USMLE Step 1 Experience – 259 – American Medical Student


Score came back faster than expected, in less than 3 weeks.

Test day: Much harder than both NBMEs I took and both UWSAs. Walked out feeling I did significantly worse than I expected to do. Obviously, that did not line up with reality — my guess is that many “stumper” questions were experimental or just washed out with the curve. The curve must have been far, far more generous than that of the NBMEs.


Timing… there was plenty of time to finish each section. I generally finished with 10+ minutes to spare, and ended the day with 90 minutes of break time remaining (I didn’t use much either because after eating, I just wanted to get back to the exam and get it over with…).


Question stems were generally fairly brief, more akin to NBME than UWorld. Some questions were off the wall and I had never heard of the topic before; that occurred particularly with respect to musculoskeletal and dermatology material. Others were prosaic topics asked about in a strange way that confused me utterly. Pictures were generally good quality. Lots of radiology (more than I expected, by far). Quite a bit of genetics. Multiple ethics questions that I could narrow down to 2 choices but could not differentiate after that. Couple of heart sound questions with the interactive interface; sound quality was great and those questions were not difficult.


Lesson learned is that Step 1 will crush your soul and make you feel you did horrible even if you did well.


Step 1: 259

Baseline/pre-dedicated study NBME (17), ~1.5 months out: 244 (580)

Second NBME (19), ~3 weeks out: 252 (620)

UWSA 1, 1 week out: 277 (730)

UWSA 2, day before exam: 262 (forgot to note assessment score)

UWorld cumulative %: 84.2% (96th percentile)


Amazingly the average of the 4 practice tests is 258.75. How crazy is that.


Resources used:

First Aid: Nothing to say here, everyone knows First Aid. Lots of stuff in the book that is actually quite low-yield. You can’t learn everything, the volume is too great. Make sure you know the stuff that comes up more than once. Anything that doesn’t, maybe don’t go crazy trying to memorize (e.g. pharmacology section’s endless pages of random side effects).

Pathoma: Awesome. Pay a lot of attention to the first few (fundamentals) chapters. These are free points if you have the facts down pat. I missed a point on an easy question straight out of the inflammation chapter and kicked myself for it later. This book is slim and easy to review once you’ve read through it once. Rinse and repeat.

UWorld: Nothing to say here. Interface is a carbon copy of the actual step 1 interface. Questions are great. Do timed and random, and suppress your rage at the endless number of arcane questions in the bank. You can’t know everything, but you can learn all the random stuff you do happen to come across…

USMLERx Qbank: I highly recommend doing USMLERx during M2 because it basically serves as a pass through First Aid in a more digestible format. I did ~90% of the question bank. Used during organ system courses midway through M2. Medium and hard questions only, timed. Did easy questions when I’d cleared a subject, just to complete them and see 0 questions remaining on the tally.

Rapid Review Pathology: Read some chapters. Not really necessary but if you have time sure why not. Goljan writes well and the chapters are fast reads.

SketchyMicro: Watched virus, parasite, and fungi videos only. SketchyMicro is amazing and I suggest using it early and often. I should have used it for the bacteria but by the time I started using it in general, I had already studied the bacteria extensively anyway.

MicroCards: Pretty good, more useful in microbiology course than for Step review in my experience.

PharmCards: Not very useful in my opinion… too dense and too many cards.


I did only one pass of UWorld because I ran out of time and motivation to go back through or even review my missed questions. However, I did review a Word doc I made with “pearls” from each question I missed throughout my dedicated study period. Were I to re-do this process (not in a million years!), I would take the time to do a second pass of UWorld and also do more NBMEs, and maybe re-review the first few chapters of Pathoma (very high yield!).

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

USMLE Step 1 Experience – 265 – Must Read

275 – USMLE Step 1 Experience IMG



December 27, 2017
%d bloggers like this: