How-to: Preparing for USMLE® Step 1 in Europe

Max Sabev

Bio: Max is a medical student from Switzerland who has taken the USMLE Step exam. Here he writes about his experience with this particular exam: how he prepared and how the day of the exam went.

January 20, 2020 |

Preparation

For medical students from Zurich like me, by the end of the 8th semester our curriculum will have covered all the preclinical subjects such as anatomy, histology, biostatistics and biochemistry as well as the clinical appearance and pathophysiology for most of the diseases from all the clinical specialties, which more or less corresponds to the subjects tested in the USMLE Step 1 examination. Taking the USMLE test any earlier than that would have required me to learn major topics from scratch and without previous knowledge and would have made the whole preparation much more time consuming. Hence my colleagues and I scheduled the exam date about 7 weeks after our final exam of the 8th semester, giving us some time to focus solely on USMLE preparation during our vacation.

The application process itself is also a rather bureaucratic process for European students and it takes at least 2 weeks until you are even able to schedule your exam date. Thus, I would recommend taking care of it at least 5 months in advance of the test day, just to be sure to get the desired test day.

There were two major resources that I, my colleagues and (according to internet forums) a lot of American medical students used in the preparation for the USMLE Step 1.

First, there is the book called “First Aid for the USMLE Step 1”, which is a very dense and concise summary covering all the topics needed for the examination, focusing mainly on high yield facts. As the word “summary” suggests, reading and understanding this book without some prior knowledge would have been very hard and time consuming.

The other resource I used was a USMLE Step 1 Question Bank. This question bank consists of about 4,000 questions which in point of their style and difficulty are very similar to the actual questions asked in the USMLE Step 1 examination and thus serve as a good way to familiarize with the question format you will face on the exam day.

I started my first two weeks of preparation by simply reading through the “First Aid” book once from beginning to end to get a good overview over the topics and maybe already trying to remember some details here and there. After two weeks, I was through the book once and started using the question bank. There I only solved the questions from one specialty at a time and looked up the knowledge gaps in the corresponding chapters of the “First Aid” book until I got through all the chapters of the book again. This took me three weeks to complete, leaving the last 2 weeks of my preparation only doing questions from the question bank, but this time, as in the USMLE, in blocks of 40 questions mixed from all the specialties, with a time limit of 1 hour to get used to the time you’ll have available to solve the questions in the exam. Ultimately, in the final days before the exam, I started doing three or four blocks of 40 questions in a row to simulate the conditions of the exam even further.

Test Day

As there are only a few certified test centers in Europe for the USMLE examinations, we had to go to Munich for our examination. We booked rooms in a motel near the test center and arrived a day before the exam. To calm down a little we went for a long walk in the Olympia park nearby as any confrontation with exam material that day would have jangled our nerves. After a rather bad and nervous sleep we went to the test center the next morning where we had to check in with our passport and scheduling permit and let our fingerprints be registered. You have to leave your snacks and all your personal belongings in a designated area before entering the examination room. Each time we wanted to enter or exit the examination room for a break or wanted to go to the bathroom, we had to have our fingerprints scanned, the pockets of our trousers checked and our whole body scanned with a metal detecting device.

The exam itself consisted of seven 60-minute blocks of 40 questions administered in one 8-hour testing session. Meaning you were not allowed to exceed 1 hour per block or else the block was automatically ended. Once a block is ended it is not possible anymore to access the questions or change your answers in this block. If you finished a block faster than in 60 minutes, the time left was added to the 1 hour of break time. If your break time is used up, the next block starts automatically. You were only allowed to leave the examination room after ending a block. Fortunately, my English was sufficient to read through the questions fast enough in order to be able to finish a block just within the time limit. I had some colleagues of mine struggling to get through all of the 40 questions within 1 hour but in the end, we all managed to pass the exam. Our scores were made available about 1 month after the examination, leaving us happy and ready to face the next step of the USMLE examination.

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