How I Scored a 256 on the USMLE® Step 1

Sean Kiesel - Mar 03, 2020
Three arrows pointng upwards to denote a high score on the USMLE Step 1 exam

Update:  On January 26, 2022, the USMLE®  Step 1 exam became pass/fail. This means you are no longer dependent on the previous three-digit score. Read the official USMLE announcement here.

I know your time is limited, so I'll just jump right in. My name is Sean Kiesel, and I'm the owner of COMPREPMED and a 4th-year osteopathic medical student. I was able to get a 256 on the USMLE® Step 1 and want to help you do the same. 

The top questions that most students ask me when they find out I got a 256 are: 

So, allow me as I go through each and offer some tips that can be applied to anyone's study plan:

What resources did you use for studying?

I really liked to use a little bit of everything to prep for Step 1, though it was necessary to use large review resources for sure. These helped to build a foundation of knowledge that made answering questions easier.

I also really liked using resources such as videos or the AMBOSS Library during my classes. This doesn’t mean I watched their videos or looked at the [Articles] during lectures. No, I mean I used them alongside classes. For example, if we were studying cardiology in lectures, I would go through cardiology videos and [Articles] during those weeks. This helped me learn from multiple sources, as well as get the important details for Step 1.

Question banks are also very necessary. Find the one that you like most and use it early and often. Question banks are so important because they force you to think critically and recall the information that you need. They really are the most efficient way to learn in my opinion.

Don’t save your questions, but start using them to learn early on. Many students forgo the benefits of doing questions early because they feel they don’t know enough, but it is okay if you miss some—this will actually help you learn. Don’t stress over a question bank percentage in the early study phases, either. Use it to learn and grow. 

Finally, make sure you have a review book handy. I think we all know that First Aid is the go-to, right? I will make another plea with you, though: don’t read it like a book. The way I used it is was similar to how I used AMBOSS and its Library. (This means if you want the all-in-one resource that I wish I had during Step 1 prep, get AMBOSS.) Use your review book with your questions. This means do a question, read the question explanation, and try to understand it. Then pull out your review book and read about that topic and all other topics closely related to it.

For example, if the question is on aortic stenosis, read the question explanation, then pull out your review book or find the corresponding [Article] in AMBOSS and read up on it there. Don’t just read it, though, compare it to similar pathologies e.g., mitral stenosis, pulmonic stenosis, aortic regurg, mitral regurg, and all of the valvular issues. USMLE questions like to compare one thing to another and really attack you on the subtle differences. The more you compare and contrast like this during studying, the better off you will be. If you do this in the context of a question where you are forced to recall, then the information will stick in your brain a lot better. Do it every single time you encounter a question. So, the next time you have an aortic stenosis question, do the same thing. This will mean you are reading your review book, doing questions, and doing spaced repetition. It takes longer but it is incredibly efficient.

How did you do board questions?

In the early phases, do board questions in Guidance mode with AMBOSS. This allows you to really learn the material with the help of special tools and tips that guide you to the right answer. Later on, say a month before your exam date, start doing them in Exam mode. This will allow you to simulate test day and get your stamina up. 

I liked doing my second pass of my favorite question bank in Exam mode. The entire first pass should be in Guidance mode, then the second in exam mode. This is a great way to learn the material and then utilize it again to build your stamina.

When did you start doing questions? 

Start doing questions on the first day of second year. I did 15 questions a day from mid-tier question banks from day one of second year until January of second year. Then I busted out my favorite question banks and started doing 20 per day. Once dedicated board prep time hit, I did 60-70 per day.

Three weeks before exam day, when I started my second pass of my favorite Qbank, I did 120 questions per day. The 120 questions per day were in exam mode and I simulated exam day. This means I sat and did questions for three hours straight. If I could do questions for three hours, then I could easily do questions for two hours, like I planned to do on test day. I took a 10-minute break every two hours during Step 1.  

What do you think about my study plan?

My plan was simple: make a pass of all the review materials, then hit the areas I was weak in again and again. My plan was really centered around doing questions as it is the best way to learn. They mimic exam day, force you to think, and are a very active, not passive, learning method. 

Essentially, start early, do questions daily, and target your weaknesses based on practice tests and question bank results. Then study those weaknesses when you aren’t doing questions. 


Looking for ways to boost your Step 1 prep? Kickstart your 5 day AMBOSS free trial, and get access to all the study plans, medical knowledge, and Qbank questions you need.

Start free trial



Sean Kiesel is a DO/MBA student with a passion  for helping other students succeed and for  entrepreneurship. That is why he created, an OMM course, and will soon be publishing books that help Osteopathic students succeed in all aspects of medical school. In his free time, he loves shooting, fishing, and being outdoors.