How to score 250+ on USMLE Step 1: lessons from 10 test takers

Updated 11/28/15

I have been looking at data from Step 1 test takers who scored more than 250.

When doing online research for my own preparation, I was never able to find pooled data from these highly successful test takers to give me more guidance. I wish I had this information before I started studying because I think I would have done a few things a bit differently (although I was very happy with my score).

I searched blogs and forums and found tips from Step 1 test takers between 2008-2015 whose scores ranged from 250-266. As it turns out, quite a few of them have been kind enough to share their experience with the rest of the world. They were a mix of IMGs and AMGs.

What follows are some observations about their experiences and tips, including what resources they used and how they prepared. My hope is that this brief article will help you to think about your own strategy to score very highly in Step 1.

1. You don’t have to be brilliant (apparently…)

A few of them stated that they were “average” students or graduates, with performances at medical school that were not stellar. Taking what they say at face value, it’s important to realize that getting a high score on Step 1 is not just about being inherently intelligent or that you have a photographic memory.

Conversely, you may have been top of your international medical school but if you do not strategize and execute well, you can end up with a mediocre Step 1 score. Take a look at this journal article about study strategy and USMLE scores.

2. Some took courses, some did not

There wasn’t a “Gold Standard” or “Magic Bullet” when it came to courses. They ranged from Kaplan Webprep/DVDs, Doctors In Training (DIT) online and Firecracker. Some did not do courses. Pathoma was mentioned by a few test-takers as a helpful resource.

Kaplan is perhaps the most well-known test prep company out of them all and they have a good track record of helping candidates be successful in their exam. DIT closely follows First Aid in their curriculum. One 250+ test taker commented that DIT would not be useful if you did not have a clue about basic sciences. You need some sort of foundation in order for it to help, according to this person. I have mentioned Firecracker in a previous post. It has a comprehensive and rather unique approach to Step 1 preparation, utilizing “spaced learning.”

If you are considering a course, you may want to check out their websites and also watch some sample videos on places like Youtube.

3. “First Aid” was THE essential book. Choose others based on your strengths and weaknesses and know that you don’t have to get every single book (Links to Amazon).

There was no set formula of book usage. Some used a minimal amount (such as FA together with a course) and others used a whole bunch. High Yield Biochemistry seems to have a lot of mixed reviews on Amazon.

Out of the books above, I used First Aid, Clinical Microbiology Made Ridiculously Simple, and the 2 BRS books, and they were all useful for my situation.

4. No surprise about the “Gold Standard” Qbank.

UWorld was used by almost all 250+ candidates. This Qbank has pretty much become a must-do. Make sure you use it well though, as I have written in a previous post. One candidate used Kaplan Q bank alone. Others used a combination of UW, Kaplan and USMLE Rx.

In terms of boosting Step 1 score, it may be useful for you to do more than one Qbank if you have the time and money, such as the combination mentioned above.

5. Do practice questions. 

Many used NBMEs to test their progress, but not all. One mentioned also using USMLE World Self Assessments.

I actually did not do any NBMEs during my own preparation. This is one area that I would have done differently. By the time I thought of starting NBMEs I think I only had around 2 weeks to go until my exam. That was just too late! I decided not to do any NBMEs as I did not want to postpone my exam and I just felt ready. If I was to do my preparation again I would have interspersed NBMEs during my studies.

6. There was no “golden rule” for length of preparation time

Serious study time varied from 5 weeks to 7 months. The shorter preparation time tended to be American Medical Students. IMGs studied for 3-7 months on average.

The lesson here is for you to know yourself and your situation. Do you have a lot of time? Are you working full-time? Do you have children? How much basic sciences do you already know? Strategize carefully, adjust when necessary and don’t let other people stress you out when you find out that their preparation duration is different to yours.

7. Don’t study 7 days per week.

Most studied 6 days/wk. Many advised against studying 7 days per week to avoid burn out. One said “whatever plan you make is the right plan.” Don’t worry too much about what others are doing and focus on what is best for you. Needless to say, study scheduled varied greatly. Most incorporated studying with question banks. Some also were intentional about taking time to socialize and exercise (which I really like!).

The hardest working candidate studied from 11am-7:30pm with a 30-minute lunch and 15-minute nap. This person then studied from 7:30-10:00pm. From 10pm-midnight he did USMLE World. Then he went on forums from midnight-2pm (what a machine!). Saturday was a half day and Sundays were off. Now I don’t think I could have sustain this at all, plus I was working full-time during Step 1 preparation! Point being, try to make a workable, sustainable schedule for yourself.

8. Tips varied widely so take what’s helpful and leave the rest.

  • Set a goal and start studying early (starting early was a very frequently mentioned tip)
  • Make sure you know the concepts. Don’t just rote learn
  • Find a good place to study. Library can be great (I agree!)
  • Make sure you are smart about how you revise mistakes from Qbanks (eg. write down mistakes and go over them carefully)


  • You don’t have to be extremely smart to get 250+ on Step 1 but you should study steadily and start studying early.
  • You do have to strategize carefully, choose the right books, courses and Qbanks to fit your situation. Doing multiple Q-banks can be helpful.
  • Set a realistic study schedule for yourself and don’t let others stress you out when their plan looks completely different.
  • Don’t burn out! Avoid studying more than 6 days per week.
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8 Replies to “How to score 250+ on USMLE Step 1: lessons from 10 test takers”

  1. lazaros tzelves

    Such a helpful post for newbies especially in step 1!
    The most important point though is that someone must make his own plan of studying according to his life-abilities-stamina! Don’t burn-out too early that’s gonna come later..:)
    Thanks StepsToResidency!Keep up the great work!

    • Shinji Yasugi Post author

      Thanks for the feedback. I’m glad you found the post to be helpful. I completely agree that you need to understand your own situation when planning your preparation time and method because there are just so many different ways to succeed. I hope your own preparation is going well!


    Thanks for the post it is really helpful
    i have a question one of my friends scored 217 n 215 in step 1 n step2 ck respectively
    can u let me knw the chances of getting into internal medicine residency program

    • Steps To Residency Post author

      Hello, it’s hard for me to say what your friend’s chances are just by looking at the USMLE scores. They are on the lower side compared to the average scores for non-US senior applicants who matched (per the 2014 NRMP data), but there’s just a lot more to the application process than just scores. You can direct your friend to this website if you haven’t already as I try to address how to maximize chances of matching on this website. All the best.


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