Khaled Abd- ElMaskod USMLE Step 1 Experience

USMLE Step 1 - Experience 259

USMLE Step 1 – Experience 259

Alssalamo Aliukum, I don’t know where to start from. I always thought about the moment when I am going to write my step 1 experience. When I read other experiences at the start of preparation and along the tough journey, I always visualized the moment when I post my experience. Some friends asked me to give detailed experience, I fear I am gonna speak more than wanted from me, to give a story not studying and exam experience.

Anyway, let’s start. My name is Khaled. I am a graduate from Tanta University faculty of medicine, Egypt. I finished my internship year at the end of February 2014. And after 1 month, I started working as GP at 1r health care unit. My actual real preparation period lasted 13 months from 20 September 2013 to 22 October 2014. But I will go years earlier.

Years before: (u can skip this passage if u are months before your exam) while in 1st year of medical college, I found difficulty in understanding what is written in the stupid books of basic science that is written by staff of my college (ex. The disgusting physiology books of my college that motivated me to read a 800-pages book not in curriculum even if I got bad grade in it), I searched for books where I can understand the subjects like physiology, biochemistry etc. and I tried to look at small books not large textbooks like Guyton and similar books, I knew my memory in not that good and at this time and for years of college, my 1st and 2nd and 3rd priority were to UNDERSTAND, I hated to memorize and tried to understand more so the stuff that need to be memorized -as it is- decrease in amount. So I read Vander’s human physiology (more than one time during college as I liked this book) and Carbohydrates, Lipids and proteins and purine chapters from mark’s biochemistry, also read some chapters from Katzung examination and board review (not the big Katzung), In anatomy, I looked at netter with my college books, In pathology, read large part of pathology illustrated + few topics from Robbins, while micro I couldn’t know how to deal with this stupid subject and got bad score in it in college. In general, no matter I tried hard in some years of college or haven’t, my score is going to be the same (very good- bad in comparison to my colleagues) but my main focus in these years was to understand not memorize besides I knew I have some strong points but, in general, mybrain is not that genius or I don’t have this brilliant mind that memorize everything it had to look at.

Most of these books size is midway between Textbooks and USMLE lecture notes (nearer in size to size of LNs). Not all what I did in this period contributed to my score. Maybe some info + some concepts + some motivation that I am not starting from zero like my Egyptians colleagues due to bad medical education system and that I am starting with some clear concepts in my mind.

The 6 months that are before the actual 13 months preparation period: In these 6 moths I had no plan, I was not at FB groups and haven’t read experiences or even got the KL books. I was intern at teaching hospital, doing some other work for money, besides I stayed away from home, so all these circumstances made me study about 9-10 hours per week, not more than this. In this period I had no plan or timetable, Only thought that I don’t want to lose my strong points that are the books I read in the old days like Vander and Katzung and Marks’, so in this period I read some chapters from Vander and Katzung then I thought I will move from the Vander 900 pages to BRS 200 pages then to FA physiology, and in Pharmacology, I will move from Katzung directly into FA skipping FA But this I did after in the serious 1st read in the 13 mths. Also in this period I did most of if not all of pretest physiology, its Qs are tough although not the exact step 1 type of Qs but I wanted to test my knowledge in physiology and I heard that Pre-test physiology is the best in the series. In katzung, I did the Qs at end of the chapters I read. But in general, I haven’t finished neither physiology nor pharmacology, again 10 hours/week. A period of indulgement and remembering the old books.

My actual preparation period: I realized that I should do anything besides studying for step 1, so I completed the 2nd 6 months of internship year in some general hospitals were 1 go for 1 12-hour shift per week. And By this my study schedule was to study for 5 days a week + 1 day in the hospital + 1-day rest. Number of my studying hours per day was 8 hours sometimes more, I was motivated and sometimes studied more than this. During the whole preparation period, I only took 1 day off every week besides week off after 6 months or so and another week off 3 or 4 months before exam. Not more than this. I am realizing now that my dedication to the studying and the determination not to waste one day had a role in my score although during the whole period I didn’t read many books or did many Q banks but the preparation period was non-stoppable 13 months. During the whole 13 months, I wasted no time except in rare occasions like in the period between intern year and going for GP work.I can’t remember the exact timetable as I haven’t kept track and made assessment for my accomplishment every week or even every month. When I started the 13 months I read many many experiences most of them on usmle-forums and made my time table. My plan was to finish each subject in one month and if it was lengthy, it will take 1.5 months or even more and I think I haven’t managed to finish any subject even in one month usually 1.5-2 months.

Now coming to each Subject (1st stage): My approach was: anatomy >> physiology (here I studied pharmacology of general, CVS and renal after their physiology analogous chapters and I dare to say that is the best timing, that is like doing antibiotics from pharmacology after doing Microbiology) >> biochemistry, molecular biology, genetics >> Microbiology >> pathology >> rest of chapters of pharmacology, behavioral I should have read it earlier as In Egypt this subject is totally new for us so it need to read it many times so that these rules and ethics become well fixed in your mind.1.


a- Embryology: I didn’t study embryology at college as I didn’t like all the books of embryology I used and they all didn’t help me to imagine and visualized the growth of baby in uterus , but at end I discovered one great site named which has the most wonderful figures ever so I took longer time to look at figures of the site and to read some illustrations, my only interest was to keep track of the baby from fertilized ova till birth not looking at details, only trying to connect the figures and imagine the defects between stages. Yes, this subject was low yield but I decided not to move on except after visualizing it. It took about 3 weeks or longer I don’t remember, then I read KL embryology and watched its videos and made some cross-reference from figures of the site into KL so that I don’t go back to site and then when I read FA I moved the important cross-references for me from KL into FA (like see figure 11-8-9 in and I would make a sign for important reference and another for less important reference and this in all subjects not embryology only.

b- Gross anatomy: KL + some netter pictures + FA +UW + some KQB Qs.Year before now, people said this is low yield and FA+UW is enough, not the more detailed high yield gross anatomy so although I studied anatomy very hard in college, I decided to go for KL and suppress all the info I knew in anatomy for the sake of higher yield subjects and but if I will go back after the new changes in exam, I would have studied from Hi-Y, and for some parts like pelvis and perineum I would have studied from bigger source like snell. Besides KL, I looked at netter and copied some pictures keys from netter into KL and then into FA (ex. See picture #99 in netter .)My mistake in anatomy which I avoided starting from neuroanatomy and the other subjects, that I haven’t read FA along with KL and FA+UW (or the analogous books only 1 time), if u didn’t do this and said that u will read FA and annotate in your 2nd time, this will waste 1-2 months from your time. U should know that once u understood concepts from KL, read FA and was understanding the very compressed info in FA and annotated some info from KL into FA, then KL or the other LNs has NO VALUE FOR U except if u r weak in a subject. And this btw is a very common mistake to postpone FA reading and annotation to your 2nd or 3rd read, and this sometimes lead u to read FA without KL as u don’t have time to re-read KL again and u will feel worried along the rest of your preparation that u have missed some GREAT FANTASTIC info found in KL, and btw some ideas keep annoying u like that I am weak in molecular bio and genetics and I need to read KL again although I annotated KL into FA in my 1st time reading KL bio and kept feeling guilty that I didn’t read KL bio again, and at the night of the exam I read all molecular bio and genetics from KL to realize that there is no new info I learned from this 2nd read except for 1 or 2 concepts. To end, I also did half of KQB anatomy Qs but this was very early.

c- Neuro-anatomy: NJ+ KL + Hi-Y + FA +UW.Some parts of neuroanatomy I studied well in the college like s.cord and brain stem, but I decided to watch Najeeb videos, note that anatomy was my 1st subject and I was very slow in it feeling I have all the time. I took more than 2 months. I watched most of Najeeb videos, but I recommend for u to only watch NJ in topics u r weak at, like forme, thalamus, hypothalamus and basal ganglia and u should imagine this area very well as many CTs come from sections in this area (caudate and thalamus and IC between), in these topics, Dr. Najeeeb draw good illustrative figures that will help u imagine the area very well. Then I read review that KL videos are also important for exam curriculum so I also watched these boring videos but both NJ and KL at 2X speed. This was the 1st subject when I will open FA and annotate after my 1st read from my LN into KL and ditch the LN forever. The books I used for neuroanatomy is combination between KL and Hi-Y. U should know that hi yield is good in its diagrams and illustrative figures so study the following chapters from hi yield: cross sectional anatomy of brain – spinal cord& its lesions – ANS – brain stem &its lesions- cranial nerves – visual & auditory & vestibular systems chapters- they present the information in summarized manner but wiz sharp words and good figures, also neurotransmitter chapter. But the other chapters like cerebellum, thalamus and cerebral cortex – cortex BS – limbic system are better in KL as these chapters present complex information not easy to link to each other or explain how this lead to that so the better is KL as it gives lesser amount of info but with more illustration (can’t explain the difference well sry.)

d- Histology: KL + 2 chapters from BRS histology and cell biology (extracellular matrix – cartilage and bone). It was very annoying, bad videos especially the chapters of nucleus and cytoskeleton but this is low Y at the end.

  1. Physiology: Vander + pre-test Qs bank then BRS + renal and respiratory KL videos + FA+UW.My strong point was Vander’s but I realized that this book burdened me also, wanting every time I review a chapter to read it again from Vander so I don’t lose my strong point -_-, but at end I went for BRS after one read of most of vander’s chapters, made some cross reference from some vander figures into BRS and said to myself: what is still in mind from what u read in vander will keep in mind and what u keep forgetting even after wasting time reading it again u will forget and u will realize that this info is not high yield, and as I already spent much time between Vander and the good book BRS, I only watched KL physiology videos in renal and respiratory and haven’t looked at the KL book as I was confident regarding my level in physiology. BRS physiology: I really liked this book, I already I understood the important concepts from vander and I could see how the book is well written in a concise manner, accurate to-the-point phrases, and I really loved these books not the way of KL books (in Arabic, elra8y &dsh), and at this stage I did BRS end of chapter Qs, I also annotated into FA and ditched BRS with some annotation from videos and BRS into FA.
  2. Biochemistry: rapid review of figures of marks’ chapters of metabolism + KL (videos +LNS) + FA +UW.KL biochemistry book is one of the best books of KL series, I haven’t regretted studying bio from KL, I made cross-reference from some Marks’ figures into KL and then take the important figures references into FA and after annotating the extra info from KL into FA, I didn’t look at marks’ or KL again, my ultimate source was FA + annotations. Also, I watched KL videos and was good esp. Dr. Raymond. Of course I had troubles with biochemistry and microbiology and in any info that need to be memorized per se and I knew that my weak point is the inability to memorize at all and if I tried and succeeded, this is the most boring thing I do, so I tried to make my own mnemonics and even If some were silly, but the act of making the mnemonic itself and the suffering to link the words with a funny story won’t make u forget it again (they call it try smartly) and month after month, I developed the skill, and to make a mnemonic is faster and easier for me than just memorizing, but this was not in my 1st read my concern in my 1st read was to understand, making mnemonics was in the later stages, in my 2nd and 3rd read of FA . The Qs I did in biochemistry were KL book Qs besides the good UW bio Qs of course.I was looking at BRS biochemistry and to my surprise, I found that most of if not all the figures in this 300 page book is from Marks’ biochem, the book I studied some chapters from in college, so BRS is like a summary for Marks’, But still KL bio is good, u can use BRS as supplementary for your weak points.
  3. Molecular biology and genetics: KL LNs + KL videos +FA +UW .Also I studied this subject from KL, not bad in KL. Although as I have no basis in this subject, I felt even after understanding what is written in KL and watching the videos that I don’t have a strong grip over parts like Blot and FISH and VNTRs and all these stuff. I was always worried about this subject, but I realized that it is not about going deeper and deeper and knowing the details but to understand the BASIC concepts and apply them in the different situations u will face in the Qs. I decided to do KL Qbank inthese 2 subjects besides UW, but I had no time also I had no time to read it from other sources like BRS.
  4. Microbiology: MMRS + (parts from KL) + KL videos + FA +UW.Microbiology made ridiculously easy was the 1st rated microbiology book in FA rating, and thanks, GOD I studied from it, I liked it and how it presented each bacteria and virus with friendly manner and some jokes and some naughty mnemonics and diagrams, it made a lifeless subject like micro amusing, although at end u will forget all details u know about each organism and will barley memorize the details about each one given in FA and u will forget the 4-5 lines about each organism but at least the book re-conditioned my relation with micro. With MMRS, I watched KL videos and I liked the lady that gave the lectures and AT THE SAME READ AND LIKE NEUROANATOMY AND BIO, I annotated some info from MMRS and videos into FA. Then I wouldn’t go for MMRS again. But I found parasitology very detailed in MMRS and knowing it is low yield, I have studied it from KL. Concerning the part of bacterial genetics, it is not well written in MMRS and I read it from KL (more detailed in KL) as it is important part. Also the part of fungi morphology I read it from KL. For immunology, I read KL and watched videos and then annotated into FA and read FA, KL were not very good but I had good background in immunology as there is well written chapter of immunology in vander’s and I read it in college many times. And I think books other than KL in immune can be better.
  5. Pharamcology: As I said, during the 6 months period before the 13 months, I read some chapters from Katzung, these were the part of basic principles (Pharmacokinetics and pharmacodynamics) which is well written in katzung, part of autonomic, cardiovascular, endocrine, some of chapters of CNS and chapters on inflammation and gout), so my mission when I get back to pharma after doing the above 5 subjects, to read it again from Katzung and then directly annotate into FA after reading it. In chapters I haven’t studied from Katzung, I would watch KL videos and annotate directly into FA as I have no time to read the very detailed Katzung in comparison to KL. And as u see as Katzung already took time from me, I sacrificed the videos of pharmacology except of course at topics I haven’t studied from Katzung. The problem with katzung that I studied it before knowing where people of usmle study from or curriculum, so I kept memorizing some tables having differences between drugs in certain groups like antipsychotics with many pluses -_- and some low yield SIDE EFFECTS -_- but this was in the 6 months before the 13 months but to be honest I was attached emotionally to this book from college and it made me understand some topics like antiarrhythmicsand diuretics and the part of general principles (pharmacodynamics and pharmacokinetics) and in general ANS, CVS, some of CNS topics sp. opioids and also general anesthetics, anti-PKM and skeletal ms. relaxants. For endocrine, it won’t make difference if u studied it from KL provided that u r good at endocrine physiology and pathology. For antibiotics, the best place to study it from was from MMRS after doing microbiology as I said before and then annotate into FA and forget FA. In chemotherapeutic drugs, I kept postponing this topic as it needed pure memorizing till less than one month before exam and then I was obliged to memorize it from FA using Wikipedia and other sites.
  6. Pathology: pathoma + FA +UW + some Qs from Robbins MCQ book .When I reached the important subject pathology, I realized I can’t do with it like I did with anatomy or physiology, I don’t have time, I felt bad that lower-yield subjects took much time than this. I read many topics in usmle-forums about Pathoma Vs. Goljan and at 1st was very confused but decided to do pathoma as I saw that some people used this and some used that and both got high scores. I knew I have no time, very bad ability to memorize, I love concise books that give u the most important concepts and the basic info so it will be easy to understand and memorize. Besides, by my way of studying, Goljan would have took from me 3-4 months to finish, and after my exam when I felt I wouldn’t get my target score +250, I felt guilty that I haven’t read Goljan, the person who failed to reach his target will look at things he haven’t did and point to them and say if only I had done them, I would have been great, if I scored about 240- 245, I would have told everyone to do goljan and KL Q bank as these are the things I haven’t done but now it differs. If I will go back again I would have watched the pathoma videos and followed directly from FA and ditched pathoma book as FA pathology approximately = pathoma book and by this I would have saved some time.While doing pathoma, I thought that if I did some Qs of pathology, I will be supplementing the defect so I did some chapters (10 chapters) from the Qbook Robbins and Cotran review of pathology, yes reviews say its pattern of Qs is not step 1 like but it refreshed my knowledge and I added some points from into FA, there was a similar book named Lippincott’s illustrated Q and A Review of Rubins Pathology 2nd Ed, and it was superior to robbins in that it contained many pictures (gross and microscopic) and u know exam now has more new pictures so if u have time, try this book. For me, I had no time to do except one chapter from. And my approach was if u r going to do the Pathoma videos only then supplement Pathoma with more Qs, not more reading from other notes like Goljan 120 pages (Qs are more active learning tool). But if I will go back I would have started UW earlier instead of doing Qs from these non-USMLE books and then KL or the Lippincott’s book. at the last month I reviewed some (2 or 3chapters) goljan pathology slides and it was useful for me in hematology and nervous system neoplasia and if I had time I would have reviewed them all to supplement Pathoma.
  7. Behavioral sciences: This subject was very strange for us, the answers of its Qs seems all valid. I did KL notes and videos but didn’t like the notes or the videos, I even couldn’t complete the biostats videos as I couldn’t understand most of what the Dr. said. And then kept postponing biostats and running away from it. I also read 100 cases by Dr. Conrad Fischer (2 times and made summary of book at 2nd time so that I don’t go back again) but points in Conrad book seem outdated. I heard that there is free 3-day trial of becker course where u can have behavioral course, so I choose to do the Biostats in these 3 days and although the same Dr. (Dr. steven) but the course was way better than KL, and the notes were more concise and better than KL, also the audio was very helpful for me and I understood all concepts in FA, then I did UW and the extra UW Qs of stats (very important) and by then I was very good at Biostats not like some weeks before. For behavioral, I annotated as usual from KL into FA but found difficulty annotating as I couldn’t summarize, either u copy some extra info or u don’t. If I will go back again, I will study behavioral from becker course (notes + audio lectures) and then to directly annotate into FA and to ignore KL LNs and not to go back for becker again. And don’t worry, the behavioral is written by same doctor so u will miss nothing. Few days before my exam, I was planning to read Hi-yield behavioral but instead (thanks to a friend advice) I did the Qs at end of important chapters of behavioral at BRS behavioral and to know the difference> [BRS = Hi-Yield + Qs at chapter end + some extra chapters]. It took me a day to do Qs of about half of the books chapters. This was a good revision of psychiatry, ethics, statistics and was better idea than just reading Hi Y behavioral.

The stage of 1st read took a long time as I was annotating into FA in most subjects after studying them but this was the best approach.

2nd stage: UW +FA Before I go for details, I should say that at this stage, I already finished my internship year, now after month free of work, I went to work. I am now studying for 6-7 months, feel exhausted and to add that I will be working 3-4 days/weeks about 5 hours or more/day and some stress from stupid problems related to administration of the HCU. In the days of work, I would stay at workplace as If I went home, the day is gone , and I didn’t go home except late when I do at least 5 hoursstudying after work and sometimes I would stay at workplace for 2 days so that time is not wasted by going from and to my home. This was very stressful for me. In 3-4 days of not-going-to-work, I would study the usual 8 hours.In this stage, my target was to finish offline UW system-wise. I will read the chapter from FA (like cardio physiology) and then do its Qs in UW. The block (46 Qs) took me one day to do Qs sometimes more than one day :), read the whole explanation carefully and then annotating all the extra info in UW with special black color (idea I knew about from a blog) into FA to differentiate these notes from other notes in FA. Although I knew that UW should be a learning tool especially in your 1st time, I was determined not to lose any easy Q, the only Q I would forgive myself for doing it wrong is Q that ask about concept totally new to me, otherwise I wouldn’t let it go easily, how come my stupid brain miss this??, what is your excuse to do it wrong?? Etc. so I trained myself to Qs doing although number of Qs I did is few, but every Q I do, I deal with it as to be or not to be, not like : ok, I will learn from my mistakes, I am now not in exam and it is ok to do Qs wrong. It is to learn how to SQUEEZE your brain and try very hard before picking an answer. It is to develop the skill. I knew about myself that I don’t concentrate very well, so any Q I do wrong due to lack of concentration, I won’t forgive myself. My score in 1st time UW was in most blocks between 70-80%, sometimes more, sometimes less. This way of doing the Qs made my mistakes in NBMEs in my marked Qs, so most of Qs I do wrong, they r Qs I don’t know or I already felt very confused about and I think in exam it was like this, The Qs I do with confident smile then realize I was deceived or that I was stupid are few in number. When I had a big passage I can’t copy into FA, I would screenshot it from the offline version. Now I revised FA 2 times, one with 1st read and one with UW.

3rd stage: FA+UW: I think this stage was the 2 months before exam. I had 40 days off from Work and in this period I made very good progress, also my studying hours per day was above 10 hours and at the last 10 days or so I was studying from the time I get up from bed till I sleep.I decided to do FA one more time and after this time I will do my 1st nbme, I was very slow in my FA reading and I was worried that I won’t be able to read it in short period to do my 1st nbme 1 month before exam. I was lucky to find a dedicated study partner and we had this read together and this helped me to finish FA rapidly and also I read my notes (notes from other books that I annotated previously into FA and UW notes).During this period I was doing UW again online random timed, my score was usually above 90% and this boosted my confidence up. That I trained myself to finish the blockin about 40 minutes as most of Qs I do for 2nd time so I should do it faster, as in exam I will face new Qs and I will be slower. I discovered that my 1st NBME is only 3 weeks before exam so I decided to go directly into the toughest one that is NBME 16, was a big risk, haven’t done any NBME before even offline, I did it online and felt while doing it that I am doing many Qs by guessing and using common sense based on the concepts I know, I expected to score220-230 but I found my score 256. I was very happy, my expectations got higher but still unsure and friends told me to do another one to make sure that this is your level especially that months ago I was doing the NBME Qs I see on groups so I said maybe I knew the tricky Qs and this is the cause I scored this high score. After the nbme, I continued doing my 2nd time UW (random time) and kept scoring above 90% in most of the blocks. I decided to take another tough NBME to make sure that 256 is where I stand and also because I decided to simulate the exam i.e. to do 7 blocks at the same day with only 1 hour break exactly like exam, so I become trained to the marathon (Idea from Ahmed Azmy experience) and also because I had a doubt that my concentration decreases with time, so I did NBME 15 online followed by 3 blocks of offline NBME 13, and my score was 254 in NBME 15 and I did 13 Qs wrong in NBME 13 3 blocks, and this simulation helped me in the exam, at end of exam I felt I can continue for 2 more hours, I was hyperactive and about to be manic :). Now I have 1 week before exam, I still have 1000 Qs of UW online not done yet, I did them in about 3 days, only do the Qs, read the summary of explanation and explanation of wrong Qs, the last 200 I only looked for new ideas. I did FA for the 5th time in 2 days but not reading everything just looking at marked info and telling important info in book without looking.I planned to not study the day before but I read a file I prepared of extra UW notes then I read some notes of biostats and behavioral. Then as I told before I read molecular biology and genetics from KL!, it was a stressful night and I tried to open the tutorial so I can skip it in my exam and I couldn’t and I realized that day that my hand watch stopped and I feared I am not gonna calculate my breaks accurately which already occurred and at I had 3 blocks with only 11 minutes break :), I divided it 3 minutes then 8 minutes :). I usually go into sleep just after I lie in bed, but this night I tried to sleep from 12 am and couldn’t sleep except at 2:30 am and I was scared that this continue and I go to exam without sleep and this made me feel more anxious. I went for exam with some stuff I wanted to revise, but I had no time. I arrived somewhat 15 minutes late from the appointed time 8:30, but I haven’t started my exam except at 9:40 minutes so I had time to relax.

Exam experience: I posted a feedback on group after my exam, I apologize if this feedback was frustrating to the others, But it wasn’t my intention at all to affect people spirits in a bad way, I only wanted the people going to the exam, to TAKE CARE and to prepare themselves to new Qs, more complicated pattern of Qs than usual Qs in UW , NBMEs (except 16), and I still say that exam is more difficult than NBME 16, here is 2 links to my exam experience and my feedback after exam.This part I wrote right after my exam:AslamoAliukum.I had my exam today, For me, exam was more difficult than NBME 16, many Qs asking about info and concepts not in FA+UW. I tend to underestimate my performance and after every NBME I did, I felt I am not gonna get a good score in the nbme, but the real exam I know my score will be less. More focus on anatomy(Qs outside Kl). Qs tesing clear concepts are not direct but tricky and depend on integration and multi-step reasoning. I think UW Qs is more direct than exam Qs.some physiology Qs were troublesome although I am good with physiology, they depend on your ability to apply your concepts on different circumstances u haven’t read about in books.May be i am talking like this as person tend to remember hard Qs.I am not depressed or angry, I studied for 13 monthes and the Qs I couldn’t get around, I wouldn’t have done them right if i studied for 1 more month.Many Qs I just answered them by guessing and they know that nobody will have this wide and deep knowledge so I think the exam evaluate your ability to feel or guess without fully understanding the subject of the Qs and I depended on this in nbme 16.I prefer not to talk about details of my study journey except after I get the score so that u can evaluate in light of the score I got. add, there is a theory I couldn’t test if it is true or not except when I got my score. There is some type of Qs I haven’t met before, In UW, I was used to Qs that SEEMS easy but, in fact, there was a trick I haven’t noticed. There is line u haven’t read carefully and rushed into answer and felt how u r stupid after knowing the wrong answer and these Qs learned me to read Q stem carefully especially the last line to know what r the Q asking about. Of course, this pattern was in the real exam but also the opposite type of Qs was found in exam. Qs that SEEM difficult and strange but, in fact, they test a very basic concept. There are many details in the Q that will distract u and make u feel that u have no idea about Q but If calmed down, and dealt with the Q in a shallow manner, u will do it right, if u overthought and invented an imaginable theory to link parts of the Q to each other, u will do It wrong, this was a risky approach from my side as UW adapted me that when I think more about the Q, it become more simple and I understand what the Q is asking about, but in these type of Qs, when u thinkdeeply, u will be confused more, say to yourself, yes it is an easy Qs, u see some very strange specimen with vignette about type of brain hemorrhage and u can’t determine from the picture what is this, but simply if u looked at the vignette even without the picture u will do it right, so don’t panic, the most strange Qs asking about some hypothetical situations -like they r making new research- can be the most easy Qs.Again don’t panic. Also, there is some CK type of Qs, like what is the next step, what is the next investigation, etc, I answered them like other weird hard Qs with common sense (bel7ob.) )):

There are some other pieces of advice concerning how to do your exam ,

-1read the last line of the Q stem to know what is the Q asking about, then u go back and read the Q from start, u will look at Q stem differently if Q was physiology than if it was molecular biology, and this will help to look at the points that can help u reach the answer .

-2U shouldn’t understand all the given data and to connect them to each other, simply u can find a key to answering but try 1st to look for a pattern that connect all the vignette, if failed look for keys and use exclusion of wrong choices (etsaraf )

-3Not all the Qs u will answer with certainty, I remember that about 30% of exam Qs I had doubt while I am answering but not to the same degree and I don’t want to say the percentage was more than this and this also happened in NBME 16 although less number of Qs, so u should use your common sense and trust your ability to apply your concepts to totally new situations, it is not about much reading but to have SOLID concepts u can build your thinking processes on .

-4U should know that u won’t excel everything and read everything, I studied for more than 1 year and felt that I had a lot to do even If I postponed for 3 months more, u go for exam when your NBMEs scores are above your target. I asked a colleague (Ahmed Azmy) if I should postpone because I felt I still have a lot to do 2 Wks before exam, I haven’t KQB except for 4-5 pathophysiology blocks, and many other things I planned to do, he said that if u postponed for 10 days or so it won’t make a difference, u will make your preparation period 13 month and 10 days, he told me that if your score in the next NBME is good, then don’t postpone and this advice was so valuable for me.

-5 Time management in the exam is very important, I learned a lesson from NBME 16 that I shouldn’t waste my time if I found difficult Q, it can waste 3-4 minutes and u r not aware, some Qs that needed calculations like Q of Vd or so in NBME 16 took time from me and made me in a hurry while doing the remaining Qs, so in exam if I thought in Q more than 1 min and didn’t get it, I will mark it and move on, even if I didn’t haveany time afterwards to go back to it, to have a Q wrong better than to do 15 Qs in 10 minutes as u forget the time while thinking about one Q, I always followed the time and made sure that I do 1Q/60s or 1Q/65 sec and at most of blocks I had 8 minutes to look again at hard Qs and yes some Qs I did right when I went back to them relieved by knowing I finished the Qs of the block except for the marked Qs. and u should do UW 2nd time timed random for this cause.

-6u can take small breaks like 5 minutes with u sitting without coming out from exam room so u don’t waste your break time. So my breaks were like this: 1st block>5minutes (at my seat) > 2nd block > 10 minutes with more3-4 minutes as I have no watch (came out of room for some snacks and juice ) > 3rd block > 5 minutes (at my seat) > 4th block > the big break (20 minutes but became more than this) > 5th block > 3 minutes :)> 6th block > 8 minutes (came out) > 7th block.

-7Don’t do NBME Qs posted on groups except if u r not planning to do the NBME, let’s say u won’t do NBME 13, then u can do its Qs on groups, this because u don’t want to do your NBME and u already know the tough Qs answers, this can over-estimate your real score and give u false indication about where u stand .

To end this long experience, here is a list of some Books and Q banks I haven’t done and yet I got a good score although some did those and scored well and some did and haven’t got good score, this I post to reassure u that there is no single road to getting good score in step1 and that before my score appeared, I felt guilty that I haven’t did some of the following although I wasted no time and was very dedicated and this because I expected lower score, so if one got bad score he/she will tell u that if only I did ex. Goljan I would have been great and this I was going to say if I got ex. 240-245, I don’t mean anything but take advice from people who scored well.Here are the sources I haven’t read: Goljan rapid review book -Goljan audio lectures – Kaplan Q bank – USMLE RX – DIT – some of KL videos – HI-Y behavioral – All NBMEs except (15,16,3blocks of 13.)

Update: Nov 2015.-I think Becker course is better than Kaplan in Pharmacology and Behavioral. And I think it will be better in biochemistry too, if the lecturer is Dr. Raymond.- For those with strong background from college, watch videos and annotate directly into FA, and skip the Lecture Notes. This pan will be better especially if u r short in time.

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

USMLE despite all odds – Journey from orphan in Nigeria to successful doctor !

My Step 1 Experience from 220 to 251 – Rachael Kim

Dr. Moumina – USMLE Step 1 Experience – Despite all odds

December 13, 2017
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