How to Actually Use First Aid for Step 1 (The Highlighting Strategy)

Everyone owns First Aid.

Almost nobody uses it correctly.

I watch students spend months "reading" First Aid. They go page by page, trying to memorize every line, every diagram, every table. They highlight everything. They annotate in the margins. They add sticky notes. They create a rainbow-colored mess.

Then they do their first UWorld block and score 35%.

All that "studying" — useless.

Here's the truth I learned the hard way: First Aid is not meant to be memorized by reading. First Aid is meant to be understood through questions, and then the memorization happens automatically.

I wasted time on one entire system trying to annotate everything, write everything down, "learn it all" before touching questions. Then I realized I was being an idiot.

I changed my approach. My students now have a 98% pass rate.

Here's exactly how to use First Aid the right way.

The Core Principle: Never Add, Only Highlight

Let me say this clearly:

If you add anything to your First Aid, you are wasting your time.

I'm not being harsh. I'm being honest.

First Aid already contains more information than you can possibly memorize. The publishers have spent years refining what goes in and what stays out. They know what's high-yield. They know what gets tested.

If something isn't in First Aid, it's because it's not important enough to be tested repeatedly.

Students think they're being smart by adding UWorld explanations to First Aid. By writing in margins. By creating elaborate annotations.

You're not being smart. You're creating more content to review that isn't high-yield.

The rule is simple:

• Find a concept in UWorld, NBME, or Mehlman that's directly from First Aid → Highlight that line in First Aid

• Find a concept that's NOT in First Aid → Don't add it. It's not high-yield enough.

That's it. Highlight what gets tested. Ignore what doesn't appear.

By the end of your preparation, your First Aid will be covered in highlights. Those highlights represent concepts that actually appear on exams. That's your rapid review material.

Why This Works

The highlighting strategy works because of one simple fact:

70% of your exam is direct First Aid content.

The same lines. The same concepts. The same wording.

When you do UWorld and find that a question tests a specific First Aid line, you highlight that line. Now you know: this is tested.

When you do NBMEs and see the same concept again, you notice it's already highlighted. Reinforcement.

When you review before your exam, you focus on highlighted sections. You're reviewing what actually gets tested, not random information.

The highlighting creates a natural spaced repetition system. You don't need Anki. You don't need flashcards. The act of highlighting during UWorld, then reviewing highlights during NBME prep, then reviewing again before the exam — that's spaced repetition built into your workflow.

The Sources That Earn Highlights

Not everything you encounter deserves a highlight in First Aid.

Highlight when you find the concept in:

1. UWorld — If a UWorld question tests a concept and that concept is directly in First Aid, highlight it. This is your primary source of highlights.

2. NBMEs — Same rule. If an NBME question tests something in First Aid, highlight it. NBME questions are created by the same people who make your real exam.

3. Mehlman Medical — If Mehlman emphasizes a concept that's in First Aid, highlight it. Mehlman knows what's high-yield.

Do NOT highlight based on:

• USMLE RX — RX questions are literally every line of First Aid. If you highlighted based on RX, you'd highlight the entire book. RX is for understanding how to read First Aid, not for identifying high-yield content.

• Your own judgment — You don't know what's high-yield. The question banks know. Trust them.

• Random online advice — "Someone on Reddit said this is high-yield" is not a valid reason to highlight.

The Practical Method: Reading First Aid During Base Building

During your system-by-system base building phase, here's exactly how to use First Aid:

Step 1: Open First Aid to the system you're studying

Let's say you're starting Renal.

Step 2: Open my PDF guidance for that system

My PDFs tell you, page by page:

• How important each page is (super important, fully important, skim)

• Which free videos help decode that page

• Key points in brackets

This eliminates guesswork. You know exactly what to focus on.

Step 3: For each page, watch the linked video first

If my PDF links a 3-minute YouTube video for a specific page, watch it first. Now the First Aid page will make sense.

The video decodes First Aid. Then you read First Aid with understanding.

Step 4: Read the First Aid page

Not memorize. Read. Understand what's there.

At this stage, you're not highlighting yet. You're building initial understanding.

Step 5: Immediately do RX questions for that subtopic

This is crucial. Don't read 50 pages then start questions. Read one subtopic, do questions for that subtopic.

Reading chromatin structure? Do the 3 RX questions on chromatin structure.

Now you understand how they test what you just read. This takes 10-12 minutes per page total.

Step 6: Move to UWorld after completing anatomy/physiology

Once you've done First Aid + RX for anatomy, physiology, and pharmacology of a system, you start UWorld for that system.

This is when the real highlighting begins.

The Highlighting Process During UWorld

Here's exactly what happens when you're doing UWorld:

Scenario 1: You get a question wrong

1. Mark/flag the question

2. Read why your answer was wrong

3. Read why the correct answer is correct

4. Read the educational objective

5. Go to First Aid and find where this concept appears

6. Highlight that specific line or section

7. Move on

You don't spend 30 minutes analyzing. You don't write paragraphs of notes. You find it in First Aid, highlight it, move on.

Scenario 2: You get a question right, but your logic was wrong

Same process. You got lucky, not smart.

1. Mark/flag it

2. Read the explanation

3. Find it in First Aid

4. Highlight it

5. Move on

Scenario 3: You get a question right with correct logic

1. Quick read of the explanation

2. Don't mark it

3. Don't highlight (you already knew it)

4. Move on

Don't waste time on what you already know. Focus energy on what you don't know.

The key insight:

You're not highlighting while reading First Aid. You're highlighting while doing UWorld.

The questions tell you what's important. Your highlights reflect tested concepts, not your assumptions about what might be important.

What Your First Aid Should Look Like

After Week 1: Almost no highlights. You're still in foundation phase doing Sketchy.

After completing 3-4 systems: Scattered highlights throughout those systems. Patterns starting to emerge.

After completing all systems: Significant highlighting across the entire book. You can see which topics get tested repeatedly.

Before your exam: Your rapid review is simple — flip through First Aid, focus on highlighted sections. These are the concepts that UWorld and NBMEs tested you on. These are what will appear on your exam.

The highlighting density also tells you which areas need more attention. Heavily highlighted section that you still get wrong? You need more review there. Lightly highlighted section? Probably not as high-yield — quick skim is enough.

Common Mistakes to Avoid

Mistake 1: Highlighting while reading (before questions)

Don't highlight during your first read-through. You don't know what's important yet. Let the questions tell you.

Mistake 2: Highlighting everything

If everything is highlighted, nothing is highlighted. Be selective. Only highlight what UWorld/NBME specifically test.

Mistake 3: Adding annotations

I see students write "Important!" or "UWorld 2024!" next to lines. Useless. The highlight itself tells you it's important. You don't need commentary.

Mistake 4: Adding information not in First Aid

If a UWorld explanation contains extra detail not in First Aid, don't add it. If it was essential, First Aid would include it.

Mistake 5: Using multiple highlight colors

Some students use yellow for "tested once," pink for "tested multiple times," green for "I keep getting wrong."

Unnecessary complexity. One color. One purpose: this was tested.

Mistake 6: Highlighting in physical book only

Keep First Aid as a PDF on your phone. Highlight in the PDF. This way, you can review anywhere — in line, on commute, during breaks.

If you also have a physical copy, that's fine. But the PDF should be your primary highlighting location for accessibility.

First Aid on Your Phone: The Command Center

Your phone should be your Step 1 command center. Here's what lives on it:

1. First Aid PDF — Your primary resource, with all highlights

2. Sketchy PDF — For quick micro/pharm review

3. Pharmacology PDF — High-yield drug review

4. Your question bank app — UWorld, Amboss, or whatever you're using

Everything accessible in your pocket.

Waiting in line? Review a highlighted First Aid page. Commuting? Skim through a system. 5-minute break? Do 2-3 questions.

When everything is on your phone, you can study without anyone knowing. No laptop needed. No "study setup" required. Just pull out your phone.

This is how you maintain consistency. This is how you study even on your worst days.

The Spaced Repetition Built Into This System

People ask me about Anki. About spaced repetition apps. About flashcard systems.

You don't need any of it.

Here's the spaced repetition already built into my system:

First exposure: Foundation phase — you learn Sketchy Micro and Pharm

Second exposure: System-by-system — you review relevant micro/pharm at the start of each system

Third exposure: UWorld — questions test these concepts, you highlight in First Aid

Fourth exposure: NBME prep — you review your highlighted First Aid before each NBME

Fifth exposure: Pre-exam — you review highlights one final time

That's five exposures to high-yield content, naturally built into the study structure. No Anki needed. No separate flashcard system.

The highlighting strategy IS your spaced repetition system.

The Review Process Before NBMEs

Before each NBME (starting with NBME 26), here's how you use your highlighted First Aid:

The day before the NBME:

1. Flip through your First Aid

2. Focus only on highlighted sections

3. For each system, spend 20-30 minutes reviewing highlights

4. Don't try to memorize — just refresh

Total time: 3-4 hours to review your entire highlighted First Aid

This is why the highlighting strategy is powerful. Your review material self-selects. You're not reviewing 900 pages of First Aid. You're reviewing the concepts that were actually tested in UWorld and previous NBMEs.

After each NBME:

1. Review your incorrects

2. Find those concepts in First Aid

3. Add more highlights if they weren't already highlighted

4. Your highlighted sections grow with each NBME

By NBME 31-33, your First Aid is a comprehensive map of high-yield content. Your final review before the real exam is focused, efficient, and targeted.

What About the NBME Review Notebook?

The highlighting strategy is for First Aid.

But you also maintain a separate notebook for NBME review (NBMEs 26-33 only, not NBME 25 or Free 120).

I'll explain the notebook system in a later post about NBME review. For now, know that:

• First Aid = highlight tested concepts

• Notebook = track patterns in your mistakes

Both work together. Neither replaces the other.

The Bottom Line

First Aid is 70% of your exam.

Your job is to identify which 70% and master it.

The highlighting strategy does exactly this. You let UWorld and NBMEs tell you what's high-yield. You mark it in First Aid. You review your marks before exams.

No adding. No annotating. No rainbow colors. No complexity.

Just systematic highlighting of tested content, followed by focused review.

Do this correctly, and First Aid transforms from an overwhelming 900-page book into a targeted, personalized rapid-review resource.

What's Next

Now you know how to use First Aid correctly.

Next, I'll show you the exact method for solving UWorld — the step-by-step process that turns question practice into actual learning.

Then we'll cover:

• How to take NBMEs offline (the 40-question method)

• How to review NBMEs and actually improve

• The 5 biggest mistakes IMGs make

• Exam day strategy

The method matters more than the resources. First Aid is only as good as how you use it.

If you want access to my page-by-page PDF guidance for every First Aid section — plus personalized mentorship through your entire journey — https://meetings-na2.hubspot.com/marish

Your highlights are waiting to be made.

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