My experience - how a slacker got a 254/99

bones4u said:

To the common med student? maybe, maybe not. To the highly motivated - hell yeah!

Doesn't matter where you start - its where you go from there. Reading the books can be done in 6 weeks, it can be done in 4 weeks. You need to pick the best ones, read them, and annotate into FA. The last two weeks is when you really get things coming together - and keep your focus on the big picture - mechanisms, concepts, why (as goljan says)

Being motivated isn't going to increase your IQ or reading speed. There is nothing wrong with his plan if a student is given enough time aka 3-6 months to apply it. I just take issue with the tone and the infomercial like quality of his advice. Most students take 6 months what he did in 6 weeks. I just don't feel it's responsible to imply that anyone can do what he did in 6 weeks. There are people who say then need 4 hours to do 50 questions. So how did he do nearly 9K questions, read all the BRS, Hi-Y, Golgian etc in 6 weeks. There is a difference between inspiring versus misleading. I don't think the OP is lying to the forum. But I do think he is underestimating his intelligence. This guy is a genius whose plan wouldn't work for 99% of the people who read this. I'm just afraid people are going to try his ridiculous plan and then freak out when they haven't gotten through a 1/4 of what he did after 4 weeks.

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bones4u said:

Dude, that was me who posted the rebuttal - anyways this thread is supposed to be advice from experience, so if you'd like to continue arguing lets move it to PM.

I would like to clear up one thing, kindly re-read my post. Nowhere do I mention doing 9k questions, instead I clearly state I stopped using Qbank (at 24%), and only did about 60% of UW.

If you want to argue anything else, please PM me. Thanks.

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lord_jeebus said:

I don't think it's that unreasonable for 6+ weeks for a highly motivated student, even an "average" one with great inner strength.

At 100 pages/day, which doesn't seem that overwhelming (particularly with HY books), you could read over 4000 pages in that time. It seems to me to be an issue of endurance, not speed.

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fatsal said:

The books will obviously vary in content so some books will be challenging for even a 100 pages. First Aid is dense so 100 pgs of that is much more challenging than 100 pages of High Yield. Also, the subject matter varies too. And that's assuming you are doing no questions. I agree that it's a matter of endurance but it's also a matter of aptitude. "Inner strength" isn't going to increase one's reading speed. Again, it's about being smart and recognizing your strengths and weaknesses. One has to be practical and accept they aren't going to get a 250 with 6 weeks left unless they are a genius like the OP. It's better to try and attain a more maneagble goal and maintain your sanity and health. I'm not suggesting that people can't achieve a 250 however, if someone really wants a 250 and they are of average intelligence, he or she should have started studying 6 months ago.

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KNightInBlue said:

looks like someone really likes to argue

I agree with the other posters on this thread - its definitely doable. I started 4 weeks ago and in that time went thru HY anatomy/Neuro/Histo/Cell and Mol Bio/Pharm/Immuno, RR Neuro/Histo/Pharm/Biochem/Physio/Micro, BRS Physio.
Going thru Kaplan lecture notes this week and doing goljan RR Path along the way.....aim to be done by end of next week

bones is right, its just a question of endurance and motivation - any 'avg' med student can do this

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Taus said:

no need to get worked up about it....just disregard the parts about how high he scored and how much he did in his prep period....there's still some damn good advice about the boards on here....

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fatsal said:

I'm as worked up as the people who responded to my thread meaning I'm not worked up at all; I'm just lending my opinion like they did. I agree that his preparation was thorough, I just disagere with the tone of this thread that anyone can do this in 6 weeks. I feel that is irresponsible especially considering thousands read this.

Anyone who has really excelled on this exam knows there are no shortcuts. The majority of people who scred a 250 will tell you that it tooks months of preparation to achieve that score. Those people who are reading this know the OP's story is a rare case but won't respond because these infommercial like threads are all over SDN. I typically ignore these threads but I decided someone has to say something because some poor MS II will read this and mismanage their time as they foolishly try to cram all these books into 6 weeks as opposed to doing questions and taking a more balanced approach.

I strongly discourage anyone from wasting what few weeks they have left with trying to read every review book that is available. That's very counterproductive. Instead, focus on a few sources and do as many questions as possible.

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fatsal said:

I'm as worked up as the people who responded to my thread meaning I'm not worked up at all; I'm just lending my opinion like they did. I agree that his preparation was thorough, I just disagere with the tone of this thread that anyone can do this in 6 weeks. I feel that is irresponsible especially considering thousands read this.

Anyone who has really excelled on this exam knows there are no shortcuts. The majority of people who scred a 250 will tell you that it tooks months of preparation to achieve that score. Those people who are reading this know the OP's story is a rare case but won't respond because these infommercial like threads are all over SDN. I typically ignore these threads but I decided someone has to say something because some poor MS II will read this and mismanage their time as they foolishly try to cram all these books into 6 weeks as opposed to doing questions and taking a more balanced approach.

I strongly discourage anyone from wasting what few weeks they have left with trying to read every review book that is available. That's very counterproductive. Instead, focus on a few sources and do as many questions as possible.

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Aseptic Pimp said:

fatsal, it is obvious that bones is not a slacker. Gunners call themselves slackers (no offense to the op). Just take a look at his post, does that sound like a slacker at all? He has everything organized to concise detail. "Slacking" to them is being ahead of schedule instead of being WAY ahead of schedule. Im sure the op studied extremely hard during his first 2 years. Understanding does not come in 6 weeks, it comes over a span of 2 years. You would have to take all the classes to be able to integrate everything later in the first place. But at the end of the day his post has legit advice. It is up to YOU to figure out your own schedule based on your own aptitute. Thank you for the excellent post bones.

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bones4u said:

First off, I want to thank SDN and its collective wisdom, some really great stuff on these boards. I just got my score back today, and I’ve been putting together this guide for a while now to give back to the community. (Its LONG!)

So, how did a guy like me who slacked off in basic sciences (I only marginally passed immunology) do well on the boards? Play the game – Know what they’re asking and you’re already two steps ahead. Here’s a good breakdown of how the test goes:

Out of each block of 50 questions, approximately:

• 25-30 q’s would be ones you know, from studying your ass off
• 10-15 q’s would be ones you *should* know, i.e. you studied but forgot, or there are little details that are tripping you up, etc.
• 5-10 are the “out of the box” q’s – experimental, stuff you’ve never seen before, minutia from your syllabi or even college courses.

Also this test is very integrative. You’ll have path, phys, and immune all in one question. They’ll combine all types of things, have you make these crazy connections – but with a strong foundation you can do it. The goal of your studying is to maximize those first two groups of questions – by building a strong foundation of BOTH concepts and details.

Strategy:
I had about 6.5 weeks to study – I would say 7 but it took me almost 4 days just to get organized – like figuring out which are the best books, putting together a schedule, etc.

Also, GOLJAN GOLJAN GOLJAN GOLJAN GOLJAN. The man is amazing, he puts stuff together like you can’t imagine. Pepper your studying with his audio lectures – i.e. listen to him whenever possible. The last couple of weeks, I would listen to him while driving, randomly throughout the day, and even in the shower/while getting ready (I know its nuts, but I got an extra lecture in everyday this way!)

Daily Schedule I would study about 10-14 hours a day, depending on when I wake up, and how I was feeling that day. Early on I would spend most of the time with books, then more time with FA as the date got closer. I would try to do 100 q's a day, but it would usually be 50.

First, start off with a pass of first aid – go through it and realize what topics you know well, and what topics you will need to focus on. Also familiarize yourself with the layout, it can be confusing at times and knowing where everything is will definitely save you some time. Then, go through the various study books you have – Read important details, really go through for UNDERSTANDING, and annotate details as much as possible into FA.

Here are my thoughts about each subject and the best book to use (based on my pouring over previous experiences and from personal experience):

• Comprehensive – First aid is still the best. At first I hated the book, and then I realized just how much information is in there. It really is an acquired taste – just get used to it at first, and make sure you annotate into it. It does have holes, and you need to fill them up.
• Question banks – So I have to say trying both Qbank and USMLEWorld, that UW freaking rocks. The question style, subject matter, etc are all so similar to the step. Qbank is a great tool for testing facts – but their questions focus too much on minutia. UW Ties those facts in with concepts – its great how they do it, and that’s exactly what you’ll have to do on the test. Plus UW costs less (after all those books trust me it adds up). If you only have time for one – do UW. Your brain will hurt, but that’s what the test is like. It really helps maximize those “should know” questions I talked about earlier, and helps tie together concepts. But make sure you read the answer choices and explanations, especially the “educational concept” at the bottom. If you have a time for a 2nd, I would then suggest USMLE-Rx – only because going through the answers is like another read of FA. Qbank? Sorry, but its yesterday’s news.
• Biochem: RR Biochem – Goljan – I always had a tough time with biochem, and this book was a good balance (in between HY biochem and Lippincott’s). The biochem q’s on the test weren’t too difficult, you either knew it or you didn’t. A lot of the tougher questions came from molec/cell biology (see below)
• Anatomy: HY Gross, HY Neuro (I got HY embryo and histo but didn’t use them) – Had quite a bit of neuro and extremity anatomy (upper and lower) – and an xray of a fractured foot which kinda threw me off. Otherwise not too difficult – the consensus here is really knowing upper/lower extremity and neuroanatomy well. Know the embryo from FA, and tie in Histo to disease, bc that’s how it’ll be tested.
• Cell/Molec bio: HY Cell/Molec bio – good book to familiarize yourself with concepts like hox genes (I had 2 q’s about them), Zn finger proteins, heat shock proteins, and cell signaling/receptor/2nd messenger stuff. Also great for knowing different molecular tests, DNA/RNA synthesis, etc. A lot of the “out of the box” questions come from molec bio, worded strangely and can piss you off, but you have decode what they’re asking and this book will help understand whats going on.
• Behavioral science – I used BRS Behavioral, and it was a good book. I had a good mix of behavioral on my test, this section makes up a relatively large chunk, and like everyone says it can make or break you – so study it well. I also had a lot of patient response questions, which are generally difficult to study for, and there are always two answer choices that look good – really try to figure out the best on though.
• ID/Micro – Micro Ridiculously simple – still the best book for micro – great stuff, annotate into FA – haven’t had a chance to look at the newest version. Micro is pretty well represented in the test, and they test details; also know your Abx well. Delve deep into the differences between each bug, the various ways they can present – compare and contrast different infections; and focus mostly on bacteria – then on viruses, then on antimicrobials – then fungi – and least important are parasites.
• Immuno – I used HY Immuno – good read (90 pages of like huge text); but here is a key point. Immunologic processes play a huge role in the mechanism of diseases, and you know this test is about mechanisms! So know your immunopath well – i.e. ARDS in pancreatitis, why?! Why do you get the consolidation in pneumonia (related to diapedesis). So much of immune related to pathophys – so learn it in immune well, learn it in FA well, learn the immunopath during pathology well.
• Physiology – BRS Phys is great – especially since this section can be tough. A lot of charts, graphs, arrows, messy stuff. I had a good mix of cardio/resp/renal/GI phys. But really really understand what physiological changes take place during exercises/sympathetic stimulation/high altitude, and those sorts of things. Really be able to tie in with path, bc pathophys is “big-time boards”
• Pathology – RR Path by Goljan – I think its better than BRS, because its more integrative. I would say Path is getting “diluted” on the boards, because they are now mixing in path questions with biochem, or path with phys, path with immuno, etc. And goljan does a fantastic job of bringing these points together. Really focus on the first few chapters, really understand the different types of necrosis, know your immunopath, dig deep into mechanisms of diseases. Pictures - I looked at Goljan's mostly, and supplemented a few with WebPath, for most you can tell what you're looking at from the question (1 of them from the answers )
  
• Pharm – USMLE Roadmap – Pharm - The pharm on the test is straight forward, and usually ties in with other questions. FA is great alone, especially if you already have a strong background in pharm. I had a tough time with Pharm, bc our school doesn’t teach it well; so I really focused on this section near the end.

NBME - After going through everything once, and/or two weeks before your test – I suggest taking an NBME. This will really let you know A) where you stand and B) where your strengths/weaknesses are. This will help you guide the last couple of weeks to focus on what can trip you up, and re-enforce your strengths. Also, the NBME questions are by far the most representative questions to the actual thing – so look at the style of questions. Forms 2 and 3 are the most representative of the actual thing, Form 1 is supposed to be the easiest, and Form 4 is the most challenging (a lot of molec bio).

The last couple of weeks then, really go through FA and your notes, atleast once in depth, twice if you can, and once more in your weakest areas. Throw in some goljan as you can, and also keep doing questions (more on that to come). Keep thinking outside the box, tie together concepts, try to anticipate how they may ask the questions, and make sure you are picking up on the finer details. This is your time to re-enforce concepts, and really memorize the little details you picked up the first few weeks.

The final week, really kick it up a notch, even if you can’t feel like it. That last week, my stomach would churn even holding first aid, but I knew I had to. Do some questions if you want to, but time is of the essence. Think through everything, UNDERSTAND concepts, whats in FA and your notes – learn all the details like about the viruses, the cancer drugs, the different CAH deficiencies – etc. Live and breathe FA

The last day – go for memorizing whatever details you have left, like anatomy, pharm side effects, etc. – pick up what you can, but don’t overdue it. Set a schedule, and a time to be done. After you are done, THAT’S IT. PUT THE FIRST AID DOWN! You know what you know – and trust me by now, you are prepared.

I knew I would have a tough time sleeping the night before, so I didn’t take any caffeine or sugar after noon the day before. After I stopped studying, I just relaxed – watched Borat, got my mind off things, and went to sleep, knowing that freaking aye man, I put my life on hold for 2 months, I was listening to Goljan in the SHOWER! I’ve done everything I can, so now I just gotta take it, and in a few hours it will be over.

The test: I arrived early, with a bag full of junk I never ended up using (except lunch). I spent each block going through the questions, and would mark the tougher ones. At the end of each block, I would go through all the marked ones, and really think through them, until I had gone through all of them. Then I would go through the whole block again, just to make sure I didn’t misread or miss something, and I would have about a minute left after that. Whatever you do, TAKE A BREAK between each block – even 2 minutes. Just zone out, wonder which test the 60yr old guy next to you is taking, but just let your brain relax. The prometric staff were professional and everything went smoothly. Seats were comfortable – they just need to get freaking LCD screens

I thought the first couple of blocks went well, then it was downhill from there. I started feeling feverish, my heart was racing, I had a bad headache, I really thought I was getting sick. Also my eyes were getting strained from the computer screen. So I would walk outside during each break just to get some fresh air. The test is a mind game – and honestly it got the better of me – I was getting very anxious, I had to calm myself down a few times. I’m telling you this now – so you can prepare for it if it happens to you.

Timing By now you should’ve been taking questions in timed blocks of 50, so you know if speed will be an issue. If you are slow, try to look for the simpler questions, realize this is one of the ones you know, and move on, save your time for 2-3 step questions. If you know you rush, fight the urge! You’ve spent two months studying, whats a few minutes? Look over each question carefully, I almost missed (atleast) two questions just because I missed one (yes ONE) word in the stem!

After the test – damn man, you’re freaking done. You did it. Now go back home, go see your family or your friends, go see the sun, go do anything. Just live life. And wait patiently for your scores (argh).

So, as far as #’s go:
First starting – about 50% on UWorld, 60% on Qbank (I stopped using Qbank about half way through)
NBME – Form 2, taken two weeks before the exam – 228
I was getting 75% on UWorld the week before the exam (finished about 60%)
Final score – 254/99

Thanks again to all the collective advice on SDN – and I hope this experience helps you out. Best of luck, and I know you will kick some ass.

Any questions feel free to ask away!

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fatsal said:

Uh...you might be a slacker but you are also a genius.You must read at a lighting pace because it would be difficult for normal med student to read all the BRS, HY and do every question bank in 6 weeks. Congratulations on your success but your advice isn't any different than the guys who spent 6 months preparing for the exam. You were just able to accomplish what they did in 6 weeks versus 6 months. Also, starting at 50-60% on Q-bank is quite good and what the students in the top 10% of the class get. No offense, but there is no way your advice applies to the common med student.

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Tired said:

6 months to prepare? Four hours to do 50 questions? What the hell are you talking about? Are you a foreign or Caribbean student or something?

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Tired said:

6 months to prepare? Four hours to do 50 questions? What the hell are you talking about? Are you a foreign or Caribbean student or something?

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daelroy said:

What the he$% are you talking about? I guess you missed the unlimited number of threads scattered all over SDN with people starting their Step I review in January. One of the most well known and highest scoring Step I SDN members Big Frank spent 6 months preparing. I guess he is an idiot too.

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lord_jeebus said:

Yeah, but for about 5 1/2 of those 6 months he also had class.

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daelroy said:

I think most people are intuitive enough to figure that out when one mentions they started preparing in January

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lord_jeebus said:

But that's not what fatsal and Tired are talking about.

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goodies said:

bones and other step 1 experts, how much were you able to retain after reviewing a certain subject?

i usually review a certain subject, do some questions, and then move onto a new subject... but i always leave the previous subject uncomfortably... i don't feel i have a good grasp on it, but i feel the need to keep moving forward.

so my question is, what's better... learning the subjects very well one at a time before moving on to the next, or running through all of them quickly (but uncomfortably) to have gone through everything once and then repeat?

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