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This is the first article in a series by Dr. Ashok Chaudhary. Below is the link to all articles in this series –

  1. My Step 1 Journey to 271
  2. Surviving Step 2 CK

Part 1

My Step 1 Journey to 271

Test date: 26th July 2016

Score: 271

 

Hello, everyone,  

I am a government medical officer working under Ministry of Health and currently deployed at a relatively rural place of my country, Nepal.

 

I don’t know…in what format should I write this experience that would be best for you all; I think it’s better to write it in a chronological order.

I started my preparation around February 2015, with the aim of taking step 1 by Dec 2015 or Jan 2016.  But the Almighty had other plans for me.  I lost about 3 months due to my familial health problems; around the same time earthquake had struck us hard (around April–May 2015) and had to abandon the idea of applying for the match in 2017.

 

I started with Kaplan lecture notes (except for Pathology) and videos (2010) with Anatomy first, then Physio, Biochem, Micro, and then I read Pathology. I was in a great dilemma which book to follow…Goljan or Pathoma. So, I watched Pathoma videos and combined it with the Goljan textbook. Actually, this was very helpful for me…Dr. Sattar explains things so well…that made reading from Goljan easier. I would suggest. . . read Goljan only if u have adequate time. Yes, Goljan is an excellent book that helped me a lot  . . .  not only for Pathology. . .  but also for Biochem,  Micro,  Physio, and  Pharma topics. I think…it helped me to answer some very weird questions which I could not have done with other sources.  But this book is very frustrating too…you never seem to finish it…so plan your time accordingly.  My advice is…if your exam is near…don’t do it…resist your temptation to study it. . . because it will rob you of your valuable time which could be utilized for even more high-yield sources like UW and First Aid. While I was going through this book…. I used to listen to his audios … for about an hour at the sleep time.

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After I finished Pathology, I read Pharma from Kaplan notes and videos . . . followed by Behavioral Science + Biostatistics from Kaplan notes and videos.

 

For BS, I also read few chapters from BRS …the chapters on the doctor-patient relationship. It was quite helpful I think. If you are at the beginning of your preparation and following these sources. . . I would advise you …don’t try to memorize things from these sources (the mistake which I think I did…. that took a lot of time). Instead, focus on understanding the things…. Why this, how this happened, the mechanisms, the way the things are occurring etc.…

 

 

After I was done with these sources….I revised all these things rapidly again (no Kaplan videos this time….except for a few topics of physio…and other subjects…the topics which were difficult to comprehend). I revised full Pathoma videos. It is just so awesome that I could not skip it. For revision of Goljan….I mainly focused on the texts given within the boxes, the images and the text in blue….that is at the side of each page. While I was in the middle of this revision phase…one of my senior told me to start First aid early and to annotate imp things in First Aid…I complied. During this time…I read the topics directly from First Aid….which I came across while revising Kaplan and Pathoma and Goljan. Like….while watching Pathoma videos….i would turn the page on First Aid for that topic……watch the videos and read it from FA….and annotate the things and mnemonics (which Dr. Sattar said). It was Dec 2015 already. Till now…I never tried to memorize things from FA….just scanning through it and annotating some important points. My advice would be……start First Aid as early as possible…as an adjunct….and get used to it…as much as possible…but don’t memorize anything from FA…without understanding things. FA is approximately 600 pages (the things that you need to study)….yet I think it’s a very concise book for step 1.

 

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Every word and sentences in First Aid is there for a purpose. So, understand the meaning of words and sentences. Don’t just memorize it (except for some things like…. the developmental milestones, most of microbiology etc.)…that will do no good. Understand it then only memorize it. Yess….you need to memorize FA….but only after understanding. Forget those idealistic Words….where people say…step 1 is all about understanding only….Nah….you also need to memorize stuff and that sometimes need cramming too….But keep the space in your brain empty to accommodate the things u learn and memorize from FA(including annotations) and UW. Don’t unnecessarily overfill your mind….with all the stuff from Kaplan or Goljan or some obscure sources. EVEN MOST OF THE DIFFICULT QUESTIONS ARE FROM HIGH YIELD CONCEPTS ONLY.

 

I started UW after all these (around mid-December). All the seniors and all the experiences I read from Facebook forum…they all had one thing in common….First Aid and UW are the two absolutely important HOLY sources……and so was it (with my experience of the exam). I was so preoccupied with this notion….that….I wanted to study UW so well……so much so that …I could barely finish 35 questions a day….from UW. (Of course….I was still working at my hospital during this period…so that might be one of the reasons for such tortoise pace). It took me almost 3 months to finish it …the first time. UNDERSTAND UW very well….Read all the explanations…and ponder…why you got a question right…or why you got it wrong and annotate the important things like the “educational objective” in FA….if that concept is not in FA. (No wonder my…FA was like a book which only an alien could understand …after all these annotations…there was no space left in my FA…even to write my name on it). So if…you plan to annotate things on FA…keep your handwriting very small from the beginning. (I wrote in big font early…which I regretted later).

 

 

Now …I turned to my most important source FA 2015 (around late March 2016) with all those nauseating annotations in it. This was the first time I was reading FA properly…with the aim to understand it and memorize it. It took me slightly more than 2 months in the first proper read. During these, I also read FA 16 PDF from my laptop…and added the new things to my FA 15 book…sometimes that required sticky notes.

 

I took leave from my hospital about three and a half months prior to my exam date…and I am glad that was such a good decision to take….now I could focus all my time on my studies……without the tension of looking after patients and administration.

 

When I finished reading FA 1st time…it was around the end of May. This time I took offline NBME 7…I don’t remember exactly…but I think I made around 10 or 12 mistakes. I was happy with the result. Now was the time to revise UW …did it rapidly in about 25 days…then after this …revised FA which also took me around 25 to 30 days….During this revision phase …I did new NBMEs….NBME-11 onwards on weekly basis. I was happy with those results ….on an average…I think I made …9 to 10…sometimes 12 mistakes.

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NBMEs

I took NBME 16, 17 and 18 online…

NBME 16(2 weeks before exam): 269 (8 mistakes)

NBME 17 and 18(1 week before exam…both on the same day):

NBME 17:273(5 mistakes)

NBME 18:266(11 mistakes)

 

The scores were very encouraging to me….but I didn’t believe them……I had a feeling, prior to the exam, that I might just cross 260 if I got lucky. Now that, I have got the scores, I can say, my friends….they are quite predictive. Don’t know…how do they predict…but they do.

 

NBMEs were quite helpful for the real exam…a few of photos were ditto from there. One of my friend…who took the exam on the same day…got some ditto questions as well from the NBMEs. I could not use NBMEs as a learning tool because of time constraint…I used it only as an assessment tool. I was happy with those scores anyway. If you have time…I would suggest …do all the NBMEs…if possible and also use it as a learning tool…and try to decipher the concepts…they are asking. Ponder over all the wrong answers…why/how u got it wrong…and also the questions u got right…why u got it right….what…if the question was slightly different, or the options were slightly different…etc.…etc.….

 

I did Fred…4 days prior…got 95% right…the tutorial and the exam is ditto…the real exam.  For ECGs…no special sources….Facebook posts were quite useful. Heart sounds….I made a collection of those that are in UW on my phone. I used to listen to them occasionally for radiological images, UW, and FA only. And yes…one more thing…do learn the images u come across FA and UW, well. I took so many screenshots of various posts on FB, and many images…and used to look at them when I was out for a walk…or after lunch and dinner etc.

 

Some people uploaded UW tables on Facebook…I went through them about 20 or 30 pages a day……while I walked to my playing field or to the gym. Thank you guys and all the kickass members. If you come across anything…that is in FA and UW….which you don’t understand……don’t just let it go……Google it, wiki it, post it on the Facebook group, ask your friends etc.…etc.…but understand it.

 

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Friends, I think I was an active member of Facebook group….and those discussions, those images posted by someone else, those files uploaded….all were helpful. Yes…there were times…when I felt so much frustrated…by someone else posted questions…I felt….OMG…I dunno this, I dunno know that…so many people…know this thing… “am I the only one who doesn’t know this??” Those posts made me feel idiot sometimes…but most of the times they were inspiring, knowledgeable, encouraging. Many friends sometimes posted their agony and insecurities …and it was really so satisfying to encourage them with some inspiring sentences. So, getting actively involved in the FB group does help a lot.

 

Friends, throughout my preparation my mantra has been…”study, sleep, stay healthy”…all 3 equally important. Resist your desires…to compromise your sleep…or diet or exercise…just to study few more pages. What is the use of studying so much…if your brain can’t remain alerted and think well?? Never ever during the course of my preparation, I exceeded 12 hours of study…not even when I was on leave. I used to sleep at least 8 hours, exercise regularly(sometimes playing football…sometimes going to the gym). I followed these schedule…as late as 4 days prior to my exam…While I was revising FA and UW….I made a note of that stuff …which was volatile…in a separate notebook……they were almost 50 pages in my register sized notebook with font size very small….I rapidly went through them in my final 2 days. You must have noticed friends……during my final 7 months of preparation… there was no Kaplan, no Pathoma, no Goljan….all that was…is some important stuff that I had annotated into my FA…which sometimes required A4 sized paper to be added in between the pages of FA.  Get yourself enough sleep…prior to the exam (very important).if you can’t….take medicine….I took Promethazine 25mg. One of my friends…took Zolpidem.(but beware…of the adverse effect…like next-day sedation, dizziness, etc.). So don’t use it for the first time…in the night prior to exam day…what I did was…I experimented with the drug…1 week prior.  

 

Why sleep is important??

Because step 1 exam wants you to think on your toes….throughout the exam…there are very few straight memory questions. It wants you to APPLY those concepts that you have understood and memorized…in the situation given in the question. And you WILL face those …out of this world questions, which requires a CALM and ALERT brain…I had many such questions in my exam. An alert brain…is equally important….as important as your whole study.  

 

And please…check your documents you need beforehand to avoid last moment panic.  

 

 

 

Exam day

I woke up…feeling refreshed….got ready for the test…took a heavy breakfast. Went to test-center……I was calm I think….maybe a little anxious for initial 20 minutes of the test….after that it was like NBME for me….some questions were very easy…some questions (like 4 or 5 in each block) very very difficult in a sense that…I didn’t even know what it is trying to ask…read the question again….got some idea……looked at the options and applied the “rule of ruling out”….this helped me a lot. I was anticipating…few WTF questions in every block …and so was it. The moral is….don’t let yourself down when you see such questions…because u will certainly face it. Use your brain…& think rationally. Sometimes u will find…how simple that question actually was. Yes… sometimes they give a lot of unnecessary details…just to SHOW…that the question is complicated …which, in fact, is not.  

 

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Yes…exam time was enough….on an average…I finished each block about 10 or 12 minutes early….that remaining time, I used it to go after my marked questions……there were on average…10 or 12 marked questions in each block. I took 5 minutes… sometimes 10 min break after each block…after 3rd block. I took so-called lunch break although I was not hungry. I took some energy bars, fruit juice etc.

 

Never ever…even in my dreams. I thought of getting this score. I never deserved it…maybe luck favored me heavily, maybe my parent’s blessings worked for me, maybe my parent’s dedication towards God (which they always have been) worked….maybe all your blessings worked.

 

Sometimes, I feel so guilty. I am a criminal to my college friends…I skipped…some of my closest friends weddings…that was so selfish of me. My jigris, if you are reading this….I am sorry to you again. My colleague friends at my workplace have been so helpful….they did work extra…Just because I could get more time to study. Thank you, my colleagues.  

 

Guys….I never felt complete…going into the exam. I think…nobody does. But yes. I was calm n  confident that I will do well. I repeat…you don’t need to know everything….u don’t need to memorize everything…what u need is to…recognize…when u see it……Rule out the wrong ones. This worked …so heavily for me. And stop comparing you with others….you will always feel…you are inadequate…you will always feel you don’t know so many things….and this and that person knows so much.

 

Guys…this is it…I think. Yess….there were a lot of days….throughout my preparation…when I felt so down….so depressed….so idiotic that I don’t know anything. I even thought of quitting …so many times(sometimes due to my family health problems, sometimes due to the frustration of this long journey, sometimes due to the feeling like” why should I suffer this much when I am already into this government job” etc. etc.)….But then “Nothing in this life …that is worth something is easy” and “Never go down”.

 

All the best.

 

 

🍁  Author

Dr. Ashok Chaudhary

 

 

🌿  Acknowledgement

This article was first posted on Facebook. It was published here with the permission from the author (Dr. Ashok Chaudhary).

Image designing was done by Arnab Mukherjee.

 

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