Karen Tien – USMLE Step 1 Experience – 243 – without Kaplan

Resources

Target score: 240

Step 1 score: 243

Baseline knowledge of pre-clinical science: ZERO – forgotten most things 3 years post-grad! But I am a hard worker.

Preparation time: 9 months = 6 months studying & working + 3 months of dedicated study (extension x1 and paid horrible fine after not reaching my goal by first 6 months)

Resources (in order of priority)

Dr. Karen Tien

  1. Building foundation – Boards and Beyond (short, high yield and easy to follow in FA, highly recommend this particularly if you are weak in biochemistry, cardio, genetics, cell biology and biostatistics). I tried most popular ones DIT, Rx videos, this is the best in terms of high yield.
  2. First aid 2016 read 3 times (first timeproperly with Study Partner)
  3. UW x2 (each time I read the explanations even of incorrect options)
  4. NBME 1- 19 (12-19 online)
  5. USMLE RX flash/ANKI and questions bank (only the 1000 hard questions)-it comes with options to make as many simulation tests as you like. I bought the Rx videos too but I felt I wasted my money, boards and beyond is far superior.
  6. Sketchy micro + Sketchy pharm (only selected parts like coagulation and anti-depressants as not all of it is useful)
  7. 400 pages of Goljan Pathology slides (whata gem! You can thank me later!)
  8. Pathoma ( you need two resources for pathology as that is the bulk of your exam, boards and beyond and Pathoma combined is more than adequate)
  9. Anatomy shelf notes 100 cases
  10. Conrad Fisher 100 cases
  11. UW biostatistics extra (for those of us whose maths brain has beenlying dormant for a while…)
  12. Goljan audio (great for car rides on the way to work)
  13. FA Q&Abook – has a simulation test at the end
  14. Kaplan Question bank (it comes with 2 simulation tests 7 hours each)

My personal favorite resources

BOARDS AND BEYOND – I didn’t use Kaplan. I was working and doing night calls often and didn’t have time for long lectures or lengthy explanations. I needed short high-yield facts and so Boards and Beyond was the key for me.  Dr. Ryan is phenomenal, his lectures are short, to-the-point and well-explained. He follows the format of First Aid. So after doing his lectures for a section, you can easily cruise through UW questions. His cardio, biochemistry, genetics, cell biology, understanding metabolic acidosis and alkalosis, respiratory physiology saved my life. He also has a great behavioral science section for how American health care system works; e.g. Obamacare, Medicare, Medicaid, PPO, HMO etc. which I found very helpful as I was weak on those topics and I dreaded those questions. My first NBME after Boards and Beyond with UW and FA was 209.

FIRST AID – it’s not a state secret that FA is the Bible for step-1. Why? Because in your exam when you are trying to decide between two answer your brain literally does a search through FA pages and the page with the answer comes up. This is why in your last week before the exam going through FA is very important. DON’T annotate too heavily into this book because it will make it frustrating to read at the end. I had my book unbound and post-its to add facts into it.

UW – this is also a no-brainer, this is the ultimate integration tool. DON’T use this as an assessment tool. Do not get over anxious if you are scoring low – my first round was 58%. A guess what, nobody cares LOL. This percentage no way correlates to the actual exam. You will hear this over and over again – UNDERSTAND THE CONCEPTS IN UW! Make use of the notes section of UW – these can be reprinted at the end of each round of UW. It’s fantastic for review before your exam. If you buy the 6-month option you can reset it once. If you can’t buy 6 months, mark all your questions and then do them. I recommend first round TUTOR UNTIMED MODE SYSTEM WISE. In the first round, you are LEARNING, it’s not about quantity; the average beginner takes 40 questions a day! Each question will have one key concept and 2-3 other must know facts. You have to read the questions concepts – this is why one block of 40 questions can take up to 4- 6 hours. I used the NOTES section which after one round of UW I printed before I reset UW or you can make them into ANKI notes. Once you reset UW, the second time is about the concepts that you missed and what concepts did you not quite get right? My second round of UW was 82%. Not great I know but the 18% that I missed was what was crucial in my final prep- working on your weakness.  Doing the second round of UW boosted my NBME 236-246 (and UWSA-1 256)

NBME 1- 19 – this wonderful bank of 3000 MCQs is the second best questions bank. I know people use this assessment tool. But let’s think about this logically, these are retired question from actual exams. I found doing old NBME decreased my NBME taking fear (we all have that), helped to realise concepts I didn’t know was high yield, It has the best practice questions for biostatistics and genetic questions and most importantly for me, helped me to approach the WTF questions that they throw at you in the exam. The early NBMEs helped me to boost my NBME from 209 to 228

ANKI – the key to not forgetting is spaced time repetition, the people in late preparation phases, you know what I am talking about!

RX flash cards – I used this 20-40 a day to make sure I covered First Aid well. This will show you that, in fact, you don’t know First Aid as well as you think! It’s a wonderful tool to identify you knowledge gaps in FA.

Lesson learned

It’s difficult to study and work at the same time; if you can get dedicated time off, TAKE IT!

Practice Sessions and The Actual Exam

TOP 3 questions banks

Dr. Karen Tien

  1.   UW
  2. NBME 1 to 19
  3.   USMLE-RX hard questions

(Kaplan is a close 4th and I didn’t do Beckers so can’t compare with that).

I did a total of more than 10,000 questions – 2500 questions from UW (I did them twice and went through even the incorrect attempts), 3000 questions from NBME-1 to 19, 1000 questions from USMLE-Rx (hard), 1000 from FA Q+A book, 2200 from Kaplan Qbank, 1160 from UWSA, and 120 ECFMG FRED questions.

Practice Exams

All ONLINE (in retrospect, I should have done NBME-17 and 19 offline to save the money, as they are easier than the actual exam and are not predictive).

NBME-15 (Score 213): I took it after doing 1 round of boards and beyond lectures, accompanied by one round of UW and 1 round of FA.

NBME-16 (Score 209): Took it after another 2 weeks of FA-weaknesses. It was at the point I canceled my exam and postponed. Paid $280 in Prometric fines and 60 dollars on ECFMG to extend 3 months. This was the low point in my life, I almost gave up!

IT IS THIS POINT WHEN I STARTED DEDICATED TIME OFF TO STUDY

NBME-12 (Score 228): After another round of FA (2nd time) – proper line-by-line reading of FA with a study partner. I also did NBME-1 to 7, which helped me to get over the NBME-fear.

NBME-13 (Score 236): After I did one thousand hard questions from the USMLE-Rx.

NBME-17 (Score 246) and UWSA form-1 (Score 256): Took it after the second round of UW and FA-weaknesses (4 weeks out).

NBME-18 (Score 242) and UWSA-1 (Score 256): After working on the weaknesses and revising FA  (3 weeks out).

NBME-19 (Score 232): This was final round (3rd time) of FA (1 weeks out). I made fewer mistakes in NBME-19 compared to 18, but scored lower). So be aware as this can happen to you too.

Practice sessions

Two weeks prior to the exam: I took the 120 practice exam at the Prometric test center. I strongly advise all of you to do the same, as it helps to decrease pre-exam anxiety by knowing what the setting is like, how the system works, how to pace yourself and how to calculate breaks.

The Actual Exam

The examples I give here are not questions I had in the exam; as discussing the actual questions is illegal so please don’t ask me.

The difficulty level is like UWSA-1 and NBME-18 (Form-1 is much more difficult than NBME 18 but because it scores higher people think its easier – it is NOT!).

50% straight from FA facts  – one step thinking and pattern recognition – mostly testing FACTS and simple deduction – you can answer them on autopilot. I was very grateful and relieved by these. These are the pattern of presentations that you have seen over and over again in UW, USMLE-Rx, or Kaplan. The bread and butter of your hard work are these. For example, you are asked to diagnose SLE or sarcoidosis based on clinical presentation; another example like recognizing the presentation of statin-induced myopathy and then choosing the drug that is causing the problem. Each one takes about 30 seconds to read and answer. Usually, they are 2 to 3 lines.

25%-35% two step thinking –  TESTING CONCEPT  – these question tested your ability on recognizing patterns of a patient scenario and getting a diagnosis and applying it. For example, they will give you a picture of worm/egg in the stool, then from that diagnosis, they will ask the mechanism of action of the drug you are going to treat it with. Another example: the scenario describes a chronic bloody diarrhea case and asks you to first make a diagnosis of Crohn’s and chose the best option for why they develop kidney stones. 1 minute to answer generally. Expect that they will throw in distractors like irrelevant lab values and irrelevant signs and symptoms.

10-15% difficult 2 to 3 step thinking – APPLIED CONCEPTS – questions are difficult but not impossible. For example, the first step you must correctly make the diagnosis of atypical pneumonia by mycoplasma and then on the second step decide the best choice of drug and finally in the third step answer what is the most common mechanism of resistance to that drug. I would say about altogether 20-25% is the concept you didn’t previously encounter on UW (5-10 % of these are WTF type!);  it’s not that they are new but just something you might not have thought about but you can work it out.  Example, reading and interpreting Km-Vmax like questions using two drugs like warfarin and aspirin or if they gave you a drug that has spare receptors. Strong concepts are what get you through these tough thinking questions.

5-10% WTF type questions – these are just simply what WTF means. They are bizarre questions that you would have no idea even if you studied for ten years for step 1. What are you going to do? take your best educated guess and move on.  The chances are everyone else in the exam also had the same gaping look on their faces when then saw this question. For example, these are random experiments about some random gene that tests a bizarre disease with bizarre outcomes. Just move on and let it go.

Exam flow

I used the tutorial time of 5 min to write out the formulas; so my total break time was 55 min (you can do the 15-min tutorial on the ECFMG website that also has the FRED questions).

Took 2 blocks – break for 10min – then another 2 blocks and then took a break of 20 min for lunch. In the remaining blocks, I took 5 min breaks between each block without leaving the computer. I just sat and cleared my mind before next block. It’s important to let go when you have sudden flashbacks (lol – like PTSD) of mistakes you made in the block before. Just breathe out and move on. Focus on the current question.

There will be distractions on the day: people coughing and typing, people nervously clicking their mouse and examiners walking up and down the aisle. Bring an extra  pair of soft ear plugs to use with the noise cancellation headphones they provide. Works like a charm.

You will also feel frustrated. I did not have enough time in each block to check my marked questions (in all NBME I had 15 minutes to check my answers for each block but somehow on that day it didn’t work) and I just stopped marking the last 4 blocks because of it. I couldn’t finish one block on time as I had 10 questions left and there were only 5 minutes, I think my ability to decipher and break down information weaned around block 4 before lunch.

You might be asking why didn’t I have enough time on that day? there were many factors: stress, new concepts that required me to take extra time to think especially two to three step thinking questions where you must make sure your initial diagnosis is correct.

Night Before The Exam

You must be asleep by 9:30 PM to wake up at 5 AM to be ready for the exam. You have to bring your A game and 50% of that depends on sleep the night before!!!!! For the last 5 days before the exam, I woke up at 5 AM every day so my body was in sync. (I usually only wake up by 8 coz I liked to study late so when I went for my practice session at 7:00 AM my brain was completely not focused for the first 2 blocks). I knew I would sleep poorly the night before because of nervousness so I practiced with 50mg diphenhydramine 3 days prior to exam to make sure it would be sufficient to give me a good night sleep.

Important, many people feel drowsy the next day after antihistamines so make sure you do a trial test! I tried melatonin too but it didn’t work well with me because of stress.

– I Stopped studying by 4 PM the day before. Went for a run to get rid of my excess energy and had a light dinner; took my antihistamines, and went to sleep by 9:30.

–    Woke up at 5 AM feeling mostly “fresh”, took a light breakfast of oats, took 10 question on RX and coffee on the road and arrived at test station at 7 am.

Things to Bring in The Exam

  1. Scheduling permit (The one with the CIN number on it),
  2. Passport or ID WITH signature,
  3. ear plugs, (no watches allowed),
  4. saline eye drops (air-con dried my eyes when I did practice tests).

You will be given 2 markers and 2 boards. Exam center has headphones (non noise cancellation) to listen to murmurs and another set of noise-canceling ones.

Lesson Learned

Most  predictive is NBME–18 (my score was 242)

 

Study Tips and FAQ

GENERAL USMLE Step-1  TIPS

Dr. Karen Tien

  1.   DONT FOCUS ON YOUR GOAL! FOCUS ON YOUR HABITS

we often get ourselves stressed out over NBME scores and our goals. All of that is actually beyond our control and so is the actual exam score. Just focus on things you can control – the time we put into studying and the quality of the study. For example, ask yourself how much ACTIVE QUALITY STUDYING  TIME are you actually spending each day on studying? Or are you just pseudo-studying (i.e. wasting time by reading but nothing is actually going into your head). It’s sometimes very difficult to critique the methods we have adopted to for many years but take a look at your study habits, are you studying smart or are you just studying hard? You do however have to…

  1.   PUT IN THE TIME and WORK

There are no shortcuts or quick ways to master concepts. The people who score high did not get there by mistake or had a “lucky” day when all the questions that came happened to be what they knew. The simple truth is that they have more knowledge and they have mastered core concepts better than everyone else.  It takes time, sacrifices, and patience. You have to build a strong foundation of concepts and a good foundation of pattern recognition. You exam depends on your ability to recognize the pattern of disease presentation and decipher information given to you in succinct and logical manner while not being sidetracked by the distractors they put in. Patients in real life don’t read textbooks so you should not expect the  USMLE examiners to give you the classical textbook cases. You score really comes down to how well you have mastered the concepts for you to get through the 2-3 step thinking they throw at you.

  1.   GET A STUDY PARTNER!

If you want to be a loner and do It yourself good for you! But for the rest of us, we need SP support when families and friends don’t understand your struggles and when you just need someone to tell you that you are not an idiot despite getting the same question wrong 3 times on UW. LOL. For real. It happens. Seriously though, thanks to my study partner, we were able to read in between the lines of FA and help each other iron out poor concepts or misunderstandings. It took us, on most days, 6 hours to get through 20 pages but we did them perfectly. Two brains are better than one, you will be surprised at how you miss things in FA that your SP picked up and vice versa.

  1.   STOP GOING OVER WHAT YOU ALREADY KNOW AND FOCUS ON YOUR WEAKNESS AREAS

we all avoid this – I  knew I was weak at genetics and pharmacology calculation but I chose to ignore it because I just thought the concepts are so boring. Face your procrastinations head on! If you know you are bad a renal and pharma calculations, the problem is not just going to disappear one day; go and do more questions and find more resources for it!  You will thank yourself in the final FA revision the week before your exam. For me, Genetics was my weakness so I did as many questions as I could find for genetics from UW, Rx, Kaplan (about 400 questions for each weakness areas). If your next NBME still shows weakness, what should you do? The answer is still, do more questions.

  1.   ETHICS is JUST AS IMPORTANT

Ethics is just as important as cardio or neuro in terms of exam weighting – it’s easy to overlook ethics because often we think “ETHICS is simple, I’ll just use my gut instinct in the questions”. WRONG. The real exam puts your ethical judgment to the test by giving you options that you think are right but not necessarily the BEST choice. PRACTICE ETHICS! It’s completely UNETHICAL actually to get difficult cardiology questions right and then lose that point to ethics! it’s just UNETHICAL to the hard work you put in cardio! LOL.. you know what I am talking about, you probably spend ten times more effort in cardio compared to ethics. Good ethics sources besides UW and FA: Conrad Fischer 100 cases, Kaplan, and USMLE-Rx also have very tough ethics and behavioral science if you need more practice.

  1.   When you reach the plateau – PERSIST!

If you are one of those geniuses who don’t plateau, great; but for most of us you will reach a plateau – for me, it was NBME-15 (score 213) and NBME-16 (score 209) one month after one another. Don’t give up, just keep on studying. I bought a new question bank for a new perspective and the next NBME was a relief at 228. I don’t know whether it’s the new question bank or going through FA with a partner or doing UW again or going back to basics again. Believe in yourself and PERSIST. The reason why most people plateau is also because they are forgetting more of the past core knowledge as they are learning new things. ANKI. Make it your friend peeps. If you don’t know what I am talking about, do a little research on something called the “forgetting curve” and understand why spaced timed repetition is essential to your success. You can thank me later.

  1.   BE KIND TO YOURSELF

Be kind to yourself and forgive. You will question yourself very often – why did I forget that again? Why did I get the same question wrong again on UW? How Is everyone doing this in much shorter time than me? am I dumb or are people just not telling me their secret formula? These are all questions I know we all go through. When you are faced with these self-doubts, remember to be kind. To yourself.  Don’t take things so personally and always do your best. What can you ask more from yourself than the best?

  1.   HAVE A SENSE OF HUMOUR?

I know it’s a very serious exam and sometimes we fail to see the bigger picture because we are stuck in the moment of wanting more and depressed because we fail expectations. Please find the humor in all of this and realize that we are, after all, just human, we make mistakes.

  1.   GRATITUDE

Being grateful is actually very powerful. It is such a blessing that we have been given the gift of education and self-improvement. I am grateful for this opportunity to challenge the USMLE, it has taught me humbleness, persistence, patience over and above knowledge. What have you learned about yourself on this journey so far?

STUDY TIPS

  1.   LOCATION LOCATION LOCATION!

The place you choose to study plays a vital part in your ability to concentrate with minimal disturbance. If you have the option, don’t study in the same place you sleep or watch movies. Choose a place that is quiet, have a good source of light for those who study late nights, and Feng Sui tips- your seat should NOT have your back facing the door (it creates a sense of uneasiness).

  1.   PROTECT your neck

I had many bouts of neck pain because I had poor posture when studying. Please do a little reading to understand the ergonomics of your table and how well it suits your neck and back.

  1.   FIND your own sense of study style

Are you visual? Audio or teacher type? Do what works best for you. Everyone studies differently.

  1.   BE CREATIVE WITH STUDY SCHEDULE

Please don’t ever assign your brain the task of “reading FA for 10 hours for the day”. That’s one recipe to brain graveyard. No brain (no heart for that matter) wants to leap out of bed in the morning thinking Yippee I’m going to read FA for 10 hours today! MIX IT UP! For example – 1 hour FA (usually can cover 3-5 pages as a beginner and 10 at pro level) then do 5 sketchy mico. Break 20 min… 1-hour FA. 2 hour of UW tutor mode. Long break. Then flash cards from last weeks UW for 1 hour and then so on. I got the idea from Pomodoro. Use the app if you like but please just make your schedule interesting and exercise even if it just to walk out for 20 min. You need the VIT D anyways because I know you have been living like a hermit. hehe.

  1.   MAKE FLASH CARDS FOR YOURSELF FOR REVISION

ANKI is great, use whatever app you have to. Spaced time repetition is the key to long-term memory. why do you need long-term memory – if you haven’t already searched the “forgetting curve”. It’s a well-studied science and you should definitely try using it to your advantage.

When making flash cards, ask the questions that you think YOU might get wrong or most likely to forget and not just make flash cards about facts.

  1.    TAKE ONE DAY OFF A WEAK

I mean this sincerely. Burnout Zombie is not a good look on anyone.

  1.   Use the FB Search Button on the Step-1 Forum

If you have a question, search it on the Facebook forum.  It’s most likely been asked before. Whether it’s a link to NBME offline or other resources or its some random fact you are querying that you came about on FA, it’s most likely been asked by someone else.

  1.   Do Difficult Topics in the Morning

Morning study sessions are usually more productive than evenings so prioritize the most difficult stuff for the mornings.

Questions I wished people gave me advice on when I was Preparing

How long does it take to study for Step-1 for an IMG?

average 6-12 months

It depends on several factors

  1. Years from graduation – the longer you have graduated from med school the more time you will need to rebuild your foundation. If you graduated more than 2 years ago. You most likely will need to start from scratch. I was 4 years out of med school and so going back to biochem, genetics, cell biology, biostats, microbiology, and immunology was a big struggle for me.
  2. Full time or dedicated. I worked for 6 months during my first 6 months of study, it was very difficult, I thought I could write after 6 months I was wrong. It was only after doing dedicated 3 months did my marks improve gradually from 209- 242.
  3. Family obligations
  4. How smart you study
  5. What is your goal ? to get above the mean of 228? Or 245? Which is one Standard deviation or is it 260, Which is two standard deviation? What does it mean? It means to get above 260, although not impossible, you need to surpass the other 97.5% of people who wrote with you. They are all just as ambitious as you are. Remember the scores depend on the bell curve and also the specialty you are aiming for.

What Sacrifices shall I have to make to prepare for USMLE as an IMG?

  1. TIME – 6-8 hours/day the average IMG takes about 2 years to write step 1 to 3 with the first test (whether you take step 2 or step 1 first) taking the longest which is 6-12 months.
  2. MONEY – Step 1 has already cost me more than 3000 USD.

 

ECFMG application for step 1 – 1100

UW 1 year – 450

FA – 45

Boards and beyond 1 year – 160

Rx online question bank 3 months – 100

Kaplan question bank 1 year – 220

Online nbme 12-19 60×7 = 420

Extension fee – 60

Cancellation fee for prometric – 280

 

  1. FAMILY and friends – like a 2 year old, your favorite work will become NO, no to dinners, no to holidays, no to social events. This exam consumes you… don’t be stupid like me. Strike a balance.

NBME – how to interpret your results?

I’m referring here to the online ones. NBME extended feedback (60 dollars versus no feedback which is 50 dollars) tell you about your performance in each area and shows you your incorrect attempts (without telling you the corrects answer) is a good way to determine your weaknesses. Besides looking to see where your subject weakness you have, you should also critically analyze your MCQ taking skills. Of the questions you got wrong, go through them and see

  1. How many silly mistakes did you make i.e. didn’t read the question properly or you made a presumptive diagnosis?
  2. How many were incorrect concepts? (crucial that you iron these out so you don’t make same concept errors again)
  3. How many were because of poor FA recall – ie you studied this before you just don’t remember this well.
  4. WTF questions where you just had no clue what they are asking (there is really not much you can do about these, except perhaps doing more question ie new question bank.

If it’s silly mistakes – you need to focus more, these are what we fear on actual exam day. If is the poor recall of FA – you need to do another round of FA.

How to improve NBME results/if you have reached a plateau?

In my humble experience, I feel There are three key factors why people don’t improve

  1.   Poor basics /poor foundation – (i.e. the beginning of FA – biochem, micro-immunology, patho, and pharma) for those of us who graduated more than 3 years ago, you can be guaranteed your basics are poor. Without a solid foundation – whether you used Kaplan, DIT, boards and beyond (best thing I ever bought for myself), you just cannot progress and you might even plateau and struggle for months with little improvement. NBME results will show you often have average or below average on “general principles”. Without a solid foundation, you will struggle to build good concepts. For example, if you don’t know what the difference between MHC 1 and 2 you will struggle to differentiate which disease are MHC 1/2 related.

Tips: do more questions on general principles using Rx, or Kaplan question bank, old NBME 1-11 are also good for pointing out our weaknesses.

  1.   poor MCQ taking skills – as I wrote above, after each NBME you should look at how many silly mistakes you make, this can be the key difference between a 230 and 250 (just 10 to 12 questions). What I mean by silly mistakes are ones where you misread the questions or you made a presumption.

Tips: read the last sentence of the question first and the answers FIRST then highlight key words in the question stem. Make sure you cross out all options before you make your final decision. If you stuck between one of two options, flag it, come back to it in the end. A second look at the question often triggers a new memory

  1. you are forgetting more than you are learning. If you haven’t done your research on the forgetting curve. Do yourself the favor and save yourself from pain. if you understand why your brain forgets then you will understand why people say they do FA 4 to 5 times, spaced time repetition is the key to long-term memory.

What should I do in my last month?

This plan is what I would have done in retrospect with the proviso you have done FA 2 or 3 times thoroughly and UW twice and done all old NBME-1 to 11.

  1. Ontop of revising incorrects of UW and marked questions of UW, do one block of NEW questions every day. use another qbank – why? because 20-25% of the exam are new concepts. You have to be able to handle them to train your brain to tackle new questions right up to the day of the exam.
  2. Do NBME-18, 3 weeks before your final exam – why? because if it is low, you have time to work on weakness so you don’t panic before your exam, NBME-19 has a weird scoring method at the moment, I got more corrects than 18 but points dropped by ten. If I had a choice I would have done 19 and 17 offline. 18 and 16 are the closest to actual exam in terms of difficulty.
  3. Then after NBME you have three weeks – of which I recommend still doing 40-80 new questions a day and one full read of FA (focus on your weakness from nbme-18) you need to be able to do this fast i.e. 50 pages a day (this is doable if you have done FA at least twice before) @ rate of 10 pages/hour.
  4. Remember to take one day off a week to relax and exercise 30 min day. Don’t burn out.  you do not want to be sick on the day or have a sore neck.
  5. one week before exam – take nbme 19 and work on weakness for 2 days
  6. Last 5 days before exam – continue 40-80 new questions a day , revise UW notes,   nbme notes, do your Uw marked questions
  7. One day before exam – do your list of forgettables – for me this was 60 tagged pages  I had in FA it took me 6 hours one day prior to exam, stop studying by 4pm so you can exercise and get good night rest before exam. Need 8 hours of good sleep .
  8. On the morning of the exam, wake up to revise your formulas (if you didn’t do so the day before) do 10 to 20 practice questions to get the brain in focus. DO not bring your FA to the exam center.

How to extend the exam?

I had to extend because I couldn’t reach my target after 6 months. Firstly, I had to call Prometric to cancel the exam, that cost me 300 dollars! (Because I didn’t read the fine print about cancellation fees 1 week prior to exam). I did a 1-time extension on ECFGM which is 60 dollars. 15 days later they gave me a new permit, it was then that I paid Prometric the fine (with the credit card over the phone). After I had paid I had to send ECFGM proof of payment after which they sent me a scheduling permit (Prometric and ECFMG work as separate entities). The bottom line is if you are going to cancel the exam – do it 1 month before the scheduled date so that you don’t pay a fine. If you are canceling after you have already done a 1-time extension then that is a different story. As far as I know, you cancel with Prometric ( not showing up to your exam goes on your ECFMG record and ERAS so please don’t do that), call ECFMG for further advice, they will tell you that you need to wait 1 month after the expiration date of your triad before you can reregister.

Thank you for this group for all the experiences you have shared and for the resources and wisdom. Thank you to my family and friends for their understanding and support. Thank you to my study partner who is always my go to girl and who always knew the right thing to say to me to keep me going. Thank you to my boyfriend who never doubted me, pulled me out of depression after each NBME (NBME fear is real lol), dragged me to exercise and supported the inner nerdy medic that I am.

Hope you found this helpful. What a wonderful gift that we have been given to learn and improve our minds. Enjoy every moment of your every experience on this journey.

A mind that is stretched by a new experience can never go back to its old dimensions – Oliver Wendell Holmes, Jr.

If this experience helped you check out the following experiences:

USMLE Step 1 – American Student – Experience – 246

246 after 270+ in NBMEs – DON’T MAKE MY MISTAKE – Advice for Step 1 Candidates from Dr. Mahmoud Yousif

My Step 1 Experience by Dr. Adeyemi Emmanuel – 249

December 25, 2017
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