STEP 1 EXPERIENCE: 253 BY DR. JAGJIT KHOSLA

253 USMLE Step 1 Experience

253 USMLE Step 1 Experience

BACKGROUND

I am graduate from UCMS, Delhi, India.

Sometimes in life you have to make a choice… Either continue to live the life of mediocrity or set sail for never ending pursuit towards mastery

I made my choice and that’s how the journey began… There were three phases in my preps…

PHASE 1

I started doing subjects one by one… and did it like this… I used to see Kaplan videos along with notes for one subject, supplement it mostly with one extra reference book for that subject… then read first aid of that subject and add all extra important info into the first aid in empty spaces n if required I added extra sheets… following this I used to do subject wise Uworld questions on that subject (and even chapter wise for pathology)… and while reading explanations I used to add all that was missing in my first aid… I did this for all 7 subjects… took me about 5-6 months to do all… but at the end of that period… I was done with Uworld once complete and my first aid contained all important info in one book… I was curious where I stood… but I knew it’s still premature stage… so just did NBME 1… got 244 (174/200)… not happy but felt confident to move on as I knew I haven’t revised anything yet… Resources I used are mentioned later in this article…

PHASE 2

 

Then began phase 2… where I started revising up the Consolidated first aid and also revising up Uworld random timed mode… but then realized after doing 40% of Uworld that doing the same ques again wasn’t really helping me learn more… because I already knew the concepts n it was just about memory recall… so I left Uworld and never returned to it… I felt doing Uworld once well with consolidating first aid was more than enough to learn concepts… so I began doing usmlerx daily 50-100 qs in the morning n rest of day revising up the first aid… it took me over a month to revise up the first aid completely… n during that time I did half of usmlerx too besides redoing 40% of Uworld ques…

This phase was the most difficult for me… because I was learning anything new just revising stuff so got really boring… also I anticipated I would be over with it in 2-3 weeks but it stretched to 5 weeks… So I was freaked out literally… in the mid-way I was so frustrated that one night… I gave NBME 7… got 251 (179/200)… felt better because I knew it’s only going to rise up…

So after finishing up this phase… I did NBME 11 n Score got better 255 (182/200)… then next day did UWSA 1 online and got 263 (770 – 83% correct)… That was morale boosting… I booked the date of 4 weeks later as I felt that’s enough time I would need for phase 3 (the last phase) of my preps…

PHASE 3

During this phase I did all NBMEs every few days… and was revising up the chapters which UWSA1 showed as weak… I was also trying to do USMLERx but then I just left it after doing 2/3rdbecause I wanted to do Kaplan qbank as many who got high scores have done it… It was about 3 weeks from exam… I was doing old nbmes but my scores had plateaued now… not rising up … I was frustrated coz I felt I was still not where I wanted to be… esp. when I know the newer NBMEs would be much harder than this… Also, I felt I was hardly able to finish up the questions on time… At that moment 3 weeks from my exam… I took a drastic step… I bought Kaplan online and started doing 8 blocks daily timed random exam style mode n then used to see the wrong answers explanations in the remaining time of the day… It was harder than USMLERx… I got all percentages from 70-89%… after 3-4 days… I was done with 2/3rd of it with 81% overall score (against 61% avg)… Then I gave completed all old NBMEs as exam was getting close n I wanted to leave last week for one final revision… scores were still in the same range… but I was able to finish blocks in 50 min… so I literally trained my brain to think fast and right… Also I was initially making many silly mistakes due to lack of concentrations… I decreased them as I moved on… So although the scores were still the same… I knew I was improving daily… by the end of that week (i.e. 10 days from exam) I was done with 2/3rd Kaplan… n all NBMEs except 12 13 15 n 16… Then I did UWSA2 online n scored 265 (800 – 85% correct)… then did NBME 12 N 13 over next two days… got good scores… In the last week… I tried working on my weak areas shown in UWSA2… but it was increasingly getting difficult… I was reaching saturation point… then 3 days from exam… I decided to sit for NBME 16 online followed by NBME 15… That day I got the shock… NBME 16 was 251 (179/200)… I was shocked to the core n furious… As it was the lowest I got in all nbmes… I was down thru the day so didn’t do NBME 15… but by the evening… I was so furious that I decided to be done with NBME 15 the only assessment left… I finished up by 12 midnight… I remember I was so tired… I was dizzy n clouded through last two blocks… But still I persisted… I was back to 262 (187/200)… That was the relief I needed… after that in last 3 days I was at peace… tried to revise a lot but still lot of revision was left undone…

MY ASSESSMENT SCORES

UWORLD – 76% (First time, subject-wise)

KAPLAN (finished 2/3rd) – 81% (Random, timed mode)

USMLERx (finished 2/3rd) – 85% approx

NBME 1 : 244 (174/200) 2 month from exam
NBME 7 : 251 (179/200) 7 weeks from exam
NBME 11 : 255 (182/200) 4 weeks from exam
UWSA 1 : 263 (770 – 83% correct) 4 weeks from exam
NBME 2 : 262 (187/200) 19 days from exam
NBME 3 : 258 (184/200) 18 days from exam
NBME 4 : 262 (187/200) 12 days from exam
NBME 5 : 259 (185/200) 11 days from exam
NBME 6 : 260 (186/200) 10 days from exam
UWSA 2 : 265 (800 – 85% correct) 9 days from exam
NBME 12 : 258 (184/200) 7 days from exam
NBME 13 : 256 (183/200) 6 days from exam
NBME 16 : 251 (179/200) 4 days from exam
NBME 15 : 262 (187/200) 3 days from exam

Actual Exam score : 253

So, in a way, NBME 16 was closest in assessing and UWSAs n other previous NBMEs over-predicted… Although I still holds that above 250, it varies according to luck and it becomes a major factor…

NIGHT BEFORE EXAM…

That was the worst night possible for me… I had to travel over 2 hrs in morning to reach centre… so I had to wake up at 4… Therefore, I decided to sleep at 8pm and get 8 hrs sleep… As it happens always in usmle journey… nothing goes according to plan… I couldn’t get to bed till 9 pm… n even then… I tried tried n tried… but couldn’t sleep till 2am… My heart was pounding and I knew I was having panic attack… and it was serious… coz not getting good sleep before exam totally screw up the exam irrespective of ur knowledge… coz its more about thinking… So I reluctantly took one Levocetrizine as I felt it will have least hangover effect next day… and still may help in sleeping process… (Although LCZ is 2nd gen but still it has some sedation side effect… not like fexofenadine) I could hardly sleep by 2am…

I woke up at 4am… got ready… I saw in the mirror and told myself that despite all that happened… it’s all past… For next 12 hrs I am going to give my best and won’t let anything affect it… I realized life always puts you through troubles to test your inner strength and determination… and it’s up to you… Either you can keep making excuses and blame others for ur failures, or you can stand up against all odds and win the day despite all resistance… I had made up my mind… I travelled 2 n half hours to reach centre… It was extremely cold n foggy (those who r from Delhi know how it is early morning in December end)… I didn’t revised anything during the travel… I felt it will only make things worse… so kept my mind free… remembered my god… and went for it…

EXAM EXPERIENCE

I started at 8… A good friend who already gave the exam told me previous day that expect the worst in the exam… and u won’t panic… I was also told that exam is very lengthy n u will not get time to review marked ques even… So with all these preoccupations I started my first block… It was average… not really difficult… got done with all ques with about 12-13 mins left… n then reviewed all marked n then saw all the answers just to make sure I didn’t accidentally clicked the wrong option (such thing can happen)… I was totally calm and no panic or tension… after finishing 1st block I felt I got into my zone… when u r ready to face anything without tension or worry of whether u wil get it right or not… u just have to give the best u can… choose what option u feel is right… there is nothing else we can do… so why worry… I had totally free mind n from there on the whole exam was like that… I took toilet break after each block… n also rinsed my face with water… n had some glucose water… by end of 4th block I felt hungry… so took a big break of 20 min n had some Rajma Rice… apart from that only thing I ate during exam was an apple after 6th block I think… just to get some energy for last push… about difficult levels.. As expected… it increases with each block… 4th n 5th block were really difficult 5th was most… so many weird ques… but I persisted… tried my best… by 6th n 7th block I was ready for anything… having already seen the most difficult ques… Overall it was great experience… I was able to maintain concentration at 100% thru out… no dizzy episode or cloudiness… My endorphins were flowing high in my brain (the same mechanism why soldiers in battlefield do not feel much pain)… I completed the final block and was done…

HOW WAS EXAM?

Pattern: Its most similar to NBME form 16 which had many weird questions… only difference was that it had very few 2-3 liners… n much larger proportion of those weird questions…

Difficulty: It’s doable… that’s something everyone who gives exam agrees… Expect the worst and you won’t really panic… but if u r going into exam expecting all things to come from book… u r going to have shock… Although about 80% of the exam is from common diseases and topics mentioned in first aid n Uworld… it’s different… They will ask very simple info but will twist the question a lot so that if u do not pay 100% attention while reading the ques… u tend to miss very important info needed to answer correctly… also they will lure u will many attractive options who will look more likely and only if u have strong concepts u will not get distracted from right answer… Rest 20% ques is like from somewhere else… u cannot prepare for it… n when u see them… u just use all ur basic concepts and reasoning skills to come to the most appropriate looking answer and then click it n move on… don’t let that ques make u panic or tensed… it’s the same for everyone… remember that… Just trust ur instincts on those and there is nothing much u can do…

People say that it’s the most difficult exam… more than any qbank or nbmes… it’s true… coz it has such large proportion of weird “out of the book” questions… but if u understand biostats you must know that you are being evaluated against a standard curve…

For example… suppose u get an easy questions block… u score 80% in it… but mean score on that is 75%… so u r only marginally better than mean… so ur score wont b that good… but if u get a difficult set… with mean score of 60% n u get 75% in it… u will get much high marks because u r lying way above on curve… That’s the reason that despite the fact that real exam has so many weird questions while nbmes mostly have simple easy questions… still scores in both r generally similar… coz no matter which exam you give… based on your basic concepts strength… u will lie in similar range over the general curve… so ur marks doesn’t change… in simple words… u don’t need to get over 92% questions right on exam to score 260 like u need to do for nbmes… so no need to panic… just do the best you can on that day and leave the rest to luck…

What’s more tested: It’s a mix bag… and really you shouldn’t deal with this exam this way… Always think each n every subject is important… coz even if there r only 10 ques of a particular subject… they hold the power to affect ur score a lot… so always focus on excelling all the subjects… In my exam there were not a lot of anatomy weird questions (a few were there but tolerable), not a lot of incontinence ques (hardly 2-3 I think), not lot of images (but many of them were weird and some were really difficult… but mostly u can make something out of stem and get to a reasonable answer)… there were two heart sounds and two ecgs… all four were easy… but in heart sounds… there was nothing in stem… so u got to identify the sound to answer them… CT/MRI I had few… one of them was really difficult… other were fine…

Length of questions: I had a mix bag there too… mostly questions were like 5-10 lines long… some were long… so long that u got to scroll down… but mostly they were long coz of lots of unnecessary labs given… U must be good at reading the labs quickly n highlight only those which r relevant to the ques… this way u can deal with such ques… I got many 3 2-3 liners too… Overall it wasn’t that scary as many others said in their experiences… May b I got lucky or something…

Timing: I had enough time to finish up all blocks with about 6-10 min spared to review all marked ones n then quickly go thru all ques to check I marked the right options… so time wasn’t an issue…

Breaks : I had done online tutorial beforehand… so I just checked headphones n quickly went thru rest of tutorial… the interface is mostly similar to Uworld… so u won’t really have trouble dealing with it… I finished tutorial in 2 min… so I was left with 58 min of breaks… I used them in the following order…

Block 1 -> 3-4 min break (went to washroom n rinsed face with water, then drank some water and went back)

Block 2 -> 3-4 min break (went to washroom n rinsed face with water, then drank some water and went back)

Block 3 -> 5 min break (went to washroom just to wash face and stood there in power pose for 1 min to energize myself… then went back)

Block 4 -> 20 min break (I was feeling hungry… so decided to take a lunch break… went to washroom n then washed face… n then had some Rajma rice I got from home… n then some glucose water)

Block 5 -> 14 min break (I was left with about 28 mins of break n just two breaks to take so took a lot of time… also as Block 5 was the most difficult block I faced… I needed some time to recover… again went to washroom… no no I don’t have diabetes inspidus… but I made sure I don’t feel peeing in middle of block… ? after washing face n having some glucose water… I went back)

Block 6 -> 14 min break (I was relaxed n happy as only one block left… just again did routine of going to washroom n washing face… had some apple for energy… n then went back… sat on seat for two min n then clicked start new block)

Block 7 -> over n done…

Any step 2ck type ques: a few “what will b next step” type ques were there but can be done with step 1 knowledge n some common sense… no extra knowledge required…

New topics: There will always be some weird diseases being asked which will not be found in first aid n Uworld… but that’s a part of game… I cannot share the questions obviously… but I would anyway advise to focus on what’s there in first aid n Uworld n do them well instead of worrying about a few new topics which will not find in any textbook…

Subject wise patterns in exam:

Gross Anatomy: Some weird ques were expected but not many were there hardly around 5 ques… n mostly u cud reach to a reasonable answer… so don’t worry about them a lot

Embryology: I think it’s pretty easy on exam… just make sure u do understand hedgehog, homeobox, fgfr, wnt pathways n their roles in embryo well coz they r really high yield… although I didn’t encounter any ques on them on my exam

Histology: Basic histology isn’t that much tested on exam… mostly its pathology related histo… but u must have an idea of how normal tissues in different body systems look like on section… I wasn’t really good at histo… but I think doing pathoma n goljan really helped me got better at it… I didn’t do webpath n other sources which people highly recommend coz never had time for them…)

Neuroanatomy: Very high yield and scoring too… make sure u understand it well… also do all the brain sections n arteriograms given in HY

neuroanatomy…

Physiology: One of the trickiest subject on exam… lots of up n down arrows… and they r risky coz if u mess up with one parameter… whole ques gets wrong…

Biochemistry: it wasn’t really difficult in my exam… most of ques were easy… a few were tricky but still nothing out of the book there

Molecular biology: I got some really weird n totally out of all the books type ques on exam on this subject… and I have no idea how can anybody prepare for them… Just do molecular biology n genetics well and hope for the best… nothing much can be done about it really

Genetics : This was pretty easy… some simple calculations… there might be 1-2 difficult ques… but not more than that… but its scoring so make sure u don’t lose ur marks here

Pathology: It obviously was all there everywhere… mixed with other subjects… Mostly doable and ques were from the topics mentioned in first aid n Uworld… but I got 4-5 difficult ques on strange diseases…n I couldn’t make diagnoses in 2-3 I guess… but still made the most reasonable guess and moved on… in exam u will find such ques… just make sure they don’t affect ur thinking process on other ques… and also u never know which ques are just experimental… so just make sure u do ur best… This subject is really important because in most of questions u will b given a patient scenario… n first and foremost step to answer a ques rightly is to make the right diagnosis… so no matter what subject they r testing… u need basic knowledge of pathology before moving on to what is being asked… that is the reason I find doing both pathoma n goljan worthwhile coz it’s such an important subject that u cannot think of shortcuts… just cannot

Microbiology : People asked me whether there are any preventive medicine ques in exam… that’s where they were… so must do modes of transmission of all infections well… coz that is quite tested… also there were many difficult images in this subject on my exam… My micro was never the strongest… n having such ques made things worse… But still it’s doable… Remember all microbes… even the minutest ones… which u might think that they will never be tested… u can have just any microbe mentioned in first aid Uworld… sometimes they ask the treatments of infections too… so correlate them well… like after u complete anti-microbials chapter… go back to microbes and see which antibiotics/antifungal/antiprotozoal/antiviral is preferred for which microbe… that’s pretty high yield… Some skin infections images were also there in exam… so make sure u learn to identify infections by looking at them…

Immunology : Apart from molecular bio… this was also another section on exam filled with many weird ques which test urn basic concepts of the immune to the core… so make sure u understand mechanisms well and which immune mechanism will come into action when… like they can give a patient scenario n ask which immune mediator is working… like that… Mostly I was able to tackle it well…

Pharmacology: Mostly were easy ques… make sure u do all the side effects and drug interactions well and also do cyp 450 enzyme types well which is given in Kaplan… overall it wasn’t really difficult n doable

Behavioral science: I used dr.daugherty lectures n brs as I mentioned later n I found it quite sufficient to tackle all the questions on exam… nothing really difficult…

Biostats: One of the easiest section on exam… I was good at maths so calculations really didn’t bother me… and they were mostly easy… some were testing basic concepts… nothing that was out of book or weird… easy stuff there

Ethics: Mostly easy questions… not a lot tricky… it’s the trickiest section of exam… but I got lucky to have got good ques there… I was able to reach one best answer in all… As I mentioned later… I didn’t do Khans or Fischer’s cases… but it didn’t affect me…

Multimedia : Many images were there which I haven’t seen anywhere and for many I was quite clueless too… but mostly stem helps u get to a diagnosis… so concentrate on basics…

Heart sounds : two in my exam… both were like u got to identify and nothing in the stem… so practice them well… there is an app on android “heart sounds n murmur” search it n download it… its sounds r mostly similar to what are there on exam

ECG: there were 2… pretty easy… from first aid… I would like to give a list of ecgs u must be familiar with when appearing for exam as they r high yield… it goes like this:

  • Atrial fibrillation
  • Ventricular fibrillation
  • Torsade’s de pointes
  • WPW syndrome
  • Brugada syndrome
  • Heart blocks (first second n third degree with both mobitz type1 n 2 for second degree)
  • Hyperkalemia n hypokalemia
  • Pericarditis
  • ST elevation MI (must know which leads are for Anterior, lateral n inferior)

CT/MRI: practice them well… there r some difficult ques there… so must be good at them… use any resource u can to practice them… HY Gross anatomy has many sections n they will really help u get hold of it.

RESOURCES I USED (ASSUME FA IS FOR EVERYTHING COZ I CONSOLIDATED EVERYTHING INTO IT)

Gross Anatomy: Kaplan + High Yield (Did it well as Kaplan is basically nonexistent in this department)

Embryology: Kaplan + High Yield (Really nice book… I think it’s a must to master embryo on usmle)

Histology: Kaplan + High Yield (Just skimmed through it n saw pics at the end… the text is too detailed and really not that high yield :P)

Neuroanatomy : Kaplan + High Yield (I personally liked Kaplan more but still felt High yield complemented it nicely… esp. HY has a chapter focusing on brain mri/CT n all arteriograms… these r real high yield topics and that’s why I think it’s a must)

Physiology: Kaplan + BRS Physio (I liked both… While Kaplan teaches concepts… it gives info very vaguely… on the other hand BRS physio gives exact info… I esp. liked the tables given of parameters going up n down in each diseases… that’s very important as on real exam… many physio ques are like that… also BRS physio has Neurophysio which is not present in Kaplan and it is high yield for exam… like I saw many ques on type of nerve fibers and skin receptors on nbmes)

Biochemistry: Kaplan (I tried starting Rapid review but felt it was too much and really I understood the metabolism really well from Kaplan… so never felt need to go for another book)

Genetics: Kaplan (I understand the person in lectures was too slow n boring… but he taught some really important topics nicely… be patient n u will gain a lot)

Molecular biology: Kaplan + High Yield (I studied it with Genetics because both complements each other… HY has many nice chapters… esp. there is chapter on Molecular techniques… teaches u those techniques very well… also it all the molecular pathways of MAP kinase PI3K Smad etc… n u must know them as just knowing Gprotein coupled mechanisms n Jakstat will not be enough for exam… I also googled to learn WNT pathway n Sonic hedgehog pathway as they are high yield and not mentioned anywhere… These molecular mechanisms and molecular biology techniques are totally missing from first aid… I don’t know why so… hopefully they will be added in future…)

Pathology: Pathoma + Goljan Big book 4th edition (I started with Pathoma videos combined with notes… did them once… They explain pathology concepts really nicely… Some people asked if notes are enough… I would highly recommend doing videos with notes as Dr. Sattar draws lot of handmade diagrams to make u understand things and u can even draw them in ur notes for revising up later… quite useful for creating a good base… After doing Pathoma… I started doing Goljan big book… having already done Pathoma really made Goljan more tolerable… coz otherwise it’s a very tough book to do… There are audios n other notes available too… but I felt nothing compares to the big book… it takes u to the next level… u start understanding diseases like u never did before… General pathology chapters given in goljan are the best part of the book and must not be missed… Esp. chapters like environmental… these are not given anywhere else… so pretty useful… J I am glad I did it… but I took it one step ahead and consolidated the whole goljan into first aid… this ensured that I never had to go back to it… which saved a lot of time in last 2 months… )

Microbiology : Kaplan (Also tried doing Lippincott microcards n clinical micro made ridiculously simple but felt it was too much… the info u get in Kaplan n first aid was more than enough and u just need to understand n remember them well… )

Immunology: Kaplan (Nothing else needed really if u listen carefully to her… she explained immuno such nicely…)

Pharmacology : Kaplan (I couldn’t think of a better source… so just followed Kaplan n I felt Kaplan + first aid was more than enough for pharma)

Behavioral science: Dr. Daugherty lectures + BRS behavioral (Did them both together chapter wise… I felt that was the best combination possible…

first listen to the lecture on a chapter with lecture notes… then do BRS chapter on that topic… n follow it up with questions given in BRS at the end of chapter… that way u will understand the concept really well… Also, BRS has chapters like one chapter on insurance which was not mentioned anywhere but is quite high yield nowadays)

Biostats: Dr. Daugherty lectures with notes followed by UWorld biostats review questions… (Do these well and you will sail through biostats easily… Also… somebody asked so clearing it… UWorld biostats review section questions are different from the biostats ques in uworld qbank… so it ensures u do about 100+ ques on biostats… good enough for preps)

Ethics: Dr. Daugherty explained it really nicely… n followed it up with First aid… never felt the need to do anything else… So didn’t do Fischer’s cases n Khan’s cases… so cannot comment on their effectiveness… do them if u feel u don’t understand these type of ques well…

QBANKS

UWORLD

No doubt it’s the best out there… and not just because of difficult n tricky questions… but also due to its good explanations… so don’t skip the explanations… do them well and note down important points in first aid…

 

KAPLAN

I would keep it second in number after uworld… although it is more based on memorizing minor details… but it’s a good test of how much u remember from the book… n has some really nice questions too… worth doing…

 

USMLERX

It was good but easier than other two… don’t really test ur skills that much but has some nice tricks u would want to learn for exam… apart from that… I does add extra points to first aid… not exactly a complete repeat of first aid… like it mentions lot of info about a topic which is not mentioned in first aid… so don’t think it’s just first aid… but only do it if u r done with Uworld n Kaplan… I realized it pretty late… but still no regrets…

IDEAL STUDY PLAN

Although there is nothing like ideal study plan as each person is different and has unique style of studying… from my experience… I felt if I was asked to rewind and do the whole journey again… I would have planned it this way… But again that’s what I felt I would have liked to do… everybody is different

PHASE 1: BUILDING BASE

Estimated time: 4-6 months

No matter how much people say do Uworld n first aid later… I found them most useful doing after each subject… coz that is the time when u r totally fresh with all the info of that subject… n so u must consolidate first aid n do Uworld questions at that time only… later u will forget things n it will never be the same again…

So start from basics… I recommend starting from Anatomy physio coz they r the most basic subjects and if u r not strong in them… u cannot get hold of pathology later… so start subject wise in following order:

Anatomy -> Physio -> Biochemistry (do genetics n molecular together) -> Micro & immune -> Pathology -> Pharma -> Behavioral & Biostats

For each this would be the order of books/qbanks:

Kaplan (videos + notes) -> Reference book -> First aid (consolidate all important into first aid) -> subject wise Uworld questions on that subject

In this phase… only aim is to understand all the concepts… u may forget many details… but it’s fine… u will get to that later… right now concepts is utmost important… I can never overemphasize the importance of this phase… it’s so important that if u screw this up… u can never reach those higher scores… so u must take it very seriously…

We all have lots of holes in our concepts and USMLE likes to exploit them to the best… so make sure u fill all the holes in there… During this phase what helped me most in filling those holes were Goljan big book, Uworld explanations and Google… these three sources answered most of my “why” n “how”.

Make sure u understand the mechanisms behind facts very well… that’s really important for step 1… as somebody said… Depth is more important than shallow breadth…

About consolidating First aid, I spiral bound my first aid… then removed spiral binding n put the first aid into binder folder so that I can easily add pages in between… then I got an A4 sheets bundle holed for spiral binding n used those sheets to add wherever required in first aid… Also there is lot of empty spaces in first aid which u can use to max… at the end of this phase u will have all material in one thick book… nothing better than that… then I took out the first aid and re-spiral binded it in two parts (coz it was too thick for one) and that became my ultimate bible for step 1

PHASE 2: REVISION N MEMORIZATION

Estimated time: 1 – 1.5 month

This phase is to revise up the consolidated first aid and do Kaplan qbank alongside daily… do it like this… 2 blocks daily morning… followed by looking at explanations n adding extra info into first aid… then use rest of day for revision… Also if possible u must do one oldest nbme each Sunday… so that way u can get thru those initial nbmes 1-6

PHASE 3: GETTING READY FOR THE FINAL BATTLE

Estimated time: 1 month

Give one online nbme at the start of this phase… if u r in +/- 10 range of ur target score… book a slot of 1 month later… Now in this phase the goal is to finish up all remaining nbmes at regular intervals n do revisions in between… hopefully u will be seeing growth in each exam… concentrate on ur weak areas… make them stronger… Also, I would recommend doing both uwsa as they r really nice uworld ques and have good explanations… they got some info which was not mentioned in qbank even… so pretty useful stuff there…

If u feel like doing more questions… u can do usmlerx… not really high yield but good for practice…

For nbmes I would say do 2 nbmes back to back on same day each Sunday… this way u would be training ur brain to think fast n answer continuously for 8 hrs… really matters a lot in exam… I would advise doing nbme 16 n 15 on same day n keep it 1-2 weeks before exam… coz by that time u will b ready prep wise n nbme 16 generally underpredict ur score… so u must give it with another nbme (nbme 15 is closest) to prevent ur morale from going down… In last week u can just thru those areas which require lot of memorization n little concepts… like biochem, micro, general pathology, general pharmacology n all the pharma at the back of each chapter… these are things which u got to memorize…

In the end… even on the last day there will be lots of things which u will b forgetting… here is a list of forgettables u must see once on last day…

Lysosomal storage disorders

Upper limb nerves

Lower limb nerves

Glycogen storage disorders

Vitamins deficiencies

Drugs of abuse

CD molecules and the significance of each

Tumor suppressor genes

Oncogenic Translocations

G protein receptors types and hormone examples

Diffusion limited versus perfusion limited

Steroid synthesis and adrenal cortex pathways

Exotoxins

Streptococci and Staphylococci characteristics

Antibiotic mechanism of actions

Rickettsia

Parasites (all of them)

Leukocyte/endothelium interaction

Sleep stages with their EEG changes

Hemoglobin synthesis pathway and porphyria

MEN Types

Cardiomyopathy types

Teratogenic drugs

Muscarinic and Adrenergic lists

The glomerulonephritis histopathologic changes

Bone tumors

Leukemias

List of Drug Inducers and Inhibitors

HLA Associations

Hypothalamic nuclei

List of antivirals and their mode of action

List of viral classes and their exceptions

Purines and Pyrimidines pathways

Monoclonal antibodies and anticancer drugs

Autoantibodies

CD counts landmarks in HIV infection

Pharyngeal arches and pouches and their derivatives

Antiarrhythmics classes

Pharmacology equations

Lipoprotein pathways and metabolism

Child developmental milestones

Immunodeficiencies

All the formulas

Also, go through all the images u might have saved through these long months… finish up everything by evening n relax… don’t do anything after that… although it’s true that u cannot remember everything n u will tend to forget things… trust urself that u know enough to tackle this beast… I hardly remembered 60% of my first aid at the time of exam… but its fine… coz exam doesn’t test u that way… it tests concepts which r long-wired into ur brain through these months… there will be very few recall type ques… So relax… be excited coz in next 24 hrs u will be done with one of the most difficult exams in medical field in the world and that also with dignity… nothing can compare to that feeling… so embrace it… n give ur best on the day… Sleep well (although I couldn’t but its importance cannot be undermined)… Good luck for the day…

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

USMLE Step 1 Experience – 258 – Abdulmunaim Eid

My USMLE Step 1 Experience 245 – Review by Dr. Sarah Brum

IMG Step 1 Experience by Dr. Sai Vikram – 262

December 13, 2017
%d bloggers like this: