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USMLE Step 1 Experience – 272 – Dr. Hamza Aftab – 2018 – USMLE Step 1 Experience 270 +

USMLE STep 1 Experience 272

USMLE STep 1 Experience 272

My name is Dr. Hamza Aftab and I am a graduate of King Edward Medical University, Lahore. My graduation year is 2017. I gave my exam on March 8, 2018 and by the Grace of Allah, I scored a 272. Alhamdulillah!

A little about myself:

Before starting my MBBS at K.E, I was a slightly above average student. My MCAT scores were decent and so were the SSC/HSSC scores. However, during med college, I was a little too involved in the extracurricular activities. I would end up studying only before exams, every year. My scores dropped considerably and I struggled during the professional exams. So, for those of you who were not as attentive during the med-school, here’s a silver lining!

Brief stats:

Exam Date: March 8, 2018

UWorld 1st pass: 92% UWorld 2nd pass: 98% UWorld 3rd pass: 100% NBME 11 offline: 17 mistakes (2.5 months out) NBME 13 online: 263-8 mistakes (1.5 month out) NBME 16 online: 259-11 mistakes (3 weeks out) NBME 18 online: 267- 8 mistakes (1 weeks out) UWSA 2 online: 271-11 mistakes (2 days out)

Real Deal: 272 (Alhamdulillah)

Preparation time:

– Total: 11 months – Dedicated: 9 months – Study hours: 8-12 hours/day in the beginning, 14-16 hours/day towards the end.

Sources and Study Material:

My major sources were Kaplan, Pathoma, F.A and Uword with supplementation from other sources for my weak areas mentioned in detail.

Kaplan: Kaplan is extremely useful and extremely low yield at the same time. For those with good concepts from the medical college, or if you are and undergraduate with good grasp, you can skip this step. However, people like me, who realize what biochemistry is for the first time after becoming doctors, Kaplan is the best way to go. Kaplan is not meant to be learned by heart. You are likely to forget everything you read from Kaplan but it will have inculcated in you the concepts that were lacking.

I started my preparation with Kaplan. I had watched some videos in Final year MBBS and completed the rest during the initial stages of preparation. I did Kaplan Physiology, Pharmacology, Biochemistry, Biostatistics & Behavioural Sciences and Immunology. I annotated the lectures on the books and tried to learn whatever I could from the annotated lecture notes. This built the base for my preparation as I did not have a sound foundation from my medical school. For every Kaplan book that I tried to learn, I tried to cover the relevant portion from F.A. For example, after doing Kaplan Physiology, I gave a quick read to the physiology part of F.A. This helped me understand F.A in a better way and probably lead to a good 1st pass percentage of UWorld.

Pathoma: Pathoma is hands down the best book for pathology. Dr. Sattar is a genius. Use pathoma during your med-school and then later during the early phase of your preparation. However, towards the end of your preparation, pathoma may not be the way to go. This is because F.A covers almost everything that there is in pathoma and much more. So, use pathoma to familiarize yourself with the subject of pathology and to understand the basics but moving forward, use F.A for the memorization part.

I had done Pathoma in 4th year MBBS as a part of my preparation for professional examination. I annotated the lectures on to the book and revised it at least 3 times before the 4th year exam. When I started my preparation for step 1, I revised it one last time and then just like kaplans, I gave the pathology part of F.A a quick read.

First Aid: I am sure everyone knows how important this book really is. It needs a lot of revisions to digest and even more to retain. However, “quality over quantity”, a deep revision which covers a lot of bases is better than a quick 5-day sprint. At the end, all I can say is that I’m sure if you have done F.A really really well and augmented it with UWorld, a 250 or even a 260 is a piece of cake.

I started the first read of F.A with Kaplan and Pathoma. I then gave it a quick cover to cover read just to be sure, which in retrospect was not warranted. I then moved onto doing F.A with UWorld system wise where I tried to cram 1 system from F.A and do the relevant UWorld online. Here came the technical part. You can make 1. UWorld notes on registers or 2. annotate very little onto F.A or 3. add blank pages into your F.A or 4. add sticky notes to the pages in F.A. I went with sticky notes because I learn better when I have a picture memory of what I read. You can also go with adding blank pages but then you tend to over-annotate and end up exhausted when you revise. Another way to go about is to annotate very little but at the risk of overlooking useful information in the nooks of the explanations. Making registers is another option but it gets cumbersome and you may not even open them. Having completely annotated UWorld onto F.A, I gave F.A with annotated UWorld notes a revision. So basically this was the 4th time I was revising F.A & the 1st time revising UWorld (from sticky notes). I then moved onto UWorld 2nd pass after which I gave my final read to F.A with annotated UWorld. This last revision took 20 days, but quality over quantity, right?

UWorld: UWorld is essentially everything on the exam. It covers almost all the concepts, facts and materials you will ever need to familiarize yourself with. UWorld helps explain First Aid and going through it for the 1st time broadens your horizons. However, there is a proper way of using UWorld.

UWorld 1st pass: THIS IS A LEARNING TOOL! Having read a system from F.A, I did the relevant UWorld questions and annotated them on F.A. Important to note, the annotations should be precise and comprehensive. Overdoing with annotations always results in over-whelming pressure during revisions. Underdoing it can have you overlook many important points. I did the 1st pass system wise and in timed tutor mode. This is important because it helps you understand those 1 line concepts in F.A that are equivalent to a 6-page topic in the textbooks. UWorld 2nd pass: THIS IS AN ASSESSMENT TOOL! After a cover to cover revision of F.A with annotated UWorld, I did the 2nd pass in random timed mode. I did 10 blocks per day to build endurance and stamina. It also helped me understand how to tackle questions in the exam. This pass was essentially the essence of my preparation. By the end of a 10 block day, I read the explanations of marked and wrong questions and revised from F.A anything I felt I was weak in. Having done UWorld the 2nd time in almost a week, I had my performance profile in front of me. An assessment of performance from 2500 questions (although you remember the answers to many) is much more accurate than a 200 question NBME. So I started working on the weak areas as pointed out by UWorld. UWorld 3rd pass: The 3rd pass essentially consisted of some 400 questions made up of marked and wrong questions. It was a one-day job with 10 blocks. After the 3rd pass, I felt really confident for the 1st time and everything felt integrated.

Sources and Study Material for each Subject:

Biochemistry, Molecular biology and Genetics: In my opinion, this is the one subject that definitely needs Kaplan lecture notes and videos even if you have had a firm grasp in your med-school years. Later, move onto F.A and UWorld. It is very volatile so you’ll have to go through it many times before you feel confident. At-least 5 times in my case.

I was very weak in this area to begin with, so I did Kaplan videos and read lecture notes. I then revised the annotated lecture notes because let’s admit, this subject sucks when you do it the 1st time and then the next 15 times. I then did F.A followed by UWorld. Since it is very volatile, REVISION is the key. Apart from the regular revision schedule, I gave a few extra revisions to biochemistry to force it down my throat, specially the storage disease and enzymes and stuff!

Immunology: F.A and UWorld are more than enough in my opinion, even if you do it for the 1st time. However, you can add Kaplan for a topic you find hard to understand.

I did Kaplan videos but skipped lecture notes and jumped right onto F.A, followed by UWorld and it was more than enough. However, it has a lot of stuff that is easily forgotten. So, like biochemistry, I gave a few unscheduled revisions to some topics like immunodeficiencies etc.

Microbiology: Sketchy Micro is GOLD! For me, sketchy was the best source I’ve ever used in my life. Add F.A and UWorld and you know more than a microbiologist himself.

I was very stubborn about not doing Sketchy. I had almost started F.A when my beautiful Fiancée, amazing as she is, convinced me to just watch one video and it changed my course of preparation for good. The subject I once hated was now my most favourite. After sketchy, F.A and UWorld felt like a piece of cake. I revised sketchy pdf 2 times later and the images were so clear in my head, micro felt like my strongest suit.

Epidemiology and Biostatistics: It was an all-new territory for me and therefore a weak area for the most part of my preparation. I paid special attention to this subject in the last days of my preparation. Thankfully,

this turned everything around in the end. So, the more resources you use the better. I used F.A, UWorld, Kaplan step 1 and 2, High yield Biostatistics, UWorld Biostatistics Review Questions, BRS Biostatistics and a few topics from the internet. This one subject can considerably change your score. So, a little effort in this direction pays off very well in the long haul. I turned my borderline and low performance in earlier NBME (13) to a high performance star (in NBME 18 and the exam) by just going through the additional resources.

I started preparing for Biostatistics with just Kaplan videos and lecture notes and then jumped to F.A. I then did UWorld Biostatistics review and moved onto UWorld. Everything seemed easy until I gave my NBMEs. I had a borderline to poor performance. So in between NBME 13 and 16, I did Kaplan step 2 Biostatistics, High yield biostatistics, BRS biostatistics, revised UWorld Biostatistics review and gave a quick revision to F.A with annotated UWorld. I also did a few topics off the internet that I found in NBMEs but absent in other resources. I wrote formulas with a marker on my door and I revised them every day.

Ethics: Also a weak area, specially for an IMG. Kaplan, F.A and UWorld are evidently not enough. This was another area on the borderline early in my prep. So, I added Conrad 100 cases, Khan 100 cases and BRS. This however did not improve my performance as drastically in the later NBMEs but perhaps paid off well in the end for there was a star in the real deal!

I began with Kaplan videos and notes, moved onto F.A and then UWorld. However, I had weak performance in NBME 13. I then did Conrad 100 cases and Khan 100 cases, gave a quick unscheduled revision to my annotated F.A but there was no improvement in NBME 16. I did not know of any other resource and I left this subject to luck at the end.

Healthcare Safety: F.A, UWorld and the few pages in Kaplan Biostatistics book.

Did it from F.A and then Uworld. Read Kaplan notes on Healthcare Safety once and that was enough.

Psychiatry: F.A and UWorld are more than sufficient. People like to add UWorld for CK but I found the 2 resources sufficient in both NBMEs and the exam.

I did Kaplan Behavioural sciences videos and lectures which was not needed at all. Did a quick F.A read and then UWorld. Revised as per revision schedule and it was sufficient.

Anatomy: There is no single resource that covers everything. However, a combination of F.A, UWorld, Shelf Notes and a few Google searches pretty much has you covered. Gross Anatomy, Embryology and histology: F.A, UWorld, Shelf Notes and inquisitive internet searches are enough. Add Snell’s review or Kaplan for pelvic and limb anatomy. Neuroanatomy: Kaplan lecture notes and Videos are very important. You may need to revise your Kaplan neuroanatomy lecture notes midway again. Add F.A and UWorld to the mix and it’s more than enough.

While doing Kaplan, I gave a quick read to the shelf notes which was the only time I ever read them. Otherwise, I did anatomy from F.A with the relevant system. Added UWorld annotations and revised as per schedule. This approach covered Gross, Embryo and Histo. For neuroanatomy, I did Kaplan videos and lecture notes, revised them once more and then moved to F.A. After which I moved on to UWorld. In the middle of my preparation, I looked up a few topics in the Kaplan Lecture Notes so keep it handy. The rest of the preparation followed the usual revision schedule.

The next 3 subjects, namely Physiology, Pathology and Pharmacology are extremely high yield. Why? Because all your questions will test at least one of them in the question stem, especially 2 or 3 tier questions.

Physiology: Kaplan Lecture notes with videos are a must. This subject is the centre of concepts asked in the exam. With all the up/down arrow questions as well as the underlying pathophysiology, this is the one subject where just memorization is not enough. You need to ensure that you understand everything and are able to make inferences from it. Plus, F.A and UWorld. UWorld is a very helpful resource in understanding general principles as well as system specific concepts.

I began with Kaplan lecture notes which I’d already annotated in my final year. Took some time to learn stuff and then moved onto F.A, and then Uworld. Followed the usual revision schedule and did not have much difficulty. I’ve heard BRS physiology is a good resource but I did not use it.

Pathology: “Pathoma, Pathoma, some more Pathoma and then F.A and UWorld.” Do Pathoma in your med school, learn it by heart, give your professional exams and thank Dr. Sattar. Then give a quick revision at the beginning of your step 1 preparation and bid farewell. Now, F.A and Uworld will have you covered for the rest of the journey. Having a lot of resources is very cumbersome and I found F.A and UWorld enough and never felt the need to go back to pathoma. So, basically for step 1, understand from Pathoma, memorize from F.A and UWorld.

As described earlier, I revised pathoma at the beginning of preparation and then subsequently used F.A and UWorld for memorization. There are usually 3 ways people go about using pathoma. 1. Annotating missing points from F.A to pathoma and using pathoma for pathology. I find it a little difficult to juggle between books. 2. Annotating from pathoma onto F.A. This is an extra effort because most of the stuff in pathoma is ultimately covered by UWorld. 3. Understand pathology from pathoma, and then use just F.A and UWorld. I liked this approach so I went with it.

Pharmacology: F.A and UWorld for everything. Add Kaplan Lectures and videos for General Pharmacology and Autonomic Nervous System. Sketchy Pharma for a few drugs that you forget easily.

I started with Kaplan videos and lecture notes but I did the entire book which was totally uncalled. ANS and General pharma are the 2 topics which need Kaplan. I then did F.A and UWorld and followed the usual revision schedule. I did a few drugs that I kept forgetting like epilepsy drugs from Sketchy Pharma and it was helpful.

Assesment tools:

I relied, like most others, on NBMEs and UWSA. However, I used UWorld 2nd pass for assessment as well.

NBMEs: NBMEs for step 1 are very important. They can be used as an assessment tool as well as a question bank in itself. However, there is a deeper implication of how it’s used that needs to be understood. All NBMEs are very similar. Most of all concepts are repeated and asked in essentially very similar ways. Don’t be surprised if you see the exact same question repeated. Then, what if we use NBMEs for learning? Offline NBMEs 1-12 and even the online ones can be used for learning, but by the time you reach NBME 18, which is considered very predictive these days, you would have learned all the NBME questions and now, it grossly over predicts your score and provides poor feedback about your weak areas. On the other hand, these NBMEs are a huge question pool that may help you with some out-of-nowhere questions in the exam as well as your weak areas. It is a 2 edged sword and there is no right answer in my opinion. A possible middle ground is to use them after NBME 18, somewhere close to your exam. This is what I did. I solved the difficult questions from NBME 7,12,15,17,19 towards the end of my preparation, thanks to my friends who would ask for explanations to the difficult questions they encountered in these NBMEs.

My experience with NBMEs was very pleasant. My 1st NBME gave me a head start and I did not have to put a lot of effort after that. But, there was one problem that persisted. I realized that I tend to mark all the difficult questions correctly and I always marked the easier questions wrong. This resulted in a disparity between number of wrong questions and the assessment score when compared to others. For example, 8

wrong in NBME 18 was a 267 for me but a 274 for some other person who had marked the difficult questions wrong. Since it is the easier questions that carry the most weightage, do not worry about the difficult ones in the exam.

UWSA: UWSAs are usually considered over-predictive, especially UWSA-I. For example, a total of 40 mistakes out of 160 questions still land you a 240-250. I therefore skipped it. UWSA-II on the other hand is another story. It may be extremely predictive or may over predict but not as grossly as UWSA-I. I took UWSA-II which for me was extremely predictive.

I found UWSA 2 very similar to UWorld and I was a bit worried that it might over predict my score. However, from what I’ve heard, UWSA-II was supposed to be hard which I did not find it to be, probably because of all the revisions that I had given to UWorld.

UWorld 2nd Pass: Unlike the 1st pass of UWorld which is used for learning and integrating with F.A, the 2nd pass is an excellent and a very accurate assessment tool. Using UWorld 2nd pass in random, timed mode with 7-10 blocks per day builds stamina and endurance. At the same time, it tests how strong your reflexes are and what are your weak areas. Always try to outperform your 1st pass percentage by a good margin.

Timeline and Revision Schedule:

3rd Year MBBS to Final Year MBBS: It wasn’t until 3rd year MBBS when I realized I wanted to pursue USMLE. So, with lots of enthusiasm I and 2 of my friends started reading Kaplan books but that did not last very long and the next week, we found ourselves basking under the sun, chilling and watching Netflix. Came 4th year and the only achievement that year was that I did pathoma very well. In final year, I again started with a lot of zeal only to be put off by hectic ward routine 2 months later. Having tried starting twice and failed, I started looking towards other options but eventually decided to complete MBBS and then decide. After graduation, I decided to forego house job and sat for my step 1, this time more enthusiastic and determined than ever. So all those amazing fellows looking to complete their step 1 and 2 exams within college years, I’d recommend reading the timelines of those who made this kind of stuff happen for themselves. A huge shout out to all the fellows out there who make do with both their professional and step exams.

First 3 months (April 2017-June 2017): I had listened to the lectures for some of the Kaplan books already in final year, so I began with reading the annotated books with their relevant portion in F.A. I also listened to the lectures I had not covered in final year and read those books again. It was very time taking and one mistake that I made was to try to cram the material from Kaplan which unduly added to my preparation time. I gave a quick revision to pathoma during this time period as well.

At the beginning of your preparation, make a plan and strictly adhere to it. This includes organizing resources, choosing a spot to study, making a time table and planning a few days off just to blow off steam. I talked to many of my friends who had given step 1, read many experiences and decided on the resources I was going to use. The initial resources are usually the same but the subjects you find your weaknesses in, may sometimes require additional resources tailor-fitted to your needs at that moment. So ask people for advice again at that point. I prepared for my exam at my home. This is a very difficult thing because I have a habit of studying in my room, ON MY BED! So I had to struggle with sleepiness in the morning and with insomnia in the evening. However, for those who can study at a library, it’s your best bet. I had some days off to take a break which included friends coming over and family gatherings. I wanted to be done with the exam by the end of 2017 but having wasted 2 months during my preparation, it was extended by almost 3 months. So, make a plan and follow it! Have a talk with your family and friends. This is very crucial. You need to have a very strong social support. I had my parents sisters and fiancée constantly supporting me throughout the highs and lows of my preparation which kept me sane.

July of 2017): I started a cover to cover revision of F.A which took roughly a month because I got distracted.

In addition, August being a birthday month in my family, I lost a few days there too; almost adding up to a month of wasted time.

Revising F.A cover to cover did not seem very helpful. This is because it is so concentrated and you need UWorld to digest it. I could save a month here, and add another revision to F.A with annotated UWorld which is far easier to understand and retain.

The next 3 months (August 2017-October 2017) I bought an online subscription of UWorld for 6 months. It took me 3 months to complete the 1st pass with annotations. Reading a chapter from F.A in a day or slightly more and then solving the UWorld questions, I started slow with 1 block per day but went up to 2 blocks per day towards the end. There were some off and on breaks during this time.

It seemed like I was wasting a lot of time writing stuff down onto my F.A and just reading explanations. I was wondering if this was the right way to go. However, I talked to some of my friends and they encouraged me to have faith and keep working this way. Although, at some point in time during this phase of preparation, I began to doubt that I was wasting time, I had a very important realization when I began my 1st revision of annotated F.A. In annotating all the information onto my F.A, I had created an excellent picture memory of where’s what! Also, a sticky note right above a topic in F.A helped consolidate the concept there and then. So, I was reading explanation of a 1 liner from F.A and therefore understanding and memorizing it at the same time.

November of 2017 was a very busy month and it went almost entirely wasted. We had our concocation. It was very distressing to realize that I had wasted almost an entire month. However, this was the time I completed the paperwork and applied for the ECFMG registration and submitted my exam application.

I’d recommend getting ECFMG registration early on and selecting a triad immediately after your 1st NBME. If you are a person like me, you are definitely going to need some sort of a deadline to work efficiently.

December of 2017: It was the recovery period. It had been 1 month since I had done UWorld and it seemed like I had forgotten a lot of things. However, with time, albeit 1 month, I gained back my momentum and revised the 1st part of F.A with annotations, which was the most likely part that I had forgotten. I then gave an offline NBME 11 in the last week of December with 17 mistakes. It was somewhat reassuring to realize that I still remembered most of the stuff. I then continued with my revision of systems.

Revising F.A with annotated UWorld for the 1st time is the most important part of your preparation. The level of effort you put into this revision sets the baseline score. So, take your time, read carefully, be meticulous and not just memorize but understand everything. It took me almost 6 weeks with the 1st revision because of my distraction but don’t be surprised if it takes you 4 weeks. Revising many times while overlooking key concepts is not a very wise approach.

January of 2018: I completed my 1st FA plus annotated UWorld revision by the 3rd week of January at which point I gave an online NBME 13. I got a 263 which boosted my confidence. At this point I realized my weaknesses were biostatistics and ethics. So I spent 1 week improving these subjects from the various additional sources I’ve already mentioned. The time between your 1st and 2nd revision of F.A with annotated UWorld is an excellent chance for you to use additional resources to cover your weak areas. This is also the time for you to give the remaining NBMEs. For me, NBMEs were more of a score assessment, so doing a lot of them was not as helpful because I could not gauge the subject wise preparation level from them because there was a star in almost all subjects. But, for someone with a score in 230-250 who wants to improve his performance in the relevant subjects, giving NBMEs periodically can help assess the improvement in the level of preparation. For example, I jumped from NBME 13 to 16 after a 263. Had I gotten a 240, I would have needed to revise my weak areas and given another NBME, let’s say 15. Here, I could have found out that I scored a 245 with improvement in some of the said weak subjects. I could have worked even harder

on the remaining weak areas and given another NBME, say 17 and scored a 255. So, use NBMEs according to the needs of your preparation.

Biostatistics and Ethics are the 2 subjects that will make or mar your score. You can use additional resources as I mentioned to cover biostatistics and ethics. Realizing I was weak in biostatistics, I did Kaplan step 2 Biostatistics lecture notes in a day, High yield Biostatistics in 2 days, UWorld Biostatistics Review Questions in 1 day, BRS Biostatistics in a day and a few topics from the internet. For ethics, I did Conrad 100 cases and Khan 100 cases, each in a day.

The Last Month (February 2018): I completed the 2nd pass of UWorld in the beginning of February and after quickly completing 3rd pass of marked/wrong in a day, I gave NBME 16 with 259. This was a minor setback because the score had dropped by 4 points and the ethics portion still seemed weak. However, I let of Ethics and it was mid-February and I had started my 2nd and final F.A plus annotated UWorld revision which continued into 1 day before exam.

The 2nd pass of UWord with 10 blocks per day was the turning point in my preparation. If I could do 400 questions in a day, 280 on the exam day were not going to be an issue. The 2nd revision of F.A with annotated UWorld was easier. I had already done it once. Also, the explanations from the UWorld 2nd pass were still fresh in my mind. It took me roughly 20 days to complete my 2nd revision.

1 week before exam (March 1-7, 2018): I gave my NBME 18 on March 1 and got a score of 267. This was when I decided I was ready because I had been having recurrent thoughts of postponing my exam for no reason at all for the past few days. I continued revising the remaining part of F.A, completed it and gave UWSA-II on March 6, 2018 which further boosted my confidence with a 271. On the last day, I did ECGs, heart sounds, CT/MRIs, some histo slides, dermatology pictures and some pages I’d marked as easy to forget including hereditary immunodeficiencies of course!

NBME 18 and UWSA-II are very predictive these days. So, save them for the last week. Free 120 questions which I did not have time to do are extremely important too. I’d recommend keeping the final week for a quick revision of F.A. I did not have the liberty of time to do it and this meant, on the exam, I solved questions from biochemistry which I had last revised some 20 days ago. On the day before exam, I was very anxious and excited. I felt like I knew everything and nothing at the same time. This is when you need to calm your nerves. Relax! Go out, watch movies or just hang out with friends. Trust your NBMEs and do as little as possible. Conserve your energy. I, however did not do any of this. Instead, I overwhelmed myself with a long list of CT/MRIs, ECGs, Heart Sounds, UWorld pictures and histology slides. I have always had this habit of sleeping in the day and staying up all night. This social jet lag caused me a lot of trouble on the night before the exam. I had been trying to push my circadian rhythm towards sleeping at 10 pm and waking early in the morning for a week but in vain. The night before the exam, I took a zolpidem 5mg and went to sleep at 11 pm. Zolpidem is really good for sleep onset and causes almost no dizziness or psychomotor depression the day over, however, it does not maintain sleep. To my horror, I was wide awake at 2 am in the night and I spent the entire night trying every other way to sleep but ended up going to the prometric centre sleep deprived. Needless to say, try setting your sleep schedule according to the exam time at least 1 month before the D-day!

Exam Day (March 8, 2018): Exam day is usually less anxiety provoking than the day before with all the anticipation. I reached the prometric centre 30 minutes before the exam. My exam started at exactly 9 am. Time went by and soon it was over. 7 blocks with 40 questions each, 1 hour for each block. 45 minutes of break with an added 15 minutes if you skip the tutorial. The exam had the same interface as the UWorld or free 120 questions. The question style was a mix of NBME and UWorld and the questions were doable. 85% questions were straight up F.A and UWorld. 10% needed a little thought process but answers could be excluded from the knowledge of F.A and UWorld. 5% were out of nowhere.

Sleep deprived from the last night, I took a cold shower, wore pocket less pants, t-shirts and sandals as it helps with the check-in every time you take a break. I had a sandwich, porridge and strong coffee for breakfast. I took my passport, I.D card and permit with me. For the breaks, I took with me dates, bananas and sandwiches, some more coffee, juices and water. My experience has another important advice and that is: Always visit the examination centre to pan the route you are going to take and factor in all the traffic and other issues that you may face on the exam day. I, on the other hand went to the centre for the 1st time on the day of my exam, ending up at the wrong gate of the college, the centre is located in. I lost 15 minutes in driving around, reaching the correct gate. All of this got me extremely worried and my sympathetic system was on full drive. Although a scare, it was a blessing in disguise for me because it took all the sleepiness away! Haha. The people at prometric, Lahore are amazing. They were very kind and cooperative. There at the centre, I met a wonderful soul. He was also appearing for his step 1 exam. We talked for a while and it was a huge support to have someone to talk to. So, if you can, plan with your study partner to give your exam on the same day. After all the security checks, I reached my desk and thus began a journey that passed in a blink of an eye. But before the blink, there was a minor moment of panic on the 1st block. I was too tired to concentrate and I started marking more questions than I needed to. But, by the 10th question, the coffee had kicked in, the sympathetic system had warmed up and everything started falling in place. The exam felt easier than UWorld and somewhat the same or easier than NBME 16 and 18. I marked on an average 5-6 questions per block and ended up with almost 15-20 minutes to spend on the marked questions at the end. Block 5 was a little hard with an additional distraction from the fellows typing relentlessly for their GRE exam. I marked roughly 12 questions in this block with almost as many minutes to spare for the marked questions but it was still doable. I did 2 blocks and took a break for 10 minutes. Then, did another 2 blocks and took a 10-minute break. The 5th block was a little overwhelming so took a long break, ate lunch, offered prayer and washed my face like I had been doing in every break. After the 6th block, I took another break because I still had time to spare. I was feeling happy that just 1 block had remained. I took a walk in the garden of the prometric centre and went back to complete the final block. Completing the final block, I came out of the centre satisfied and happy.

Result Day (March 28, 2018): The result is usually provided on the 3rd Wednesday from the exam date at 9 am EST. An email is received that tells you that the result is available on OASIS. The anticipation of the result is usually very stressful so try to invest yourself into activities that take your attention away from the constant worry.

For me, the wait and the anticipation was very painful. I was so stressed I almost got an ulcer. I talked to seniors and those who had taken the test and they reassured me that it happens to everyone. So sit back and relax. Trust your NBMEs and pray. Do not make the mistake of checking if you got a question wrong. Do not try to calculate the number of wrong questions. Supress as much as you can, everything related to the exam.

Things I did differently:

  • I did UWorld 2nd pass with 10 blocks per day.
  • I used Step Up to medicine (CK) for risk factors, most common cause and similar Evidence based medicine type Questions.
  • An unusual resource: I used USMLE Step 1 preparation forum as a resource as well as my flash cards. How? I made a new account on Facebook to avoid distractions and I started visiting the page every day for all the time that I was not studying. People post a number questions of all kinds all the time. Some very high yield and some very new concepts. In the beginning, the questions were something new that I was not familiar with. As my preparation progressed, so did the number of questions I encountered on the forum that I already knew the answers to. Toward the later period of

preparation, I knew the answers to most of the questions and now this exercise started reinforcing my knowledge, much like flash cards do.

  • I did internet searches for a lot of topics.
  • Volunteer work: If you are religious or if you believe in Karma, know that good things will happen to you if you do good things. I was a part of a volunteer organization called Volunteer Force Against Hepatitis Transmission (VFAHT) which is striving to eradicate hepatitis and T.B from Pakistan. I made awareness videos for the general public along with my preparation. There were times when it took me 3-4 days on ends to make the videos but since I’m a strong believer in God helping you if you help people, I kept going.

Things I wish I had done differently:

  • There is nothing I can say for sure that could have brought an outcome better than this. So, I’m very happy with all the mistakes and slips that I had during my preparation. But, if I had to do it all over again, I would change a very few things:

– Would not have taken such long breaks. Follow your schedule very carefully. I took

unneeded breaks for a total of 2 months (plus added time for recovery). – Done Kaplan as quickly as I could. I tried to memorize Kaplan which was wishful thinking because you are bound to forget almost everything you read from Kaplan. If there is something so important that only Kaplan helps you keep it in, annotate that part of Kaplan onto your F.A. – Tried studying in a library. There are way too many distractions at home. – Exercised or at least taken out some time to walk. My health took a serious toll from the constant sitting and I gained 5 inches in the 11 months that I spent in my bed or a chair. Make time for some physical activity. – Corrected my sleep cycle in time. Sleep deprivation results in silly mistakes which I know

I made during the exam.

People I would like to thank:

  • My parents are my biggest support. I have seen my father work with passion and honesty all his life. He is the most hard working doctor I have ever seen in my life. My mother has dedicated her entire life to bringing her children up and having us reach where we are today. May Allah bless them both. Allah has also blessed me with a grandmother who kept praying for me the entire time I was in the test centre. I still see her pray for me while I write this. My mother-in-law to be is an angel and her prayers kept me going. These are the people who prayed for me, encouraged me and gave me so much love, I can never pay back.
  • My Fiancée, Dr. Paras Mehmood is the most wonderful person in the world. She was my study partner, my guide, my motivator, my teacher and the iron wall that never let me fall and always had me going. She supported me at my lowest, she pushed me to achieve the unbelievable, she brings out the best in me. Whenever I was scared, she was there to calm me down. Having a partner to share this long painful journey with, makes it so much easier.
  • My Family, specially my sisters Dr. Ammara, Hooria, Dr. Dalia and Dr. Maria.
  • My Friends, Dr. Ahmad Bani Sadar, Dr. Taha Masood, Dr. Fazila, Dr. Amna, Dr. Sania, and Dr. Fatima for visiting me at my home when I wouldn’t come out of my house. Seeing them always refreshed me. Dr. Aleesha, Dr. Ruhma, Dr. Ahmad, Dr.Amna Dr. Anam, Dr. Sana, Dr. Nisa, Dr. Aruba, Dr. Abeera and everyone else who texted me to remind me everything was going to be okay.
  • Dr. Sameer Shafi for being an excellent mentor, he has set an amazing example of philanthropy for everyone to follow. He provided me with the opportunity to serve mankind and re-ignited in me the spark to work hard for a beautiful future, every time we met.
  • Dr. Moeed Ahmad for guiding me so well like an elder brother. He is the nicest most helpful senior I ever met and I aspire to help my juniors just the way he helped me.
  • Dr. Qudratullah for guiding me about resources. All the resources he told me about were extremely important and helped me a lot, specially with biostatistics and ethics.
  • Dr. Fahad Khalid, Dr. Salma Malik, Dr. Talha Saleem, Dr. Asnia Latef, Dr. Usama Talib, Dr. Kashif, Dr. Nawal, Dr. Sidra, Dr. Wajeeha and Dr, Tehreem for their support when I most needed.
  • All those who called or texted to celebrate my result with me.


I have tried my best to divulge everything I know or I have experienced to the best of my knowledge. However, I advise you to consult other people for advice as well. If you have any further questions, you can contact me at the following. I’ll try my best to answer whenever I could make time.

Email: hamzaftab93@gmail.com Facebook: www.facebook.com/hamzaftab

Yours truly,

Dr. Hamza Aftab King Edward Medical University, Lahore, Pakistan.

September 30, 2018
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