
help  you  boost  your  score  by  dozens  of  points!  
 
 
As  far  as  tools  go,  that’s  what  you  need!    Now,  let  us  get  into  the  details  
of  the  strategy.  
 
 
 
THE  BASIC  STEPS  INVOLVED  
 
 
Below  I  am  going  to  outline  the  general  overview  of  the  success  
strategy.    After  the  outline,  I  will  go  into  detail  about  how  to  approach  
each  step,  and  how  to  maneuver  your  way  through  the  entire  strategy  
from  Day  1  of  your  studies,  all  the  way  until  the  moment  you  are  ready  
to  write  the  exam!      
 
Let’s  go…  
 
1st  step  –  Take  an  NBME  exam  
2nd  step  –  Develop  a  study  schedule  based  on  your  timeframe  (+  
schedule  your  USMLE  Step  1  exam)  
3rd  step  –  Begin  studying    by  moving  through  each  discipline  
4th  step  –  Once  through  your  initial  review,  start  doing  3-­‐4  blocks  of  UW  
questions  per  day  
5th  step  –  Perform  the  2nd  run  through  Qbank  
6th  step  –  Take  NBME  
7th    step  –  Improve  weak  areas  based  on  NBME  feedback  
8th  step  –  Take  NBME  (repeat  step  6,  7,  &  8  until  no  identifiable  
weaknesses)  
9th  step  –  Take  your  USMLE  Step  1  confidently  
 
  
At  first  glance,  it  looks  as  though  a  good  chunk  of  your  time  is  spent  
taking  NBME  exams,  but  this  isn’t  the  case.    In  fact,  the  NBME  exams  are  
only  going  to  take  up  a  couple  hours  of  your  time  here  and  there.    But,  
the  layout/schedule  of  your  NBME  exam  attempts  are  very  carefully  
placed,  and  should  be  followed  exactly  as  prescribed.  
 
So  now  that  you  get  what  the  overall  picture  looks  like,  let  us  take  a  
much  closer,  more  detailed  look  at  exactly  what  to  do  in  order  to  go  
from  where  you  are  right  now,  to  a  place  where  you  are  equipped  to  
score  in  the  top  1%  of  all  USMLE  test-­‐takers.  
 
 
Before  we  start…  As  I  mentioned  earlier  in  this  guidebook,  your  USMLE  
scores  are  yours  and  yours  only!    They  are  not  for  your  school,  they  are  
not  for  anyone  else  but  you.    So  don’t  think  for  a  minute  that  you  MUST  
take  the  test  in  1  month,  or  2  months,  or  even  6  months  if  you  aren’t  
ready.    The  clinical  rotations  will  always  be  there,  you  only  have  one  
shot  at  this  exam  –  so  take  your  time,  but  don’t  fall  into  the  trap  of  
taking  too  much  time.    For  example,  there  is  absolutely  no  plausible  
reason  for  taking  1yr  to  prepare  for  this  exam.    If  you  are  a  student  who  
is  fresh  out  of  the  basic  sciences,  we  should  have  you  ready  quickly  (1-­‐3  
months).    For  those  of  you  who  are  out  of  school  for  5+  years  and  who  
truly  and  honestly  believe  they  are  starting  from  scratch,  you  should  be  
working  hard  and  efficiently,  but  may  need  6-­‐9  months  to  prepare.    In  
general  though,  you  are  likely  a  relatively  recent  graduate  who  can  
manage  to  get  ready  in  90  days  or  less.  
 
 
 
 
 
 
 
1ST  STEP  –  TAKE  AN  NBME  
 
I’ve  dealt  with  students  fresh  out  of  the  basic  sciences  and  I’ve  dealt  
with  students  20  years  out  of  medical  school,  and  no  matter  what  your  
case  may  be,  taking  an  NBME  will  give  you  an  idea  of  where  you  stand.    
It  will  let  you  know  how  strong  or  weak  you  are  overall,  and  it  will  
pinpoint  your  strengths,  your  weaknesses,  and  your  average  areas.    So  
get  an  NBME  and  take  it.  
 
Since  we  are  just  getting  started  with  our  preparation,  ultimately  we  
need  to  identify  our  weaknesses,  but  we  are  still  going  to  do  thorough  
and  detailed  studying  of  all  the  principles  tested  on  the  USMLE  Step  1  
exam.    At  this  point  take  note  of  your  strengths  and  weaknesses  based  
on  the  NBME,  but  we  are  still  going  to  attack  all  of  the  material.  
 
 
2ND  STEP  –  DEVELOP  A  STUDY  SCHEDULE  BASED  ON  YOUR  
TIMEFRAME  GOALS  
 
This  is  trickier  and  different  for  everyone,  but  as  a  general  guideline,  a  
student  who  is  above  average  in  their  basic  science  classes  should  aim  
to  write  their  exam  within  6-­‐8  weeks  from  now.    My  suggestion  is  to  be  
honest  with  yourself  as  far  as  how  much  time  you  need;  did  you  fail  a  
few  classes  in  med  school?    If  you  did,  you’ll  need  more  time.    If  you  did  
well,  then  schedule  your  exam  for  a  couple  months  away.    The  most  
important  thing  is  that  you  do  in  fact  schedule  your  exam.    Nothing  is  
worse  than  starting  your  preparation  without  having  a  defined  date  and  
goal  in  place,  because  what  are  you  working  towards  if  you  don’t  set  a  
date  and  goal?    You  can  always  change  your  test  date.  
 
You  also  need  to  identify  a  target  score.    If  your  goal  is  to  become  a  
Family  Physician,  which  is  known  to  be  a  favorite  amongst  IMG’s,  don’t  
for  a  second  think  that  just  ‘passing’  the  exam  will  get  you  in  these  days,  
because  it  absolutely  will  not!    When  I  hear  a  student  tell  me  their  goal  
is  to  ‘just  pass’,  I  will  immediately  warn  them  about  thinking  too  small.    
Even  if  you  want  to  get  into  one  of  the  easier  specialties,  you  should  still  
be  shooting  for  a  top  score.    Never  limit  yourself  based  on  your  own  
falsely  set  limitations…  Just  because  you  are  an  IMG  doesn’t  mean  you  
can’t  get  into  Dermatology,  or  Plastic  Surgery.    Sure,  it  is  highly  unlikely  
and  extremely  challenging,  but  never  limit  yourself  based  on  what  you  
hear  from  others.  
 
And  so  with  that  said,  what  is  your  goal?    Do  you  want  to  try  for  a  
challenging  specialty?    If  you  do,  then  you  want  to  score  at  least  a  235,  
especially  these  days  with  the  high  number  of  competitors.    If  you  want  
an  easier  to  get  into  residency  such  as  Pediatrics,  you  still  want  to  aim  
for  a  score  that  is  above  the  national  average,  which  is  around  222-­‐225  
(this  is  always  changing  on  a  yearly  basis,  but  usually  hovers  around  
this  marker).  
 
So,  define  your  ultimate  career  goals.    Define  your  goal  score.    Set  a  date  
for  your  exam.  
 
 
How  do  you  plan  a  study  schedule?  
 
This  is  done  based  on  a  few  factors,  namely  whether  or  not  you  are  
dedicating  100%  of  your  day  to  your  Step  1  preparation.    And  if  I  may  
say,  this  is  one  exam  you  will  want  to  focus  100%  of  your  time  and  
effort  towards.    A  rock-­‐solid  approach  is  to  dedicate  6-­‐8  hours  of  each  
day  to  Step  1  preparation.    In  The  Academy’s  Step  1  Preparation  
Program,  we  ask  students  about  the  amount  of  time  they  can  dedicate  to  
their  studies,  and  based  on  this  recommend  4,  8,  or  12  weeks  of  
preparation  time.    For  a  student  who  has  only  the  Step  1  to  focus  on,  4  
very  intense  weeks  should  be  enough  time  to  get  through  the  basic  
sciences,  while  also  implementing  daily  questions  into  their  strategy  
and  also  keeping  an  hour  or  so  for  review.    For  those  with  part-­‐time  
jobs,  children,  or  other  responsibilities  that  use  up  part  of  their  day,  
aiming  to  dedicate  2-­‐4  hours  of  highly  focused,  interruption-­‐free  
studying/preparation  is  ideal.      
 
Now,  based  on  the  amount  of  time  you  can  dedicate,  create  a  plan  that  
maps  out  how  you  will  divide  your  time.    Did  your  NBME  tell  you  that  
you  are  weak  in  a  few  areas?    If  it  did,  give  yourself  some  extra  time  to  
go  over  those  topics.    Now  keep  in  mind,  the  major  topics  you  must  
master  for  the  USMLE  Step  1  exam  include:  
 
 
-­‐ Genetics  
-­‐ Cell  &  Membrane  Behavior  
-­‐ Behavioral  medicine  
-­‐ Biochemistry  
-­‐ Neurology  
 -­‐ GI  Systems  (GI,  Renal,  etc)  
-­‐ Dermatology  
-­‐ Pathology/Pathophysiology  
-­‐ Pharmacology  
-­‐ Physiology  
 
To  name  the  big  ones….  
 
Now,  where  and/or  how  you  get  the  information  for  this  material  is  up  
to  you.    Ideally  you  took  excellent  notes  during  your  basic  sciences  and  
have  that  took  take  from,  or  you  could  join  our  preparation  program  to  
get  everything  you  need.    But,  one  thing  I  absolutely,  positively  must  
warn  you  about,  again,  is  that  using  a  review  book  such  as  the  First  Aid,  
Step-­‐Up  series,  USMLE  BIBLE,  are  not  sufficient  for  in-­‐depth  review  and  
analysis  of  the  important  information.    They  are  ‘guides’,  not  
comprehensive  sources.  
 
So  once  you’ve  got  your  plan  in  order,  it  is  time  to  really  dig  into  the  
hardcore  studying.  
 
 
3RD  STEP  –  BEGIN  STUDYING    
 
How  you  study  is  ultimately  up  to  you,  but  a  couple  things  I  can  
recommend  that  will  go  a  long  way  in  helping  you  master  a  lot  of  
complex  material  is  to:  1.  Draw  when  possible  and  2.  Create  lists  
 
 
About  Drawing:  
 
Drawing  is  one  of  the  best  ways  of  taking  complex  material  and  turning  
it  into  easy-­‐to-­‐understand  and  remember  material.    Take  the  Brachial  
Plexus  for  example;  how  on  earth  could  you  possibly  master  that  
anatomical  structure  without  drawing  it  out  over  and  over  again?    Sure,  
you  may  remember  the  names  of  the  nerves,  which  muscles  that  supply,  
and  what  kinds  of  pathologies  occur  when  they  are  damaged,  but  it  sure  
makes  it  easier  when  you  can  visualize  that  image  of  the  plexus  and  its  
major  nerves  travelling  throughout  the  arm.  
 
This  is  effective  for  anatomy,  and  equally  effective  for  Physiology,  as  we  
can  really  simplify  complex  physiological  processes  by  turning  them  
into  illustrations.    Take  the  tubules  of  the  kidneys  as  an  example;  we  
know  that  we  can  turn  a  lot  of  complex  physiology  into  very  easy-­‐to-­‐
understand  processes  with  a  single  picture,  as  I  have  drawn  in  below.  
 

 
 
Look  at  what  this  simple  illustration  can  explain  to  us…  not  only  how  
the  PCT  physiology  works,  but  how  Pharmacology  effects  it’s  ability  to  
function.    A  picture,  as  they  say,  is  worth  a  thousand  words.    And  turning  
your  medical  information  into  illustrations  will  allow  you  to  learn  an  
astoundingly  greater  amount  of  information  than  simply  trying  to  
memorize  a  bunch  of  books.    For  this  reason,  we  use  hundreds  of  
illustrations  for  our  students  throughout  our  own  Step  1  program,  not  
because  we  like  to  draw,  but  because  it  works!  
 
This  is  an  effective  strategy  throughout  every  topic  you  will  study,  so  
making  use  of  drawings,  both  anatomical  and  physiological,  will  help  
you  boost  your  score.    And  of  course  can  help  you  with  your  
Pharmacology  as  well.    Take  the  following  image  as  an  example:  
 

 
This  is  a  drawing  of  the  pro-­‐insulin  and  insulin  molecules,  which  I  can  
guarantee  you  will  be  on  your  exam!    Sure,  this  isn’t  a  complicated  
example,  but  just  looking  at  this  simple  drawing,  which  took  me  20s  to  
make,  can  tell  us  a  world  of  information  relating  to  not  only  the  
structures  of  the  molecules,  but  it  directly  links  to  several  pathologies  
(Insulinoma  vs.  insulin  administrated  hypoglycemia  for  example).    By  
just  looking  at  this  image,  I  can  talk  to  you  about  Physiology,  
Pharmacology,  Pathology,  Pathophysiology,  Histology,  and  Anatomy.    I  
can  even  link  it  to  Neurological  information.  
 
The  point  is,  start  drawing!    It  will  truly  make  a  difference  in  your  
overall  education  and  this  type  of  stuff  will  stick  with  you  for  the  rest  of  
your  career,  while  others  are  constantly  reading  to  remember,  you  will  
never  forget!  
  
 
About  making  Lists:  
 
Lists  are  an  effective  way  to  organize  information.    Pharmacology  and  
Microbiology  are  two  areas  that  can  best  be  supplemented  with  well-­‐
organized  lists.    Take  it  a  step  further,  and  do  yourself  a  HUGE  favor  by  
implementing  mnemonics  anywhere  and  everywhere  that  you  can.    The  
best  way  to  make  use  of  mnemonics???  Make  up  your  own!  
 
I  remember  back  in  my  Pharm  class  during  basic  sciences,  I  decided  that  
for  the  anti-­‐hypertensives  lecture,  I  would  create  all  of  my  own  
mnemonics,  and  forego  anything  that  I  was  to  read  or  be  told  about.    
And  to  this  very  day,  I  can  rattle  off  every  single  anti-­‐hypertensive  drug,  
even  though  I  go  months  without  thinking  about  it.    The  point  is,  there  is  
massive  power  in  creating  your  own  memory  aides,  so  don’t  be  afraid  to  
make  up  something  unique  to  you,  something  that  only  you  will  
remember,  as  there  is  a  great  deal  of  benefit  to  be  had  from  doing  it.  
 
Another  great  addition  to  lists  is  the  addition  of  COLOR.    Using  colors  to  
separate  classes  of  drugs  can  be  exceptionally  helpful.    Using  a  color  
system  to  separate  gram  negative  lactose  fermenters  from  the  non-­‐
lactose  fermenters  can  impact  your  score  in  the  long  run,  simply  
because  we  tend  to  remember  colors  very  well,  and  if  we  combine  
colors  with  categories  and  sub-­‐categories  of  information,  we  can  help  
out  our  own  cause.  
 
 
Once  you  have  finished  a  thorough  review  of  your  basic  sciences  
material,  dive  into  USMLE  World  questions!  
 
Perform  3-­‐4  Blocks  Of  USMLE  World  Questions  Per  Day:  
 
In  addition  to  daily  review,  you  should  perform  3-­‐4  blocks  of  46-­‐48  
questions  per  day.    The  reason  why  I  say  3-­‐4  blocks  is  because  it  is  just  
enough  to  help  you  get  through  the  entire  question  bank  in  just  14-­‐21  
days,  and  it  is  not  so  much  that  you  can’t  absorb  everything  on  a  daily  
basis.    You  should  mix  your  USMLE  world  questions,  as  this  will  create  
the  environment  that  you  will  experience  on  the  real  exam.  
  
Below  I  have  outlined  the  necessary  steps  that  you  should  follow  while  
doing  QBank  questions:  
 
First...  keep  in  mind  that  you  don't  want  to  use  your  UW  %  as  the  
predictor  of  your  knowledge,  you  want  to  use  it  to  build  your  
knowledge.  Use  the  NBME's  for  assessment  purposes...  that  is  important  
to  remember!  
 
So  here's  my  suggestion:  
 
1.  Go  through  questions  in  a  TIMED  format,  doing  a  full  block  of  
questions  at  a  time  (46-­‐48q)  (Reason:  you  need  to  train  for  the  USMLE  
exam  like  you  would  train  for  a  physical  event  like  a  marathon,  and  the  
best  way  to  build  your  stamina  is  to  perform  a  full  block  of  questions  in  
the  same  timeframe  that  you  will  do  so  on  the  real  exam.    If  you  do  this  
from  the  start,  you  will  build  excellent  stamina,  you  will  learn  to  work  
faster  yet  still  efficiently,  and  it  will  go  a  long  way  on  the  real  exam).  
 
2.  Once  finishing  each  block  of  questions,  now  is  the  time  to  go  back  
over  all  of  the  answers.    Open  up  your  basic  science  notes  (the  ones  you  
took  or  the  ones  you  have  from  a  review  course)  and  take  insert  notes  
anywhere  appropriate.    This  will  help  round-­‐out  your  notes  and  will  
also  force  you  to  review  everything.    Keep  track  of  your  strengths  and  
your  weaknesses  as  you  move  through  these  question/answers.    This  
takes  time,  but  the  more  detailed  you  can  be  with  your  explanations  
about  each  question,  the  more  you  will  learn  and  the  better  you  will  be  
in  the  long-­‐run.    Continue  this  until  you  finish  the  entire  question  bank.    
With  each  passing  day,  look  over  the  notes  you've  made  in  your  
notebook,  talk  aloud  in  explaining  certain  concepts  or  pieces  of  
information  you  are  struggling  with,  and  be  sure  to  consistently  review  
review  review.  
 
You  should  continue  to  study  your  notes  and/or  follow  your  prep  
program  and  doing  questions  in  the  format  explained  above  until  you  
are  through  everything.    For  the  qbank,  it  should  take  around  14-­‐21  
days.      
 
 
4TH  STEP  –  TAKE  ANOTHER  NBME  
 
At  this  point,  you  have  finished  going  through  your  notes,  you  have  
finished  taking  notes,  and  you  have  finished  your  first  run  through  the  
USMLE  World  question  bank.    You  have  come  a  very  long  way  since  
beginning  your  preparation,  and  now  you  should  take  another  NBME  
exam  in  order  to  determine  where  you  are  weak,  average,  or  strong.      
 
The  image  below  is  the  image  attained  at  the  end  of  an  NBME  exam,  and  
as  you  notice  there  is  a  ‘borderline’  marker  near  the  middle  of  the  chart.    
Everything  to  the  left  of  this  marker  is  indicative  of  a  weakness,  
everything  to  the  right  is  indicative  of  a  relative  strength.    It  is  important  
to  realize  that  any  subject  that  crosses  over  the  borderline  marker  at  
any  point  should  be  assumed  ‘weak’.      
 

 
 
The  ultimate  goal  is  to  get  all  subjects  in  the  ‘Strong’  side  of  the  chart.    
Based  on  this  NBME,  this  student  should  spend  time  working  on  Mental  
Disorders,  Gynecologic  Disorders,  and  Psychiatry  above  all  else.    Those  
topics  deserve  1  full  week  of  intense  study  each,  totaling  3  weeks.    The  
subjects  that  hover  over  the  ‘Borderline’  area  should  also  be  studied  
further,  although  a  couple  days  for  each  of  these  ‘average’  areas  may  be  
sufficient  to  bring  them  over  into  the  ‘Strong’  area.  
  
While  spending  more  time  specifically  on  your  weaker  and  average  
areas,  you  will  also  do  a  2nd  run  through  of  your  USMLE  World  question  
bank,  however,  you  are  going  to  do  it  in  a  completely  unique  way  that  
will  help  propel  your  knowledge  above  and  beyond  its  current  level.  
 
 
5TH  STEP  –  PERFORM  A  2ND  RUN  THROUGH  YOUR  QBANK  
 
 Before  doing  this  step,  spend  extra  time  on  each  one  of  your  
weaknesses  in  order  to  bring  them  up  to  par  with  the  rest  of  your  
knowledge.  
 
The  2nd  run  through  of  your  QBank  is  performed  as  follows:  
 
Now,  the  mistake  I  see  a  lot  of  students  making  at  this  point  is  to  simply  
re-­‐do  the  entire  question  bank.    When  you  simply  re-­‐do  the  qbank,  you  
may  see  an  improvement  in  your  %,  but  you  have  to  realize  that  this  is  
most  likely  due  to  memorization  of  some  answers.    Instead,  as  you  move  
through  each  day,  you  should  be  truly  MASTERING  the  information  
within  your  notes.    So  by  the  time  you  are  done  with  the  1st  round  of  the  
qbank,  your  depth  and  breadth  of  knowledge  should  be  much  greater.  
Once  you  have  thoroughly  studied  your  notes  (in  addition  to  your  
straightforward  studying  from  your  basic  science  notes  or  review  
course  if  you  choose  to  do  one),  then  it  is  time  to  go  through  your  UW  
Qbank  a  2nd  time,  but  the  key  to  truly  using  it  to  maximize  your  
knowledge  isn't  to  simply  go  through  the  questions  again  in  a  Multiple  
choice  format  -­‐  NO!  Instead,  what  you  should  do  is  the  following:  
 
Note:  this  time  you  don't  have  to  perform  the  questions  in  a  timed  mode  
and  you  should  perform  them  in  ‘random’  mode.  
 
1st  -­‐  Read  the  question  as  you  normally  would  (note:  be  sure  to  always  
read  the  last  line  of  the  question  first,  as  sometimes  reading  the  entire  
stem  isn't  even  necessary  to  answer  the  question  -­‐  and  if  you  have  2-­‐3  of  
these  per  block,  you  can  save  yourself  a  few  minutes  of  precious  time).  
Back  to  the  main  point...  read  the  question  as  you  normally  would,  but  
instead  of  simply  choosing  the  correct  answer  (which  should  be  easy  
based  on  your  having  properly  gone  through  the  1st  time),  you  want  to  
identify  the  proper  answer  from  the  answer  choices,  but  instead  of  just  
answering  it  and  moving  to  the  next  question,  explain  to  yourself,  aloud,  
why  the  question  you  believe  to  be  correct  is  in  fact  correct.  If  you  can  
explain  why  an  answer  is  right,  then  you  have  a  much  better  overall  
comprehension  of  the  material.    In  addition,  take  a  look  at  the  answers  
you  find  to  be  incorrect,  and  discuss  with  yourself  why  each  incorrect  
answer  is  in  fact  'incorrect'.    You  see,  if  you  only  master  the  information  
for  each  correct  answer,  you  overlook  the  learning  opportunity  for  all  4-­‐
5  of  the  other  answer  options,  because  even  though  they're  incorrect  for  
this  particular  answer,  they  are  still  pieces  of  information  that  you  
should  know/learn/understand.  
 
Simply  move  through  the  qbank  this  way  until  you  get  through  the  
entire  thing.    So  this  means  your  2nd  time  through  is  more  about  being  
able  to  explain  information,  instead  of  simply  being  able  to  remember  
correct  and/or  incorrect  answers.    This  is  just  like  teaching  someone  the  
information…  When  you  can  discuss  something  out  loud,  then  you  can  
be  certain  that  you  truly  know  the  information.    This  takes  time,  I  won't  
lie  to  you,  it  takes  lots  of  time  and  patience...    BUT,  you  will  learn  so  
much  medical  information  that  when  it  comes  time  for  you  to  sit  for  the  
real  exam,  all  of  the  hard  work  that  you  put  in  will  make  things much  
easier  for  you.  
 
 
6TH  STEP  –  TAKE  ANOTHER  NBME  
 
By  now,  you  have  properly  studied  your  basic  science  material,  and  you  
have  performed  the  QBank  two  times.    You  should  be  extremely  close  to  
ready,  if  you  are  not  already  ready  to  write  your  exam.    But  before  you  
do  so,  we  need  to  be  sure  that  you  will  pass  with  100%  certainty.    There  
are  a  couple  of  important  criteria  you  absolutely  MUST  meet  if  you  want  
to  ensure  you  are  completely  prepared  to  write  your  exam;  which  
includes  a  WELL-­‐DISTRIBUTED  exam  result  and  a  minimum  score  of  
500.  
 
Let  me  explain  first  what  I  mean  by  ‘well-­‐distributed’…  It  means  that  
when  you  see  your  results,  you  want  all  of  the  subjects  to  be  fairly  
equally  distributed  across  the  entire  spectrum.    Take  the  two  NBME  
results  below,  where  each  yields  a  score  of  500,  but  the  one  on  the  left  is  
not  well-­‐distributed  (ie.  All  of  the  bars  are  not  approximately  in  the  
same  area  on  the  chart).    The  one  of  the  right,  while  all  topics  are  not  on  
the  far  right  (higher  performance)  side  of  the  chart,  is  well-­‐distributed  
and  means  that  you  have  a  very  well  overall  knowledge  of  the  
information.    The  reason  why  a  poorly  distributed  result  is  risky  is  
because  lets  say  the  real  USMLE  exam  is  heavier  in  those  topics  you  are  
a  bit  weaker  in…  If  you  don’t  take  the  time  to  bring  up  those  weaknesses  
yet  have  a  false  sense  of  security  because  of  a  decent  NBME  score,  you  
risk  failing.    On  the  other  hand,  if  all  of  your  subjects  are  at  least  on  the  
right  side  of  the  ‘borderline’  performance,  at  least  no  matter  which  
topics  may  be  heavier  on  the  real  exam,  you  at  least  know  that  your  
knowledge  is  well-­‐distributed  and  that  you  know  enough  to  safely  pass  
your  exam  with  a  good  score.  
 

 
           Poorly  Distributed           Well  Distributed  
 
And  finally,  you  want  to  achieve  a  score  of  at  least  500  because  this  
correlates  with  the  approximate  USMLE  Score  of  220,  which  is  at  the  
marker  for  the  National  Average  for  all  test-­‐takers.  
 
 
 
 
 
7TH  STEP  –  IMPROVE  WEAK  AREAS  BASED  ON  NBME  FEEDBACK  
 
If  you’ve  taken  an  NBME  and  achieved  a  score  of  at  least  500  and  the  
results  were  well-­‐distributed,  you  are  ready  to  take  the  exam.    If,  on  the  
other  hand,  there  are  still  weaknesses  (ie.  Bars  to  the  left  of  the  
‘borderline’  marker),  then  you  should  dedicate  1  week  to  each  of  your  
weaknesses,  and  then  repeat  an  NBME  (note:  Don’t  do  the  same  NBME  
twice).  
 
8TH  STEP  –  TAKE  AN  NBME  
 
 
From  here,  you  will  repeat  steps  6,  7,  and  8  until  you  reach  a  point  
where  you  have  achieved  a  MINIMUM  score  of  500  and  all  subject  bars  
are  to  the  right  of  the  ‘Borderline’  marker,  as  you  see  below:  
 

 
 
If  you’ve  achieved  this  important  point,  I  highly  suggest  taking  another  
two  NBME  exams,  as  a  way  of  solidifying  your  confidence  in  your  ability  
to  pass.    I  have  a  very  important  motto  that  I  use  with  my  students  
inside  The  Academy:      
 
Once  is  a  Fluke,  Twice  is  a  Coincidence,  Three  times  is  a  pattern  
 
What  this  means,  simply,  is  that  it  is  possible  that  you  got  lucky  and  
scored  well  on  the  exam,  so  by  taking  another  exam  and  scoring  in  the  
same  ballpark,  it  demonstrates  that  you  may  be  onto  something,  but  
twice  is  still  a  possible  coincidence.    But,  once  you’ve  achieved  the  same  
result  three  times  in  a  row,  it  demonstrates  that  you  are  in  a  pattern  of  
success,  and  you  are  absolutely,  100%  ready  and  prepared  to  do  well  on  
your  USMLE  Step  1  exam.    And  now,  you  should  be  confident  in  your  
ability  to  pass!  
 
 
9TH  STEP  –  TAKE  YOUR  USMLE  STEP  1  EXAM  WITH  CONFIDENCE  
 
I  think  this  one  speaks  for  itself.    At  this  point,  you’ve  put  in  the  blood,  
sweat,  and  tears,  and  you  have  come  a  long  way  in  your  entire  
preparatory  process.    By  following  the  steps  that  have  been  outlined  for  
you  here  today,  you  can  be  confident  that  you  will  pass  your  exam.  
 
You  see,  inside  The  Academy,  students  often  ask  us  why  we  offer  them    
a  passing  score  money-­‐back  guarantee.    And  the  reason  why  we  do  this  
is  to  demonstrate  that  we  have  the  utmost  confidence  in  our  program  
and  in  our  entire  preparation  strategy,  which  gives  our  students  the  
confidence  to  push  hard  and  follow  the  plan  exactly  as  it  is  laid  out.    The  
thing  that  most  students  don’t  realize  is  that  with  the  awesome  high-­‐
yield  lecture  series  we’ve  created,  in  combination  with  the  steps  that  
they  must  take  in  order  to  prepare  for  the  exam,  we  can  be  100%  
certain  that  each  student  will  pass.    When  a  student  demonstrates  that  
they  have  scored  over  500  on  three  consecutive  NBME  exams,  along  
with  a  well-­‐distributed  knowledge  base  that  is  based  on  the  hard  facts  
of  the  NBME  results,  it  is  simply  impossible  for  you  to  fail.    The  hard  
data  tells  us  whether  or  not  our  students  have  taken  the  appropriate  
steps  and  mastered  the  information;  there  is  no  risk  involved  with  our  
preparation  program,  which  is  why  our  students  consistently  score  
above  the  national  average.  
 
When  we  took  the  last  three  years  to  create  this  perfect  preparation  
strategy,  and  started  to  implement  it  within  our  Academy,  the  results  
were  the  same  every  time  –  a  passing  score.  
 
 
Thanks  for  taking  the  time  to  read  and  absorb  The  Academy’s  Success  
Strategy  Manual.    If  you  made  it  this  far,  you  are  serious  about  scoring  
exceptionally  well  on  your  Step  1  exam..  
 
To  your  USMLE  Success!  
 
Dr.  Paul  &  Dr.  Stavros