How to Create Your USMLE Step 1 Study Timeline (The 16-20 Week Blueprint)

Marish Asudani
Jan 19
8 min read

Everyone wants a study schedule.

They want someone to tell them: do this on Monday, do that on Tuesday, take a break on Sunday.

That's not how this works.

What I'm going to give you is something better — a framework. A phase-by-phase breakdown that adapts to your situation while keeping you on the fastest possible path to passing Step 1.

I completed all three USMLE Steps in under 11 months of cumulative preparation. I've helped over 100 students do the same. Students working full-time during internship. Students with children who only had 4-5 hours a day. Students who had wasted months with other approaches before finding me.

All of them followed this timeline. All of them passed.

Here's the exact breakdown.

Before We Start: The Non-Negotiables

Minimum time commitment: 6 hours per day.

I need to be brutally honest with you. If you cannot commit 5-6 hours daily, do not start. You will waste your time, waste your resources, and set yourself up for failure.

I've had students complete this in 4 months with 5-6 hours a day during internship. I've had students complete it in 3 months with more time available. The timeline I'm giving you — 16 to 20 weeks — assumes 5-6 focused hours daily.

If you have more time, you'll finish faster. If you have less time, this is not for you. Come back when your schedule opens up.

Total timeline: 16-20 weeks, broken into three phases.

Phase 1: Foundation (Days 1-10)
Phase 2: Base Building (Weeks 2-14)
Phase 3: Acceleration / Dedicated (Weeks 14-20)

Let's break down each one.

Phase 1: Foundation Forming (Days 1-10)

This is where everyone else wastes months. You're going to do it in 10 days.

Days 1-5: Sketchy Micro

Your first five days are dedicated to microbiology through Sketchy.

Here's the method:

Watch 5 Sketchy videos
Read the Sketchy PDF for those 5 videos
Repeat

That's it. Watch 5, read the PDF. Watch 5 more, read the PDF. Continue this cycle.

By day 5, you will have completed all of Sketchy Micro.

I know what you're thinking: "That's impossible." It's not. I've done it. My students have done it. Some complete it in 4 days.

The Sketchy PDF will be available in my resources. It condenses everything into a reviewable format that reinforces what you watched.

Days 6-10: Pharmacology

Same approach, different content.

I have a high-yield pharmacology PDF that tells you exactly which topics to cover and in what order. Some topics you'll cover through Sketchy Pharm, others through Osmosis — it's all specified in the PDF.

Follow it exactly. Complete pharmacology in the next 4-5 days.

What you've accomplished:

By day 10, you've completed an entire chunk of microbiology and pharmacology. You now have a foundation that most students take 2-3 months to build.

This is spaced repetition starting from day 1. Everything you learn in these 10 days will be reinforced throughout your system-by-system studying because each system connects back to micro and pharm.

Phase 2: Base Building (Weeks 2-14)

This is where the real work happens. You're going to complete all systems — First Aid plus UWorld — in approximately 12 weeks.

There are 13 systems. At roughly 6-7 days per system, that's approximately 90 days, which is 12-13 weeks.

The System Order:

This order is not random. I've designed it to build confidence and create logical connections between topics.

Renal (7 days)
Pulmonary (6-7 days)
ANS + Neurology (10 days)
Psychiatry (6-7 days)
MSK (6-7 days)
Dermatology (2-3 days)
Biochemistry (included strategically)
Immunology
Hematology
Endocrine + Reproductive together (12-14 days)
GIT + Cardiovascular (18-20 days)
Biostats and Ethics (final stretch)

Why this order?

Because it builds confidence and removes friction.

When you do Psychiatry, you'll encounter Neuro questions. But you've already done Neuro — no problem.

When you do Hematology, there will be Biochem and Immunology questions. But you've already done those — no friction.

Before Endocrine, you'll do Biochem metabolism of lipids and carbs. This makes Endocrine click.

I'm removing every possible obstacle before you encounter it. That's how you maintain momentum.

The 6-Step Process for Each System:

Every single system follows the same framework:

Step 1: Relevant Microbiology

Open the yellow micro image (provided in resources). Find the microorganisms relevant to that system. Review them.

For Renal, that's E. coli, Staph, Proteus, Klebsiella. Takes 15-20 minutes. This is spaced repetition — you learned these in Phase 1, now you're reinforcing.

Step 2: Relevant Pharmacology

Open the Pharma PDF. Go to that system's section. Review the relevant drugs.

For Renal, that's loop diuretics, thiazides, spironolactone. Then open First Aid and review the pharmacology section for that system.

Another 15-20 minutes. More spaced repetition.

Step 3: Read First Aid with PDF Guidance

This is critical. You don't just "read First Aid." You read it with my page-by-page PDF guidance.

For every page of First Aid, my PDF tells you:

How important it is (super important, fully important, skim)
Which free videos to watch for that page (YouTube, free B&B, Mehlman, etc.)
Key points in brackets

You watch the linked video (usually 2-5 minutes), then read the First Aid page. Now it makes sense. Now it sticks.

This takes roughly 10-12 minutes per page. For anatomy and physiology of a system, that's 1.5-2 days.

Step 4: Solve USMLE RX Topic by Topic While Reading

As you read each First Aid subtopic, you solve RX questions for that subtopic.

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

RX is organized exactly like First Aid. You go to High Yield Topics → Select the system → Select the subtopic → Solve.

This takes 10-12 minutes per page including questions. But now you understand HOW they test what you just read.

RX eases you into the question style before UWorld difficulty hits.

Pro tip: You can get RX free trials using temporary email services. Create a temp email, sign up, get 5-7 days free. Rotate as needed.

Step 5: Solve UWorld Blocks

Now you're ready for the gold standard.

Once you've completed First Aid anatomy, physiology, and pharmacology for a system with RX support, you move to UWorld.

Tutor mode
Unused (or All)
Select the system
Start solving

Your first blocks will be rough. I started Renal at 45%. I started CNS at 35-38%. That's normal. You are not supposed to know everything yet.

UWorld is a learning tool, not an assessment tool at this stage.

The goal: By your last 2 blocks of that system, you should be scoring above 60%. If you're not, you need more reinforcement before moving on.

I'll explain the exact UWorld solving method in a separate post. For now, know that you're solving 40-50 questions daily and reviewing them.

Step 6: Watch Mehlman if Final Blocks Are Below 60%

Mehlman Medical videos are your safety net.

If you've done everything and your last 2 blocks of a system are still below 60%, watch the Mehlman videos for that system.

You don't need Mehlman for every system. Only when you're stuck.

Timeline per system:

These are relaxed timelines. Most students finish faster.

Renal: 7 days (can be done in 5-6)
Pulmonary: 6-7 days
ANS + Neuro: 10 days (should be 8-9)
Psychiatry: 6-7 days (very lenient)
MSK: 6-7 days (very lenient)
Dermatology: 2-3 days (I did it in 2-2.5 days during internship)
Endocrine + Reproductive: 12-14 days
GIT + Cardiovascular: 18-20 days

Decision point after each system:

If your last 2 blocks are 60%+ → Move on.

If your last 2 blocks are below 60% → Pause. Watch Mehlman. Don't move on until you're above 60%.

Momentum matters, but don't move on without understanding the system.

Phase 3: Acceleration / Dedicated (Weeks 14-20)

You've completed First Aid and UWorld once for all systems. Now it's time to consolidate, assess, and prepare for the real thing.

The Pre-NBME Push (Days 1-10 of this phase):

This is a 7-10 day period where you consolidate everything.

Daily structure:

Morning (2-3 hours):

Sketchy review: Complete 1 micro system (Gram positives, RNA viruses, etc.) by watching on 2x or reading highlighted PDF — 1-2 hours
Pharma PDF: 2 pages per day — 30-60 minutes

Afternoon (4-5 hours):

One BIG system from First Aid (Hematology, Neurology, Respiratory, etc.)
Focus on highlighted sections only — you highlighted throughout Phase 2, now you're reviewing those highlights
Complete one big system before dinner

Evening (2-3 hours):

One SMALL system (Immunology, Psychiatry, Dermatology)
Lighter review to end the day

Simultaneously: NBME 25 blocks

Starting Day 6 of this phase, you do ONE block of NBME 25 daily.

NBME 25 is your acclimation NBME. You're not taking it as a full exam. You're doing one block (40 questions) per day to get used to NBME style before your first real assessment.

By Day 10, you've:

Revised all of Sketchy
Revised all of Pharma
Revised all systems through First Aid highlights
Done 4-5 blocks of NBME 25

You're ready for your first real NBME.

Day 10: NBME 26 (Your First Full Assessment)

NBME 26 is your baseline. This is where you find out where you actually stand.

Take it as 5 blocks of 40 questions each (I'll explain the offline method in a separate post). Simulate real exam conditions.

Interpreting your NBME 26 score:

65%+ (130+ correct): You're on track. You can book your exam for 5 weeks out.
58-64%: You're close but need reinforcement. Focus on weak systems.
Below 55%: Something went wrong. You didn't follow the system correctly. Reach out for personalized help.

If you've done everything I asked in the timelines I gave, you will not score below 60%. It has never happened with any of my students who followed the system.

Weeks 15-20: NBME Progression

From here, you're taking NBMEs strategically while continuing to strengthen weak areas.

Give NBMEs in chronological order (26, 27, 28, 29, 30, 31, 32, 33)
Save the latest ones (31, 32, 33) for the final weeks — they're most predictive
If 2 consecutive NBMEs are below 62%, stop. Do more UWorld. Solidify your knowledge. Don't waste NBMEs.

The 68% Mark:

68% on an NBME translates to approximately passing.

Once you hit 68% on two consecutive NBMEs with 10-15 minutes remaining per block, you're ready.

Final Week: The Simulation

7-8 days before your exam:

NBME 31 (4 blocks) + Free 120 (3 blocks) = 7-block simulation
This simulates the real exam exactly

If you cross 135 correct on NBME 31 and 68% on Free 120, you're ready.

After Free 120, go through Divine Intervention's Rapid Review Free 120 series. It gives insight into the question creator's thinking.

Resources to Use When Scores Plateau

If you're stuck and scores aren't improving:

Mehlman Medical videos — for weak systems
Divine Intervention podcast — high-yield topics
Neil Randy videos — specific concept reinforcement
Amboss 200 Questions Asked in Every Step Exam — finds your weak subtopics
Amboss Risk Factors — do before exam
Amboss 5 questions/day — 30 days before exam = 150 high-yield questions

If you've tried all of this and you're still stuck, reach out. I always have a solution.

The Complete Timeline Summary

Days 1-10: Foundation (Sketchy Micro + Pharma)

Weeks 2-14: Base Building (13 systems, First Aid + UWorld, 6-7 days per system)

Week 14: Pre-NBME consolidation (7-10 days of revision + NBME 25 blocks)

Week 15: First NBME (NBME 26 baseline)

Weeks 15-19: NBME progression + weakness targeting

Week 20: Final simulation (NBME 31 + Free 120) + exam

What's Next

This was the timeline framework. Now you know WHAT to do and WHEN to do it.

In the next posts, I'll break down:

The only resources you actually need (and which to avoid)
How to use First Aid the right way (highlighting strategy)
The exact UWorld solving method
How to take NBMEs offline (the 40-question method)
How to review NBMEs and actually improve

This timeline works. Trust the process.

If you want personalized guidance through this entire journey — someone tracking your progress, adjusting your schedule, answering your questions daily — [https://meetings-na2.hubspot.com/marish].

Let's get you to that passing score.

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