Detailed USMLE Step 1 Experience by Dr. Leah Abraham – 247

Hello, everyone! I’m thrilled to be sharing my journey with you guys and I hope you can take the good out of it and make the best of these suggestions for your own voyage. Most of this is an amalgamation of advice I accumulated from this group, various forums, my seniors and of course, my family & friends. This is a lengthy post, so my apologies in advance, but I’ve organized it into sections so that you can skip ahead to the ones you want to read:  

Introduction

I’m an IMG from India who used to be a promising student till I got into Medical school when the pressure got to me, and I’ve been below average or average at best throughout. I was, however, determined to change all that when I decided to do my Step 1 and it wasn’t all a walk in the park. I’ve been priming myself for preparation since October 2016, but essentially got oriented and started preparing only 9 months back.

Materials Used

 

Primary Resources – First Aid, UWorld, Goljan

Anatomy – Gray’s Atlas of Anatomy, Google, Anatomy Shelf Notes, few chapters from High Yield Neuroanatomy, and Blumenfeld’s Neuroanatomy through Clinical Cases.

Biochemistry – A few chapters from Harper to spark my interest + Sam Turco’s Kaplan videos 2010

Physiology – BRS Physiology and Costanzo for few topics like Acid-Base balance. I read Ganong for a few chapters in which I needed to gain confidence in after my NBMEs.

Pathology – Pathoma videos + textbook

Microbiology – Few topics from Microbiology Made Ridiculously Simple + Google and some Microbiology textbooks to get acquainted with images

Pharmacology – Katzung Board Review + Kaplan Pharm for General Pharm and ANS only

Behavioral Science – 100 Cases + BRS Behavioral Sciences + UWorld Biostats Review

 

The First Three Months

This time went in figuring out how to study and what resources to use. Being a graduate, I felt completely out of touch with the subjects, especially the first-year ones.  

My friend and I first went through which books we would use for each subject and counted the number of pages of FA and a secondary book we might use for clearing concepts. That way, we decided an arbitrary number of days for each subject, and the order to read them in, to roughly calculate how long our first read would take. This was very important in helping me stick to a schedule, after getting used to a year of haphazard timings in the internship.  

1) I started with Biochem FA and tried to supplement it with Kaplan videos and its text. On realizing it’s too time-consuming and FA is mostly enough, I stuck to FA beyond the genetics chapter. It took me almost a month to finish Biochem the first time, as I was still getting used to sitting on a stretch to read, and finding the right atmosphere to study in.

2) In my second month, I started with Behavioral Sciences, to mix things up a bit. It took me almost a whole week to cover BRS, and I did not practice any Biostatistics questions, beyond understanding the concepts. I viewed few Kaplan 2010 videos of Dr. Daugherty to improve some basic concepts in Biostats but did not stick with that either, after 4 videos, as it was taking up too much time.

3) 5 days of Behavioral Sciences later, I switched to Gross Anatomy. I started with BRS Gross Anatomy but eventually tapered to just FA. Around this time, I learn it was important to start UWorld early, and thus subscribed. I finished half of Gross Anatomy, using Gray’s Atlas of Anatomy, before deciding to change subjects to something more interesting.

4) The next two weeks, I clubbed Pharm and Physio topics together and managed to complete both while doing UWorld in parallel. UWorld was initially moving very slowly, as I was quite sensitive about the score in each test, wasn’t comfortable doing more than 15 questions at a stretch and would get saturated quickly. Although I did not use videos, I did find Dr. Lionel Raymond’s lecture on antiarrhythmics very, very helpful, and it made a hitherto scary topic very doable for me.

5) The next month, almost the entirety of it was spent doing Pathology. I read all of Rapid Review by Goljan, while simultaneously watching Pathoma videos. I tried catching up with missed topics in UWorld but wasn’t doing too well stamina-wise. I was following my schedule of heading to the library and studying 6-12 hours a day, with a rest day most weeks. When I had to take long journeys for any reason, I’d listen to Goljan’s delightful audio lectures and most times when I was still awake, it was an immense pleasure and a great educational experience. Highly recommended!

The Next Three Months

6) After covering Pathology, I moved on to Microbiology. I was saturated with reading too many books and decided to stick to only FA and UWorld for this one. My pace on UWorld picked up, although my scores still fluctuated between 50-70% on most tests. I switched from Timed Tutor to Timed Non-tutor mode and that helped me complete more tests than before. Ten days for Micro later, I switched to Immunology from FA and finished it in another 3-4 days.

7) Lastly, I finished whatever topics I’d left stranded in each subject in the coming two weeks, and tried to focus on completing UWorld and doing one complete read of FA. I struggled with both and took me a whole month and a half to finish them both. I was particularly lazy to read FA, as it took too much time to cover just 3-4 pages, and the lack of progress was discouraging. If you find yourself in a similar situation, it’s completely normal, give yourself a kick, and finish it off. It only gets better from there.  I stuck to FA and UW for topics such as Psychiatry and Derm.

8) After completing one round of UWorld, I bought all online NBMEs together, stupidly believing I could finish them off in a month and a half. I restarted the process of doing FA and Goljan as well. It took me almost another month to go through my marked and incorrect questions in UWorld.

Last Trimester

9) My first online NBME, 13, was a scary experience. I started a block and got too overwhelmed and signed out. I went back in the next day and split it between two days to alleviate my test-taking anxiety. I managed to score 232.  

10) My revisions continued, with FA and UWorld incorrect still my main focus, while trying to improve on my weak areas. NBME 15 followed ten days later and my score came back – 232 again.

11) Slightly disappointed at the lack of progress, I decided to give my next NBME sooner, a week later, after trying to finish my revision faster. In the meantime, I got a copy of Pathoma as well, to revise Pathology faster, as the second read of Goljan was taking too much time. This time, however, I gave NBME 19 instead of 16, by mistake and scored a depressing 211.  

12) It took me almost two weeks to muster enough courage to attempt the next NBME. I was trying to read more standard books, believing my entire foundation of Medicine might be shaky. Big mistake. NBME 16, given in very nervous conditions, I made the same number of mistakes – 37 – and scored 223.

13) After hitting a couple of forums to figure out what was going wrong, I realized I’d been neglecting FA and UWorld. Coming back to the primary books, I decided I’d book a date after NBME 17. Ten days later, my NBME 17 turned up with 28 mistakes and a score of 230. Although 15-20 points below my target score, I thought booking my date would help me focus and jump right in, I kept a month for my last revision.

14) I renewed my UWorld subscription determined to finish the second round in two weeks. In desperate need of a confidence booster, I gave my UWSA1 ten days later, halfway through UWorld. I was able to score between 85-97% on most tests and managed to maintain a centile score of 96. UWSA 1 – score 243.  

15) Believing to be on the right track, I got back to Goljan to complete my second read, viewed one topic of Pathoma video daily in the afternoons when my concentration dipped and would do 5-7 blocks of UWorld daily. I made sure to do at least 2 blocks in succession each time to develop my stamina. Two of my friends and I also started having more frequent discussions and Q&A sessions during our tea breaks, pimping each other on various topics. This forced me to confront my weak areas further and sent me back to FA/UWorld each time consolidating a fact I thought I’d learned before.  

16) I came down with a fever and lost ten days in between, interrupting my flow. This was more difficult to bounce back from than I anticipated and I decided to postpone my exam by two weeks. My main focus was on completing UWorld, even if I couldn’t read all the explanations thoroughly, to instill the confidence that I’d seen all 2488 questions recently.  

17) Three weeks before my test I thought it was time for my next and last, NBME 18, and I wanted it to go well. In my pursuit of perfection, I spent the entire morning reading and revising, and waited until the afternoon to start my test. Big mistake. I thought I was alert throughout, but after receiving my score, I was shattered; I got 225. It was only later while reviewing my answers that I realized how stupid some of my mistakes were.  

18) My confidence taking a terrible beating, I decided to push my date further, another three weeks.  

Three Weeks before the Exam:

19) A proper perusal of Reddit and Student Doctor Network made me realize all the things I was doing wrong with my NBMEs. I wasn’t revising First Aid enough. I was overthinking and getting distracted by minutiae in NBME questions and marking the wrong answer. My entire approach to answering questions needed to change. Although I had no NBMEs left to give, I decided I’d give my UWSA 2 all my best.

20) I needed to revise FA at least two more times. Meanwhile, I needed to take care of my anxiety on test-taking. I booked a date for the Prometric center, to give the free 120 (well, not anymore) there. I got acquainted with the center, its proceedings and got to plan my real exam day better. I scored 80% on this and went back home.  

21) I also started using the search feature on UWorld more after finishing it the second time, to revise related questions together, whenever I didn’t feel like reading FA. Thankfully, FA cover-to-cover was moving way faster, and I decided to have fun with it by ‘discovering’ new things in diagrams/corners/weird places and making a contest of it with friends. We maintained a WhatsApp group from then, to post these ‘new’ facts, cementing our need to hit the books as frequently as possible.

22) I also covered UWorld Biostats review once to consolidate my understanding of concepts, and it helped immensely in bumping up my performance in the final exam. I read 100 cases for Ethics, and also went through a few old NBMEs to improve my exposure to questions. Finally, I also went through USMLE-Rx Qbank for selected topics which I needed to improve my confidence in – Genetics, Psychiatry, Immunology, and Behavioral Sciences.  

23) Finally, I gave two NBMEs to simulate an 8-hour exam – I did not calculate the score. I gave UWSA 2 and another offline NBME two days later. Unfortunately, I had a glitch with my internet, and 22 questions I’d answered did not get submitted in my first block. I ended up scoring 228 with the omissions, but counting the number of correct answers I would have submitted and comparing my performance with friends’, I presumed my score was somewhere between 240-250.

Last Five Days

I stuck to very quickly breezing through FA, using the newly released Flashcards feature on UWorld and also referring notes I’d made earlier to improve my visual memory. I also kept mentally practicing the act of being in the exam center, planning my breaks, imagining various what-if situations (what if I get stuck with a question, what to do if I feel saturated, what if I feel sleepy, etc.). Although scared stiff, I learned how to optimize my anxiety and when to take a break and just sleep on it. The last day, I really did not want to read anything but ended up going through old notes till dinner. Whether or not that helped or harmed me is debatable, but it was enough for me to remind myself that I’d done everything I could till then.

Exam Day

I went there not too early, and kept a water bottle and some snacks outside, before stuffing my bag into the locker. After the biometric registration and security check, I went in familiar with the surroundings thanks to the Prometric practice session. More importantly, the interface looking like the UWorld one made me feel like I’m just taking UWorld tests in a much quieter, better-controlled environment.

I divided my exam as Check headphones-skip tutorial → 2 blocks → 10 min break → 2 blocks → 15 min break → 1 block → 10 min break → 1 block → Remaining break time (almost 25 minutes thanks to time added from the blocks) → the Last block.

Each security check took almost 5 minutes, and the short breaks left me with enough time to just make a visit to the ladies’ room and freshen up, take a sip of water and get back, I had a sip of Red Bull after my 4th block, which helped me remain alert without going overboard there onwards. I had another sip just before going in for my last block as well.

I came out feeling like I knew most of the topics covered. Anatomy and Behavioral Sciences were mostly straightforward and minimal. I was heavily tested on Blood and Endocrine systems. Most Micro and Pharm questions were things I’d remembered seeing in FA.  

Most importantly, I was just happy I was done.

The Result

Yesterday, I got my score report, it’s 247.

I couldn’t be more thankful for the wonderful score, especially after the scare my NBMEs gave me. I would really like to stress on the fact that while NBMEs are pretty predictive in pointing out your weak areas and the likelihood of you getting a similar score if you repeated your performance on the test day, it really is not a final judgment. With the right support, I was able to overlook my bad scores and focus on just improving. Take it as an indicator that something needs to change and be harsh, yet kind, on yourself as needed. Nothing helped me more than the self-awareness where I needed to be improving and what bad habits needed to be chucked out the window. There is no room for self-pity. My final score is 22 points higher than my last NBME – it’s definitely possible to whiz past your expectations.  

Things I Wish I’d done Differently

Taken NBMEs much earlier. I could have probably saved some time and effort by taking a baseline NBME, as they helped me better understand which areas needed more focus. Even doing an offline NBME earlier might help much more than doing nothing at all, as it orients you towards the exam itself, and you can fine-tune your test-taking strategy and thinking along the way.

Not been overwhelmed with UWorld. I used to get upset with the scores and would end up not doing UWorld for days or weeks in the beginning. I let my ego and anxieties get in the way of genuine learning. UWorld, the first time is only for learning and to improve your test taking stamina. Even if you score 0 on a test, you should come away having learned 100% and that is the only progress that matters.

Taken better notes to revise better. Despite having delved into the depths of certain topics, I couldn’t retain 99% of it. Certain notes of UWorld objectives, FA pathophysiology & immunology, that I’d made later, really helped me in the last few days of the exam. I couldn’t be happier with my score, but one wonders how much more they could have pushed the limit. In that sense, keeping better notes would probably have helped me more than I thought in the beginning. More than anything, it gives you a sense of having covered many topics just before your exam, providing you ample confidence to slay the exam. And if this exam had to be narrowed down to one thing, it all comes down to genuine confidence.  

Used flashcards better. I am not very well-versed with using flashcards as a study method and was very apprehensive. It was only when UWorld introduced the feature ten days before my exam that I realized it’s potential. Make your own, preferably, and go through them periodically. The USMLE might be largely clinically-oriented, but there is still a mountain of facts and figures that need to be just memorized. There is no other way to retain interleukins or monoclonal antibodies or embryological derivatives, which are all very high yield and flashcards are surprisingly effective. If it works for you, don’t hesitate.  

Lastly, understood how to improve test-taking strategies. I believed knowing facts and finishing on time was all that it took to score well. Everything from how you read the question to what order you do it in can make a difference.  

My own method toward the end of it was to read the last line first or read enough to see if I can answer before I attempt to read from top to bottom. Also, instead of looking to see if the answer choices made sense, I would have an answer ready in mind and go looking for it in the choices. This greatly reduced inaccuracies that came from the elimination method. Elimination was used as a last resort only. Very importantly, I marked the answer only when I was sure of it, or would leave it for review. I did not waste time if I got stuck and moved ahead quickly, leaving the time after attempting the last question in the block to mull over difficult questions. Marking a question, you’re unsure of increases your bias toward that choice, and often you also end up changing the correct answer to a wrong one, if at all. It’s better to give yourself time to think through unsure answers and select what you’re most at peace with, in the end.

I’m eternally grateful for the camaraderie and generosity shown by the members of the group and would have traveled in an entirely different direction if not for the advice and experiences I’ve read here – sincerely Thank you. Best of luck to all those yet to take the exam! Have faith, and go in and come out with your head held high

A Conversation

Zoe Ali – Take a bow! By far, the most eloquent and well put together experience. The beginning of your experience sounded just like mine. Surely a huge majority of the people would be able to relate to your experience as well. You ought to be extremely proud for breezing past your NBME scores in the end.

Also, I am following SDN for over a year now and I couldn’t agree more with you. There’s just so much knowledge (not the theory one) you can gain from the American students. Only if our fellow IMG’s realized.

Author – Thank you, for the extremely kind words! Yes, SDN and Reddit are very useful when it comes to understanding how their system works and how American Medical students work through their system!

One of the reasons I decided to post my experience here was my NBME scores – most of the people here with good scores usually had predictive NBME scores, which was very scary for me till I opened my score report, irrespective of how comfortable I felt on the day of the exam. If this account helps one person feel reassured that NBMEs aren’t the end of everything and there is still a lot that can be done, I’d be happy. It helps to be aware of your shortcomings while preparing and reminding yourself of your strengths while taking the exam

If this experience helped you, make sure to check out the following experiences:

USMLE Step 1 Experience – 250 – Dr. Hemel Ahmed

USMLE Step 1 Experience – 247

USMLE Step 1 Experience – 268 – Dr. Sara Khan

December 26, 2017
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