Note (2026): This article was originally written during the era when USMLE Step 1 was numerically scored. While some resources and strategies have changed, I have preserved the article as a record of my own preparation experience as an IMG.
There is one feeling that many International Medical Graduates (IMGs) experience when they first begin preparing for the USMLE:
"I have no idea what half of this is."
I still remember opening First Aid for the USMLE Step 1 for the first time. Instead of feeling motivated, I felt overwhelmed. Page after page contained concepts that had either never been taught in my medical school or had been covered only briefly.
The gap between what I had learned and what was expected for the USMLE seemed enormous.
For a while, I regretted many things. I regretted not discovering the USMLE earlier. I regretted not being more proactive during medical school. I regretted not studying harder when I had the opportunity.
Perhaps you experienced the same feelings when you started your own preparation.
Eventually, however, I realized that regret would not help me pass the exam. The reality was what it was. Instead of focusing on what I should have done years ago, I decided to focus on what I could do from that day forward.
So I developed a study plan. It may not be the perfect plan for everyone, but it helped me organize my preparation, and I hope some of these ideas can help you as well.
Phase 1: Mental preparation
Start by defining your goals and building a study plan around them.
Whether your goal is simply to pass, become competitive for residency applications, or build a stronger medical foundation, having a clear objective will make it easier to stay motivated during the long months of preparation.
Back when I started preparing, Step 1 was still numerically scored. Many IMGs dreamed of seeing a score of 240 or even 260 on their score report. While Step 1 is now pass/fail, the underlying lesson remains the same: write your goal somewhere visible and remind yourself why you started this journey in the first place.
Tip: When creating your study schedule, avoid planning more than ten hours of study per day. Also, leave one day each week for rest. Burnout is one of the most common reasons people abandon their study plans. Your free day can also be used to catch up on material you missed during the week.
Phase 2: Fill the gap
One of the biggest challenges for many IMGs is not the difficulty of the material itself, but the differences between educational systems.
When I prepared, Kaplan Lecture Notes and Kaplan Classroom Anywhere were among the most popular resources for building a solid foundation. Today, there are many alternatives available. The specific resource matters less than choosing one comprehensive resource and completing it thoroughly.
At this stage, your goal is not memorization. Your goal is understanding. Focus on learning the concepts and building a framework that will allow you to retain information later.
Tip: While reading, I recommend using the Pomodoro Technique to maintain concentration and retention. You can also enjoy a cup of coffee after a study session. Some research suggests that caffeine consumed after learning may help with memory consolidation.
Phase 3: Consolidate your memory
Once you have built a solid foundation, it is time to transition from passive learning to active learning.
Question banks become your most important resource at this stage. When I studied, UWorld was considered the gold standard, and that remains true for many students today.
Before diving deeply into question practice, take a self-assessment exam to identify your strengths and weaknesses. Then focus your review on the areas where you struggle most.
In this phase, learning occurs through repetition, pattern recognition, and exposure to high-yield concepts. Do not simply read explanations—study them until you understand why every answer choice is correct or incorrect.
Tip: Flashcards can be extremely useful for memorization. The Anki app with USMLE flashcards remains one of the most popular tools among medical students. If you are new to spaced repetition, start small—perhaps twenty cards per day—and gradually increase as you become comfortable with the workload.
Phase 4: Evaluate your knowledge and repeat the cycle
After completing a major review of the material, take a self-assessment exam such as an NBME Comprehensive Basic Science Self-Assessment (CBSSA).
The purpose of these exams is not only to estimate your performance but also to identify weaknesses that still need work.
Review your mistakes carefully. Then return to your study materials, strengthen those areas, and repeat the cycle.
Tips: Practice under realistic testing conditions whenever possible. Learning to manage your time and maintain concentration throughout a long exam is almost as important as mastering the content itself.
Although pacing is important, avoid constantly watching the clock. Instead, use a few predetermined checkpoints throughout the block to ensure that you are progressing at an appropriate speed.
Bonus: Additional resources
Over the years, many supplementary resources have become popular among IMGs preparing for Step 1. Some of the resources that helped students during my preparation era included:
Anatomy
- Mavrych. Anatomy Shelf Notes: 100 Cases Anatomy For USMLE Step 1
Biochemistry
- Biochemistry Lippincott's Q&A. gWhiz
Pathology
- Sattar, Hussain A. Pathoma: Fundamentals of Pathology online videos + Goljan, Edward F. Rapid Review Pathology
- Rubin's Pathology Q&A Review. gWhiz
Microbiology
Pharmacology
Physiology
- Costanzo, Linda S. BRS Physiology
Ethics
- Fischer, Conrad. Kaplan Medical USMLE Medical Ethics: The 100 Cases You are Most Likely to See on the Test
Final thoughts
The USMLE journey can feel intimidating, especially when you are studying far from the educational system where the exam was designed.
Many IMGs begin their preparation feeling that they are already behind. I certainly felt that way.
The good news is that thousands of IMGs have successfully walked this path before us. Progress rarely comes in dramatic leaps. Most of the time it comes from showing up every day, studying one more chapter, answering one more block of questions, and slowly closing the gap.
If you are currently preparing for the USMLE, I wish you the very best of luck. Feel free to share your own experiences and study strategies in the comments below.