USMLE Step 1 Experience – 262 – American Student


#USMLE #Step1 Experience – 262 – American Medical Student


I wanted to share my experience in hopes that it will help some others who are still fighting the good fight. This thread helped me a ton in prepping for this test and kept me motivated in times where I was feeling pretty down about all the studying.


I also want to preface this writeup by saying that I am a very average student by what is considered for a U.S. medical school applicant; I attend a small medical school that is primary care focused and is ranked somewhere around 100 in terms of annual NIH funding for research. I had a 31 mcat and feel lucky that I even got into medical school. I also know plenty of other people who had mcat scores less than 30 who destroyed this test. Natural intellect and a strong history of doing well on standardized tests is not what is necessarily needed to do well on this test–Step 1 is a test that rewards those who work hard. If you grind it out and actually learn your basic sciences well in the first two years of school, this test will reward you for it.


Resources: First Aid, Pathoma, USMLE Rx, Goljan Audio, UWorld, and ?DIT videos?


To begin with, nothing can compare with gaining a solid foundation by fully learning and understanding the material the first time around during courses. This has been stated countless times on this and other threads, but it is the truth. Taking all of your classes seriously and doing well will ultimately be the best preparation of all for doing well on this exam. Many students do not realize this until it is too late, and waiting until the last semester of 2nd year to prepare for this test is simply just not enough time to cover all of the information you’ve learned in the first two years. Additionally, when you start doing questions in the qbanks you will be shocked by how often the only reason you are able to answer some of these questions is by recalling or recognizing things from your classes, because all of the info is NOT covered in the review books.


With regard to resources (other than Rx and Uworld), I believe that the Goljan audio and Pathoma were key to my success. Some people say that Goljan audio is outdated and too old to worry about using, but I swear that dude’s audio recording was freakin gold for me. It is ridiculous just how high yield it really is. I never sat down or took time out of my classes or pathoma to listen to it, but throughout 2nd year I routinely listened to him when I was driving or on a flight or anything where I could get a solid 20-30 minutes at least of listening. Some people recommend listening to him in the gym, but depending on what you call “working out” I would advice against this. Passively listening to Goljan is a waste of time; you need to be able to listen and pause regularly to answer his questions and stay actively engaged in the lecture. I was seriously able to probably answer between 5 and 10 very challenging questions on my exam thanks to that audio, and many other straightforward questions.


I don’t have a lot to say about Pathoma that hasn’t already been stated by everyone else. The whole book is amazing and insanely succinct. Sattar is an incredible teacher, and I would argue that anyone who hasn’t gone through this text and videos is doing themselves a huge disservice in terms of prepping for this exam. I used this book as my primary means of actually learning pathology, and then I would go through my school notes once or twice prior to the exams just to memorize enough to do well on the test.


DIT: unless you have time to waste, I wouldn’t bother. I went through some of the videos but most of it was pretty superficial. I would use it for areas you feel your school courses were weak in, or areas that you are struggling with. I just had some of the videos, not the big workbook and all that stuff.


USMLE Rx: I ended up completing 68% of the qbank with an overall end average of 74%, with a predicted score of 261 +/- 20 for the 95% Confidence Interval (It happened to end like this, but be aware that my “predicted score” typically fluctuated anywhere from 242 to 262). This was done on total random for the large majority of the qbank. I did a few blocks before the micro shelf just strictly on micro. I always did blocks on timed mode however. When I started the qbank, my averages were typically in the low 60% area, sometimes getting down into the mid-low 50s, and every now and again I would hit around a 70. By the end my run with Rx, I was averaging high 70s and sometimes low 80s, and only occasionally getting anything below a 70%. As many have stated, I would recommend using this qbank along with FA, and the two should basically be a single unit. For me, reading FA was a total waste of time and I pretty much never just read FA alone. 95% of the FA “reading” I did was in the context of going over it along with the questions I was doing in FA.


UWorld: I only ended up doing 70% of the qbank, and did every single block in timed random mode. My overall ended up being an 83% average for Uworld, and it really didn’t fluctuate much from when I started the qbank. I think after my first 10 blocks my overall average was 80%, so it only ended up coming up a few percentage points. I largely attribute Goljan and Rx for the reason why I was able to come into this qbank and make decent scores from the beginning. Uworld really is an amazing qbank and I wish I had more time to have finished it.


Overall, the golden ticket is this: UFAP + Goljan (do NBMEs to tell you where you are score-wise)


Practice exam scores:


  • NBME 13 (~6 weeks out): 258


  • NBME 15 (4 weeks out): 249 ßte fuq?


  • CBSSE (given by the school 4 weeks out): >260


  • UWSA1 (3 weeks out): 260


  • UWSA2 (2 weeks out): 262


  • NBME 17 (2 days before step1): 260


STEP1: After all the horror stories I heard about the test, I was sure I was going to get in there and it was going to be an insanely challenging, long test with huge stems and tons of data and graphs everywhere, but it wasn’t really anything like that. My test overall felt like a mix of uworld and nbme exams. It really wasn’t THAT bad. At least half of the Uworld blocks I had taken felt harder than most of the blocks on my exam. Some questions were extremely straightforward first-order questions, and some I literally had no clue on and just had to guess. If I could break it down for an average block I would say that about 20 questions on each block were pretty straightforward and as long as you had been an average student you would probably answer most all of these correctly. Another 15 or so required a bit more integrative thinking or required some little detail you had to know in order to answer the question, and then another 5-10 were pretty tough and I basically had to completely guess on anywhere from 3-5 of these. The biggest challenge I faced on my test was the ambiguity in the questions or answer choices. It was exactly like NBME practice tests on so many of the questions; you know the disease they’re describing, you know the pathophys behind it, and you know how to treat it, but then the way they phrase the question kinda leaves you thinking “well wtf do they mean by that”? Or, if its not the question, you look down in the answers and you swear that 2 or 3 of the answers are right, and then you basically end up blindly picking between two. Unfortunately it felt like this was happening pretty consistently throughout the test. You could easily narrow the answers down to two choices, but from there you just had to go with your gut. So despite knowing the majority of the diseases and pathology behind them on each block, I still on average marked like 15-20 questions per block, and almost never had the time to actually go back through all of them. I do want to also state that I tend to mark a LOT of questions in general; on Uworld for instance I routinely mark around 10-12 questions per block.


Additionally, the ethics/patient interaction bull**** was honestly some of the stuff that bothered me the most my test (luckily there wasn’t just a ton of it). Half of the answer choices sounded correct, and I just had to guess. It was not a comforting feeling at all. I also had 2 or 3 epidemiology questions that required graph interpretation and I was never able to figure out exactly what was going on and had to guess. When I left the test center, I felt confident that I passed the exam, but I still felt sick to my stomach because it seemed the score could basically end up anywhere from a 220 to a 270. I tended to feel this way after the 3 NBME tests I took as well, so I was just hoping everything turned out ok and was at least somewhere in the vicinity of my practice test scores. Overall, I want you guys reading this to realize (at least from my experience and others I know) that the test will not be that different from things you’ve already seen. Trust your uworld scores and nbme exams. Just about everyone who takes this test uses those resources too, so your percentile on uworld and scores on nbme exams will likely correlate pretty well with how you will do on the real deal. Best of luck to all of you.


Took Step 1 on June 15– actual score: 262

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

Step 1 Exam Experience By Armia Kirlos Ephraim Michael

USMLE despite all odds – Journey from orphan in Nigeria to successful doctor !

My Step 1 Experience from 220 to 251 – Rachael Kim

December 11, 2017
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