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The 16-Week Step 1 Plan

Four phases · Foundation → Systems → Revision → NBMEs · screenshot any tab

By Dr. Marish Asudani · Published · Updated

What is a 16-week study plan for USMLE Step 1?

A 16-week Step 1 plan runs in 4 phases. Foundation, days 1–9: finish Sketchy Micro and High-Yield Pharmacology. Systems, ~10–12 weeks: every system in a fixed order starting with renal, the same loop each time, with biochem split in right before the system that needs it. Revision, 8–10 days: micro revision 1 hour daily, Foundation Anki 2–3 systems a day, and timed blocks. Then NBMEs: your first real NBME is form 27, and you keep going until you are consistently at your target.

📸 Tap a tab, then screenshot the card — each is a standalone guide.
01
Phase 1 · Days 1–9

Foundation

Finish Sketchy Micro + High-Yield Pharmacology — start to finish — in 7–9 days.

🦠 Sketchy Micro — the method
~20–22 organisms a day (4 per hour): watch the Sketchy video → read the PDF. Do them in this exact order — and the night you watch, do that day's Vault MCQs for those bugs. Watch → test, same day. That's why it sticks.
The order (~85 bugs)
1 · DNA Viruses 13
HSV-1 · HSV-2 · EBV · CMV · VZV · HHV-6 · HHV-8 · Polyomavirus · HPV · Parvovirus · Adenovirus · Poxvirus · Hep B
2 · RNA Viruses 13
Poliovirus · Coxsackievirus · Rhinovirus · Hep A · Calicivirus · Flavivirus · Hep C · Togavirus · Orthomyxovirus · Paramyxovirus · Rhabdovirus · Filovirus · Reovirus/Rotavirus
3 · Parasites 13
Entamoeba · Giardia · Cryptosporidium · Toxoplasma · Trypanosoma brucei · Naegleria fowleri · Trypanosoma cruzi · Babesia · Leishmania · Trichomonas · Enterobius · Tissue nematodes (optional) · Schistosoma
4 · Fungi 12
Histoplasma · Coccidioides · Blastomyces · Paracoccidioides · Malassezia · Sporothrix · Dermatophytes · Aspergillus · Candida · Cryptococcus · Mucor/Mucormycosis · Pneumocystis
5 · Gram Positives 10
Staph aureus · Staph epidermidis · Group A Strep · Group B Strep · Strep pneumoniae · Enterococcus · Bacillus anthracis · Clostridia (all 4) · Listeria · Actinomyces
6 · Gram Negatives 19
Neisseria · Proteus · Yersinia · Shigella · E. coli · Campylobacter · Klebsiella · H. pylori · Pseudomonas · Salmonella · Vibrio · Bordetella · Chlamydia · Legionella · Brucella · Francisella · Coxiella · Pasteurella · Bartonella
7 · Indeterminate / Myco / Spirochetes 7
Gardnerella · Mycoplasma · Rickettsia (all 3) · Leprosy · Borrelia · Syphilis (Treponema) · Leptospirosis
💊 High-Yield Pharmacology
45 videos · 3 per hour · ~3 days. Mechanism-first — learn the MOA and the uses, toxicities and contraindications fall out for free. Do it now, before your systems, so drugs are owned by the time they show up in renal, cardio, endo.
📂 Your resources
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02
Phase 2 · ~10–12 weeks

The Systems

Where the real work lives. Every system, same loop, in this exact order. Biochem is split in — never crammed.

🔁 The loop — every single system
  1. Micro revision 🦠 systems only (micro + pharm per system): open Files → System-Wise Microbiology in University, read that system's column (12–15 organisms) — or go straight to the per-system organism pages, then re-watch those bugs + their Vault MCQs (~4h)
  2. First Aid Guide + First Aid read page-by-page; do each page's First Aid Guide MCQs as you go
  3. Mehlman — only if UWorld < 65% sort the playlist by date, watch the last 3 years
  4. Foundation Anki locks the whole system in ~2 days (each card = a First Aid page)
  5. UWorld system blocks. Averaging >70% on your last 4–5 blocks? You can skip Mehlman + Anki.
📋 The exact order · days @ 10–12 hr pace
  1. 🫘Renal6 d
  2. 🫁Respiratory6 d
  3. 🧬Biochem — Nutrition (before GIT)1 d
  4. 🍽️Gastrointestinal7 d
  5. 🧫Reproductive6 d
  6. 🧬Biochem — Metabolism: Carbohydrates1 d
  7. 🧬Biochem — Metabolism: Fats / Lipids (before Endo)1 d
  8. 🦋Endocrine6 d
  9. 🧬Biochem — Cellular1 d
  10. 🧬Biochem — Molecular1 d
  11. 🧬Biochem — Metabolism: Amino Acids (before Immuno/HemOnc)1 d
  12. 🛡️Immunology5 d
  13. 🩸Hematology & Oncology6 d
  14. 🦴MSK7 d
  15. 🩹Dermatology3 d
  16. 💊ANS (General Pharm core)1 d
  17. 🧩Psychiatry5 d
  18. 🧬Biochem — Genetics (before Neuro)1 d
  19. 🧠Neurology8 d
  20. ❤️Cardiovascular6 d
  21. 📊Biostats & Ethics3 d
  22. 🔬General Pathology (optional)1 d
  23. 💊General Pharmacology (optional)1 d
🧬 Why biochem is split: it's a prerequisite, not a block. Each piece lands right before the system that needs it — Nutrition before GIT, Carbs/Fats before Endocrine, Cellular/Molecular/Amino-acids before the Immuno–HemOnc block, Genetics before Neuro. Learn it cold and you forget it; learn it the week before, and it's obvious.
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Biochem auto-placed, Mehlman auto-dropped when UWorld dips → usmlevault.com
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03
Phase 3 · 8–10 days

Revision

Pure consolidation after you finish the Vault — the run-up to your first NBME. Only start this if you've followed the schedule to here.

🏛️ The 3 pillars — every day
  1. 🦠 Micro revision — 1 hour every single day (Sketchy PDF or First Aid micro)
  2. 🃏 Foundation Anki — 2–3 systems/day each card maps to a First Aid page — consolidates the whole book, system by system
  3. 📝 Timed practice blocks — last 5 days 2× NBME-26 blocks/day (20 Q in 30 min), two-phase method
⏱️ The two-phase block method
First pass ≤ 23–24 min — max 80 sec/question, flag anything shaky and move on. Second pass — return to your flagged questions. Practice harder than the real exam, so exam day feels easy.
📺 Watch first (Day 1 of this phase)
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The Vault schedules these days for you → usmlevault.com
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04
Phase 4 · NBMEs

Push Your NBMEs

Give them, review them, climb. Your first real NBME is form 27 — then keep going until you're consistently at your target.

📝 NBME 27 — your first real NBME
Give it in 20-question blocks using the two-phase method. Keep three timers running, exam-day style:
⏱️ 30-min block timer ☕ 55-min total break timer 🕓 6-hour exam timer (~5h Q + 1h breaks)
Take a major break every 40 questions — hydrate, keep your glucose up. Reset with three deep breaths between blocks.
🔁 The loop: give → review → climb
  1. Give the next NBME 27, then 28, 29… spaced as the schedule lays out
  2. Review every question right and wrong — why the trap answer is wrong is the real lesson
  3. Patch + log weak system? a stuck score? run the NBME Booster to break the ceiling — it recycles older forms
  4. Repeat until you're consistently at your target across consecutive forms before exam day
📺 The block method, on video
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👉 It's all on usmlevault.com/schedule — FREE for your first 3 days →
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New in the Vault

Week 1 to exam day — the whole road, with what happens at NBME 1.

Read next

The NBME Booster — every topic from forms 20–33 as a tutored one-liner, run system-wise in the final 1–2 weeks.

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