So, this is my USMLE Step 1 experience with advice to people who are going to take their exam in the near future.
I graduated from the University of Cairo, Egypt in February-March 2015. I’ve done Step 2 CK last year (got 243, here is my Step 2 CK exam experience) and CS (my Step 2 CS exam experience) just a couple of days ago.
I won’t be telling the whole story, like I did in the CK experience because of the following 2 reasons
- No one really remembers all that he/she did with the preparation.
- We tend to overestimate or underestimate the effect of some factors and thus mislead other people.
So, basically what you are going to read is my 2 cents on the exam and what the proper preparation should be like especially for an IMG. These impressions are not my pure experience; rather they are my evaluation of the experience besides a lot of reading and listening to other people who told their stories of Step 1 on and off the internet.
THE SHORT VERSION OF THE STORY
I started by watching all Kaplan videos from 2010 (except pathology and histology) along with the Kaplan lecture notes. After that, I did UW Subject-wise and annotated Kaplan lecture notes. For pathology, I watched some Pathoma videos, listened to some Goljan lectures and read some Rapid Review chapters and annotated here and there. After that, I did 1500 Qs from Kaplan QBank. Then I did UW again (this time in random mode) and read First Aid once. Then I did UW for the third time and some blocks (around 8) from USMLE-Rx without reading the explanations. Then I read the first half of FA for the second time (the subjects not the systems). And of course while doing all this I took all of the NBMEs from 12 through 19 and the UW assessments as well. Then the exam.
FIRST IMPRESSIONS AFTER THE EXAM
I wrote this post after the Step 1 exam.
I wasn’t planning to read FA at all because in general, I don’t like condensed books (that’s why I thought Rapid Review instead of Pathoma would be a good idea). However, when I was finished with UW once and 1500 Qs from Kaplan and only had 1 month to go, I realized that I couldn’t study the beautiful Kaplan lecture notes that I spent a lot of time annotating! This is not because the lecture notes are huge. They are actually around 2000 pages (without the pathology) and they contain a lot of blank pages, question and answer sections, summary Pages!, even “learning objectives” so, I’d say those 2000 pages probably contain a similar amount of information compared to FA or even less! The real reason I didn’t continue reading them is that I realized they are not written in a way that makes making comparisons and linking related information feasible to the reader and actually that’s what FA is best at and that’s what the USMLE is all about.
FA is very condensed and everything you need is there but you might not be able to find it before reading it multiple times or being at an advanced stage of your preparation. FA should be the main, excuse me, the only book you use. It’s perfect but ignore 80% of the mnemonics and focus on the understanding. While reading FA you won’t understand some stuff, it’s fine, UW will teach you those concepts and if not, you have the internet, search for what you need to understand or visualize and you can even open Pathoma, Kaplan or any book to understand a specific point more but don’t make these books part of your essential material.
USMLE WORLD AND THE OTHERS
UW is the best QBank for USMLE. Some people say that Kaplan has great physiology questions and that’s true but they are overly more difficult than what you need and that’s why they won’t help you. See, I did 1500 Kaplan Qs and my score in the assessments stayed the same. Your score won’t go up unless you know the high-yield information more deeply and be able to use it more efficiently. Kaplan has the whole package of the high-yield stuff but they are repeated disproportionately i.e. some very important info has a relatively smaller number of related questions and vice versa. Also, the explanations in Kaplan are very long and not focused on the important points and that’s not a good thing. USMLE-Rx, on the other hand, has shorter though weirder explanations. The weirdness is not in the content of the explanation itself, rather in the way the QB presents them e.g. they put the wrong answer you choose first then the right answer after that. The most problematic thing in USMLE-Rx though is that its question-style is not 2017-USMLE-question-style, much shorter and simpler and sometimes trickier in a way that doesn’t match what you’ll find on the exam. UW and Kaplan do a much better job in this regard. USMLE-Rx can teach you details of FA but I’m not sure if this is worth a try because if you do what I suggested about FA you won’t need that.
So, UW is your QB. But how should you do it?
Do it random timed from the beginning. I know this might seem difficult and unorganized. But this is the way to go. Why?
- Timing is an important part of all USMLE exams and you should practice that from the beginning to the end
- Randomization will do the trick regarding what is called “spaced repetition”. You will get the same information in UW in more than one question. Some topics like vulvovaginitis have like 30 questions or something! So, if you do system or subject wise you’ll be exposed to all these questions in a few consecutive days and then forget about them for 1 or 2 months until you do them again. But if you do random mode you’ll be exposed to these information on spaced occasions throughout the whole period.
- Also, randomization will make the flow of the studying easier because there’s less boredom and you won’t be tempted to kill yourself after doing 80 biochemistry questions in one day.
Another thing about UW is that you should read the whole explanation and try to understand everything in it. Why? Because that’s the main part of your studying and this is what will make you understand FA and this is what will make you comfortable with the information. Memorizing mnemonics and chunks of information is not going to help except for specific topics that you are the only one who can detect and those topics shouldn’t exceed like 10% of the whole thing. Understanding and repeating are invaluable. Besides, the explanations a lot of times contain more important information than the question stem and the main question point itself!
Rapid review is a very nice book but this is not a book that you can read in a few nights. It’s huge and contains pathology along with microbiology, biochemistry, physiology, biostatistics…! And I don’t know why. Pathoma is a fine book but I found it very dull and very condensed and not in a good way. And the videos are the same. Some people can call that “simple” but for me, it was very dry. Anyways, FA has all the pathology you want to know and UW explains it, so no need to go for other sources. Pictures especially microscopic pictures are not a big deal i.e. the exam is not about that. Yes, some questions will have some pictures but you may finish your 7 blocks without a single tissue sample image showing up. And even if it showed up it will be just one or two or a few occasions at most and most of the time you’ll be able to answer the question using just the stem itself. No need for atlases. You’re not a pathologist. UW and FA have all that you need, even sometimes I feel like UW has more details than necessary in this regard.
NBMEs AND THE WHOLE ASSESSMENT DILEMMA
There’s a big problem with the Step 1 assessment exams that I didn’t encounter when I was preparing for CK last year. A lot of people find NBMEs and UWSAs over- or under- estimating and sometimes in a hectic manner like what happened with me. I got 230 in NBME 17 and 215 in NBME 19 2 weeks after that and that was 1 day before my exam so, I had to take the advice a lot of people gave me which was “postpone” and I delayed the exam for 1 month but even then when I did NBME 13 and NBME 15 which I have had done already before I got 240 and 250 respectively. UWSAs are worse because I got 247 and 237 2 months before the exam. So, nothing really correlates and I wasn’t even going in a rising pattern regarding the assessments although I was regarding the studying and learning process. I think the following may be the causes for this erratic behavior of the assessment exams:
– There are a lot of assessments for Step 1, 6 online NBMEs, 2 UWSAs and 8 or 9 old NBMEs. I didn’t even count the other less popular assessments like the 2 full-length exams that Kaplan provides or the whole USMLE-Rx QB which you can use every 4 or 7 blocks in it as an assessment and it will give you a score +/- 20! So, all these assessments make people do them in different orders and thus at different distances from the exam and this is especially problematic for UWSAs because the curve is dependent on people performance and because people do them generally earlier in the preparation process they tend to perform relatively poor and this makes the curve much less steep. That’s why if you do UWSA just before your exam and get 240 for example, take care! Because you’re being compared to people who perform poorly because they are at earlier stages than the one you’re in.
– a lot of people go online and see NBME questions posted and a discussion is being held about them before they do the test. So, when they do the test they have an advantage over people who didn’t see the question and this gives them overestimating scores and might make the board change the curve to a more steeper one or make another assessment with questions similar in difficulty to that removed but much harsher curve and this is the case for NBME 19 and NBME 12 for example. Sometimes you don’t read the NBME question on the Facebook group but you read someone’s post who is asking a question or giving an answer to a question that’s, in fact, an NBME question but he/she doesn’t say that.
– NBME questions and concepts repeat themselves over time. That’s why when you do older NBMEs like 1 through 7 you tend to get better scores in the newer ones.
– this is actually the most important point: any assessment should have 2 criteria: 1) questions that are similar in length, difficulty, distribution across disciplines and “design” e.g. choice of words to the actual current exam question pool. 2) scoring system (curve) that’s also similar to the actual current exam curve. Number 2 is lacking in UWSA more than NBME especially the NBMEs people tend to do in the end and I explained why. Number 1 is lacking in NBMEs, not in UWSAs! Why? NBME questions are probably real retired exam questions but they are modified for the assessment test so that they become shorter, more direct and not well distributed e.g. a lot of times I found the same concept asked in the same assessment exam more than once in a ridiculous way. So, for example, I tend to be better in integrating and thinking critically under stress than recalling facts and another person is the exact opposite. If we both take an exam with all the questions just focusing on the recalling I will tend to perform poorer than I deserve and vice versa. That’s why it’s important that the assessment exam questions be balanced and similar to the actual exam without modifications. The best regarding that is the sample test at USMLE.org and the next is UWSA then maybe NBME 18. But again, all are inaccurate because if they get the curve right they get the questions wrong and if they get the questions right they get the curve wrong!
Finally: don’t study NBMEs. Do them and know the correct answers to questions you got wrong or were confused about but don’t try to spend more than 2 hours analyzing each NBME. Doing UW and FA is better. We will of course continue to use the assessments to measure our competence to take the exam but don’t forget that your feeling matters too, if you do great in an assessment but you feel you were a little lucky don’t be blinded with the score and trust your feeling and if you feel competent but you get a bad score it’s a more difficult situation but try to trust yourself.
STUDY PARTNERS, INTERNET GROUPS, AND COURSES
Use with care! Don’t read anything in any group except the general posts like this one or an answer to an inquiry you made. Don’t read questions from NBMEs, UW or any other source. Limit reading other people’s mnemonics and explanations to things you didn’t ask about. It’s important to be focused on what you’re doing (mainly UW and FA) because you can be discouraged easily and/or distracted. Don’t do any courses, they are overpriced and the material you need is free on the internet and I’m not talking about pirated material. Use your money to buy UW, NBMEs, and FA and use the internet to search for things you don’t understand.
HOW TO STUDY
There are 2 concepts called focused mode and diffuse mode that I talked about in my CK experience (link is provided earlier in this post) and they are very important for any type of learning especially the one needed for the USMLE.
Another point is that the first time you read FA or do UW you can just read and try to understand but after this phase when you do FA and UW again you should use pen and paper and try to explain things to yourself, take notes, draw diagrams and pathways… etc Don’t overlook half of the material, you have to be focused and try to really understand what every concept means. And of course, spaced repetition. Spaced repetition can be achieved by doing FA and UW multiple times, doing UW always in random mode and reading difficult topics and any special notes that you make more than you read the rest of the material. You can make notes by just writing down the main concept in each UW question. It will be like 50 pages and you can read it in 2-3 hours when you are familiar with it.
I) Introduction (1 month)
Kaplan Video Lectures just to familiarize yourself with the content especially if this is your first step.
II) Building the base (1 month)
Reading FA carefully and trying to understand it.
III) Building the tower (2 months)
USMLE World in random-timed mode 1 block a day (Take notes and annotate FA but don’t overdo it, make sure to understand everything in UW)
IV) Recap (2 weeks)
Read FA again, this time with pen and paper.
V) Again (1 month)
Do UW (second time) 2 blocks a day along with reading FA 20 pages a day and read your notes.
VI) Again (1 month)
Do UW (third time) 2 blocks a day along with reading FA 20 pages a day and read your notes.
VII) Finish (1 week)
Read FA and your notes.
N.B. Don’t do any assessments before you finish phase #5 and don’t forget to do the free questions on USMLE.org
Praying is all I have. Really. All I talked about in this post are just “means” or “causes” but the reason for all these causes is Allah (God). Only because of Him I can “There is no might nor power except in Allah.”
Thanks and good luck to all of you guys in all endeavors.
This article was first published on Facebook as a post by the author, from there it was edited and published here with the permission from the author.
All images were designed by Arnab Mukherjee.
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