USMLE Step 1 Experience – 256 – Dr. Karim


Study Materials:

  • Kaplan videos and lecture notes for all subjects except Pathology.
  • Pathology: Pathoma videos and lectures + Goljan audio and Goljan 125 page transcript.
  • First Aid 2013.

References: (used on an as needed base for topics not understood from study materials)

  • Goljan’s Rapid Review of Pathology
  • BRS Physiology (Board Review Series)
  • Lippincott’s Illustrated Reviews: Pharmacology
  • Google Images (seriously!!)
  • Others:

o Medscape, NEJM, Wikipedia

Question Banks:

  • USMLEWorld QBank: Online QBank for 5 months (3 months are fair enough, however I had several interruptions so I subscribed for 2 extra months because I didn’t finish my first pass in the first 3 months)
  • Kaplan QBank offline:

o Most of: Biochemistry and Genetics, Microbiology and Immunology

o Few of: Pathophysiology, Pharmacology, Statistics

o None of: Pathology, Physiology, Anatomy, Embryology, Histology and Behavioral)

NBMEs (CBSSA): All forms taken online.

  • Form 15: 18 October 2014 – (251) – performance profile included.
  • Form 13: 26 October 2014 – (254)
  • Form 16: 1 November 2014 – (251)
  • Form 7: 12 November 2014 – (254)

UWSA: online.

  • UWSA 2: 12 October 2014 – (257)
  • UWSA 1: 21 December 2014 – (265)

Actual Step 1 Exam: 28 December 2014: (256) – performance profile included.

Timeline: I prefer not to mention this because it might be disappointing. I wasted too much time due to multiple interruptions during my preparation plus a bulk of time wasted at the beginning, when I used large, exhausting, low-yield resources until I read recent examinees’ experiences (in this group) and followed them.

Tips and Advices

(The next part summarizes in points what I learned during my preparation; my mistakes and ways to avoid them in my opinion)

Advices Regarding Study Materials:

  1. Before starting, choose among the study materials mentioned in the various experiences in this group. They are more than enough. Big text books are never good for exam preparation. Using Lange for physiology or Lippincott’s illustrated reviews for biochemistry and pharmacology are probably terrible ideas, unless you have done them already during coursework.
  2. The choice of your study resources should only be based on your own personal preferences. Pick up a resource you feel comfortable with, a resource that you feel more friendly. Avoid studying from a resource that you don’t like or can’t handle just because it has more recommendations. A good example is pathology. I’ve read many experiences (in this group) about people who scored 250+, and each one of them studied pathology from a single resource whether Kaplan, Goljan or Pathoma. So pick up the one that “appeals” to you the most and “master” it.
  3. Avoid using more than one study material per subject. If you use other materials for reference only, that is fine. Mastering 100% of the material in Pathoma alone is better and more time efficient – in my opinion – than accomplishing 90% of Pathoma and 75% of Goljan (as in my case).
  4. In your first read, start with foundation subjects (physiology, anatomy, immunology, biochemistry). Leave pathology till the end. During your revision (i.e. your second read), start with your weakest subjects and topics first.
  5. QBooks (I am not talking about QBanks here) could be used best – if any – only during your first or second read. Kaplan QBank, First Aid Q&A and Robbins Review of Pathology are all good QBooks to aid the consolidation of important concepts. But they are NOT good at all to prepare you for the actual exam. To be honest, I barely used any of these.
  6. Do not even try to memorize anything during your first read. Your first read has only one purpose: to understand the concepts. Spend time on understanding rather than memorization. Refer to text books, lectures, YouTube, Google Images, Wikipedia, Medscape, NEJM, etc. to understand any concept that seems hard.
  7. Get the First Aid book. Regardless of whether you like this book or not, it is a treasure. I didn’t like it myself. I used it as a review tool, as a study guide and as a curriculum reference.

Advices Regarding Online Question Banks (USMLEWorld)

  1. QBanks – especially USMLEWorld – focus on high-yield concepts tested on the real exam. They make you able to “highlight” important principles and focus on them while doing a second reading of the syllabus. Without starting solving QBanks, you would never know what to focus on. So start solving UW early; after your first read if possible.
  2. When solving question banks online, you should do them at least twice. Please do your first pass in a subject-wise (physiology, pathology, microbiology, etc.) rather than system-wise (neurology, cardiovascular, gastroenterology) manner. My first pass was system-wise and I really suffered because I had to learn new materials about every single subject in each test block I solved, so I felt messed up rather than focused on one subject at a time).
  3. USMLEWorld QBank is a MUST. If you are doing only one QBank (which is more than enough by the way) it is USMLEWorld for sure.
  4. How to study the UW QBank is what makes a big difference – in my opinion. You must master the contents of this bank. To do this, for every question you solve you should:
  • know why the correct choice is correct.
  • know why all the other choices are incorrect.
  • read the question stem itself and get used to the “key words” and how to interpret what they mean in a flash.

For example, in the exam they are less likely to tell you: “the patient is in shock”, but they are more likely to say: “blood pressure is 90/60 and pulse is 120”.

They are less likely to say: “the patient is complaining of proximal muscle weakness” but are more likely to say: “the patient finds it difficult to get up from a chair or comb his hair”.

  • read other information provided in the explanation of each question even if they seem “irrelevant” and have nothing to do with the concept of the question.
  • Solve full blocks (46 question per block) in a “timed” setting to practice timing.
  • Memorize by hard – in my opinion – the ranges of normal values for the following lab values. These lab values are provided in the exam of course, but it would be really time-wasting to look for these values, especially if you are looking for two or more values:
  1. Glucose, triglycerides, cholesterol, bilirubin, albumin.
  2. Sodium, potassium, bicarbonate, calcium, phosphate.

iii. pH, PO2, PCO2.

  1. Bleeding time, platelet time, PT, PTT
  2. So to summarize: Do UW QBank two or three times. First in a subject-wise, then system-wise, then random and read thoroughly the explanation of each question.
  3. If you are doing other question banks as well, remember this rule again: studying 100% of questions on UW is much better than doing 80% of the questions of two or more QBanks. I recommend using other QBanks only to repair certain defects. In my opinion, if solving more QBanks is going to distract you from USMLEWorld, please don’t do it. Ensure your mastery of UW then do any of the other banks you want.
  4. If you are that kind of person who likes to take down notes from the QBank, please, try NOT to do it during your first pass. You are likely to encounter these facts you are writing down over and over again and they would “stick” to your memory while doing more questions, so by the end of the first pass you would end up with notes that you are already familiar with. Take down notes during your second pass, writing down things that did not “stick” to your mind during the first pass. This will make the notes shorter and well organized. I took notes during my first pass, and ended up throwing them away and taking down new notes during my second pass!
  5. No one is perfect, so don’t try to be so. Start practicing USMLEWorld even if you don’t feel you are fully covering the syllabus. The QBank will repair your defects.

When I say you should “master” the material, I don’t mean you shouldn’t miss anything. We all miss things. Just don’t neglect concepts or lessons that seem boring.

Advices Regarding NBMEs and Real Exam

  1. The best predictor of your actual score is a “consistent NBME scoring”. If you get two similar NBME online scores, that’s your most likely score if you take the real exam (in shaa’ Allah).
  2. Never engage in a discussion regarding an NBME question on this group unless you have done it before. NBME is meant to assess your actual level and their test forms are limited in number. Solving an NBME test, which contains many questions that you have “seen” and “discussed” before might overestimate your NBME performance and give you a false high score.
  3. This advice is intended for those who are anxious and get their brains blocked sometimes. It worked somehow for me. If it doesn’t suit you, please ignore it. If you decide to use it, please start applying this advice during your early online QBank practicing to make sure it is OK for you and has no negative effects:

When you are confronted by a hard question, do not waste time rereading it over and over again. Do not get driven to despair just staring at the question wishing it didn’t exist. Decide quickly that this question is not doable now, make a good hunch or even a random guess and pick up an answer, then mark the question, and move to the next question.

When you are done with all questions in the test block, return to your marked questions and try again. You will find out – in most cases – that your brain figured out a good way to deal with it.

Applying the above principle seems easy, but you must ensure you have enough time to review all of your marked questions. This depends greatly on how much time you spent to decide to postpone solving this hard question and move forward.

  1. No matter how well prepared you are, you will make mistakes, even silly mistakes, so don’t demonize yourself if you discovered you picked up wrong answers when it is too late. Do not let anything bring you down, you still can score high. We want to minimize – not to eliminate – our wrong answers. Always stay in focus. Always stay in good mood during the exam.
  2. The USMLE is meant to test your endurance. It is an 8-hour exam with 322 different problems, each of which you have to decide a correct response in less than two minutes. The USMLE is meant to stress you out. So don’t freak out; don’t panic. The exam will seem harder than you expect but you will do well with good preparation in shaa Allah. There are always new experimental, hard questions that do not affect your score but could freak you out for nothing.

When is it good time to panic? NEVER!

Always cheer up and keep moving forwards.

At the end, I wish you all the best for your preparation, your exam and your life.

May Allah guide you.

Best Regards,

USMLE Step 1 Preparation Group Member

Dr. Karim Adel

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

My USMLE Step 1 Experience 245 – Review by Dr. Sarah Brum

IMG Step 1 Experience by Dr. Sai Vikram – 262

To The Point Step 1 Experience by Dr. Sojan Sapkota

December 11, 2017
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