Use an efficient strategy to prepare for the USMLE Step 1 or COMLEX Level 1 exam. This guide breaks down a proven 10,000-question approach to help you succeed.
How Many Questions to Do
Practice questions are the cornerstone of effective board exam preparation. Doing enough questions ensures you gain exposure to diverse question styles and topics, identify knowledge gaps, solidify key concepts, and build test-taking stamina and time management skills.
I took the USMLE Step 1 and COMLEX Level 1 when these exams were scored (before the switch to pass/fail scoring), but my recommendation is still the same. You need to complete 10,000 questions by the time you take Level 1/Step 1. Around 5,000 of them should be completed during a dedicated studying period before the exam (meaning the other 5,000 are done throughout the year leading up to the exam).
How to Tackle 5,000 Questions During Dedicated
Plan Your Study Schedule
The length of the dedicated period for the USMLE or COMLEX will depend on how many questions you can realistically finish and review within a day. Assuming a 40-question set takes an hour to complete and an hour to review, you can complete and review four sets in a full-time studying day if you have 8 hours to study. This will be 160 daily questions, so it would take 4-5 weeks to get through 5,000 questions. You can do the math if you think you can complete more than four sets in a day or if you prefer to do less and reserve a few hours a day for other types of review like Anki or a video-based review resource (e.g., Sketchy, Boards and Beyond, OnlineMedEd).
5,000 Questions Before Your Dedicated Period
Integrate Questions Into Your Coursework
When thinking about the 5,000 questions you want to finish outside the dedicated studying period that will take you to 10,000 total questions, you should split this up over a year. Do this alongside your second-year courses (e.g., the cardiology questions during that course to help you study for the cardiology exam). As you go through the year, you want to focus on the subject your school is covering while incorporating some review questions from previous blocks to retain some content knowledge. Anki works well for this, too. I wouldn't recommend working ahead by doing questions from future blocks because you don’t have the foundation to approach those questions well. I share more of my approach to studying during the school year here.
Why You Should Avoid Redoing Questions
I don’t recommend redoing any questions. Some people like to do a second pass through questions with incorrect answers. However, I think it’s worth your time to do unique practice questions that may phrase questions and answers differently. You don’t want to waste your time getting practice questions correct just from pattern recognition or remembering what an answer was. If you want to work on recall like that, use Anki and save your practice question sets to see things presented differently.
What the Pass/Fail Scoring Means Moving Forward
Pass/fail scoring does not mean you don’t have to study as hard as students have in the past. The rigor of the test is still there. There were students each year who did well in their classes and still failed their board exam(s) even with the motivation of a three-digit score. I would argue that the consequences will be greater with a board failure because it shows residency programs that you underestimated the test and chose not to study as hard.Â
Think of Level 1/Step 1 as practice for Level 2/Step 2, which will be used to compare you to your peers with an objective score. The percentile you get during your Level 1/Step 1 studying will likely reflect where you stand for Level 2/Step 2. Start working now on good habits to enable success next year. You can learn what works well for you and what doesn’t so that you enter the Step 2/Level 2 season with confidence. You will never 100% know you will pass, so put in the work now so you don’t have to put in the enormous amount of work needed to bounce back from a failure.
Tips for Success on the USMLE or COMLEX
Consistency is Key: Spread your 10,000 questions over time to avoid burnout.
Learn What Works for You: Use Step 1/Level 1 prep to refine your study strategies for Step 2/Level 2.
Stay Focused: Treat preparation for these exams as a marathon, not a sprint.
FAQs About Preparing for USMLE Step 1 and COMLEX Level 1 During Dedicated
Why should I aim for 10,000 questions?
10,000 questions give you comprehensive exposure to topics, build stamina, and improve test-taking skills. It’s a proven method to ensure you’re well-prepared.
How do I fit 5,000 questions into my dedicated study period?
Set aside 4–5 weeks and aim for 160 questions daily. Adjust based on your study pace and include time for reviewing incorrect answers.
Should I redo practice questions?
No. Focus on unique questions with different styles and phrasings. Use Anki to reinforce recall instead of redoing the same sets.
Does the pass/fail format mean I don’t need to study as hard?
No! The test’s rigor hasn’t changed, and a failure can have significant consequences for your residency application.
What question bank should I use?
I recommend using TrueLearn (check out this blog post to get a discount on your subscription), but there are many others to choose from. I find it helpful to purchase two question banks.
How can I use other resources alongside practice questions?
Incorporate video-based resources (e.g., Sketchy, B&B) for deeper understanding, and use Anki for spaced repetition of key facts.
Happy studying! You got this!