Hey guys, I just took the beast a week ago. I’ve been using this forum as a resource for a while now, and I just wanted to contribute those who have yet to take it.

 

I also posted it on SDN. This is for those who want to have a “feel” for gauging the test.

 

One thing very difficult to grasp and that I’ve wanted to know prior to my exam was: What is the STYLE of questions compared to the practice tests. Here is my personal interpretation from the exam:

 

Type 1. Straightforward knowledge-based question. Seen in typical NBMEs and a good deal of questions on the Step.

 

What’s the state capital of California?

 

a) Kathmandu

b) New York City

c) Sacramento

d) San Francisco <– The only other “PLAUSIBLE” answer

e) Beijing

 

For these questions, if you read that paragraph on FA or heard Sattar’s beautiful voice on Pathoma, you’ll get it. Pretty straightforward.

 

Type 2. The verbose stem but straightforward type. A good deal of questions UWorld, some on the real Step 1.

 

State capitals are really nice. Some are big, some are small. The patient comes from some the state capital, and he really likes them. He also likes dogs and cats, but not skunks. Why not skunks? Because they smell. Here’s a map of Nevada:

By the way, what’s the capital of California?

 

Same answer choices.

 

For these questions, it’s simply a matter of skipping to the end (if you’re confident) or skimming it (if you’re a fast reader) and ignoring irrelevant BS. The trouble is not getting bogged down. I distinctly remember a handful of questions on my test that had the key facts in the middle of the literary novel.

 

Type 3a. The straightforward question with HARD answer choices. Some Uworld, a large minority Step questions.

 

What’s the state capital of California? “OOO I KNOW THIS”

 

a) a large commune sitting at the base of the Himayalas. <– “OH **** can’t be Himalayas”

b) New York City <– easy elimination

c) a population center which has a subpar NBA team windward of the Sierra Nevadas. “WTF…this..maybe?”

d) a metropolitan area closely associated with the MUNI transportation system. <– you gotta know MUNI is SF and NOT Sacramento

e) a city in a province <–Classic vague answer choice.

 

As you can see, the QUESTION itself isn’t hard. But the answers PARAPHRASED with additional facts that you must know to answer that question. You might know that the Sacramento Kings are a bad NBA team which would help. You may have never heard the word “windward”, but you can sort of guess what that means. This is when good ELIMINATION and INTUITION come in.

 

Type 3b. Straightforward ANSWERS but vague QUESTIONS. A large minority of Step.

 

There are areas that may determine the legislative future of its surrounding area. That large region around the Pacific that’s part of the US, what’s that legislative-area?

 

a) California. “What? no?”

b) Oahu. “Well, it is around the Pacific…but legislative?”

c) Sacramento

d) the White House. “It IS politically-related…but it’s not an AREA?”

e) Dolphins <–easy elimination

 

I would say 3a/3b are why people come out of tests so unsure. Notice how it’s awkwardly phrased with non-specific words. It’s not terribly long, or terribly anal in its wording, yet it’s hard. I suspect there’s only so many ways you can test one fact, so they gotta soup it like this.

 

Image - Quote

 

Type 4. “WTF?!” Only seen in real Step 1.

 

Who’s that one construction worker who worked on that capital building of the capital of California? <–super specific

 

or…

 

Where do you get sandwiches around the capitol building? <– easy if you KNOW the answer but WHY WOULD YOU?

 

I would argue there’s NO DELIBERATE WAY to study for these questions, other than having incidentally heard it OR having closely listened to professors during your first two years. It helps to have good long term memory too.

 

On MY TEST (YMMV), I would say the approximate break down would be:

40% Type 1 questions.

15% Type 2 questions.

40% Type 3a/3b questions.

5% Type 4 WTF.

 

These are obviously arbitrary classifications (just as in a lot of medicine). There’s overlap and some questions can be a combination. But I hope you get the idea.

 

So in summary, MOST Step questions (Type 1/2/3a/b) can be answered with UFAP studying, but a good amount requires ADDITIONAL processing of the question or the answers. And obviously some questions are next to impossible (type 4) but I wouldn’t worry about those.

 

Hope this will help someone with a similar mind to me 🙂

 

Author and Acknowledgement

This article was first posted on Reddit by the author (username – u/GarbledLogic). It was published here with the permission from the author.

 

Abbreviations

SDN = Student Doctor Network

UFAP = UW + FA + Pathoma

UWorld = USMLE World

SF = San Francisco

NBME = National Board of Medical Examiners

YMMV = Your Mileage May Vary

WTF = 🤐

 

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2 Comments

  • Anonymous Reply

    Most amazing article on Step 1, simply WOOOOW !!!!!!!

    • Sherlock Holmes

      I agree with you, very beautifully written.

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