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Hi guys I am a relatively older graduate. This is my experience of

doing USMLE Step 1 after doing residency of 3 years in my home
country.

Medical School Graduation: March 2013

Residency Graduation: May 2017

I was a above average student in my medical school but that did

not matter as I took my USMLE after such a long gap that I had
forgotten everything of medical college & things like Urea Cycle
seemed like ancient fossils to me. I started almost fresh when i
began USMLE prep. I started my USMLE prep in between
residency and I had done Kaplan Lecture Notes for USMLE Step 1
along with latest First Aid USMLE Step 1 before i finished
residency. After residency was over i studied for 4 months before
giving the test.

My Husbands Under Here Somewhere Col

Packrats and Compulsive Hoarders

I had done Pathology residency so pathology which is a major

chunk of USMLE was easy for me. However, the difficult
questions in my exam were not of Pathology by of Anatomy and
Behavioural Science. Fortunately i had done all NBMEs before
giving the test so I was aware that these 2 subjects had to be
studied more in depth. Below i will explain how i did those 2
subjects.

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So lets start out.. First things first and that is First Aid USMLE
Step 1.. It is a great resource.. However it is more like an Index
than an actual book. What i mean is every word in the book is
important. Just rote memorization of the book will not work. You
have to understand each and every point in the book. If there is
even one small line in a diagram then you have to understand the
topic before memorizing. For example:

Hospitality Management

There is a topic of ECL cell stimulating Parietal Cells via Histamine.

Now this might seem like an obscure minutae but it is actually
very important. For example, a question could be framed using
the history of epigastric pain and history of smoking (risk factor
for peptic ulcer). Then they may say that person was given a drug
which caused Gynecomastia. The drug blocks the substance
which is produced from which of the following cells. Then options
could be the labelling of the following diagram below. Now the
way to answer this is multiple steps. First step > Understand
which disease patient has > That can be done from history give
and risk factors given > Then you have to understand which
drug the patient is on > He has been given a pill which caused
gynecomastia > Out of the Peptic Ulcer drugs the one which
most commonly causes this is Cimetidine > Now you must
know the mechanism of action of Cimetidine is H2 receptor
blocker > So drug is blocking Histamine > You now know the
substance > Last step is to know the cell which made it -> Cell
is ECL cells > That is the answer. Understood how it works ? Its
multi-step reasoning ? Read on in the experience and i will reveal
more tricks and tips to score well on the test below.

USMLE Gastric Acid Secretion Parietal Cells ECL Cells Histamine

Now you see that while this image is quite daunting but it must
be understood well in order to score well on the test. Brute force
memorization just will not work. The way to learn FA is simple.
Whenever you are doing FA.. and dont understand XYZ topic then
the simple way to find out more is to type into google:
XYZ USMLE.. Like in this case it would be Enterochromaffin Cells
USMLE.

It is important to put USMLE at the end..as simply searching

Enterochromaffin Cells will lead you to pages which have non-
specific information about it. Like it may have an esoteric
research paper of ECL cells which talks about the anthropology of
the cells and how similar cells are also available in primates and
monkeys and in humans. This is useless information as this does
not pertain to our studies.

So, TIP 1: Always google every small part of First Aid USMLE which
you dont understand as it may be high yield. In fact a lot of the
topics i was tested on..they were not given anywhere, but when I
searched them online then i found a lot of sites where entire
USMLE related information is given of a topic. Dont look at the
forum posts results.. Like i used USMLE Forums and SDN etc but
there sometimes the students are discussing a topic and they
themselves also dont know the exact topic, so instead of forums
rely on articles written in sites.. there are many such sites, just
google and i am sure you will find the information. So, long story
short, dont rely on First Aid USMLE blindly, instead do google
search of topic with USMLE in the search string. Like
Enterochromaffin Cell USMLE instead of just Enterochromaffin
Cell and use First Aid as Index.. its not final book.. it just gives
you topics but if you search properly you will get many topics
noone will know of.

Now, back to my journey, I started doing this FA with google

search + UW + Fundamentals of Pathology (Pathoma) after my
residency was over. It took me 2 months to do that. Please keep
in mind that i had already done Kaplan Lecture Notes for USMLE
Step 1 and 1 time memorization of First Aid USMLE Step 1. So i
was done with that in 2 months.
After this I took 2 NBMEs back to back every Saturday & Tuesday.
So every week i was doing 4 NBMEs. 2 NBMEs each on both the
days I mentioned. The reason i did it this way is that the real
exam is 7 blocks long, but NBME is only 4 blocks long. This is a
discrepancy. Because when you will give long exam you will
realise that last 2 block is when the mind fatigues out. It is
inevitable, there will always be mild deterioration of execution
capacity in the last 2 blocks. One of the reasons i thing some
people get worse score in real exam as compared to NBME is that
they have given 4 block test with fresh mind but in real exam
their performance deteriorates a lot in the last couple blocks and
the NBME score no longer remains predictive because of the
deterioration of functioning. I wanted to make sure this doesnt
happen to me, so i gave 2 NBME back to back. I calculated my
score as average of the 2 NBMEs. So lets say i got 245 and 252.. i
would calculate my score as 248.5 In this way i gave 2 NBME on
aforementioned days of the week and remainder days I would
meticulously go over the NBME explanations. This helped me a
lot as i used the NBMEs as a learning tool as well as an
assessment tool. I identified that i was very weak in Anatomy and
Behavioural Science. This was very helpful as in my real test these
2 topics were asked in depth. if i had not done NBMEs like this I
would never have been able to diagnose and treat my 2 USMLE
ailments: i.e. Anatomy & Behavioural Science.

Anatomy:
To improve anatomy i did 2 books. Both with their pros and cons:

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High Yield Gross Anatomy:

This is a great book with a lot of useful information especially on
Clinical application of Anatomy. That is a part which is missing in
many places. While the information related to Anatomy is good in
UW, it is terrible as far as Kaplan USMLE Step 1 Lecture Notes is
concerned. Also the information in First Aid USMLE is average at
best. So i recommend looking into High Yield Gross Anatomy for
the clinical aspect of Anatomy. Things like which intercostal space
to do thoracocentesis, where to do Liver Biopsy, which layers are
passed through while doing it. Such topics amongst many others
are not given elsewhere.

BRS Gross Anatomy

BRS Gross Anatomy was an amazing book not for its text but for
550 questions in it. There is a lot of amazing material there about
basic gross anatomy. Also they have MRIs and CTs of weird
angles not given elsewhere. Things like Carpal Tunnel MRI with
the tendons in there and identification of the same is a very high
yield topic. Even in my wildest dreams i would not have been able
to identify stuff on my real exam had it not been for this great
book. The questions are pure gold. Also there is a test at the end
of the book which is great and worth doing. I got a lot of high
yield info from here.

Guys you wont believe that in entire medical college education i

used to suck in Anatomy. I got fail score on my first NBME i took
online for Anatomy. But you wont believe that in the real exam i
got an amazing score in Anatomy. I got a star at the right side on
my test. I was very worried about this subject but gradually as i
went one by one through the NBMEs I improved from left side
bar in assessment (i.e. fail level in assessment) i went to right side
(meaning very above average). Thats the power of using NBME as
a learning source i did each and every NBME and also did the
wrong questions before exam. I had done them all with
explanations as real power of NBME lies in the explanations. You
cannot expect to score well without doing it as learning source in
addition to assessment source. The key lies in identifying
mistakes in NBME and improving those subjects. For that you
have to dissect NBME inside out. Not just do test and leave but do
entire explanation. Do each and every option and the right
answer as well as wrong answer you must understand what is
going on, why option which is wrong is wrong. Because in test
you may not get the exact question but there is high chance you
will get question based on one of the incorrect options. I learnt a
ton from incorrect options and believe me that is what got me to
270+

Behavioural Science:
This is achilles heal of all IMGs, and the way to mitigate this issue
is to do 3 books in addition to Kaplan and FA and UW. These 3
books are:

BRS Behavioral Science

This is a great book and like all BRS Series, it also has tons of
questions. 700 to be specific. This amazingly large number of
questions is what makes this a great resource. I did each and
every question and dissected the subject inside out. In the real
USMLE test.. This paid off as i had a lot of topics in the book
which i hadnt seen anywhere else. Also I recommend doing the
NBME Behavioural Science questions separately as they are very
high yield and you will get a decent amount of topics repeated if
you do the NBME Behavioural Science questions with
explanations.

High Yield Behavioural Science

This book is also decent. I did both BRS and HY. Many things in
HY were also in BRS. But also many things were new. So i
recommend you have a look at this if you are short of time and
cant do BRS.

Kaplan Medical USMLE Medical Ethics: The 100 Cases You Are
Most Likely to See on the Exam (Kaplan USMLE)

This book is well known. It has high quality information which can
be covered in 1 day if you start from morning and do till evening.
I recommend this for sure.

So basically i did UW + FA + Pathoma for first 2 months. Then i did

NBME 4 test per week on 2 days along with indepth explanations
of each for rest of the NBMEs. I did this for 4 weeks and finished
all the NBMEs before last month of exam.

In last month, I went over UW, FA, Anatomy, Behavioral Science

and NBME test wrong questions. After doing all this i was sure i
would get good score.
Exam experience:

I packed a ton of food. Red Bull, sandwiches, peanuts, etc. The

exam was lengthy and blocks were quite long for me. I felt i was
alert throughout the test. I felt the test was much harder than
NBME test but thats how everyone feels. After 3 long weeks of
sleepless nights.. finally got the score. It was like a dream come
true for me.

I wish you all the best. If you have queries, please post below and
will try to help.

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USMLE STEP 1 EXPERIENCE -

EXPERIENCE - 276 How I went from
October 1, 2017 USMLE Step 1 227
In "270+" to 273 ?
September 30, 2017
In "270+"
USMLE Step 1
Experience - 268
IMG USMLE Step 1
Preparation
September 21, 2017
In "260+"

195
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October 28, 2017

 5Comments Sortby Top

Addacomment...

JankiPatelInternshipatL.G.Hospital,Maninagar
Ihaventdoneanyoftheanatomybookswhichyouhave
mentioned!shouldIdotheminordertoscoregood.?AndifI
decidetodoBRSanatomy,howmuchtimeshouldispendto
readthewholebook.?Willonereadbeenough.?
LikeReplyOct28,20177:01am

WaliMArian
Thankyou,buthowcanicopythistext.itcantcopythat.
LikeReplyOct29,20177:09am

MahmoudA.Ismail
Youcansnapscreenshots.
LikeReplyNov1,201711:18am

SalhaSabeehaShajahanThoothukudiGovernmentMedical
College,Thoothukudi
Congratsonthemassivescore!!Howmanyhoursadaydidu
dedicate?
LikeReplyNov19,20175:55am

ChediakTakotsuboHigashi
Thankyou
LikeReplyOct28,20177:35am

MarwaSaad
MaureenAdione
LikeReplyOct28,201711:47am

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