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Discussion Starter · #1 ·
I have graduated medical school in Finland. I was talking to one colleague who had taken his residency in USA and had very positive memories about programs. Unfortunately he has done it over ten years ago and didn't have so clear picture about USMLE. From his speeches I planned myself to do USMLE, but after reading USMLE homepage I still wanted to know more about exam I am preparing.

If those of you who have already taken step 1 could share your exam experiences.

How detailed questions were? Is it necessary to memorize for example every reactions and cycles in biochemistry. As I understood with USMLE homepages that the questions are more like clinical cases so should I ignore those little details and concentrate on clinical correlates.

Ex-USMLE Forums Staff
753 Posts
Shortly about USMLE Step 1

It's nice to have here with us and we are glad to have the first Finish member in our forums :cool:

The USMLE Step 1 Exam has significantly changed over the last decade.

It's now more of a clinical format. Where you are presented with clinical case scenarios after which you'll be asked a basic medical science question.

For example, you will be presented with a patient who's having severe chest pain with ST elevation in ECG and high cardiac enzymes. Then the question will ask you for example what pathological microscopic finding is expected in the myocardium or which part of the coronary circulation would be affected if you have inferior leads involvement or which illicit substance could have caused this presentation ....etc

So the setting is clinical but the required answer is basic. Therefore, you have to have a good clinical orientation before you attempt USMLE Step 1 yet the core knowledge is about basic medical sciences.

Likewise in biochemistry. They will for example present you with a case of Cyanide poisoning and ask you which part of the electron transport chain would be affected or they may present you with a case of B12 deficiency and they then would ask which enzyme in Fatty acid synthesis is expected to be affected or they may present you a case of starvation and then you are asked about which of glycolysis, gluconeogenesis, or glycogenolysis is affected first or last ....etc

They will not show you the Krebs Cycle and ask you to label the enzymes and products and they will not ask you to name the third enzyme in the Hexose Monophosphate Shunt for example. Such mere factual questions are disappearing from the exam.

Therefore when you read Biochemistry or any other basic medical sciences try to focus on the clinical application of the materials you are reading.

There's no point of memorizing the origin and insertion of a muscle unless it has a clinical implication and there's no point of knowing the exact details of an ultra-structural component of the cell unless it has a clinical implication and so forth.

When your friend took the exam 10 years ago. At that time there wasn't many helpful materials that are written exclusively for USMLE students nor there was the numerous excellent online question banks that are available nowadays and therefore it can be argued that USMLE prep has gone bit easier than before and this might have then led to a harder and harder level of difficulty of the exam questions.

In our Recommended Step 1 Threads List, you can find valuable information about how to prepare for the exam and what books are useful ....etc

I suggest you read those threads to get an idea.

Please feel free to ask more if you still have queries.

All the best,
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