This is the first article in the series “The Rebel Route”, written by Dr. Karen Tien based on her own experience with USMLE Step 1 Exam.

You can find the whole series here –

  1. First article
  2. Second article
  3. Third article


Part 1



Target score: 240

Step 1 score: 243

Baseline knowledge of pre-clinical science: ZERO – forgotten most things 3 years post-grad! But I am a hard worker.

Preparation time: 9 months = 6 months studying & working + 3 months of dedicated study (extension x1 and paid horrible fine after not reaching my goal by first 6 months)



Resources (in order of priority)

Image - Dr. Karen Tien
Dr. Karen Tien
  1. Building foundation – Boards and Beyond (short, high yield and easy to follow in FA, highly recommend this particularly if you are weak in biochemistry, cardio, genetics, cell biology and biostatistics). I tried most popular ones DIT, Rx videos, this is the best in terms of high yield.
  2. First aid 2016 read 3 times (first timeproperly with Study Partner)
  3. UW x2 (each time I read the explanations even of incorrect options)
  4. NBME 1- 19 (12-19 online)
  5. USMLE RX flash/ANKI and questions bank (only the 1000 hard questions)-it comes with options to make as many simulation tests as you like. I bought the Rx videos too but I felt I wasted my money, boards and beyond is far superior.
  6. Sketchy micro + Sketchy pharm (only selected parts like coagulation and anti-depressants as not all of it is useful)
  7. 400 pages of Goljan Pathology slides (whata gem! You can thank me later!)
  8. Pathoma ( you need two resources for pathology as that is the bulk of your exam, boards and beyond and Pathoma combined is more than adequate)
  9. Anatomy shelf notes 100 cases
  10. Conrad Fisher 100 cases
  11. UW biostatistics extra (for those of us whose maths brain has beenlying dormant for a while…)
  12. Goljan audio (great for car rides on the way to work)
  13. FA Q&Abook – has a simulation test at the end
  14. Kaplan Question bank (it comes with 2 simulation tests 7 hours each)


My personal favorite resources

BOARDS AND BEYOND – I didn’t use Kaplan. I was working and doing night calls often and didn’t have time for long lectures or lengthy explanations. I needed short high-yield facts and so Boards and Beyond was the key for me.  Dr. Ryan is phenomenal, his lectures are short, to-the-point and well-explained. He follows the format of First Aid. So after doing his lectures for a section, you can easily cruise through UW questions. His cardio, biochemistry, genetics, cell biology, understanding metabolic acidosis and alkalosis, respiratory physiology saved my life. He also has a great behavioral science section for how American health care system works; e.g. Obamacare, Medicare, Medicaid, PPO, HMO etc. which I found very helpful as I was weak on those topics and I dreaded those questions. My first NBME after Boards and Beyond with UW and FA was 209.

FIRST AID – it’s not a state secret that FA is the Bible for step-1. Why? Because in your exam when you are trying to decide between two answer your brain literally does a search through FA pages and the page with the answer comes up. This is why in your last week before the exam going through FA is very important. DON’T annotate too heavily into this book because it will make it frustrating to read at the end. I had my book unbound and post-its to add facts into it.


Image of The Rebel Route


UW – this is also a no-brainer, this is the ultimate integration tool. DON’T use this as an assessment tool. Do not get over anxious if you are scoring low – my first round was 58%. A guess what, nobody cares LOL. This percentage no way correlates to the actual exam. You will hear this over and over again – UNDERSTAND THE CONCEPTS IN UW! Make use of the notes section of UW – these can be reprinted at the end of each round of UW. It’s fantastic for review before your exam. If you buy the 6-month option you can reset it once. If you can’t buy 6 months, mark all your questions and then do them. I recommend first round TUTOR UNTIMED MODE SYSTEM WISE. In the first round, you are LEARNING, it’s not about quantity; the average beginner takes 40 questions a day! Each question will have one key concept and 2-3 other must know facts. You have to read the questions concepts – this is why one block of 40 questions can take up to 4- 6 hours. I used the NOTES section which after one round of UW I printed before I reset UW or you can make them into ANKI notes. Once you reset UW, the second time is about the concepts that you missed and what concepts did you not quite get right? My second round of UW was 82%. Not great I know but the 18% that I missed was what was crucial in my final prep- working on your weakness.  Doing the second round of UW boosted my NBME 236-246 (and UWSA-1 256)


NBME 1- 19 – this wonderful bank of 3000 MCQs is the second best questions bank. I know people use this assessment tool. But let’s think about this logically, these are retired question from actual exams. I found doing old NBME decreased my NBME taking fear (we all have that), helped to realise concepts I didn’t know was high yield, It has the best practice questions for biostatistics and genetic questions and most importantly for me, helped me to approach the WTF questions that they throw at you in the exam. The early NBMEs helped me to boost my NBME from 209 to 228


ANKI – the key to not forgetting is spaced time repetition, the people in late preparation phases, you know what I am talking about!


RX flash cards – I used this 20-40 a day to make sure I covered First Aid well. This will show you that, in fact, you don’t know First Aid as well as you think! It’s a wonderful tool to identify you knowledge gaps in FA.



Lesson learned


It’s difficult to study and work at the same time; if you can get dedicated time off, TAKE IT!






published with permission from the author.


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