USMLE step 1 Experience – Dr. Alnoor Akber

USMLE step 1 Experience - Dr. Alnoor Akber


My USMLE Step 1 journey

I am Dr. Alnoor from Pakistan, YOG 2013, got 241 in step 1. I received many queries regarding exam and my study plan. I would try to answer as per my experience and observations but before that let me share some key points about USMLE:

  • USMLE step 1 is difficult but doable exam and if you have WORK HARD SMARTLY, you can achieve 240+.
  • There is no official standard book of USMLE. FA and UW cover 90-95% content of exam. Almost all of us use these 2 resources for preparation but some get score in 220s and some get in 260s. The difference is due to the manner of study. Let me hare my experience.

I started my prep last year in Feb and appeared in April 2016. I was doing job along with my step 1 prep that’s why it took 15 months for me but I think 6-8 moths should be enough if you are consistent. Resourced that I used are following:

Anatomy: Kaplan, Hy anatomy and embryology, Netter for brain images

I didn’t watch Kaplan lectures for anatomy and histology. Anatomy is the one subject that I think is not covered completely by FA and UW. I had few questions in exam that I had no idea about. UW covers histo well so don’t worry about that.

Neuroanatomy: kaplan, HY neuroanatomy, Neter atlas and google images

I think I did a mistake by not watching lectures. I read kaplan and HY for few topics like cranial nerves and blood supply. Know spinal tracts pathway, blood supply of different regions and their integration with different diseases and stroke. You should be able to identify the location of lesion by reading signs and symptoms. Look for labeled brain images. Do CNS drugs well particularly antiepileptics.

Biochem and Genetics: 2014 kaplan lectures by Dr. Turco, Kaplan, HY cell and molecular biology.

Dr Turco has explained biochem concepts very well. The main part here is integration of normal and abnormal biochem process with disease process. For e.g.: anaerobic glycolysis in abscess and suppression of TCA cycle in hepatic encaph. For genetics I did kaplan and Hy cell and mol bio. To understand genetics you need to love it first 😀 Practice its questions from kaplan q bank and UW to clear basic genetics concepts of hereditary traits.


Physio: BRS, Dr. Wilson Kaplan 2014 lectures and kaplan

Physio is just concepts and extensively asked in exam either with its integration to pathology or pharmacology. Dr. Wilson has explained integrated concepts well. I read BRS after my UW 1st pass because my performance was poor. Bottom line is that understand and learn physio well. USMLE exam tests your basic concepts and ability to integrate it with clinical conditions. BRS is good book but extensive so don’t try to memorize it but understand it.

Immunology: Kaplan and FA.

Very interesting subject for me but I felt it more difficult than any other subject. Questions were not straight forward so learn the basic functions of different component of immune system and their role in disease. Immunodeficiency diseases are very HY topic. Lean it by heart.

Micro: Kaplan and FA

I think FA is more than enough. You should catch the hints of bugs characteristics to get straight to the answer. Learn Micro pharma and their mechanism of action and resistance.

Pathology:  Pathoma, Dr. Sattar lectures and FA

Major part of exam. I watched pathoma videos once and read pathoma twice along with UW and FA. I didn’t read Goljan so can’t comment about it.

Pharmacology: kaplan 2014 lectures and kaplan, FA is enough though with lectures.

Most of it is just memorization. Exam questions focused on mechanism of actions and major side effects of drugs.

Behavioral science, Biostats and Psych: kaplan 2010 lectures, kaplan and FA.

Ethics part is tough and it is so subjective that the only way to learn it is that practice its questions a much you can. You have to develop an insight and understanding of US ethical standards and practice.  Same goes with behavioral science and psych. Learn anti psychotics by heart and their collective and individual side effects with antidotes. Duration of signs and symptoms is crucial for differentiating among different disorders.  


The key to score high is to practice as much USMLE styled questions you can. This is the only way to assess yourself that how much you have understood a particular topic. I initially used kaplan q bank but didn’t complete it. After read kaplan and FA once I started UW. If I had read FA twice thoroughly before starting UW I would have given my exam in Feb. The reason behind it is that FA covers almost 90% of USMLE content. If you have understood each and every line of FA then you would perform better. Key is to understand FA well. If you are not clear of anything then read it from any review book. Remember USMLE tests you on your understanding of basic science concepts more than simple facts. Start UWorld when you have read FA cover to cover atleast once.

When you start Uworld, keep in mind that it’s a learning tool. I started with random timed blocks. After finishing 10-12 blocks I did system wise to improve my understanding of individual systems and with that I was able to read that particular system from FA. So I covered Uworld system by system till the end. My average was 70%. While reading explanations, focus on the points that were necessary to answer that particular question. Uworld has explained everything in detail and covered almost every topic that could be tested in exam so make sure to learn it effectively. When you get a question wrong, ponder upon it that why you marked it incorrect. Either it was due to lack of knowledge or understanding or you didn’t understand the question. Develop the art of solving USMLE styled questions. In exam you will face questions that you wont understand what patient had actually but your clarity of concepts will help you to solve the most difficult question and clarity comes by practicing more and more questions.

Other Q banks I used were First Aid Q and A and Robbins review for few pathology topics like hematology, kidney, pulmo and repro.

After completing UW once I gave NBME 15 online and scored 213 2 months before exam. I realized that I had not read FA well because most of the questions that I marked wrong could have been right if I had read FA thoroughly. So for over next 5 weeks I read FA, BRS, Hy for anatomy and embryo, pathoma along with UW 2nd pass.  My aim was to understand everything whatever is written in FA. I focused more on week areas and then gave UWSA 1 and scored 232. I got some confidence and continue with remaining topics. Then I gave nbme 17 3 weeks before exam and scored 247. This is how I improved my score by working on the understanding of basic science core concepts and their clinical integration rather than just memorizing FA. Memorization is important but without the clarity of concepts it is of no worth. Nbme 18 one week before exam 241. Nbme 16—230 amnd UWSA 2—242 both on the same day two days before exam. I didn’t get distracted from nbme scores rather I focused on mistakes. People read Fa 6-7 times but they don’t score well is because of 2 reasons according to my opinion:

1: They might have not practice enough questions

2: Going for exam without clarity of what you have read.

It’s the clarity of your concepts that help you to answer most of the questions, not just the memorization. This is actually what I meant my HARD WORK SMARTLY. Every one gives their maximum efforts but it is your approach that gives you an edge. Everyone has different background and learning styles. Do not follow me or anyone else blindly. Make your own strategy the way that suits you. When you think you are ready, just go and get done with it. Don’t delay it or your graph will go down but don’t compromise on scores. This is the most difficult exam and once you are done with it, you will have a sense of accomplishment.

I hope I have cleared many queries, if not then ask anything you want to in comment box below.

Thanks. All the best and cheers! ☺

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250 – USMLE Step 1 Experience

December 4, 2017
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