USMLE Experience : 268 in Step1

USMLE Step 1 268

USMLE Step 1 268

Hi My Name is – Nimer Abushehab

Today I am going to share my USMLE Experience on step 1 study plan which I finished on December 2015 and scored 268.

Score: 268

Length of focused study: 4 months

I tried to start in Jan 2015, but was working as research fellow and barely managed to watch pathoma videos and add it to the book without memorizing, and quickly looked at BRS physiology, neuroanatomy, and Kaplan Biochemistry and genetics. Then I stopped for several months until I took a time off in August 2015 and started all over again. I did the test in December 2015. I was very tight in time because I had to start working at a new hospital. Otherwise I might have studied more.

Previous USMLE steps: Step 2CK – 262

Year of graduation: 2013


Main books read for each topic:


Pathology: Pathoma book and videos (I love it !!)

Physiology: BRS physiology

Biochemistry and genetics: Kaplan Biochemistry and genetics

Microbiology: First Aid (I looked at the Lippincott cards quickly after each topic but barely added some information about bacteria or viruses that are not in FA, I think it helped)

Neuroanatomy: High-yield + First Aid  Anatomy and embryology: First Aid only

Immunology: First Aid only

Pharmacology: First Aid only

Behavioral: First Aid + I only solved the questions in Ethics part of BRS Behavioral (I felt weak in ethics) without reading the book

Statistics: First Aid + Quickly looked at BRS Behavioral for anything I couldn’t understand and solved the questions

Psychiatry: First Aid only

Review books:

First Aid 2015: Where it says First Aid only up, I read the topic twice except psychiatry, behavioral, and statistics which I only read once few days before exam.


Pathology: Barely looked once for few topics not all. Only memorized few extra things in the basic pathology chapter. o Physiology: Looked quickly after each topic in BRS Physiology, but barely found anything to add or memorize o Biochemistry and genetics: I read once after each topic in Kaplan. Memorized the extra parts that are not in Kaplan. But I read the tables about Glycogen Storage Diseases and Lysosomal Storage Diseases several time.

Question Banks:

USMLE Rx: Did around 600 questions. Used to do some topics after I read them from text books. I left notes on separate notebook. For people who don’t know it, it the official question bank for First Aid. Styles of questions are similar to USMLE World but not as important.


USMLE World: The most important source of questions. Did it all after finishing my reading. Used to do 80-100 questions a day because I was running out of time. Quickly read explanation and left notes on a separate notebook. I only did it once. Then quickly went through more than half the questions I did wrong. I never left a note of FA. If I totally forgot about the topic of the question I sometime would go back and read about it quickly.

My notes:

I left notes on separate note books when I was doing question banks. I read most of them quickly before the test but didn’t have time to read them all. None of them actually showed on the real exam. So they were not vey helpful.

Self Assessments:

UW question bank (started almost 1 month before test) – Mixed: 89%  UWSA 1 (6 days before test): 261  NBME 16 (4 days before test): 269 – Most accurate  NBME 17 (3 days before test): 266

Main points:


The most important part I believe was not how much you memorize but how much you understand. You will see this on the real exam. Almost all the questions are clinical and you can’t pinpoint the answer in any text book or FA. So you have to understand what you read. I used to look at Wikipedia if there was something I didn’t understand. Number of times you read FA has nothing to

do with your performance if you don’t understand the content. You are just wasting your time. At the same time, in my case, I believe not finishing all FA was not a smart idea, but I was running out of time.


Doing UW many times is also a waste of your time. If you have time after finishing it, redo only the questions you got wrong, and use the extra time to look for another source. Practicing questions is the most important part.


I honestly never used Anki, although the concept is very nice.


I did step 2 CK before step 1, and I felt it really helped. The question style is clinical which is something you get used to, and it helped me to go quickly through pathology as I already knew most of it from step 2.


Feeling that you are forgetting what you read is very normal, unless your self assessment tells you otherwise.


It is very important to learn how to do the questions more efficiently. The time is limited and if you spend more time on one question you might lose the others. Mark any question you don’t know or you suspect and then at the end of the block go back to those you marked. The stress during the first round through the block is way more, which makes it harder to think deep.

Before test day: The day before test day I had to look at my notes but couldn’t read them all as I said. I tried to have enough sleep.

Test day: On test day I went wearing my pajamas. It is very important to feel comfortable sitting all this time. You can start whenever you show up unless you come late, I came 30 minutes earlier and started then. I felt the first block was the hardest. Then you get used to the situation. I did 2 blocks – break – 2 blocks – break – 1 block – break – 1 block – break – 1 block

At the end I would look to thank everyone who helped me before and during my preparation, and I would like to pay it forward for anyone who needs any advice.

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

Detailed USMLE Step 1 Experience by Dr. Leah Abraham – 247

The Gunner IMG Method to Ace USMLE Step 1 – by Dr. “Budd Chiari”

Detailed USMLE Step 1 Guide by Dan Levi

December 10, 2017
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