USMLE Step 1 experience-Mohammed Qussay Al-Sabbagh I’m Mohammed Qussay Al-Sabbagh, a 6th-year medical student at the University of Jordan, and I have recievedmy Step 1 resultsa few days ago, which’s turned out to be 263, Alhamdulillah!Thus, I havedecided to note down and sharemy experience, as I found reading others’ experiences very useful to me… This experiencedocumentationwill be divided into three sections; general take home messages, my USMLE step 1 journey, andmystudyingsources. I.Big misconceptions“Just because everybody does it,doesn’t make it right”In this section, I’ll present some big misconceptions about Step 1 preparation, which drives students to be needlessly worried, rendering them unefficeintly anxious and distressed at all times. Before starting,ALWAYS REMEMEBR that there exists no schedule or technique that fits all kinds of medical students, which calls for the creation of your own personal approaches according to your own capabilities which no one knows for exact exceptforyourself!Misconception #1: “You won’t get a high score without reading FA and UW at least 3 or 4 times!”FA and Uworld are amazingand competent resources, so competent,most of my exam came directly from these resources. However, there’s no point of repeating something you’ve already know! This especially true for UW. Despite the fact that the actual exam is identical to UW in terms of style and apparence, you’ll never encounter a question that is copied from UW.UW is a great training tool, its sole purpose is to be used in order to develop exam-taking approaches and strategies. Your intial impact with UW and its associated questions will provide you with enough information for you to develop exam-taking strategies, however, that happens only once as your reruns of UW will be nothing but asubconscious memory indurancetestof familiar questions and contexts. Some may argue that the knowledge embedded inUW’s questions are ofhigh yieldqualityand needs to be memorized by heart, this is partially true,as you can review and re-examine such information from your self-generated notes and flashcards without the need to waste time and effort going through a huge testbank.
Actually, If I had more time, I’d do another test bank like Amboss or Rx.A.Misconception #2: “Never take your exam until your assessment scores are within your target.”The circumstances and the surrounding environment in the real exam differs a lot from your home environment. Moreover, no one knows the exact questions’percentages and scoring systemsthat shall be usedin the real exam. So there’s no point of using assessment exam scores to predict your performance in the real exam, then ultimately start developing anxiety instead of re-evaluting your studying strategies andsubject-specificweaknesses. Perosnally, Ihavenever used online NBMEs and did not even finishall of the offline ones. In addition to that,Ihave never doneany assessmentexam in the ideal conditions, as Ihave used to take my assessmentexams under conditions where I was either tired, sleepy or ‘fasting’(its noteworthy to mention that most of my dedicated study period wasin Ramadan). Does this mean that assessment examsare useless? The answer is no!They are very good tools to assess your relative weaknesses and strengths, with which you can polish your skills in areas you’re competent in and re-examine areas in which you have a significant knowledge deficit, however,don’trely on them to predict your performance and scorefor the reasons mentioned above.B.Misconception #3: “You have to skip your classes or rotations and sacrifice your GPAto have a good score in USMLE.”Although this statement might ‘sound’ true, yet it has little to no authenticity. Simply becausetheUSMLE step 1 is clinically relevant/oriented, and the more clinical experience you gain, the more you understand, memorize and develop concepts. Most of my actual study period was during the second semester of the 5thyear.(For those who are not familiar withmedical school curriculum here, this is the busiest semester in the faculty of medicine, where we have a different rotation every two weeks, with all of its exams, seminars and on-calls.)Although this was very stressful for me, I enjoyed it! As interacting with people every day, dealing with patients and hanging out in the university groundsreduced my anxiety andalleviated myburnout,thus USMLE Step 1 preparation becameapart of my daily routine.
II.My USMLE journey “It’s not what you do, it’s how you do it”As I have developed insight for the gravity of the USMLE, I tried to make USMLEa part of my usual studying schedule in an effort to disseminate the burden of Step 1 equallyall over the last 5 yearsof medical school, to the point that Step 1 has become a part of me, and Ihave started tofeel emptyafter finishing it. In general, myUSMLE journeycould be classified into three phases: A.Gaining knowledge (1.5 years)As I mentioned earlier, I tried integrating USMLE Step 1 in my regular studying schedule over my basic and clinical years. Such mindset led me touse variousUSMLE-centeredresources like Pathoma and Kaplaninstead of disorintedsources of information. After finishing my basic years, I analyzed my weaknesses and found out thatI had very bad basics in Pharmacology, Microbiology and Biochemistry. Thus,I studied these topics in depths during my vacations (Pharmacology and Biochemistryfrom Kaplan’s videos and Microbiology from Boards and Beyond).During my clinical rotations, I studied eachrotation’s correspoindingbodysystem from FA, so that I could integrate clinical knowledgewithin its‘basic’ context. At the end of each rotation,Iused to solve old offline UW questions in order to have anidea about thereal-lifeapplicationsof such knowledge. In this way,I was buildinga very strong foundationfor Step 1while keeping my GPA unaffected. This period ended in the middle of the 5thyear, where I’ve finished all the four clinical majors. B.Actual USMLE preparation (3 months)At 1/1/2019, I decided to start my real journey, I made a schedule and triedashardas I couldto stick to it, and fortunately, I succeededto achieve such fate! I startedto study FA while addressing my weak areas from high yield resources. In this period, Ihavesubscribed to UW and allocated only one hour per day for its usage. Morevoer,I started to use Anki flashcards for Pharmacology and Microbiology with an average use of 30 minutes per day. 3 months thereafter, I finished all the systems and topics, with 60%completionof UW. Yet, I had to postpone my actual preparationfor oneand ahalf months due to finals. (It should be noted that i did some offline NBMEs in thisperiod).
C.Dedicated study period (6 weeks)After finishing my finals, I was really burned out and tired, and to make things worse, most of my dedicated study periodwas in Ramadan, when I was fasting most of the day, andwasunable to sleep or study. However, I pushed my self to the limit and tried to study in every single available moment. In this period gave 2 hours daily for Anki,and4-5 hours to memorize FA and 3 hours daily for UW. (It should be noted that during this final read of FA, I recorded any piece of information I find difficulty in, syndromes, or equations in a notebook and revised it daily, thus I created my personalized “Anki” and ended up memorizing the FA).It wasa very harsh and stressful schedule, and I had many burnout blows and stress episodes, but I knew how to manage them and make the most of the avalible resources andthis iswhere this very important take-homemessage appear; You know the dimensions yourself better than anyone. One of these demensions is your stress-taking threshold, this means, always try to create a schedule that isn’t purely in your comfort zone and isn’t a hellhound imbedded with unhealthy stress.I finished UW and this final FAread inabout4 weeks. In the next 2 weeks, I did a lot of assessment exams,revised NBME images, and read some miscellaneous material from USMLE groups in attempt to train myself for whats upcoming. Threedays before the exam, I did the free 120, then revised some high yieldpoints from FA and my notes.In the last 2 days, I followed dirty USMLE video recommendations (https://www.youtube.com/watch?v=zJgjMZk8_To&t=2s), and surprisingly, I slept well the night before the exam, and never had caffeine withdrawal headache! This video is gold!D.The day of the exam–A.K.A the real deal:I reached the exam center at 7:00 AM and started the exam at 7:20, I finished all the blocks in 35:00 to 40:00 minutes, and took a break after each block to eat protein bars, drink water, and pee. In general, the exam was in the style of UW. I’d say 80% questions were like Uworld. In terms ofinformation,90% was mentioned in FA, Uworld,and Pathoma.The exam depends on understanding and comprehension more than memorizationyet both are necessary.I’d say 70%of the exam was doable, 20% neededdeep thinking and linking of different concepts. (From my experience,no weird syndromes were tested as most of thequestions were atypical presentations
of very common andeasy diseases, so if you read the questioncarefully, you wouldfigure out the answer). Finally, there were the10%ofquestions that are very weird per se that required the memorization of someweird image orbizzare concept, however,you can answer most of them by exclusion.I marked 2-3 questionsin each block.Moreover,the most useful thing I’ve doneis doing UW with random-timingas that practice made me feel that I was doing an average difficulty Uworld block during the exam.Pharmacology, Biochemistry and Microbiologywere straight forward and are really guaranteed points/marksif you studiedthemwell. Most of the pathology and physiology sections were doable. However, I did face 5 questions that werevery tough and weird in which they testedweird associations between pathways.In terms of anatomy, it tested multiple conceptsand ideas, but most of the questions were easy to answer if you have good basic knowledge/foundation.Biostatistics was tough but doable if you’ve understood the basic concepts well from the Uworld review, which is enough for Biostatistics. Ethics was centered on doctor-patient relationshipsand other family-medicine centered topics. I’ve answered 50% by logic,25% from family medicinerotation experience and 25% by educated guessing.Finally, the exam had 10 to 20 questions testing unanticipated concepts such as basic ideasfrom pathology and basic biology (101), and some clinical CK-like concepts.My general impression is that theexam was fair and easy. Which isbad actually, as missing some basic questions may miss up all your score, so concentrate on basics of pathology, pharmacology, microbiology, and biochem, any small mistake could be fatal!If you are aiming high.III.Study resourcesIn general, there are multiple excellent study resources out there. You can use whatever works for you, but don’t distract yourself with multiple resources. Use one resource for building concepts and a summarized resource for memorization. Never ever attempt to go the exam without mastering the gold standard: FA, UW, and pathoma.This is summery of what I’ve used: 1.Biochem: Kaplan 2015 Dr.Turco (to build concepts) + FA to memorize.2.Immune: I had a very good basic, so I used FA alone ( B&B is good as a good source)3.Micro: B&B (to build concepts) + Anki flashcardsto memorize.
4.Bistastoics: UW review.5.Ethics: Kaplan 2010 videos for (ethics and doctor-patient relationship)+ FA+ 100 cases by Conard fisher.6.Public health: Kaplan 2018 behavioral sciences textbooks (the last two chapters)7.Pharma: Kaplan 2010 Dr. Raymond (to build concepts) + ZAnki flashcards 8.Anatomy: I readHY anatomy and neuroanatomy quickly 3 months before my exam, then revised FA+UW+100 concepts in the dedicated period. For neuroanatomy, I watched B&B as well + ZAnki flashcards.9.Embryo and Histo: FA alone. 10.Physio: FA + UW (more than enough, but you have to master it well), I used BRS and B&B to understand some topics.11.Pathology (the most important, 70-85% of the exam is pathology and pathophysiology): Pathoma+FA, I revised some pathways from robbins as well.Note: Anki and B&B are amazing resources! if I’ve decided to start from scratch in the 5thyear, I’d do B&B along with FA+Anki for memorization alone. I think these resources are enough.And finally, these are my assessment scores for those who are looking for predictive values: Offline NBMEs 13: veryearly in my study, 23 mistakes (which’s something around 240-245) Offline NBMEs from 15 to 19: from 5 to 14 mistake (between 250 and 265).Offline NBMES 20 and 21: 25 and 23 mistakes respectively (around 255).UWSA 1: 271 (before the dedicated period, after finishing my last final exam directly)UWSA 2: 269 (3 days before my exam)Free 120: 92%UW 1sttime (random, timed): 89%Real Exam: 263