5 Tips to Master USMLE Step 1 Biochemistry

1 out of every 5 questions on the USMLE® Step 1 Exam test your understanding of basic sciences (USMLE). This means that learning biochemistry is a make-or-break factor in achieving a competitive score and opening the door into your dream residency.

However, biochemistry is a difficult subject, and many medical students avoid studying it. This results in missed points on test day.  In this post, I’ll share 5 simple tips to help you learn USMLE® biochemistry, so you can get every point on test day.

1. Unify and Connect Concepts

Medical education separates knowledge into distinct buckets: the heart is taught independently from the lung, and glycolysis is separated from the urea cycle. Truth is, all systems are interconnected. Just like how lung function dramatically impacts your heart, many biochemical processes have overlapping enzymes and intermediates. You can increase retention and improve understanding if you remember where they connect.

For example, ALT is often treated simply as a lab value, a marker of liver health. But the biochemistry behind this is rooted in ALT’s, or alanine aminotransferase’s, role as a transaminase enzyme: something that moves amino groups between compounds. This role is especially important in the breakdown of amino acids (Review Cahill Cycle). This explains why ALT is found at high levels in the main metabolic organ, the liver. And since ALT is present at high levels, liver injury can be measured by ALT release.

Connecting concepts like the above reinforces your memory through simple repetition and dual coding, a cognitive finding that we learn better when we remember the same information in different ways. Linking concepts is also thought to form additional neural connections, strengthening memory. So if you’re studying biochemistry, try to connect concepts — understand why a specific vitamin is needed as a co-factor, rather than just memorizing it (Review Vitamin Biochemistry). At Pixorize, our USMLE Step 1 videos emphasize connections and explanations, because we believe you remember better if you can reason through concepts.

2. Use Images to Boost Retention.

People are better at remembering pictures than text, a phenomenon known as the picture superiority effect. Reasons for this are not well understood, but theories suggest an evolutionary dependence on vision to capture important events (“A bear has appeared!”).

Importantly, you can tap into your brain’s wiring to master biochemistry, a subject that requires a lot of memorization. In fact, memory champions and high-performing medical students have been using similar methods for years. This method involves memory palaces (a.k.a. the method of loci), which turn facts into pictures to improve memory.

For example, I struggled to memorize that ribose-5-phosphate, a pentose ring compound, is converted into PRPP during nucleotide synthesis. However, a much easier way is to simply picture a ruby ring: ruby for ribose, and ring for the pentose ring. And what are ruby rings good for? They’re good for proposals: proposal for PRPP (Review De Novo Purine Synthesis). Pretty easy, isn’t it? You’ll never forget it. This method also improves memory by storing information in two different ways (text and picture). This means that even if you forget one source (the words), you can still rely on the other (the picture).

You can use the power of image learning by imagining pictures as you study. However, this process can be very time-consuming. Instead, a more efficient method is to use pre-curated images, such as Pixorize’s visual mnemonics for USMLE Step 1 Biochemistry. Our images are custom-built so you can master material like all the biochemical pathways within just a few hours. Sounds high-yield, doesn’t it?

3. Concentrate early, then review.

If you have a 6- to 10-week dedicated study period for the USMLE Step 1 Exam, set aside the first week(s) of your study schedule to focus on biochemistry. These concepts will set up a foundation for other clinical knowledge, and you’ll be surprised by how often biochemistry concepts reinforce and repeat across physiology and especially pharmacology.

And by concentration, I’m talking about reviewing one topic at a time. Every review book you read and every question bank you use should be specifically targeted at mastering biochemistry. In fact, you should study every topic and organ system by devoting your full attention to them one at a time. This study plan is more efficient than a shotgun approach studying everything simultaneously, for two reasons. First, you’re able to think more deeply when you concentrate on a topic in depth. Second, you reduce time spent flipping pages between subjects, which adds up over time.

At this point, you may be thinking: won’t a focused approach prevent me from connecting information related to other topics? Well actually, I’m not saying to ignore hematology completely if a question on red blood cell biochemistry comes up. What I’m saying is that learning medicine is like building a tower. If topics are like levels, you need to build a foundation solidly, floor by floor. There may be holes, but you can fill them in later. On the other hand, if you start building all the floors at the same time, you’ll have no foundation in any subject to really rely on.

After focusing on biochemistry in the first weeks, include periodic reviews of high-yield material in the weeks after (e.g. reviewing the vitamins every Wednesday). This helps you retain your biochemistry knowledge while you shift your focus onto other subjects.

4. Reinforce Understanding with Questions.

There’s no better way to cement biochemistry knowledge than challenging yourself with questions. Answering questions can make you think more about why things happen, such as why lactate dehydrogenase is a marker for hemolysis. (Answer: mature RBCs don’t have mitochondria, and only undergo glycolysis. Therefore, they need LDH at high levels to regenerate NAD+.)

Supporting my earlier point to study topics one at a time, I recommend concentrating your approach when using USMLE Step 1 QBanks like UWorld. Use the topic filter when creating a question block to concentrate on biochemistry early, then diversify your questions as you get closer to the exam. This will help you build a deep understanding and reinforce it over time.

5. Draw the Pathways.

Yes, it may feel like college biochemistry all over again, but sometimes there’s no better way to learn biochemistry pathways than to just pick up pen and paper.  Simply drawing the intermediates and arrows by hand can improve retention, just like note-taking does. My recommended approach is to study a visual mnemonic covering a biochemical pathway (such as De Novo Purine Synthesis) . Afterwards, draw the entire pathway from memory, once every day for an entire week. By the end of the week, you should have that pathway mastered.

A related point when studying biochemistry pathways is focusing on where drugs and diseases act. Question writers will use these touch points to test your knowledge of the pathways in their clinical context. Notably, you should remember the specific enzymes affected, as well as their immediate upstream and downstream intermediates. For example, ornithine transcarbamylase deficiency increases levels of carbamoyl phosphate upstream (Review Urea Cycle). This carbamoyl phosphate can be converted into orotic acid, which is the reason why ornithine transcarbamylase deficiency presents with elevated orotic acid. Consequently, this disease is often confused with orotic aciduria, another disease with increased orotic acid. However, orotic aciduria is caused by defects in pyrimidine nucleotide synthesis (Review De Novo Pyrimidine Synthesis), and not the urea cycle. Just draw the biochemistry pathways focusing on where these touch points interact, and you’ll be sure to get every point on test day!

Conclusion

Many students fail to form a good study plan for biochemistry on the USMLE Step 1 Exam. But I urge you not to do that, because biochemistry is high-yield — there’s too many points at stake. Instead, just study smarter, using the five simple interventions described here. Here’s to improved studying, and higher scores!