The 5 Biggest Step 1 Mistakes IMGs Make (And How to Avoid Them)

BLOG 8: The 5 Biggest Step 1 Mistakes IMGs Make (And How to Avoid Them)

Author: Dr. Marish Asudani Category: USMLE Step 1 URL slug: biggest-usmle-step-1-mistakes-imgs SEO Title: The 5 Biggest USMLE Step 1 Mistakes IMGs Make (Avoid These) Meta Description: These mistakes cost IMGs months of wasted time and failed attempts. The 5 critical errors I see constantly and exactly how to avoid each one. From a mentor with 98% pass rate.

I've mentored over 100 students through Step 1.

I've seen students with average intelligence pass on their first attempt. I've seen students who seemed brilliant fail multiple times.

The difference wasn't IQ. It wasn't resources. It wasn't luck.

The difference was mistakes.

Specific, avoidable mistakes that cost months of time, thousands of dollars, and sometimes entire careers.

I'm going to share the 5 biggest mistakes I see constantly. These are the errors that make me want to pull my hair out because I've warned students about them hundreds of times, yet they keep happening.

If you avoid these 5 mistakes, you dramatically increase your chances of passing. If you make even one of them, you're putting your entire journey at risk.

Mistake #1: Reading First Aid Without Doing MCQs

This is the biggest mistake. The most common. The most devastating.

What students do:

They buy First Aid. They buy Boards and Beyond. They buy Pathoma. They buy Kaplan.

They spend 3-4 months watching videos. Reading First Aid page by page. Trying to memorize every line, every diagram, every table.

They're afraid to start UWorld. They think they "don't know enough yet." They want to "learn everything first" before "testing themselves."

So they keep watching. Keep reading. Keep highlighting random things. Keep feeling like they're making progress.

Then, finally, after 4 months, they start UWorld.

They score 30%.

Panic.

They realize they don't remember anything from those months of videos. They don't understand how questions work. They wasted 4 months.

Why this is wrong:

First Aid is not meant to be memorized by reading.

You cannot understand what's important in First Aid until you see how it gets tested. The lines all look the same on the page. But some are tested constantly, others rarely.

Only MCQs reveal which is which.

Without doing questions, you have no idea what to focus on. You're trying to memorize 900 pages equally when only 70% of it matters for the exam.

The fix:

Yes, read First Aid for a system. Take 1.5-2 days. Understand the concepts.

Then IMMEDIATELY start MCQs.

Use RX while reading to understand how each page gets tested. Then do UWorld for that system. Let the questions teach you what's important.

The memorization happens automatically when you review MCQs through First Aid. You highlight what gets tested. You see patterns. The important stuff sticks because you've applied it.

Don't wait until you've "learned everything" to start questions. The questions ARE how you learn.

Mistake #2: Not Completing 100% of UWorld Per System

What students do:

They start a system. They do 100 UWorld questions. They're scoring 55%. They think, "I get it now."

They move to the next system. They leave 150 questions undone, planning to "finish them later."

This happens with every system. By the end, they have 800 UWorld questions scattered across all systems that they "saved for later."

They never do them. Or they do them randomly during dedicated, completely out of context.

Why this is wrong:

You cannot say you've completed a system until you've done 100% of UWorld questions for that system.

Those "leftover" questions contain concepts you haven't seen. Patterns you haven't recognized. Gaps you don't know exist.

When you leave questions for later, you never do them properly. You do them out of context, after you've forgotten the system, and they teach you nothing.

The fix:

Complete 100% of UWorld questions for each system before moving on.

No exceptions. No "I'll finish later." No "I've done enough."

All questions. Then move on.

If you're scoring below 60% on your final blocks, don't move on yet. Watch Mehlman. Strengthen the system. Get above 60%. Then complete remaining questions. Then move on.

Mistake #3: Wasting NBMEs by Taking Them Too Early

What students do:

They finish reading First Aid once (without proper UWorld integration).

They think, "Let me see where I stand."

They take NBME 26. Score 45%.

Panic. They take NBME 27 to "see if it was a fluke." Score 48%.

More panic. They take NBME 28. Score 50%.

Now they've burned three NBMEs with almost no improvement, and they have severe test anxiety.

Or worse — they take the latest, most predictive NBMEs (31, 32, 33) early because they want to "see real exam questions." Now their best assessment tools are wasted.

Why this is wrong:

NBMEs are not just assessment tools. They're a Qbank of their own — roughly 1,800 questions total.

Every NBME you take is questions you can never see fresh again. Once you've done NBME 26, those 200 questions are burned. You know the answers. You can't truly reassess with them.

Taking NBMEs before you've completed First Aid + UWorld is wasteful. You're using limited, valuable questions to confirm what you already know: that you're not ready.

Taking the latest NBMEs early is even worse. NBME 31, 32, 33 are the most predictive of your actual exam. They should be your final assessments, not your first.

The fix:

Only start NBMEs after completing First Aid + UWorld once for all systems.

This gives you a real baseline. You've done the work. Now you're assessing whether it stuck.

Take NBMEs in chronological order: 26, 27, 28, 29, 30, 31, 32, 33.

Save 31, 32, 33 for your final weeks. They're most similar to the real exam. Don't waste them when you're still building your foundation.

If you score below 62% on two consecutive NBMEs, STOP. Don't burn more NBMEs. Go back to content review. Fix the foundation. Then resume.

Mistake #4: Exhausting NBMEs Online

What students do:

They take every NBME online through the official NBME website.

They do 50 questions per block. They have 1 hour 15 minutes per block. They finish with time to spare. They feel good about their pacing.

They take NBME after NBME online, scoring 65%, 67%, 70%.

They walk into the real exam confident.

40 questions per block. 60 minutes per block. Different rhythm. More pressure.

They run out of time. They guess on questions. They panic.

They fail.

Why this is wrong:

The online NBME format does not match the real exam.

Online: 50 questions, 75 minutes per block Real exam: 40 questions, 60 minutes per block

The math looks the same (1.5 min/question), but the experience is completely different.

With 75 minutes, you feel like you have time. You can spend 3 minutes on a hard question and recover.

With 60 minutes, every second matters. One hard question throws off your rhythm.

Students who practice online develop a false sense of security. They've never experienced real exam timing. When they face it, they crumble.

I've seen students scoring 72% on online NBMEs fail the real exam because of timing. They had the knowledge. They didn't have the skill.

The fix:

Always take NBMEs offline.

Download the PDFs from Telegram or use the IMD app.

Convert 4 blocks of 50 into 5 blocks of 40 (I explained exactly how in Blog 6).

Practice with 60 minutes per block. Use the two-pass method. Train yourself to have 10-15 minutes remaining after first pass.

This is how you build real exam stamina. This is how you avoid timing disasters on test day.

Mistake #5: Taking NBMEs Online (Yes, This Deserves Two Spots)

This mistake is so critical, so common, and so devastating that I'm emphasizing it again with additional detail.

The deeper problem:

When you do NBMEs online, you're not just practicing wrong timing. You're building wrong instincts.

You're training your brain that 50 questions with 75 minutes is "the NBME experience." Your pacing instincts, your stress responses, your break rhythms — all calibrated to the wrong format.

On exam day, everything feels wrong. The blocks feel shorter. The questions feel rushed. Your instincts are screaming that something is off.

That cognitive dissonance alone can tank your performance.

The students who fail despite high NBME scores:

Almost universally, they took NBMEs online.

They had the knowledge (high scores). They had the wrong training (online format). They couldn't translate knowledge into performance under real conditions.

The students who pass despite lower NBME scores:

Almost universally, they took NBMEs offline with 40 questions per block.

They built correct instincts. They knew exactly what exam day would feel like. No surprises. No dissonance.

The absolute fix:

Never. Take. NBMEs. Online.

I don't care if it's "easier." I don't care if it "feels more official." I don't care if you "want to see the interface."

The interface doesn't matter. The timing matters. The rhythm matters. The stamina matters.

Offline. 40 questions. 60 minutes. Two-pass method. 10-15 minutes remaining.

Every single NBME. No exceptions.

Bonus Mistakes That Deserve Mention

While those 5 are the biggest, here are a few more I see regularly:

Choosing multiple mentors:

Students pay me for mentorship, then also follow advice from another mentor, their senior, Reddit posts, and YouTube gurus.

Different mentors have different approaches. When you follow multiple conflicting strategies, you follow none of them effectively.

Choose one mentor. One system. One approach. Commit fully.

Not reviewing NBMEs same-day:

Taking an NBME and reviewing it 3 days later is almost useless. You don't remember your reasoning. You can't diagnose your specific errors.

Same-day review or next morning at latest. No exceptions.

Skipping the pre-NBME push:

Going straight from base building to NBME 26 without consolidation is a mistake.

The 7-10 day pre-NBME push (Sketchy review, pharma review, system consolidation, NBME 25 blocks) prepares you for assessment. Don't skip it.

Studying only on certain days:

"I'll take weekends off." "I need a day to reset."

You're resetting your momentum. Every day you skip, you start from zero the next day.

Study something every day. Even if it's just 30 minutes on your worst day. Momentum compounds. Breaks destroy.

The Pattern Behind All Mistakes

Notice what all these mistakes have in common:

They're all shortcuts that feel productive but aren't.

• Reading without MCQs feels like studying but isn't learning.

• Leaving UWorld questions feels like moving forward but leaves gaps.

• Taking NBMEs early feels like assessing but wastes resources.

• Doing NBMEs online feels like practice but builds wrong instincts.

Real progress is uncomfortable. Real progress means doing MCQs when you feel unprepared. Completing every question even when you're tired. Taking NBMEs offline even when it's harder.

The easy path leads to failure. The systematic path leads to passing.

What Happens When You Avoid These Mistakes

When you follow the correct system:

• You start MCQs immediately, learning through application

• You complete 100% of UWorld per system, leaving no gaps

• You take NBMEs only after proper preparation

• You save the best NBMEs for final assessment

• You train with real exam timing

Your NBME 26 score is 63-68% (not 45-50%). Your progression is steady (not erratic). Your exam day is familiar (not shocking). Your result is passing (not failing).

These aren't complicated changes. They're simple discipline. But they separate students who pass from students who fail.

What's Next

You now know the 5 biggest mistakes to avoid.

But even with perfect execution, some students hit plateaus. Their NBME scores stop improving. They feel stuck.

In the next blog, I'll show you exactly what to do when scores plateau — the resources to use, the strategies to implement, and how to break through when you feel stuck.

Then we'll cover the final piece: exam day strategy — from the day before to the moment you walk out.

If you're making any of these mistakes right now, stop. Reset. Fix your approach before you waste more time.

If you want personalized guidance to ensure you're not falling into these traps — https://meetings-na2.hubspot.com/marish

Your mistakes are costing you time. Let's eliminate them.

Dr. Marish Asudani Co-Founder, P2A Consultancy PGY-1 Internal Medicine | USMLE Mentor