Having taken step1 just 2 weeks ago, I thought i should contribute to this discussion.
After devoting about 12 months of studying for the boards(I know, sounds like a lot of time, but I am an IMG) and looking back to my studying strategy, If I had to do it all over, it would be something like this:
1) I would buy one of the highly rated review books in first aid for each subject
2)Provided that there is a strong foundation from the normal courses, I would NOT go through them cover to cover(which I did and was clearly a mistake), but rather concentrate on 1st aid-emphasized topics. This will save a lot of time that would be otherwise used for studying extremely low yield topics(which again happened with me).
3)I would buy at least one good question book for each subject, and a couple of comprehensive question books(like the nms review for step1).
4)The last month or so, I would enroll an online course( I did Kaplan, but there are others as well), and try to simulate the real exam every day. That is, sleep early, wake up at the same time, and do one hour sessions followed by short breaks for AT LEAST 8 hours a day. I don't think time is an issue in step1(and I was a person with no experience of standardized,mcq tests until I started studying for step1, so i guess it is even less of a problem for a US student). However, even though i did my best to simulate the test at home during the last month on a daily basis, I did burn out during the last couple of blocks, merely answering based on instict rather than knowledge, trying to find the magic word that would prevent me from the -by then- extremely painful process of thinking, so I guess fatigue IS an issue.
Hope this helps,
Theodore