USMLE Step 1 Experience – 271 – MUST READ !!!

USMLE Step 1 - Experience - 271

USMLE Step 1 – Experience – 271

Ashok Chaudhary


Test date:26th July,2016


Hello everyone,

I am a government medical officer working under Ministry of Health and currently deployed at a relatively rural place of my country,Nepal.

I don’t know…in what format to write this experience that would be best for you all….but I think

It is better for me to write it in a timeline manner.

I started my preparation around February,2015,with the aim of taking step 1 by Dec 2015 or Jan 2016.But  my almighty had other plans for me.I lost about 3 months due to my familial health problems,around the same time earthquake had struck us hard(around April –May 2015) and had to abandon the idea of applying for match in 2017.

I started with Kaplan lecture notes(except for pathology) and videos(2010) with Anatomy first ,then physio,bchem,micro.And then I  read pathology ….was in a great dilemma which book to follow for it…Goljan or,I watched pathoma videos and combined it with Goljan text book.Actually,this was very helpful for me…Dr sattar explains things so well…that made reading from Goljan easier.I would suggest Goljan only if u have adequate time.Yess Goljan is an excellent book that helped me a lot ..not only for pathology..but also for bchem,micro,physio,pharma topics. I think…it helped me to answer some very weird questions which I could not have done with other sources.But this book is very frustrating too…u never seem to finish it…so plan ur time accordingly.My advice is…if ur xm is near..dont do it…..resist ur temptation to study it..because it will rob u off ur valuable time which could be utilized for even more high yield sources like uworld and First Aid.While I was going thru this book….i used to listen to his audios ….for about an hour at the sleep time.After I finished pathology,I read  pharma from Kaplan notes and videos ..followed by behav+biostats from Kaplan notes and videos.For BS,I also read few chapters from BRS  …the chapters on Doctor-patient relationship.It was quite helpful I think.If you are at the beginning of ur preparation and are following these sources..i would advise u …don’t try to memorise things from these sources(the mistake which I think I did….that took a lot of time).Instead focus on understanding the things….why this,how this happened,the mechanisms,the way the things are occurring etc…

After I was done with these sources….i revised all these things rapidly again(no kaplan videos this time..except for a few topics of physio..and other subjects…the topics which was difficult to comprehend).I revised  full pathoma is just so awesome..that I could not skip it.For revision of Goljan….i mainly focused on the texts given within the boxes,the images and the text in blue..that is at the side of each page.While I was in the middle of this revision phase…one of my senior told me to start First aid early and to annotate imp things in First Aid…I complied.During this time…I  read the topics directly from First Aid….which I came across while revising kaplans and pathomas and goljan.Like….while watching pathoma videos….i would turn the page on First Aid for that topic… the videos and read it from FA….and annotate the things and mnemonics(which Dr Sattar says) .it was Dec 2015 already.till now…I never tried to memorize things from FA….just scanning thru it and annotating some imp points.

My advice would be……start First Aid as early as an adjunct….and get used to much as possible…but don’t memorize anything from FA..without understanding things.FA is approx 600 pages(the things that u need to study)….yet I think it’s a very concise book for step 1.Every word and sentences in First Aid….is there for a purpose.So understand the meaning of words and sentences.Dont just memorize it(except for some things like..the developmental milestones ,most of microbiology etc)…that will do no good.Understand it then only memorize it.Yess..u need to memorize FA….but only after understanding.Forget those  idealistic words….where ppl say…step 1 is all about understanding only…..nahh….u also need to memorize stuffs and that sometimes need cramming too..But keep the space in  ur brain empty to accommodate the things u learn and memorize from FA(including annotations) and uworld.Dont unnecessarily overfill ur mind..with all the stuffs from kaplans or goljan or some obscure sources.EVEN  MOST OF THE DIFFICULT QUESTIONS ARE FROM HIGH YIELD CONCEPTS ONLY.

I started uworld after all these(around mid December).All the seniors and all the experiences I read from facebook forum….they all had one thing in common….First Aid and Uworld are the two absolutely important HOLY sources…..and so was it(with my experience of xm).I was so preoccupied with this notion….that….i wanted to study UW so well… much so that …I could barely finish 35 questions a day..from uworld.(Of course….i was still working at my hospital during this period…so that might be one of reasons for such  tortoise pace).it took me almost 3 months to finish it ..the first time.UNDERSTAND UW very well….Read all the explanations..and ponder…why u got a question right..or why u got it wrong.and annotate the important things like the “educational objective” in FA….if that concept is not in FA.(No wonder my..FA was like a book which only an alien could understand ..after all these annotations…there was no space left in my FA…even to write my name on it).So if..u plan to annotate things on FA…keep ur handwriting very small from the beginning.(I wrote this big fonts early..which I regretted later).

Now ..i turned to my most important source FA 2015(around late march 2016) with all those nauseating annotations in it.This was the first time I was reading FA properly…with the aim to understand it and memorize it.It  took me slighty more than 2 months in the first proper read.During these,I also read  FA 16 pdf from my laptop…and added the new things to my FA 15 book..sometimes times that reqd sticky notes.

I took  leave from my hospital about 3 n half months prior to my exam date…n I am glad that was such a good decision to take….now I could focus all my time on my studies…..with no tension of looking after patients and administration.

When I finished reading FA 1st was around end of May.This time I took offline NBME 7…I don’t remember exactly..but I think I made around 10 or 12 mistakes.I was happy with the result.Now was the time to revise UW ……did it rapidly in about 25 days…..then after  this ..revised FA which also took me around 25 to 30 days….During these revision phase …I did new nbmes …nbme 11 onwards on weekly basis..i was happy with those results ….on an average..i think I made …9 to 10..sometimes 12 mistakes.

I took NBME 16,17 and 18 online…

NBME 16(2 weeks before exam):269(8 mistakes)

NBME 17 and 18(1 week before exam..both on same day):

NBME 17:273(5 mistakes)

NBME 18:266(11 mistakes)

The scores were very encouraging to me….but I didn’t believe them……I had a feeling,prior to the exam,that I might just cross 260,if I got lucky.Now that..i have got the scores..i can say, my friends….they are quite predictive.Dont do they predict..but they do.

NBMES were quite helpful for the real exam….a few of photos were ditto from there.One of my friend ..who took exam on same day…got some ditto qsns as well from the NBMEs.I could not use NBMEs as a learning tool because of time constraint..I used it only as assessment tool. I was happy with those scores anyway.If u have  time…I would suggest all the NBMEs..if possible and also use it as  a learning tool..and try to decipher the concepts …they are asking.Ponder over all the wrong answers…why/how u got it wrong…and also the qsns u got right…why u got it right….what…if the question was slightly different,or the options were slightly different..etc etc….

I did Fred…4 days 95% right……the tutorial and the exam is ditto…the real exam.


For special sources….facebook posts were quite useful. Heart sounds…i made a collection of those that are in uworld in my phone..i used to listen them occasionally.For radiological images,uworld and Fa only.And more learn the images u come across FA and UW,well.I took so many screenshots of various posts on fb,and many images…and used to look at them when I was out for a walk..or after lunch and dinner etc.Two of my friends  from this group…I think one is “staph aureus” and other “usmle something”(sorry I couldn’t remember the name…..had uploaded UW tables to this group..which Moiz had asked for…I had those in my phone….i went thru them about 20 or 30 pages a day…..while I walked to my playing field or to gym.Thank you guys……and all the Kickass members.

If u come across any thing…that is in FA and UW….which u don’t understand……don’t just let it go… it,wiki it,post it on the facebook group,ask ur friends etc etc…but understand it.


Friends,I think I  was an active member of facebook group….and those discussions,those images posted by someone else,those files uploaded….all were helpful.Yes…there were times..when I felt so much frustrated…by someone elses posted questions..i felt….omg..i dun know this,I dun know many people…know this thing…”am I the only one who doesn’t know this??”Those posts made me feel myself..idiot sometimes……but most of the times they were inspring,knowledgeable,encouraging.Many friends s ometimes posted their agony and insecurities …and it was really so satisfying to encourage them with some inspiring sentences.So,getting actively involved in the fb group does help a lot.

Friends,throughout my preparation my mantra has been…”study,sleep,stay healthy”….all 3 equally important.Resist ur compromise ur sleep..or diet or exercise…just to study few more pages.What is the use of studying so much..if ur brain cant remain alert and think well??Never ever during the course of my preparation,I exceeded 12 hours of study…not even when I was on leave.i used to sleep at least 8 hours,exercise regularly(sometimes playing football..sometimes going to gym).I followed these schedule…as late as 4 days prior to my exam…While I was revising FA and UW…i made a note of those stuffs ..which was volatile…in a separate notebook…..they were almost 50 pages in my register sized notebook with font size very small….i rapidly went thru them in my final 2 days.U must have noticed friends…..during my final 7 months of prepn..there was no Kaplan,no pathoma,no Goljan….all that some imp stuffs that I had annotated into my FA…which sometimes required A4 sized paper to be  added in between the pages of FA.

Get urself enough sleep..prior to exam(very important).if U cant….take medicine….i took promethazine 25 mg.One of my friends..took Zolpidem.(but beware..of the adverse effect…like next day sedation,dizziness,etc). So don’t use it for the first time…in the night prior to exam day…what I did was…I experimented with the drug…1 week prior.

Why sleep is important??

Because step 1 exam wants u to think on ur toes….throughout the exam…there are very few straight memory questions.It wants u to APPLY those concepts that u have understood and memorized…in the situation given in the question.And you WILL face those …out of this world questions,which requires a CALM n ALERT brain…I had many such qsns in my exam.An alert equally important….as important as ur whole study.

N plzz..check ur documents u need to avoid last moment panic.

Exam day:I woke up..feeling refreshed….got ready for the test…took a heavy breakfast.went to test center…..i was calm I think….may me a little anxious for initial 20 mins of the test….after that ….it was like NBME for me….some qsns were very easy…some questions(like 4 or 5 in each block) very very difficult in a sense that…I didn’t even know what it is trying to ask…read the qsn again….got some idea…..looked at the options and applied the “rule of ruling out”….this helped me a lot.I was anticipating..few wtf qsns in every block …and so was it.Moral is….dont let urself down when u see such questions…because u will certainly face it.Use ur brain…..n think rationally….sometimes u will find…how simple that qsn was actually.Yes.. sometimes they give lot of unnecessary details..just to SHOW…that the qsn is complicated ..which,in fact, is not.

Yes…exam time was enough….on an avg..i finished each block about 10 or 12 mins early….that remaining time, I used it to …go after my marked qsns…..there were on avg..10 or 12 marked qsns in each block.I took 5 min..sometimes 10 min break after each block..after 3rd block..i took so called lunch break although I was not hungry.i took some energy bars,fruit juice etc.

Never ever…even in my dreams..i thought of getting this score.I never deserved it…may be luck favoured me heavily,may be my parents blessings worked for me,may be my parents dedication towards God(which they always have been) worked….may be all ur blessings worked.

Sometimes,I feel so guilty..i am a criminal to  my college friends…I skipped…some of my  closest friends weddings…that was so selfish of me.My jigris,if u are reading this….i am sorry to u again.My colleague friends at my work place have been so helpful….they did work extra…just because I could get more time to study.Thank you my colleagues.

Guys….i never felt complete…going into the exam.i think..nobody does.But yes..i was  calm n confident ….that I will do well.I repeat…u don’t need to know everything….u don’t need to memorize everything…what u need is to…recognize..when u see it…..Rule out the wrong ones.This worked heavily for me.N stop comparing urself with others….u will always feel…u are inadequate…u will always feel u don’t know so many things….N this n that person knows so much.

Guys…this is it…I think.Yess….there were a lot of days….throughout my preparation..when I felt so down….so depressed….so idiotic that I don’t know nothing.I even thought of quitting many  times(sometimes due to my family health problems,sometimes due to frustration of this long journey,sometimes due to the feeling like”why should I suffer this much when I am already into this government job” etc etc)….But then “Nothing in this life ..that is worth something is easy” and “Never go down”.

All the best.

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

USMLE Step 1 Experience – 253

USMLE Step 1 Experience – 253 – IMG

Old Graduate Mom Scored 252

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