STEP 1 SCORE: 259 (+1,5 SD)

USMLE STEP 1 259 Experience

Stavros Matsoukas

International Medical Student

Status of Career: Undergraduate

Medical school: Aristotle University of Thessaloniki, Greece

Preparation Time: 17/02/2016-23/02/2017

Exam Date: 23/02/2017

Step 1 Score: 259


– 6,610 Pages Reading

– 1,328 Pages Notes

– 13,261 QnAs

Dear IMGs from all over the world,

After a long time of preparation and anxiety, I would like to describe my experience about the STEP 1 preparation and give some advice to all those people who are preparing for this exam. I will also try to answer all the questions that I you‘ve asked me.


I think that this is the most important part!!! I will describe the resources I used. Then, I will suggest a study plan based on what to do first, second, etc., in order to go through the stuff with an efficient way for the best result.

I’m not fan of multiple resources, but here is my opinion. I try to have one main source. Then, I use one of the second most read source on that subject. I don’t emphasize enough, but I try to read it fast in a way that I can firstly remind myself the knowledge I gained from the first source and secondly to find knowledge that my main source hadn’t had well or hadn’t had at all. Then, I try to make notes from the second source to my primary source book. In that way, you have two books in one!!!! You may take notes from some pages or one or more chapters to emphasize enough from the second source, because they are better than in the first one (as I did in GI physiology; see below). Don’t try to study the second source as intend as the first one, because this might become counterproductive.


  1. Anatomy:
    • Kaplan Anatomy Lecture Notes (Main Source)
    • High Yield Embryology (I read this book late in the preparation, so I already knew most of its knowledge. I recommend you to study this book just to work on areas that you are weak. There are also some charts, e.g. in CVS chapter that I found high yield)
    • High Yield Neuroanatomy (read only a few pages – FA has a lot of clinical stuff in neurology and it’s well organized)
    • First Aid USMLE Step 1
  2. Physiology:
    • Physiology Kaplan Lecture Notes (Main Source)
    • BRS Physiology I tried to read fast every chapter that I did from Kaplan and find some factoids that
      Kaplan didn’t had and I would like to write them on FA. GI physiology was way better in BRS than in
      FA or Kaplan physiology. For the best result in GI physiology, I recommend you to also use Kaplan GI
      Histology from the Kaplan Anatomy book. I also recommend you to do the QnAs that BRS book has
      at the end of each chapter, just for training (It worths!).
    • First Aid USMLE
  3. Pathology:
    • Fundamentals of Pathology – Pathoma with Video Lectures (Main Source and one of my favorite during STEP 1 preparation)
    • Rapid Review Pathology by Goljan I did it after I had finished Pathoma, so I tried to pick up the additional knowledge. I mostly
      used: Infectious Diseases Charts, Gynecology, Electrolytes, Nutrition, CNS, and some Autoimmune
      and Connective Tissue Disorders that I found better than the other resources.
    • First Aid USMLE Step 1
  4. Pharmacology:
    • Kaplan Pharmacology Lecture Notes (Main Source)
    • First Aid USMLE Step 1
  5. Biochemistry:
    • Kaplan Biochemistry Lecture Notes (Main Source)
    • First Aid USMLE has a lot of useful stuff, so it’s highly recommended to study it
  6. Microbiology and Immunology:
    • Kaplan Microbiology and Immunology Lecture Notes
    • First Aid USMLE
  7. Behavioral Science:
    • Kaplan Behavioral Science Lecture Notes (Main Source)
    • High Yield Behavioral Science (Didn’t read at all)
    • Kaplan USMLE Ethics – 100 Cases by Conrad Fischer (HIGLY RECOMMENDED FOR MEDICAL ETHICS. IT WORTHS 100%)
    • First Aid USMLE (Highly recommended for Psychiatry and Biostatistics; Try to learn ALL the biostatistics equations)
    • This is your STEP 1 BIBLE!!!!! TRY TO MASTER IT!!! Make enough notes, but you can also note pages of some books, if it is difficult to note everything that you want.
    • It helps you go from theory to clinical vignettes. Do it before any Q-bank and QnAs.
  10. Kaplan Q-Book
    • It is not predictive, but it worths doing it for better training. I had low scores there, but I learned a lot of things!!!
  11. FIRST AID Q-Book
    • It has QnAs from Rx Q-Bank, and it worths doing it for training and for testing yourself (try it with time)
  12. Kaplan Q-Bank
  13. Rx Q-Bank
  14. USMLE WORLD Q-Bank
  15. NBMEs

What should I do differently if I could turn back time:

  1. I would try to literally MASTER every subject that I studied. From my experience, the way by which you can be sure you that you will remember pretty enough one subject, is by having it mastered during the first time. When you do a revision it is just a REVISION. You want to revise as much as you can and in the less possible time. You don’t want to spend much time trying to learn something new; you just want to remind yourself all the details and mnemonics that you have mastered the first time.
  2. I would do the Kaplan Q Bank simultaneously with the first study of Kaplan books.

Recommended way of studying for each discipline and STUDY PLAN:

Kaplan Lecture Notes (Basic theory and notes)

First Aid Book (Try to make some notes from Kaplan Books)

First Aid CASES Book (go from theory to clinical vignettes and prepare for Qbanks)

Kaplan Qbook

First Aid Q & A

Kaplan Qbank

Once you‘re done with each and everyone discipline, then you should go for the other Qbanks that you are willing to do. (I recommend 1st the Rx Qbank, 2nd the UW Qbank, and finally the NBMEs) Rx is closer to the basics, and it has good questions in general, but it has tricky ones, too. UW is waaay more difficult, and it asks you a lot of details or mind blowing things, but it will prepare you for the best. I highly recommend you to take notes from the answers of UW to you FA Book, and you will soon discover that many of the answers was just there in this book. This is why FA Book and UW Qbank combination constitute the ABSOLUTE WEAPON of success for this exam.

I took ALL the NBMES after I was finished with all the other Qbanks. This is not the most right way to make the most of those tests, but this is what I had as a plan in my mind from the beginning. There are 15 NBMEs for step 1, so you may take some of them after some preparation just to assess yourself and see your weaknesses. Try to do the first ones because there are old and not very similar to the real deal, although they are still predictive. From the number 11 and after they get trickier and more similar to the real deal, and they might get a little bit more predictive.

How to take full advantage of the Qbanks (Studying and Taking Notes):

Take all the time you need to think:

Don’t make yourself nervous with the time. Don’t try to finish some QnAs in little time just because other guys do like that. Try to think deep in your mind and try to rule out as many answers as you can. You don’t want to make silly mistakes that you could avoid!!! (This is worse…).Tell yourself that you HAVE TO find the right answer no matter how long it will take. If you apply this technique I guarantee that very soon you will be able to think in a faster and more efficient way. It will come with practice. ALL you have to do before you answer is to remember all the theory that you‘ve learnt and rule out or rule in answers. If you are between two or three, just select the one that has most possibilities to be true, or the one that it makes more sense to you, or the one that is closer to what you have learnt, or just the most appealing one.

Take some notes:

Take clever notes, such as diagrams, graphs, mnemonics, and key-signs/symptoms. Don’t try to note everything, because it might be harder to revise all this stuff. DO NOT NOTE what you know again and again because that could be counterproductive. Try to shrink clinical vignettes in as less possible words that you can. For example: What do I do first in this situation? – Answer in 2- 3 words. It will be way easier to revise that kind of notes. Try to make enough notes from UW in FA Book

Mark the QnAs that you possibly or for sure would like to see again (use different color for different significance!!!): Well, that applies if you are writing the number and the answer of the questions in a paper.

Period of studying and Medical Career:

I was preparing while I was in the summer semester of 4th year and the winter semester of 5th year. Just for your information, Medical School in Greece is 6 years!!! As I said before, I was preparing for about a year. However, I am still a medical student, and I have to be in clinics too many hours a day. I decided to take the exam while in 5th year, because as far as for the medical knowledge, that is the Ideal time for medical students in Greece.

If not in time of program?

It is important to realize that the first time you do something is the best time to master it. So take all the time that you need and try to master everything during the first time. Search for every possible details etc. It doesn’t matter if you forget that knowledge 5 days later. You will know that all you need is there and is only a matter of minutes to refresh it in your mind!!! The role of revision is to REMIND yourself the knowledge and not to learn new things. Also try to revise a lot!!!

Daily routine:

My daily routine was variable, depending on what I had to do at Medical School. For example, if I had too many hours, I studied in the evening. If it was summer I studied all day long. I tried to push myself to the limits and work even 36 hours. I wanted to be able to work properly under tiring circumstances just to make sure that I will also be able to work properly at the test day. I tried this at summer, when I had nothing else to do. Two months prior the exam I tried to regain my normal sleep pattern and sleep as much as I wanted in order to feel relaxed during the day and do a good and efficient revision. One month prior the exam I tried to have the SAME PATTERN EVERY SINGLE DAY. The difficult part was to sleep at night, not only because of the anxiety, but also because the only thing I was doing during the day was to sit in a chair and study, so I wasn’t tired. Paradoxically, the night before the exam, it was a little bit easier to fall asleep.

When to register for the test:

Registering can be a difficult part for Step 1. This is for the following reasons. It is the first time that you register, so your medical school has to send your papers to the ECFMG. If you are applying for Step 2, you only have to do the electronic part, and you don’t need to send papers again. Secondly you have to keep in mind that all the processes of acceptance (each one of whom takes enough time) must be completed until the 27th day of your eligibility period. For example if your eligibility period is March-May, you HAVE TO BE VERIFIED FOR THE EXAMS until March 27th. So, you have to take under consideration two factors. Firstly, it can take 1-1,5 month from the registration until the verification. Secondly you have to think about where you will be really ready for the test, which is also difficult. In case that you are not, you can take an extension of your eligibility period, but you can take it ONLY ONCE and it is ONLY 3 MONTHS EXTENSION. Applying this in the previous example, you would have an eligibility period from March to August.

Minimum and Maximum time:

It is difficult to answer this question. That actually depends on how well you were prepared for the disciplines in your medical school, how big is the time between now and your preclinical experience, what is your score goal and of course, in what university you are in. I am in a university that we are not prepared for USMLE (contrary to American and British medical schools) and I also had too many gaps in knowledge, especially in pathology and pharmacology. So I had to study harder and more carefully in these particular fields. I have heard about people who studied for 1,5 to 3 months and I have heard about people that studied for over a year. I can give two advices here. First of all, try not to have gaps in studying and to do revisions regularly. The most important error that most of the people do is not to do revisions appropriately. You need to keep the knowledge fresh in your mind, especially the one that is new to you. Secondly, you have to be alright with yourself by the time you will go to take the exam. I didn’t wanted to have regrets because I didn’t give my absolute all.


I took ALL the NBMES after I was finished with all the other Qbanks. This is not the most right way to make the most of those tests, but this is what I had as a plan in my mind from the beginning. There are 15 NBMEs for step 1, so you may take some of them after some preparation just to assess yourself and see your weaknesses. Try to do the first ones because there are old and not very similar to the real deal, although they are still predictive. From the number 11 and after they get trickier and more similar to the real deal, and they might get a little bit more predictive.

How many hours a day?

This one depends on each and every one of you. Everyone has its own plan of study and a different courage. There were days that I pushed myself to study for 36 hours (too many coffees) and other days that because of the clinics I managed to study for ONLY 4-5 hours a day

How motivated?

Try to remember your goal and what you are fighting for every single time that you feel weak.

How to start?

I highly recommend starting from the disciplines that you have the most weaknesses, because it usually takes some time to establish new knowledge in your memory.

Percentage of confusing QnAs in each block:

There were approximately 3-4 really difficult questions in each block, on the real deal.

How long did it take for each Q-Bank?

Before I started to do the Q-Banks I thought that it will take 2 weeks for each of them, by doing 300 QnAs per day (HA-HA-HA 😛 ) It actually took 1 month for every Qbank. (Kaplan and Rx) It took me 1,5 month for UWORLD, but before I do every discipline I tried to first do a very good revision on it. So again, it was 4 weeks for UWORLD and 2 weeks for a very detailed revision. It took me 20 days for the NBMEs, because I used some days for ONLY REVISION.

Questions percentage from each subject in the exam

I think that most of them was pathology. Each system is represented in 10% of the test, but all of the questions are integrated, so a GI pharmacology question counts for both GI and Pharmacology. There where few questions about biochemistry, immunology, biostatistics and psychiatry

How to avoid silly mistakes:

This is simple. Read again the question. USMLE requires you to READ CLOSELY in many questions. Read energetically and NOT passively. I read twice almost ALL of the questions in the exam.

Test taking strategies:

Try to look at the clock for the remaining time. Don’t mark too many questions because you may not have time for all of them. Try not to leave unanswered questions. You may need more time for difficult questions. Just make sure that it is possible to do them right. If it is impossible to do so, just guess and go on. I did this 3-4 times in the exam day.

Questions were like NBMEs or UW?

There were closer to the NBMEs. UW enables you to have a proper way of thinking for the exam. So you may find that it is similar to UW, too. The questions are not too long (as they are on UW). You might see some pictures from NBMEs. I had 3-4 questions EXACTLY the same as NBMEs.

Well, that is all of my experience… If you have any questions or advices I would be happy to hear from you.


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

US MS2 scores 253 on USMLE Step 1 – Experience of 253

US Medical Student scores 256 – USMLE Step 1 Experience

USMLE Step 1 Experience – 247 – American Medical Student

November 12, 2017
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