Old’ IMG (2006), working full/part time, Score 243

Experience of an ‘old’ IMG who was also working while preparing for the USMLE Step 1. 

USMLE Step 1 – Score 243 ; Exam March 2013 

Graduated in 2006; Did clinical work till 2008; MPH in 2009 and working in Global health since then. So no clinical work/exposure for almost 4 years. Working full time currently. Total study time 7 months. Studied for 4 months while working full time. Then took partial leave (working from home about 2 days a week) for 3 months to focus on preparation. Luckily I requested for leave during Dec-Feb when the office workload is low. 

Target Score:
I was initially aiming for 240 but the initial NBME’s that I took dampened my expectations and I decided I would take the exam if my NBME score became 220+. But by the end I was scoring higher in the UWorld assessments which made me hopeful again. Then I decided on a target ‘range (220-240). [dancing with joy with anything above 240, but anything above 220 will still be a welcome relief. Less than 220 I’ll just go hide somewhere] 

Here are my scores:
– Dec 24 – NBME11 – 204
– Jan 24 – NBME 12 – 207 (no change in NBME score for one month! So changed study strategy, read below)
– Feb 8 – UWorld Self Assessment Form 1 – 242 
– Feb 22 – Prometric Practice Test – 93%
– Feb 24 – Uworld Self Assessment Form 2 – 252
– Feb 24 – NBME Form 7 – 231 
– March 1st – exam date

Study Materials 
– Kaplan Videos + Lecture Notes (once, very rapidly)
– Pathology videos from www.pathoma.com (I did not use Kaplan for Pathology)
– First Aid (main review book, did it thrice, almost knew it cover to cover by the end)
– Uworld Qbank (did it twice)
– Kaplan Qbank (did half – about 1000 qs)
– Flash Cards Microbiology – “Illustrated Microbiology Memory Cards: MicroMnemonics” (helped me memorize things I found difficult in a very fun, memorable way)

Study Schedule
♣ Aug 1st – Nov 30th 2012: Kaplan videos and books. One week per subject, some subjects like Pathology took around 2 weeks. I was working full time (9 – 6 pm) during this time. So I studied in the evenings (average 1.5 hrs/day) and entire weekends. 
♣ Dec 1st – Jan24th: Completed UWorld Qbank (scoring 60% average on random blocks) + FA in bits and pieces
♣ Jan 24th –Feb 8th: Did FA chapter wise + subject wise questions from Kaplan Qbank. (scoring 70% on subject wise blocks) (Did not complete Kaplan qbank, did only about 1000 qs)
♣ Feb 8th – Feb 21st – First Revision of FA chapter wise and repeated all of Uworld subject wise in timed tutor mode. (scored around 80% this time).
♣ Feb 24th – Feb 28th – Completed “intense” subject wise second revision of all of FA + did the leftover/incorrect/marked questions from UWorld. 

Day before the exam – Feb 28th
Only studied Biochem from FA in the morning and reviewed 4 pages of written notes from UWorld and did two remaining blocks of marked questions from UWorld. Was very relaxed while studying (not intense), and also stopped studying around 4 pm. Went out to lunch. In the evening I prepared food and laid out clothes and packed bag for the next day. Did the exam tutorial from the USMLE site. Meditated and went through exam day in my head (explained later). Watched Greys Anatomy, had a heavy dinner (helps to make you sleepy) and slept on time (10:30 pm).

Exam Day – March 1st 
Woke up at 6 am. Reached exam centre by 7:30 am. Started exam at 8 am. Exam centre was only a 5 minute drive from my place and I had requested a friend to drop me there. Had a good breakfast with eggs and toast and coffee. Felt reasonably relaxed. On arrival. I put my cards/money/keys/phone in the locker. Rest of my bag I left on the floor, next to the locker so it would save me time in accessing my things. Put my coffee mug and water bottle on top of the lockers for quick access. You may have to check whether the staff at your exam centre are ok with you leaving your things outside the locker. Went to the restroom before starting. In the tutorial I went straight to the ‘sound’ tab and ensured my headphones were on and clicked ‘end block’. This got me an additional 14 minutes of break time. I am restless so I took a break after every question block (some friends I know did 2-3 blocks at a stretch, so it’s a personal choice no hard rules here). I had packed some lunch but in the end I only ended up eating bananas. 

Exam day – break schedule 
Break 1 – 5 minutes, stretched, took a sip of water
Break 2 – 10 minutes – Ate banana, had coffee, went to restroom and looked up something in FA 
Break 3 – 5 minutes, stretched, water/coffee
Break 4 – 15 minutes – Ate banana, coffee, restroom, read some FA and even switched on phone to google
Break 5 – 5 mins – stretched, water/coffee and a piece of chocolate
Break 6 – 10 mins –ate banana, looked up FA, restroom 
Break 7 – 5 mins. Stretched. 

1. Watch Kaplan videos at 1.5x or 2x speed. You will find this option in most video players including windows media player and VLC player. 
2. Do Uworld twice. You will be surprised to see how much you have forgotten just doing it once. 
3. Take UWorld for 6 months atleast because you will be redoing all the questions and will need to reset your questions. There are strategies for redoing all the questions on a shorter subscription without resetting but I think it’s best to pay a little more and keep it simple. 
4. FA is hard initially but it gets easier the more you do it. And it will really be the best last week review book. Try to go through it thrice before the exam. 
5. I found subject-wise review and timed tutor modeto be most helpful for learning.
6. Do the prometric centre practice test if you are willing to pay for it. I found it very helpful. It is only 3-4 blocks so does not simulate the length of the real exam but familiarizes with the centre etc. 
7. Do a full day simulation. I used NBME 7 + USWA 2 for this. Keep a sign in/sign out sheet like in the real exam. And pack lunch/ coffee like you would for exam day. This lets you know whether you can do blocks at a stretch and whether you need breaks etc.
8. If you have a high target score then listen to Golijan. I did not listen to all of it but did it in bits and pieces and there were atleast 3 questions on my exam that I was able to answer because of Golijan. I would strongly recommend listening to all of them. But I think they are most useful if done closer to the exam. Maybe one month before the exam. 
9. If possible fine 3-4 supportive people (friends/family) particularly those who have taken the steps. It helped me to call them when I was feeling low and needed motivation. Stay away from non-supportive people. 
10. Try to enjoy learning. We are privileged to have access/opportunity to such knowledge. Malala Yousufzai’s story motivated me. Also, not to sound cliché but you are learning to save lives, so respect that and be grateful. 
11. You will need a lot of what you are studying for Step 2 CK also so don’t throw away your study materials once you are done with Step 1. 
12. Make sure that you fix your sleep/wake habits. At the minimum you should be sleeping by 11 pm and waking up by 7:30 am every day for 2 weeks prior to the exam. If you can sleep/wake earlier (10 pm/6 am) even better. Use multiple alarms, ask roommates/parents to help. Do whatever works. This is important. 
13. Don’t nap in the afternoon! I used to nap in the afternoon and was unable to fix my sleeping habits. When I stopped napping I was able to fix my sleeping. I don’t usually drink coffee but it helped me to stop napping when I was initially fixing my schedule. 
14. Exercise for atleast 30 mins twice a week. Try free yoga videos online – google yogayak free videos, or get dumbbells and do some simple weight exercises at home, or go out for a run. Go for walks to refresh yourself. Exercise for me is critical to making me feel happy and motivated. 
15. Make an ‘After exam list’ – whenever there is anything you think of doing, that is distracting you. Put it on the after exam list and forget about it for now. 
16. The day before the exam do some meditation. Find a soothing video on youtube with a meditative, pleasant soundtrack and play it. As you are relaxing yourself, imagine your exam day from opening your eyes, dressing up, leaving for exam centre, feeling confident, imagine yourself taking each of your breaks, eating, drinking water, going to the restroom and imagine the end of the exam. This is a powerful exercise, one thing it does is it will remind you if you are forgetting anything to take/plan, but most importantly you will feel much more confident during exam day because in your mind you have already been through the whole day before, it will not be new!

For ‘old’ IMG’s who are working full-time 
1. You can do this no matter how ‘old’ you are. I know of people who graduate 20 years ago and scored in the 250s on the Step 1. Although it may be more challenging for those of you who have work and kids. But it can be done. 
2. I would recommend taking atleast 2 months either completely off or atleast flex-time/part time before the exam. Especially if your target score is about 230. (I had three months of flextime/part-time) 
3. You will need to go through the Kaplan videos/notes to refresh your memory. But do this quickly and don’t get boggled down and think you don’t know enough. Trust the process, you may not know everything perfectly in your first round but repeated rounds of revision will get you there. 
4. If possible find someone who gave the exam as an ‘old’ IMG and keep communicating with them for motivation/guidance. I was lucky to have a friend who had been in a similar situation as me and given the exam one year before me. He ‘understood’ and was very supportive and encouraging. It is difficult to relate to IMG’s fresh out of medical school and studying for this full time, or AMG’s who usually give this during medical school and need only 6-8 weeks to prepare. 
5. Strongly recommend doing Step 1 before CK. I am now studying for CK and it feels so much easier because it feels like I already know half the stuff. You can give CK first BUT in that case studying for CK will be a struggle and studying for Step 1 after that will be a struggle. If you do Step 1 first then although it will be a struggle, studying for CK will be much smoother. 
6. Motivation/momentum and perseverance are KEY. It will be a bit of a struggle at times to push yourself through. Don’t stop, stick to it and you will get through. 

Having said all this, there is a lot of advice out there, do what feels right to you, find your own path. You can contact me if you have any questions. I do not promise that I will be able to reply though. 

I also hope to upload a more detailed study plan for the working ‘old’ IMG. I call it the ‘onion method’.  

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

STEP 1 EXPERIENCE – 260 – Dr Vashistha (Indian IMG)

Dr. Aamir Laghari – USMLE Step 1 – 255 Experience

Journey to 250+ USMLE Step 1 – Dr. Donmez

December 26, 2017
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