USMLE Step 1 Experience

Score 255 (>90th percentile)

I am currently a final year foreign medical student, I took the exam during my 6th year clinical rotations(final
year) and this here will be my personal experience, this plan worked for me, it does not necessarily mean that
itll work for everyone, but Id like to mention how things were for me and what were the pitfalls I fell into so
you could avoid them and learn from my mistakes.

Total preparation time: 11 months with 9 months in between the two phases.

Early preparation:

-Subject wise (Time spent):

Pathology: Pathoma book + videos ( 3 weeks)

Pharmacology: Kaplan Lecture notes + videos ( 3 weeks)

Microbiology: Clinical Microbiology Made Ridiculously Simple ( 2 weeks)

Gross Anatomy & Embryology: Kaplan Lecture Notes + videos ( 3 days)

Neuro-Anatomy: Kaplan Lecture Notes + videos ( 2 weeks)

Physiology: Board Review Series (BRS) ( 1 weeks)

Biochemistry + Cell Biology + Molecular Biology: Kaplan Lecture Notes + videos ( 2-3 weeks)

Immunology: Kaplan Lecture Notes + videos (2 days)

Behavioral Sciences: Kaplan Lecture Notes + videos ( 2 weeks)

Phase I (5.5 months): These were all done during my 5th year clinical rotations so the time allotted for every
subject would vary according to the time needed for me to cover those clinical rotations. Then I had a go at First
Aid 2013 edition and went through the book over 4 weeks; where I noticed that going through Kaplan Lecture
Notes was pretty much useless, as those books are humongous and retaining information from such vast
resources is undoable (at least that is what I found). I then had to start studying for my 5th year clinical rotations
as I was far behind on the material covered while I was studying for Step 1. So I took a break January through
September where I prepared for my final exams and went to the US for USCE and sat for my Step 2 CS exam.
Once I got back and had my results for my Step 2 CS I was encouraged to re-start studying for Step 1 again.

Phase II (5.5 months): This time I was better oriented and knew how impractical it was for me to try memorizing
all the information in Kaplan Lecture Notes Series, so I bought the new First Aid 2014 Edition which I started
going through around October 2014 and this was my sole review book for the exam alongside some annotations
from Pathoma and Immunology Kaplan videos. I also bought a 6 month subscription from Uworld Question Bank
and I would simultaneously go through a chapter from FA and solve 50 Qs covering that specific chapter, I
wasnt concerned much with scores I was getting ( 65%) because I knew Uworld was a learning tool rather than
an assessment at this moment. This first read took me around 5 weeks to finish which was quite a long time but
I was feeling much better since I was retaining much more information than when I went through the book the
first time and whenever Id feel weak in a certain topic Id go through the respective chapter in
Kaplan/BRS/Pathoma videos. By mid-November I had finished around 50% of Uworld and was going through
my second read where I decided I should subscribe to USMLE-Rx and so I did. I bought a 2 month USMLE-Rx
subscription and solved the questions in the Qbank till January while simultaneously reading FA over and over
again. By late January I had finished FA 3-4 times and had solved over 3500 Qs from Uworld and USMLE-Rx. I
then started doing the what was left of Uworld (Mixed; Timed Tutor; Unused Questions mode) and noticed I
started scoring much higher (78%). I went through Uworld annotating everything I found useful into my FA
until it ended up being full of all sorts of information on disease pathophysiology to interviewing techniques
used by psychiatrists. Early February I decided that I should book an exam appointment and commit to it and so
I booked my exam on March 11th. Now as to the scores in my self-assessments and Qbanks I solved:

USMEL-Rx Online: Random, mixed questions 84% (Estimated score 269!!); this overshoots a lot.
UWorld Online: Mostly Mixed; Timed Tutor; Unused Questions mode: 78%
UWSA1 (3 months before the exam): 256 (700)
UWSA2 (1 month before the exam): 253 (680)
NBME 15 Online (three weeks before): 249 (600)
NBME 16 Online (two weeks before): 251 (610)
Free 150 Qs (4 days before): 89%; these are found on the usmle.org website.
I also did NBMEs 11, 12 & 13 offline and had 27,24 & 23 mistakes respectively.

By the end of my preparation I had gone through FA probably 5-6 times but I consider myself a fast reader and
would not spend much time reading a certain page but rather make sure I go through it a bunch of time and
each time I would retain information so at the end what I would retain in 6 reads, someone else could definitely
retain in 3-4 reads depending on their personal preference as to what works for them. I had also gone through
around 6800 Qs in total and would say that this was the single most important part of my preparation, since at
the end this is an exam and some topics can never be memorized from a book, regardless of the amount of time
spent reading that book, but after solving a single question it just sticks there, especially if you solved it wrong.

Now as to the time I would put into studying on a daily basis this was very variable, I had planned to put 6-7
hours daily and take a day off every week, but with my clinical rotations and having night shifts as well as
seminars every other day, I was putting an average of 5 hours daily with a day off every week or so. I must
emphasize though that the time I actually spent was very inconsistent as I would take a week off here and then
take a couple of days off there. I also must say that everyone has different capabilities so I think this should be
tailored according to what you personally see fit. The most important point being that you should go through FA
numerous times and make sure you grasp all the diseases pathophysiology as the exam is a very conceptual
exam rather than one that tests how much you memorize. On the exam Id face memory questions every so
often but without understanding disease pathophysiology it wouldve been a disaster.

One point worth mentioning is that you should try your best to have one single resource as your
Quran/Bible/Torah when studying and make sure you annotate to that single book. It might look cramped up at
the end but its extremely important that you dont annotate on various books as when youre close to your
exam, you WILL NOT have time to go through various books and if so youll end up wasting a bunch of time
looking for your annotations here and there; while they all could be in one single book. Another extremely
important point is that you should try your best to find a study partner, I had an amazing study partner, we both
wanted very similar scores going into our studying for the Step 1 and although we would study separately and
use different methodologies at times, we yet would still sit there every night recalling various topics and going
through some tough questions here and there and this really did add a lot to my fund of knowledge and
definitely helped me throughout the preparation period. You should also let your family know that youre sitting
for a major exam that can determine your future career since you will be missing out on many family gatherings
and you will really need their support throughout.

Now as to how I annotated different Qbanks and different sources on my FA, well I used a technique which I
thought was extremely helpful, where Id write down notes from different Qbanks using different colors and
would highlight different topics with different colors as to the extent to which Id consider that certain topic
high-yield and to the difficulty Id face memorizing that certain piece of information, for example, after reading
through FA three times Id still read certain words here and there that Ive never read before (Of course I did
read before, but it didnt stick) so Id highlight it using orange so during my next read Id make sure that I
specifically look for stuff highlighted in orange and see whether or not I had them memorized, and this cycle
would go on and on. Another issue is that you will definitely hear people that tell you, that you should memorize
FA, as amusing as that might seem, its not feasible so just make sure you know all the major topics and have an
excellent understanding of the underlying mechanisms of everything on the book and just sit for the exam.

9 days before the exam after having done NBME 16, I went through one final read of FA in 6 days then 2 days
prior I just reviewed a list of forgettable materials that I had compiled throughout those five months and 1 day
prior I just read a few things in the morning, ran a few errands I had to do and made sure I would exhaust myself
so that I would have a good nights sleep before the exam as that was the most essential part of my preparation;
you DO NOT want to go tired to the exam.

Day of the exam, I woke up at 7 a.m. I had a nice cup of coffee with extra caffeine, a banana and a nice cream,
strawberry and nuts snack bar. I drove to the exam center, which I already knew the directions to beforehand,
this is very important, you dont want to get lost going to the exam center on the exam day. I got there at 8 so I
still had an hour before I had to enter the center, so I listened to some music made sure Im relaxed and
walked into the center. The people at the prometric center were all extremely helpful and awfully supportive,
they know how stressful it is on your exam day so theyre trained to make sure they dont make it any worse for
you. I checked in my bag where I had a bottle of mineral water, 3 diet Red Bulls, 4 snack bars and a couple of
bananas plus all my personal items (i.e. watch, wallet, cellphone etc.). I started my exam at 8:45 and skipped the
tutorial after testing the headphones, then went through my first block, which was a bit of a hassle not because
of the difficulty but rather that my computer station would flicker black every time I clicked on it, which freaked
me out, I called for the proctor she quickly came and moved me to another station and it was completely fine
over there. The first block is a bit immense as youre now facing the big Step 1 exam, but after the first couple of
questions its just like doing Uworld all over again, since the screen looks exactly like that in Uworld. I finished
the first two blocks back-to-back then took a 20 minute break where I drank a Red Bull, had a snack bar and
used the bathroom. I then went through the 3rd and 4th blocks and took another 20 minute break where I had
another Red Bull, a banana and used the bathroom, then it was 5th block, break, 6th block, break and a Red Bull
and finally the last block. I left the center feeling consumed and hesitant on many questions I faced in the exam,
but having known that I would be feeling like that from friends who sat the exam earlier I was actually relieved. I
knew I was going to face easy questions often, medium to difficult questions much more often and every block
Id face at least 3-5 WTF questions. The most important thing is to leave the exam knowing that you just finished
Step 1 and thats all that matters, going through the questions and looking for answers is useless, as no one
knows whether those questions were pilot questions nor can you now change any of your answers, so just leave
the exam hoping for the best and if youve worked hard for it, youll most definitely get it.

Three weeks later I got my score back, it was a 255, and I was thrilled as this was higher than any of my NBMEs
and so I was grateful for all the time Ive spent doing various Qbanks and going through all those different
resources as it all had paid off, quite nicely.

One last piece of advice, dont let anyone put you down, you are going to hear all sorts of crap from fellow
students and even friends, try avoiding these negative people and surround yourself with more positive ones.
Do what you deem right and move on, work hard and itll definitely pay off. Good luck to everyone.

I really hope you find this, long, detailed (& perhaps boring) experience, useful throughout your studies.