USMLE Step 1 Experience - 256

Qasem N. Al-Shaer

AnNajah National University – Palestine

Done the exam during the 5 th -6 th year

Preparation period: around 6 months

  • Step 2 not done yet
  • Exam date: Dec 14, 2016, During 6th year of medical school
  • Score report: Jan 11, 2017
  • Assessments:
    • Oct 9: online NBME form 16: 520 = 232
    • Nov 15: online NBME form 18: 560 = 241 (the last one before the test)
    • can’t recall the results of UWSA!
  • USMLE Step 1 Score: 256

You have to take a decision!

If you are like me, a procrastination master, You will never take the exam unless you have registered and paid. So decide NOW when you want to take the exam. Start now! From my basic years I’ve been thinking about taking the exam, it was a dream until I registered after the 5th year. Then I started to study for real, it became a goal not a dream any more.. Decide, don’t just Dream!


  • First Aid USMLE Step 1 & UW are the corner stone, for most of the subjects they are enough.
  • DIT helped me read through FA, because I’m not used to sit for studying for long times. Having someone reading for me made things easier.
  • Fundamentals of Pathology – Pathoma book and videos (more important), most of it. It is a masterpiece.
  • High Yield Embryology, in less than a day
  • For my weak points I used other resources before starting FA, to fill the gaps. Some of them before starting studying for the step. I didn’t necessarily study the whole reference:
    • Anatomy and Neuroanatomy: Kaplan Lecture Notes and videos (2014)
    • Pharmacology: Kaplan lecture notes and videos (2010, Raynaud!)
    • Biochemistry, metabolic: Kaplan + 2014 videos
    • Behavioral sciences: Kaplan book + videos
    • 100 cases by Conrad Fischer – Kaplan USMLE Medical Ethics book
    • UW biostatistics course review (about 73 Qs, they are good)
  • Finally, don’t distract yourself between resources. Don’t take notes from any book other than FA & UW. Any reference other than these 2 is only for understanding not memorizing. Don’t write excessive notes from different resources on your FA, it will become very difficult to review and memorize. Any subject that you have studied or understood during your college, you don’t need to study it from any source other than FA & UW, even if you can’t remember its details. Trust me with that!


What did I do?

During basic years:

I rarely memorized anything, but I understood most of the concepts. Good understanding makes life easier. But because I wasn’t used to memorizing, I had hard time memorizing while studying for the step. So if you can memorize do it, try as much as you can. If you don’t want to memorize then make sure to understand every piece of information. During my preparation for the test, First Aid USMLE with DIT were enou7gh to refresh my memory for any concept I studied and understood before. But for subjects that I didn’t study before I had to go for more detailed references.

During clinical years:

I connected basic with clinical sciences. With many topics in clinical years I reviewed the related basic concepts. For example, with medicine I reviewed physio and patho for many systems. With anesthesia rotation reviewed respiratory physio and CNS drugs. With pediatrics I reviewed some micro and pharma… This way the basic concepts became more clear, and remained fresh in my mind and some of my weak areas were improved. This approach will help you get higher marks in your tests in the collage, understand clinical practice much better, and understand the clinical applications of what you’ve studied in your preclinical years.

Dedicated study period:

I started in the summer vacation, 2016. It was a long vacation, but I wasted a lot of time, also Ramadan was in the middle of this vacation . So didn’t make great progress until I decided that I really need to dedicated myself for the step. I deactivated my facebook account, stopped doing any activity or participating in most of the social activities. I registered for the test and paid its fees. This way I started studying for real. The 6th year started, I almost didn’t study anything for it during my preparation and depended on my previous knowledge. Most of my study was during the 6th year, so I would study after coming home from the hospital.

How did I study?

  1. Filling the gaps, during the 5th year (out of 6) and in the first month of the dedicated study period, I studied or reviewed my weakest subjects,. For example, I studied some microbiology, pharmacology.. I tried to improve any weak point. The goal was not to be perfect in that topic, but to become familiar with it, and set bases for future study. Before dedicated study try to improve your weakest subjects.
  2. FA first read, this was the most boring and exhausting period! I read it while watching DIT to force myself to study for longer times. If you are used to study for long times and like to read books then DIT is of no use, it adds only minimal new information apart from what’s in FA.
  3. From time to time during studying FA I would answer some questions from UW. I would chose questions from the system I’m studying. This will make studying FA easier, less boring, and more exam-oriented. I advice you to start UW from the first day and use it along FA from the beginning.
  4. UW: I started random timed mode. Don’t become depressed if you started with low scores. After finishing a block I would go over the explanation. When reading the explanation for every question I reviewed it’s subject from FA. For example, when I have a question about Digoxin, after studying the question’s expalnation I go to FA and study the paragraph about this drug. This way I reviewed most of the FA many times, and the most important topics regularly.
  5. I didn’t take notes for UW on a notebook, instead I used to add notes on FA. If a question gives extra information more than what’s mentioned in FA I would write these info on the book near its title, if it needs more space I would use small sticky notes, or some times larger papers and attach it. This way I had only 1 reference to study, I think this was easier than having many notebooks.
  6. FA second read: after finishing around 35-40% of UW. I went back for FA and reviewed it once more. This time I almost memorized everything, as much as I can. Before this read you might feel depressed due to the low scores you get in UW. After reviewing FA your scores should rise significantly.
  7. After the second read I suggest that you do an assessment, not to predict your final score, but to know your week points and try to fix them. If you delayed the assessment to the last 2 weeks, and found that you are weak in behavioral sciences for example, you won’t have time to improve. So do an early assessment to know how to improve your study plan.
  8. I continued UW as mentioned before, reviewed some FA, and so on. Sometimes I would study random-timed, other times I would use random-timed tutor to save time. But I think I’ve never been able to study more than 1 block/day. So please never compare yourself to others, a friend of mine used to study 2 blocks/day!
  9. I did some offline assessments early on. Close to my test dates I did online assessment, and wasn’t happy with the results, so I delayed the test more than once. The last assessment was 1 month prior to the test and its results were not satisfactory. But I decided not to postpone the exam this time. Because I reached beyond my peak, a point where I couldn’t study any more, I was extremely exhausted and burnt out, and started to forget more than what I learn. So I decided to enter the exam without an assessment and without finishing UW. That’s why the month after the exam was the most stressful month in my life! Please plan better than me and don’t do this!

General points:

  • Duration of study period: I don’t recommend studying for more than 4-6 months. The nature of the material for step 1 is forgettable. Moreover, it will be very boring and exhausting. So make your dedicated study period as short as possible. I mean the period when you do nothing but studying for the step.
  • Ankicards: I tried them, but they didn’t work well with me. It’s just that my study method doesn’t go along with cards. So don’t stress yourself, If you found them useful and helpful then use them, if not don’t. People are different, accept that fact.
  • Assessments: They have 2 goals. The first is to predict your final score, to achieve that try to use the least uptodate forms, and close to your exam time like 2 weeks before. The other goal, which is often not mentioned, is to assess your study, and determine your weak points and improve them. To achieve that you need to perform an early assessment more than a month or two before your exam time, or even earlier. You have to give time to study your weakest topics and this needs time. So do an assessment early enough.
  • UW:Please start it as early as you can. You can start it system wise while reading FA for the first time. But don’t finish more than 30% in the system wise. After finishing FA move to random and always study in the random mode. My mistake was that I delayed UW. Subscribe for it very early, and start it from the beginning. Please start UW from the first day.
  • Read a lot of experiences, but make your own way.
  • Faith: to be honest, the study period was the worst period in my life regarding my religion, worshiping and faith. You have to keep a good company around you. Keep in touch with those who rise your spirits, those who help you be a better person. Standing alone is not always good. Surround yourself with good friends and don’t lose contact with your peers.
  • Finally, you won’t reach if you don’t start. Register as soon as you decide to take the exam, work hard, pray from your heart and have faith! You will Achieve what you Aim for.Make sure you “SHARE” this post with your friends to help them out in their preparation.


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

USMLE Step 1 Experience – US AMG

USMLE Step 1 Experience – 259

USMLE Step 1 – 240 Experience – US AMG

November 11, 2017
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