90 Days Before Step 1: Weekly Goals for Content and Question Banks

90 Days Before Step 1: Weekly Goals for Content and Question Banks

It’s 90 days before your Step 1 exam.
Your school schedule is either light or just ended, your friends are “starting dedicated next week,” and you’ve got a UWorld subscription, an Anki deck with 10,000 overdue cards, and a slightly terrifying NBME score from a “baseline” you maybe should not have taken on a post-call day.

At this point, you need a timeline. Not vibes. Not “I’ll do UWorld and First Aid and Pathoma and Sketchy and… somehow it’ll work.”

Here is a week‑by‑week guide for the next 12 weeks (90 days) that tells you, very directly:

• What you should focus on each week
• How much content vs questions you should be doing
• When to take NBMEs and self-assessments
• What to change if you’re behind or your scores stall

I’ll break it into three phases:

• Weeks 1–4: Foundation + high‑yield content
• Weeks 5–8: Question‑heavy with targeted content
• Weeks 9–12: Exam simulation + ruthless refinement

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90-Day Step 1 Study Timeline

Period	Event
Phase 1 (Weeks 1-4) - Week 1-2	Content-heavy, start UWorld
Phase 1 (Weeks 1-4) - Week 3-4	Finish first pass of major systems, baseline NBME
Phase 2 (Weeks 5-8) - Week 5-6	Question-heavy, daily mixed blocks
Phase 2 (Weeks 5-8) - Week 7-8	Fill weak areas, add self-assessments
Phase 3 (Weeks 9-12) - Week 9-10	Full-length simulations, refine
Phase 3 (Weeks 9-12) - Week 11-12	Light content, high-yield review, taper

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Ground Rules for All 12 Weeks

Before the week‑by‑week breakdown, a few non‑negotiables. If you ignore these, your schedule will unravel.

1. Primary resources only

   • UWorld (or AMBOSS as a secondary bank, but UWorld is non‑negotiable)
   • First Aid or Boards & Beyond notes / similar consolidated text
   • Pathoma (for pathology)
   • Anki (ONLY if you’ve been using it or can commit daily without flaking)

2. Daily non‑negotiables

   • 1–2 UWorld blocks (40–80 questions)
   • Review every question in painful detail
   • At least 1–1.5 hours of dedicated weak‑area content review

3. NBMEs / Self‑assessments

   • Every 2 weeks starting around Week 3–4
   • Taken timed and standard length, not “for fun” in tutor mode

4. Score ranges and expectations (roughly)

   • 90 days out: you might be anywhere from “barely passing” to “already 230+” on practice tests
   • The important thing: trajectory, not where you start

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Typical Weekly Study Time Allocation (90-Day Plan)

Category	Value
Question Banks + Review	55
Content Review (videos/books)	25
Anki / Flashcards	15
NBME / Self-assessments & Review	5

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Phase 1 (Weeks 1–4): Build the Framework + Start Real Questions

Week 1: Baseline Structure, Not Baseline Panic

Goal: Get your systems/content map laid out and start UWorld with discipline.

At this point you should:

• Pick your resources and lock them in (stop shopping for the “perfect” video series)
• Sketch your 12‑week calendar: which systems/topics each week
• Decide your daily start + stop times (protect at least 1 real break)

Weekly targets:

• UWorld: 120–160 questions
  • 1 block/day (40 questions) for 3–4 days
  • Start with system-based, easiest for you (often cardio, heme/onc, or endocrine) to build momentum
• Content:
  • 2–3 hours/day of Pathoma + your main text (First Aid or B&B notes) on the same system
• Anki:
  • 30–60 minutes/day, ONLY on high‑yield decks or your own cards tied to what you did that day

End of Week 1 checklist:

• You’ve finished at least 1 small system OR a chunk of a bigger one (e.g., cardio + renal starting)
• You’ve completed 3–4 UWorld blocks and reviewed them fully
• You know your worst topics from this first round (e.g., acid-base, murmurs, lysosomal storage diseases)

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Week 2: Increase UWorld Volume, Finish 2–3 Systems

Goal: Ramp the question volume slightly, keep content aligned with questions.

At this point you should:

• Be doing 1–2 UWorld blocks on at least 4 days of the week
• Stay system-based in UWorld but push into systems you dislike (GI, neuro, repro)

Weekly targets:

• UWorld: 160–240 questions
  • 4–5 days of UWorld
  • For weaker systems, do:
    • 40-question block → review → related Pathoma/First Aid → brief Anki
• Content:
  • Aim to cover 2–3 full systems (e.g., cardio, renal, pulmonary)
• Anki:
  • Keep it short and consistent. Missing 3 days in a row and letting reviews explode is how people tank their last month.

End of Week 2 checklist:

• At least 300–400 total questions done so far
• 3–5 systems covered at least once in notes/videos
• A written list (or spreadsheet) of “frequent miss” topics from UWorld

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Week 3: First NBME + Finish First Pass of Most High‑Yield Systems

Goal: Reality check. You can’t improve what you won’t measure.

At this point you should:

• Take your first NBME (if you didn’t already) at the end of the week
• Shift into slightly more mixed blocks but still leaning system-based

Weekly targets:

• UWorld: 200–240 questions
  • 5–6 days of 1–2 blocks/day
  • Start sprinkling in mixed blocks (maybe 1 block mixed, 1 block system)
• Content:
  • Pathoma + notes to catch you up on:
    • Pulm, cardio, renal, GI, heme/onc, endocrine at minimum
• NBME:
  • 1 NBME (or UWSA1 if you absolutely can’t access NBMEs)
  • Same time of day as your real exam if possible

How to interpret that Week 3 NBME:

• <200 / barely passing: You’re behind on fundamentals.
  • Next 2 weeks = more content focus, but do not stop questions.
• 200–220: Solid base. You need volume and targeted review.
• 220+: Good position. The priority is not burning out and steadily polishing weaknesses.

End of Week 3 checklist:

• 500–650 total UWorld questions completed
• NBME score logged, with error breakdown by system + subject
• You know your bottom 3 systems and bottom 3 disciplines (e.g., pharm, biochem, immuno)

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Week 4: Consolidate Systems, Fix Foundational Holes

Goal: End the first month with a mostly complete “first pass” of high‑yield content and a stable study routine.

At this point you should:

• Be able to do 2 blocks/day without totally frying your brain
• Have at least touched all major systems once (maybe not micro/biochem in full depth yet)

Weekly targets:

• UWorld: 200–240 questions
  • Mostly system-based, hammering your weak ones
• Content:
  • Finish remaining “big” systems (neuro, MSK, repro, GI if not done)
  • Start structured review for:
    • Biochem (metabolism, inborn errors, vitamins)
    • Micro (major organisms + drugs)

End of Week 4 checkpoint:

By the end of the first month you ideally have:

• 700–900 UWorld questions completed
• 1 NBME score to compare against later
• At least one clear written plan for:
  • How you’ll tackle micro (often Sketchy + UWorld + a small table in your notes)
  • How you’ll tackle biochem (structured charts, not random reading)

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Phase 2 (Weeks 5–8): Question-Heavy, Data-Driven Adjustments

Now you’re not “starting dedicated.” You’re in the middle of it. This is where people either get systematically better or just spin inside UWorld without fixing anything.

Week 5: Switch to Mostly Mixed Blocks

Goal: Train your brain to switch topics quickly, like the real exam.

At this point you should:

• Move to majority mixed blocks (by organ system and discipline)
• Get comfortable being uncomfortable: you will feel worse at first

Weekly targets:

• UWorld: 240–320 questions
  • 6 days of 2 blocks/day on most days
  • All in timed mode, random or mixed
• Content:
  • 1–2 hours/day of targeted review driven by:
    • UWorld % by subject
    • NBME breakdown from Week 3
• Anki:
  • Only if it fits. If Anki is eating 3 hours/day and your questions are dropping, cut it down aggressively.

End of Week 5 checklist:

• 1–2 pages of concise notes (or a OneNote/Notion file) of “commonly missed patterns”
• You’re seeing repeat errors less often (because you’re actually fixing them, not just reading the explanation and moving on)

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Week 6: Second NBME + Complete First UWorld Pass (or Close)

Goal: See if your changes are doing anything.

At this point you should:

• Be approaching the end of your first UWorld pass (or at least >60–70% through)
• Take another NBME at the end of this week

Weekly targets:

• UWorld: 200–280 questions
  • If you’re close to the end of the bank, don’t rush sloppy blocks just to finish; quality still matters
• NBME:
  • NBME #2 (or UWSA1 if you did NBME last time and want variation)
• Content:
  • Focus on your worst 2 systems and worst 1–2 foundational areas (usually pharm or biochem)

How to read the Week 6 NBME:

• If your score went up ≥10 points: you’re on a good trajectory.
• If it’s flat: your studying is not targeted enough; you’re just “doing questions.”
• If it went down: check for:
  • Fatigue (overdoing hours, no real rest days)
  • Sloppy timing / rushing through stems
  • Not actually understanding why answers are wrong/right

End of Week 6 checklist:

• 1000–1300 total UWorld questions done
• 2 NBME scores, graphed, with notes on what you changed between them
• A ranked list of systems by strength: Strong / Medium / Weak

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Week 7: Start Second Pass Elements, Ramp Up Weak Disciplines

Goal: Begin revisiting key questions and patterns, not just plowing forward.

At this point you should:

• Have either finished UWorld or be close enough that you plan to finish by Week 8
• Start a selective second pass:
  • Marked questions
  • Topics you continually miss

Weekly targets:

• UWorld:
  • 160–240 “new” questions if you haven’t finished first pass
  • Plus 80–120 “marked” or incorrect questions review
• Content:
  • 1 discipline‑focused block per day (e.g., all pharm, all micro) with immediate targeted review
• Add 1–2 short “rapid review” sessions daily:
  • 20–30 minutes of:
    • Buzzword drills
    • High‑yield tables (glycolysis vs TCA vs ETC inhibitors, autosomal dominant diseases, etc.)

End of Week 7 checklist:

• You know EXACTLY which disciplines drag you down on every practice test
• You have a sustainable way to re‑see high‑yield facts multiple times (Anki, rapid review docs, or both)

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Week 8: Third NBME + Nail Down Exam Strategy

Goal: Transition from “what to study” to also “how to test.”

At this point you should:

• Take another NBME toward the end of the week
• Have fully completed UWorld first pass

Weekly targets:

• UWorld / Questions:
  • 160–200 questions, mostly:
    • Second-pass marked questions
    • Random mixed blocks from bank #2 (AMBOSS or leftover UWorld if you were slow earlier)
• NBME:
  • NBME #3 (or UWSA2—many people like this one closer to test day)
• Strategy:
  • Time yourself per block:
    • How many questions left at 10 minutes?
    • Are you always rushing last 5 questions?

Score interpretation now:

• If you’re not reasonably above passing by Week 8, you need an honest talk with your dean/advisor about pushing the exam. I’ve seen people salvage from low 190s in the last 4 weeks, but it’s not fun and it’s definitely not guaranteed.

End of Week 8 checklist:

• UWorld first pass complete
• 3 self‑assessments done and trended
• Concrete timing strategy: how long you allow per question, when you flag, how you move on

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Phase 3 (Weeks 9–12): Simulation, Refinement, and Taper

This last month is not about discovering new resources. It’s about hitting exam day with:

• Stable scores
• A repeatable test‑day routine
• A brain that’s tired in a good way, not fried beyond recognition

Week 9: First Full-Length Simulation Week

Goal: See how your brain holds up across a near‑full exam day.

At this point you should:

• Schedule a “mock exam day”:
  • 7 blocks of 40 questions (NBMEs + UWorld mixed, or UWSA timed)
  • Realistic breaks, realistic start time

Weekly targets:

• Questions:
  • 1 full simulated test day (280 questions)
  • 2–3 other days of 80–120 questions + review
• Content:
  • Short, sharp reviews:
    • Pharm autonomics
    • Antimicrobials
    • High‑yield pathology (vasculitides, nephritic/nephrotic, cardiomyopathies, etc.)
• Post‑simulation:
  • Write down:
    • When did you mentally dip? Block 5? 6?
    • Were your last blocks way worse than your first?

End of Week 9 checklist:

• One near‑full exam reproduced under timed conditions
• A list of non‑content issues: timing, stamina, breaks, hydration, caffeine timing

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Week 10: Last NBME/UWSA + Focused Polishing

Goal: Get your last solid snapshot of where you stand.

At this point you should:

• Take your final “big” self‑assessment this week (NBME or UWSA)
• Accept that your knowledge ceiling is mostly set—now it’s about execution and recall

Weekly targets:

• Questions:
  • 160–200 questions, mostly random mixed
• Assessment:
  • NBME #4 or UWSA2 (if not already used)
• Review:
  • Brutal focus on:
    • Mistake patterns that keep repeating
    • Topics you “almost know” (these are easier points to gain than brand‑new areas)

Score interpretation at this point:

• If last 2–3 self‑assessments are stable and safely passing → stay the course
• If wildly fluctuating → you’re either fatigued or studying chaotically; simplify and protect sleep
• If right at the pass cutoff → speak with a mentor about extension, but be honest about your trajectory

End of Week 10 checklist:

• Last formal score on record
• A clean, prioritized list of topics for the final 2 weeks

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Week 11: High-Yield Blitz, Low-Stress Volume

Goal: Cement what you already know; do NOT blow yourself up with 12‑hour marathons.

At this point you should:

• Scale total hours slightly down, not up
• Focus on recall speed and pattern recognition

Weekly targets:

• Questions:
  • 80–160 per day for 4–5 days
  • Block size can be 20–40 questions, but always timed
• Content:
  • Quick passes through:
    • First Aid rapid review section
    • Your own condensed notes / “do not miss” list
• Sleep:
  • Start normalizing your exam‑day sleep schedule this week, not the night before

End of Week 11 checklist:

• You can flip through your notes and actually recognize almost everything
• No huge new content gaps, just a few “annoying” topics that you’ll give one more pass

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Week 12 (Final 7 Days): Taper, Don’t Cram

Break this down day‑by‑day. This is where students either protect their score or self‑sabotage.

7–5 Days Before Exam

At this point you should:

• Do 1–2 blocks/day (40–80 questions), all mixed and timed
• Spend more time reviewing than answering

Daily structure example:

• Block of 40 questions → 2–2.5 hours review
• 1–2 hours of rapid review (pharm tables, micro, biochem, high‑yield path)
• 30–45 minutes of light Anki or flashcards
• Hard cutoff time in the evening (e.g., 7–8 PM)

4–3 Days Before Exam

• Drop down to 1 block/day, max 40 questions
• Avoid new resources, avoid long videos
• Re-read:
  • Your “most missed” notebook/pages
  • Pathoma chapters you still feel shaky on (short ones, not the whole thing)
• Visit (or mentally rehearse) the test center logistics:
  • Travel time
  • ID, snacks, breaks

2 Days Before Exam

At this point you should:

• Stop heavy questions
  • Maybe 20 easy/mid‑level questions in the morning if you’re antsy
• Spend the rest of the day on:
  • Light review of your own notes
  • Making sure everything is ready: Prometric email, snacks, clothes, directions, ID

1 Day Before Exam

Do not be the person who “just did one more NBME” the day before and then couldn’t sleep.

• Zero heavy questions
• If you must do something:
  • 20–30 minutes of flipping through rapid review or images
• Get outside. Move your body. Eat food that won’t upset your stomach.
• Go to bed early with your exam‑day routine already planned.

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Phase & Weeks	Total Questions/Week	Main Focus
Weeks 1–2	120–240	System-based, content-heavy
Weeks 3–4	200–240	Finish systems, first NBME
Weeks 5–6	200–320	Mixed blocks, second NBME
Weeks 7–8	200–320	Second-pass + third NBME
Weeks 9–10	200–280	Full simulations + final NBME/UWSA
Weeks 11–12	80–200	Tapering, high-yield refinement

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Final Takeaways

1. At each week, know your main goal: build base (Weeks 1–4), sharpen with questions (Weeks 5–8), then simulate and refine (Weeks 9–12).
2. Questions without targeted review are a waste; content without questions is a fantasy. You need both, in shifting proportions.
3. The last 10–14 days are about protecting your score, not heroics. Taper, sleep, and walk into Step 1 with a brain that can actually use what you’ve spent 90 days building.