What is USMLE Step 1? The Complete Beginner's Guide for IMGs

Let me be real with you.

USMLE Step 1 is not about knowledge.

Yes, you read that correctly. Step 1 is not primarily about how much you know. It's about having the correct strategies and, most importantly, having the right mindset.

I'm Dr. Marish Asudani. I completed all three USMLE Steps in under 11 months of cumulative preparation. I scored 254 on Step 2 CK and 230 on Step 3 with only 3.5 weeks of prep. I've mentored over 100 students through this journey, with a 98% Step 1 pass rate.

I'm not a guru. I don't pretend to be one. I'm not going to tell you to wake up and meditate every morning or give you some motivation hack. That's not how I work.

I teach what actually works. Systems that are battle-tested. Strategies that have helped students who were working full-time, students with children, students who had failed before — all of them passed using the exact methods I'm about to share with you.

But before we get into any of that, you need to understand what Step 1 actually is and what mindset you need to approach it with.

What is USMLE Step 1?

USMLE Step 1 is the first of three exams in the United States Medical Licensing Examination series. It tests your understanding of basic science concepts and their application to clinical scenarios.

For International Medical Graduates, Step 1 is your entry ticket into the U.S. medical system. Without it, you cannot apply for residency. Period.

The exam is now Pass/Fail (as of January 2022), which means you don't get a three-digit score anymore. You either pass or you don't.

Some people think this makes it easier. They're wrong.

Here's why: Programs can no longer differentiate candidates based on Step 1 scores. This means everything else on your application matters more — your clinical experience, your Step 2 CK score, your personal statement, your interviews. But none of that matters if you fail Step 1.

A Step 1 failure is devastating. You either need to be a citizen, have contacts, or set up multiple application cycles. Programs check ERAS and Residency Explorer — they can see attempts. Many programs simply don't interview candidates with a failed attempt.

So yes, it's Pass/Fail. But failing is not an option.

The Reality of This Journey

You're about to embark on 16 to 20 weeks of focused preparation.

Let me be very clear about what "focused" means.

When you're sitting to study, you need to be laser focused. If you have five to six hours a day, you need to use every minute of those five to six hours. Laser focus during study time, then enjoy the rest of your day.

I studied for Step 1 throughout my internship. I had small pockets of hyper-focus throughout my day. Every 15 to 30 minutes, I would look at my phone and focus intensely on a question or whatever I was studying, then switch back to my internship work.

The exact timeline depends on your daily commitment. 16 to 20 weeks is realistic if you have 5 to 6 hours a day to study. If you have a lenient internship or dedicated study time, you can do it.

But let me be honest: if you only have 1 to 2 hours a day, this is not for you. Close this page. Come back when you can commit real time.

If you have anywhere close to 5 to 6 hours a day, you can do this.

Your Life Must Become Step 1

For the next 16 to 20 weeks, you cannot separate your life from Step 1.

If you're really serious about this, you need to understand that your highest priority in life right now is your Step 1 journey. Everything blends together.

Going out? Step 1 comes with you. At your internship? Step 1 is on your phone. Going on a date? Step 1 is in the back of your mind. With family? Step 1 is still priority number one.

It should become a part of who you are.

People will look at you like you're crazy. They looked at me like I was crazy too. And you know what? You are being a little crazy. But I'll help you tune the crazy down so people don't call you out, even though you're being one.

You Will Question Everything

There will be days where you question everything.

I questioned my decisions once every 20 days. I was doing something nobody around me had done before. I had a timeline of roughly 4 months. I had to attend two friends' siblings' weddings, and I needed to be done before that.

So I had to do things in a very unconventional way.

Every 20 days, I would think: Am I doing the right thing? Is this right? Is this how it's supposed to be?

After helping over 100 students achieve what I achieved, I now know this is the best way. This is the most efficient way. No matter what situation you're in, no matter what stage of preparation, no matter what your knowledge base — this works.

When you question yourself or question my advice, understand that it's normal. All you need to do is trust it and go for it.

The Most Important Decision: Choose One Mentor

I cannot stress this enough.

I've had students pay me north of $1,500 for mentorship. I'm with them day in and day out on WhatsApp, helping them figure things out.

And then they go and choose a different mentor. Maybe that mentor is closer to them, or they had paid them before paying me.

Here's what happens: if you have two different mentors, you have two different approaches. I'm not saying the other mentor is an idiot. What I'm saying is if you're confused by advice from two different people, you won't achieve anything.

Too many cooks spoil the dish.

A recent student joined my program scoring in the 60s on NBMEs with 40 days until her exam. I told her: listen to me for the next 40 days, update me daily, and your chances of passing will be 99%.

She listened for three days. Then she told me she had another mentor nearby and wanted to follow their advice for a week.

That mentor gave her different strategies — wrong strategies for timing NBMEs, for pacing questions. She went to the exam, got flabbergasted, and failed. A student scoring above 70% on NBMEs failed because she followed two different approaches.

Choose one mentor. Commit fully. Do not tiptoe around.

The Core Philosophy

This is not some guru knowledge I'm giving you.

The core philosophy is simple: you need confidence in your abilities. Confidence comes from preparation. Preparation comes from consistency.

Consistency leads to confidence. Confidence leads to calmness during the exam. Calmness comes from knowing you've prepared, knowing you're confident in your approaches.

That only comes from consistently, repeatedly doing what I ask you to do.

The Non-Negotiable Rule

You could be dying, and I don't care.

You could be on your deathbed with Step 1 in a week, and you still need to open your phone and study something that day.

I do not care what's happening in your life. If you're committed to this, you can spare one hour every single day to do something related to Step 1.

This is like wanting a six-pack but saying you don't have time for the gym. That person doesn't really want a six-pack — they just wish they had one.

If you really want to get this done in 16 to 20 weeks, you need at least one hour a day. Even on your worst day.

Going to a wedding? Solve 20 questions on your phone. Traveling somewhere? Watch Sketchy videos on your phone. Out with friends? First Aid is right there on your phone. Celebrating a family event? Same thing.

Your phone becomes your Step 1 command center. First Aid PDF lives on your phone. Sketchy PDF lives on your phone. Pharmacology PDF lives on your phone. Your question bank lives on your phone.

If everything is on your phone, nobody questions you. You're just "on your phone." Nobody needs to know you're studying. You don't attract unwanted attention.

The Mindset Shift You Must Make

Stop saying: "I'll take a break from studying this weekend." Stop saying: "Maybe I need a day off."

Here's what happens when you take a two-day break:

You and I both study Sunday through Friday. On Saturday, you think you need a break. You take Saturday and Sunday off. You start again Monday.

I think: "I need to study one or two hours on the weekend so my consistency doesn't drop and my momentum doesn't break." I study Saturday and Sunday.

When you start Monday, you're starting from zero. Any day you miss, your brain resets.

You might think you need a break. You might think you need a reset. That's not what you should do.

You should take mental breaks throughout the day — I'll teach you how. But you should never take full days off that reset your momentum.

If you're thinking "I'll study when I get home" or "I'll study when I have my desk set up" — those are thoughts of people who won't get their exam done in 16 to 20 weeks.

MCQs should become second nature. In a car ride? Phone open, solving questions. Free moment? Can I open UWorld and do a question?

Make it as natural as breathing.

The One Thing You Must Understand Before Starting

Here's what I wish someone told me before I started:

First Aid is the ultimate resource for all Steps — Step 1, Step 2, and Step 3.

The better you understand and learn First Aid, the easier all steps become.

The lines of First Aid are literally 70% of the exam.

But here's the critical mistake everyone makes: they try to memorize First Aid without understanding it, without using MCQs to apply the knowledge.

They watch Boards and Beyond. They watch Pathoma. They watch Kaplan. They read First Aid for months on end. They're afraid to start UWorld. They don't know how to start UWorld. They waste enormous amounts of time.

I made this mistake too. I learned from it.

Here's the truth: without doing MCQs, reading First Aid is useless. You can read and understand a system in 1.5 to 2 days, but then you must immediately start MCQs.

Only through application of First Aid knowledge will you understand what, why, and how First Aid is important. Then automatically, while reviewing MCQs through First Aid, you start memorizing it naturally.

The best resources to decode First Aid:

• UWorld (gold standard)

• Amboss (for specific things like the "200 Questions Asked in Every Step Exam")

• Page-by-page PDF guidance linking the best free videos for each topic

Don't try to memorize. Apply, understand, and the memorization happens automatically.

What's Next

This was the mindset foundation. Without this, nothing else matters.

In the next posts, I'll break down:

• The exact 16-20 week timeline

• Which resources to use and which to avoid

• How to actually use First Aid (the highlighting strategy)

• How to solve UWorld the right way

• How to take and review NBMEs

• The biggest mistakes to avoid

• What to do when your score plateaus

• Exam day strategy

If you're serious about this journey, follow along.

And if you want personalized guidance — someone who will be with you day in and day out, who has helped over 100 students pass with a 98% success rate — [https://meetings-na2.hubspot.com/marish].

This is not a sprint. It's a 16-20 week marathon that will change your life.

Let's get it done.

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