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Yep... most of us would fail step 1 if we had to take it right now.
But that's because the minutiae that's tested there isn't clinically relevant. It's a foundation. All you need to retain in active memory is the basic concepts.
Knowledge of which specific binding site is involved in Goodpastures doesn't help me much. For clinical practice, I know it's the basement membrane, but could really care less that it's the NC1 domain of the alpha-3 chain of type IV collagen. That's the sort of information that gets lost with time.
I think the most important thing is knowing of these things so that if it does become relevant, you know what to look for. There have been plenty of times when I was like oh yeah wasn't there a disease where blah blah blah and I looked it up. It's not there with me being able to rattle it off the top of my head but I do know where to find the information.