Dr. Khayri – Palestinian IMG – USMLE Step 1 – 266

USMLE Step 1 266

USMLE Step 1 266




Khayri Shalhoub,
USMLE Step 1 Experience.
● Who am I ​?
A fresh graduate. Graduated in May 2014 from An­Najah National University\Palestine.
● Duration of preparation​:
I started studying solid and consistently since September 2014.​I started reading about
how to study for the USMLEs in June. I stopped everything during June as I was
arranging for my engagement and all that. In the beginning of July​I started by trying to
desensitize myself to the MONSTER I had since back in med school,
[[BIOCHEMISTRY]]! I started off just by watching the videos of Metabolic biochemistry
from Kaplan Classroom­anywhere videos. It didn’t take me a lot( maybe a week or so),
as my goal was only to get rid of the fear,and I had a couple of notes on FA from the
videos only. In the middle of July, I was supposed to travel to Canada for an elective
there, and had so many issues at the borders and etc, so it all stopped since the middle
of July. I finally got to Canada and finished the elective, and a quick visit to the states by
the end of August. During that time, I was trying to familiarize myself with Bacteriology.
The elective was heavy and we were busy daily from 8:00 am till 5:00 pm continuous
and trips on weekends. I only got 1­2 hrs\day ​just to familiarize myself with Micro. I used
Microcards at the time. Let me tell you, they’re completely useless and I never touched
them again after coming back. Bottomline, I started studying when I got back in
September.
● Journey and materials​:
­ I would like to note that I didn’t add a lot of notes to my FA. I believe FA is a review
book and should stay as such.​I didn’t wanna fill it up with notes and annotations and
overwhelm myself whenever I just wanna “ Review”. I added some that I thought are
very very important. I mainly added pictures, using google images, making them small
just like FA usually does. I looked at alot of pictures, and it helped alot.
­ I started off reading First Aid 14, trying to figure out what is Step 1 is about. I would
google anything that I didn’t understand. I had to know why every word was there. It took
me about a month and a half or so to complete the whole thing. I then subscribed to
USMLE World. I started doing a block\day. I was doing fine, but I was so weak in
micro\biochem as I didn’t read any after my readings in June\July. After completing
about 20%, I decided to go back again to FA and read carefully the Biochemistry and
Mircobiology parts. That took me two weeks or so. Same approach, using wikipedia+FA.
Then back to the question bank. But this time was different. I was introduced to Flash
cards using the application Anki. I will talk about this in the next point.
­ I remember using BRS for cardiovascular and Respiratory physiology at the beginning
because I had some trouble with them , but skipped rapidly through the book.
­ I skipped rapidly through some HY Neuroanatomy chapters before I studied the
neurology chapter, just quickly in 4­5 days. Never came back to it. Just familiarizing
myself. Didn’t take notes or anything. Just a couple of pictures I saved and later added
them to the FA.
­ Back to Anki. As I said, I didn’t wanna fill my FA with all the extra information from UW.
I discovered all about Anki and was fascinated. I loved it. This website is what introduced
me to it Yousmle.com ​I made all my notes from UW into Anki Cards. If someone is
going to do this, please make sure you go through the website and read all the
instructions on how to best make a card.​I tried to minimize the amount of notes I am
taking because UW is huge. I used to review the cards daily while walking, gym, bus..
anywhere.
­ Pathoma videos at 1.7 speed and slowing down whenever I feel he’s discussing
something new to me. I used them after I finished FA pathology part and after going
through more than a half of the Q bank. Simply because I had other stuff to do. Videos
are great and very high yield.
­ The way I did UW was to carefully read everything. I would google the tiniest thing that
I didn’t understand and find an answer. I did the first few blocks in a timed mode, but
didn’t have trouble with time so I switched to tutor untimed to really use it as a learning
tool. And of course all the blocks were random.
­ I used to constantly visit my FA during the Q bank. But most of the day would be doing
Questions\explanations. My pace was average 2 blocks\day.
­After completing about 60­70%, the time I was planning to give my exam was getting
close, about 6 weeks left. I decided its time to assess myself and see if I am on the right
track or not. I decided to quickly revise metabolic biochem and microbiology from FA
before giving my first assessment. Took me a week to have the courage to finally give
my first assessment. I chose to go with NBME7 as it would probably be the easiest and
wouldn’t destroy my self­esteem if I didn’t do well. After completing it on January 14th
, I got 269​. I was shocked and was like this is noway true. I told myself this is probably
due to the fact that it’s old and most of the info is gonna be included in FA or so. But I
was relaxed because I knew I wasn’t on the wrong pathway to say the least. Anyways, I
got back to UW to finish it off. Finished it before 2­3 weeks of my test date. Then started
redoing the same old blocks I did before, Except this time I wouldn’t redo
questions, just reading my annotations and trying to interpret questions.​I only
repeated the ones I got wrong.
At that time, I was going really quickly doing 4­5 blocks\day as it’s just rapidly reviewing,
and most of the stuff I know because of the flash cards. I finished about 50% of the Q
bank at that time. I would also give 2­3 hours daily to revise FA chapters quickly too, just
skipping as by that time I was familiar with everything.
­I did UWSA1 with 265 + before 2 weeks of my exam.
­ After the first assessment, I was overwhelmed with the amount of cards because I had
so many in a short amount of time, so I switched off to taking notes from UW on a small
book. 4 days before my exam, Februrary 14th, I did NBME16 and got 262​. I knew
this time it was real and that I was ready to take the exam since numbers don’t lie. Every
part of me was telling me to delay the exam, but I am glad I did not.
­ Conrad Fischer 100 cases: In the last few days of my preps, I felt guilty of not reading
anything about ethics other than FA\UW which very minimal. I did the cases only and
read their explanations in a total time of 1 day.
­I didn’t use any of the Kaplan books\videos except for the ones mentioned above. It was
more time efficient and better for me to look for answers and create questions myself. I
only read the lipid metabolism part of Kaplan Biochem book because they always
bugged me. I did that before giving NBME 16 and took some notes and only revised
these later.
­ I probably used and read stuff from google\wikipedia more than any book and
more than FA
­ ​I used to watch alot of youtube videos on concepts I didnt understand.
● EXAM DAY:
­ ​My exam was on Feb 18th . In the first few questions, I had a high heart rate, but after
feeling its the same as the NBME 16, I felt fine and tried to enjoy the experience. I did the first
two blocks without any breaks and then had a 10 minute break. I decided to do the same with
the next two blocks. That was a mistake​. My concentration went really down by the middle of
the fourth block. I should’ve taken at least a 5 min break between 3d and 4th. After that I took
about 10 break between each block.
­ Questions were doable. Similar to NBME 16. I had questions where I had no idea what
they are talking about, tried to simplify what they are asking about and try to give my
best guess.
­ I had a really high threshold for marking a question. The question I know is hard and I
would not change anything if i came back to it, I would answer it and move on, and didnt
mark it.
­ I had an average of 10 minutes time left to review marked ones each block. I had about
17 minutes in the first block, and about 8­9 minutes in the last few blocks because I was
exhausted and felt like my concentration was so low compared to the first block.
­ I went out so happy that I was done with it. I had a good feeling because I knew if i
studied for a whole other year, I would get the same score. I knew I would get the same
questions wrong because I wouldn’t think of studying about what they were asking me
about.
● Things I think I would have done differently:​
­ I would have done all the other old NBMEs offline as a learning tool earlier in my
preparation. I only did 7 and 16. I didnt do any other NBME.
­ I would have used cards way earlier in my preparation
● The page I made​:
In my last 4­5 weeks of preps, I made a page called USMLE Abusers, where I posted some of
my High Yield notes. Feel free to check it out. I will keep updating it regularly. Here is the link :
https://www.facebook.com/pages/USMLEAbusers/1555609858011167
● Miscellaneous
­ First of all, using this way of studying worked for me, it might not work for others. Using
flash cards by using the spaced repetition method has been scientifically proven to be a
good way to stick information in your mind forever. A lot of people asked me for my Anki
cards, and my answer was the same for everyone. My cards are no big deal, a lot of
them were bad ones, simply because I didn’t read a lot about how to make a good
card. Because of that, I got overwhelmed at the end of my preparation, and had an
extra 1000 new card that I didn’t have the time or motivation to study anymore​.
Step 1 is full of new and detailed information. This was the thing for me. I was studying
one thing today, and I know it will be gone in a week because I am not a genius.​This
bugged me and that’s why I looked for other more effective methods. Some people have
a great memory and do not need such methods. I was not convinced that repeating and
memorizing again and again the FA would take me anywhere. I did not believe in in
doing UW 2­3 times. I felt that this was way too overwhelming. I asked myself why all the
time and I used the cards. I did not even complete UW for the second time.​
● Anki is just an app. There are several other apps out there. The thing I liked about Anki
is its programmed algorithm. It is well known and very much used among students in the
states. I like the algorithm it has which is the main reason I decided to use Anki cards
instead of hard classic cards. Because by using Anki, I will be repeating stuff I find
difficult more often than stuff I find easy, which can’t be done with classic cards.
● For anyone who is considering using the cards, I have some recommendations:
­ Cards give you the best help when you make them. Do not download premade ones and
do not buy any​.
­ If you are at the last few weeks of your preps, I do not recommend introducing such a
new thing to your preps. Stick to your original plan and it will do you fine hopefully.
­ Please go through the website and read carefully about how to make a card. Do not
make huge cards with lists and all that. Just read what’s in there and you will know it all.
● Kaplan series are great series for someone who has the time. It has a lot of information
that are extra and well known to be low yield, but that’s fine if you have time. I didnt have
time so I didnt study from them. I used my time more efficiently by creating questions in
my mind for anything that comes up and using google to take care of it.
Answers to questions asked​:
­ My UW score after finishing the first round was 87%, 95­96 percentile. Not exactly sure
cause at some point I didnt care about it I just used it for learning.
­ My med school performance is completely irrelevant. For a graduate, the last time I read
Biochem and micro was 4­5 years ago. A topper or a regular student would have
forgotten everything by that time. My point is, preparing for step 1 is like nothing else. if
you have an average GPA, you can totally get a high score if you prepared well.
­ My schedule : was pretty hardcore. I would wake up and go to the library, packed with
food and fruits and water. Would start at 8­9 am and study for 60 min and then a 10 min
break. I then hit the gym at about 4­5 pm. Go home and relax and eat. Total break of 2­3
hours. Read again at home for 4­5 hours before going to bed again. I had some days
where I was very productive. However, I had some days where I just couldn’t do it and
knew what it really feels like to be burnt out! I had to take some days off to recharge and
go back to solid work!
­ For the reasons mentioned above, and for personal reasons, I will not be sharing the
cards I made, which are about 4­5 thousands. Mainly because I believe you should
make your own if you really want to use this method the best.
­ I made my own cards. I did not buy the cards themselves. Even the guy who made the
website recommend this. I do not recommend buying anything on the website.​I
personally did not even try the free ones that are offered there.
­ I used to review the cards while walking to the library, coming home, going to the gym
etc.. I also gave 1­2 hours daily for cards. At some point you need to give more, thats
where I got overwhelmed because I didn’t use them from the very beginning of my
preps. I used to review about 150­200 cards each day. Remember that almost each card
was talking about a question from UW, which was my way of constantly revising it.
­ I followed what’s recommended on the website and found it very useful. I only made two
decks, one for pharmacology, and one for everything else. The Pharma part helped me
stick all these Side effects and bad names permanently in my mind.
­ I did not read Goljan​, but I skipped through some papers at the beginning and found that
there is just too much details for me, almost like having a university course. That’s why I
switched to Pathoma.
­ The app is for free on androids and mac\windows, and you gotta pay some $ for the
apple one. I have a mac and an android phone so didn’t have to pay anything hehe.
­ All my preparation was on my Mac, I did not use FA hardcopy. The main reason for that
is being able to easily add pictures. This is a sample of how it looked like, Page 583 of
FA14​.

­ I used to listen to motivational videos every morning. The guy named Eric Thomas
helped me tremendously.
­ At no point in my preparation I stopped going to the gym except in the last week +.
Keeping yourself on a disk day and night will get you no where I believe. Find something
where you can vent. Whether its the gym or whether its a movie, just do something.
● Summary​:
­ Prep time : 5 months.​
­ Study material : Wikipedia+ UW + FA
­ NBME 7 (4+ weeks out) : 269
­ NBME16 (4 days out) : 262
­ Real deal : 266
Thank you all for all of your nice words and wishes. I believe that If I did it,
anybody can do it. Keep pushing. Do the efforts required. Set your goals high so
you can always have something to get to. Don’t settle for average, and be allergic
to average. Good luck to everyone​.
Khayri Shalhoub

September 24, 2019
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