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After wrestling the beast, I realise that no amount of training can truly prepare you. It’s like nothing else out there. That being said, this account is an attempt to alleviate the anxiety that will plague me for hopefully only the next three weeks. Reading past experiences guided me during the gruelling undertaking that was my STEP 1 preparation. Maybe it will benefit you knowing the path I took, maybe not.
tl
dr (skip to the bottom if you're just after my stats on qbanks)
Eight and a half months ago I cracked open First Aid and got a taste of what lay ahead. It had been four and a half years since I finished my second year of medicine, so everything seemed a little new. I had never really studied very hard in med school because there was not much payoff in my system. You never really had to understand anything. If you knew a little bit of everything you’d be fine so I focused my learning on what I found interesting; mainly diagnosis and the clinical aspect of medicine. So a lot of what I now had to learn was new or information I had glossed over during my foundation years because it was of no utility to me. I never saw the point in knowing BRAF and RET are associated with PCT or the multitude of different CD markers.
Initially I had planned to invest very little money into my preparations as bootlegged resources are very easy to come by. I only bought a set of Kaplan Lecture Notes and First Aid, what I believed was essential according to sources researched years ago. It probably wasn’t the smartest idea not to research the new trends and resources available. I hear anki is all the rage now, but technology seems to be leaving me behind in general.
I started out slowly doing a couple of hours of Kaplan videos a day and reading through the corresponding text the next day. During med school I discovered the only way to learn anything was repetition and so the method I developed was to read through the text three times on the first pass. Once to let the information seep into your brain, once to sort out what seems useful and highlight it for later and a final read to underline the key points for rapid review later. I then had to reread my highlights the day after the first reading and a also a week after that, attempting to recall it from memory before checking the page. This way the information starts getting familiar. Bear in mind I despise studying and hate repeating anything more than once, so it requires a little discipline but studying without retention of the material is pointless.
Going through the Biochemistry lectures, I started doing a little more every day, building momentum. I really enjoyed watching those recorded live lectures and thought it would be useful and more enjoyable to have a more interactive form of learning. It just so happened that Kaplan was starting Summer course at a time slot that didn’t need me to be a vampire. It was an accidental find but a stroke of good luck at exactly the right time. According to their schedule I would get through their material in four months - three months less than at the pace I was going at. I signed up without any hesitation.
They provide a medical advisor who is useful when you’re starting out and have no idea where you stand but the advice is a little generic at times. Still, it was useful for me to bounce my ideas off of someone who knew the upcoming battle better than I did. The reassurance also helped my crippling anxiety until I could touch my goal score.
The live classes started out with Biochemistry again, which I had managed to finish before enrolling. Since I didn’t need to read my material as intensely I decided to read ahead and use the live classes as revision and a chance to clear my doubts. I used the extra time to watch recorded video lectures of the next subject to be covered and read the lecture notes, while taking the live online classes in the evening and reviewing the corresponding notes the next morning. This added another couple of layers of repetition; painful but efficient. I aimed to complete the subjects about three weeks before the live classes so that the fourth pass would be almost a month after the 1st. I did an extra pass for Micro and Path because of all the nitty gritty details.
I was studying about 10 hours a day. We were advised to do 10-15 bank questions a day, which I was initially getting done before my morning boxing session, but later I prioritised getting through the material so that my spaced repetition was adequately spaced. I highly recommend not touching the bank until you’ve finished a pass of all the subjects because certain categories are covered in a different subject and the explanations are not the easiest to understand without a base. I do recommend doing the on demand quizzes as you go along and the subject tests when one is complete.
By the end of august I had finished the live online, about 500 of the Kaplan bank and about 300 pages of First Aid. I had also started sketchy micro around the beginning of August. It seemed terrible at first but I found that those bizarre picture associations seemed to stick, so it got incorporated into my plan. I did the Kaplan mid term and final, definitely not even close to USMLE quality. My advisor was very impressed with my performance, but I was starting to burn out.
My sister was in town for a few weeks, which did’t help my diminishing motivation. I had my med school graduation at the beginning of September too. My sister, dad and I took two days out for that. After all this time and preparation I still hadn’t even applied for the STEP. Initially it kept me calm knowing it was a far off date that hadn’t been set yet, giving me plenty of time. I was planning on an early December date but DEC-FEB permits only become available mid september so I had to wait.
The day after returning from my med school, I was able to apply for my permit. This meant another trip back to my med school 300km away and days waiting for the slowest clerks on earth get a document signed and shipped. Without follow up, they tend to forget, so I had to stay five days. Five days without a single USMLE question or any form of studying, just a trip to the office in the morning, then drinks with old friends later in the day. It was probably the best cure for my burnout. I got tired of doing nothing and left for home leaving a close friend responsible for following up.
Back home I had to compensate for my three simmering weeks since the start of September where I only managed to about a block of day. I had planned to be finished with Pathoma by this point but I suppose the break may have allowed me to press harder in this next phase of preparation. That’s probably just my optimistic side talking, which I usually tend to ignore. My advisor had told me to take the Kaplan simulated exam and an NBME a week ago so I bit the bullet and did the SIM exam. I got 244/280 and realised I had no idea how the USMLE is scored. Looking into it won’t be of much help because the NMBE guards their secrets herbs and spices a lot more closely than your favourite fast food restaurant. Going by people’s past experiences can help gauge where you’re at but you’ll never be certain, not until you see your score in your inbox. My advisor was impressed with this score too and I was beginning to feel most other test takers have a harder time with this. He told me the best predictor was to do an NBME. So After I finished my first pass of FA, using the same spaced repetition method of course, I took my first NBME (15) the beginning of October.
My stomach was full of goat soup and I took it pretty lightly, taking a few breaks and not really caring too much about it. I just wanted to get it out of the way so my advisor could tell me what to do next. What I truly needed was more intrinsic drive and new material. My advisor was once again impressed with my 248, but this was well below my goal of 260. He was afraid I wouldn’t be able to retain the information, whereas I felt I had very superficial level of knowledge of most topics. This gave me the kick I needed and I was able to pick up a pace, doing my last few block of kaplan and watching Pathoma, while reviewing it and the rest of my path the next day and a week after. Going through question banks, I realised the vast majority of this test is probably Pathology so a extra read can only help.
Around the first week of October I started UWorld and fell in love. What a delight it was to read such well written explanations. With the Kaplan questions, I would take screenshots and review the every day until I could recall the information before looking. Now without screenshots, I turned to writing notes. I did them in a flash card format so as be more active. Halfway though I realised I was writing the same note again and since the system clearly wasn’t working, started writing notes directly into FA and made a spreadsheet with page numbers and a keyword or two for recall. This method was much better and I recommend that all notes should e written in First Aid, otherwise there’s a high chance of repetitive note taking. Scattered notes are difficult to go through at the last minute as well. Hindsight 20/20. The spreadsheet entries would only get checked when I was satisfied I could recall all the associated information. This revision was also painful but there were a lot of new concepts I gained through UWorld and wanted to have them readily accessible in the back of my head to be brandished at will.
At the very end of October I took my second NBME (16) and got 263. It’s usually reassuring to cross your goal score, but my self doubt won’t let me believe that it wasn’t a fluke or a miscalculation. Do I need to mention my advisor’s reaction at this point anymore? He still felt retention would be difficult since I was so far from test day. I however planned a last round of revision was there to solidify any information that was still loosely held.
After getting through Pathoma, I revisited my Kaplan notes for what was probably going to be my final round before D-day. This time I would read the material once and repeat it the next week making notes of things still not firmly ingrained. These post it notes were stuck and read until all points could be recalled from memory and then repeated a week after that. The same way I did the final Pathology review combined with Pathoma. This was also the time I started panicking that my time left was getting shorter and I was not in a comfortable enough position. I decided to become a shut in after I couldn’t enjoy Kingsmen 2 (It was pretty bad) because all I could think about was how much time I was wasting not studying. I quit boxing and weight training shortly thereafter to maximise studying. I also started showering only twice a week now that I was barely breaking a sweat, not the most hygienic confession but that was the level of my anxiety. Detangling my mane was a luxury I gave up in exchange for an extra 2 hours a week.
The load was piling up and my hours had to match for me to be able to finish at least half of what I had planned on. I started doing about 12-13 hour days to accommodate a UW block everyday reviewing all the questions, previous UW reviews and some Kaplan Lecture Note review from the last week and some fresh Kaplan review for the day. I squeezed in some Sketchy Micro during breakfast and lunch. My only downtime was dinner with Dad, my morning bowel movement, 15 minutes of conversation with the aforementioned friend of mine and bathroom breaks. Sometimes I would crack and read through some past experiences on SDN and other forums or buy stuff for my desk from amazon. Once a week I would do seven blocks at a stretch to stimulate the real deal and build some stamina. That seventh block was a challenge initially. It also helped me figure out my food and water consumption and how to time them with the bathroom breaks because STEP 1 is so generous with their break time allocation (I hope the sarcasm is obvious). The thing I missed most during this intense phase was my morning play time with my puppies.
Mid-November I took another NBME - 265. An upward trend is good and this reaffirms that this is my range and not just a happenstance score. At the end of November, after finishing my first pass of UW, I was deciding which bank I should do next. I had just enough time for one more and Rx seemed to be more highly recommended than Becker or Medbullets, which were the only other options I was aware of. I later found out about Pastest (free this year) and loxolab but it was too late by that time. First I wanted to get through all the retired NBMEs (1-12). I found not having to review UWorld a welcome break. It’s a lot less taxing just to look up answers on different forums and I was just taking notes that I planned on reviewing only once; just before test day.
Early December I started Rx and while reviewing the answers, found them to be fairly cursory for the most part. A few were well explained but I already knew most of these concepts so decided to read through only my marked and wrong questions and questions where there were unfamiliar options. I would highlight anything unfamiliar (mostly minutiae), download the notes (an incredible feature I feel all other question banks should adopt), read them the next day and reread anything that still seemed unfamiliar. I was trying to grind for that low yield that could show up while reinforcing the neural pathways of the higher yield material I already knew. I did the questions as fast as I could to build speed and save time, so there were a few careless errors. My Practise exam at the Prometric centre was pretty cold and noisy, so I also had to readjust my home A/C to 19C to adapt and I ordered some earplugs - finding a pair that would fit into my small ear canals and block out the distractions took a couple of weeks. I prefer colder temperatures, but it takes me about 20 minutes of shivering for my body to adjust and I couldn’t have that affect my performance each time I took a break. I was able to bring down my water intake to 2.5L from my usual 7L to avoid needing the restroom.
My Kaplan review was going fairly slow at this point. I had half of Anatomy, Immunology, Micro and Pharm left. Another round of First Aid was also a minimum goal. After anatomy I would only read the text once and make notes which I would read till everything was familiar. No more weekly repetitions. There were 24 days to go, I didn’t have the time to be thorough and just hoped everything would stick till test day. I got done with this last round of Kaplan Notes by mid December and had to race through FA. Initially I used the same post it method but it was too slow for me to finish in time so I started marking things that seemed slightly unfamiliar and read it the next day. Whatever was still unfamiliar went on a post it note but no more active recall, just a single read through. I was banking on these superficial connections to suffice rather than be blindsided completely by a question on some unrevised topic. Mid December I also hurried through my Kaplan qbank incorrect questions because my subscription was expiring and I was afraid time would not allow me a review of my screenshots. Their tech support is the absolute worst! There were 12 questions that I was never able to access. When I brought this to their attention, they first assured me there was no problem when there was and after pestering them got a month free while “their developers got back to them”. A month passed and when I emailed them again, all I got was stony silence. I don’t want to encourage piracy but I make an exception for Kaplan. Their content is good for the most part but the most of the faculty only replied to 1 or 2 of my emails before ignoring me.
17 days out NBME 17 - 269
10 days out NBME 19 - 271
Confidence was sky high after 19, especially because everybody says it’s a tough test and under predicts your score. I finished FA 3 days out, but still had my initial UW notes to go through and the notes I made doing the retired NBMEs. I had also started doing my UW incorrect about 10 days out and unfamiliar facts or concepts went on a post it to be read the morning of the test.
2 days out NBME 18 - 263. It was disappointing especially after 17 and 19. I was advised to take 18 after 19 for my confidence, but clearly I’m an exception to that rule. The rest of the day was spent looking at all my incorrect NBME answers and all of the NBME pictures and graphs in case they decided to reuse one on my test.
My last day I finished the pictures and read a few post it notes of formulas, Inheritance patterns and other topics that I found be volatile over the course of the last few months.
Despite 10mg Zolpidem, 10mg Escitalopram and 2.5mg Clonazepam, I couldn’t get any sleep the night before. I should explain that my psychiatrist prescribed these when I started developing insomnia because of my anxiety. About 6 weeks out, I was started on Zolpidem and after 2 weeks Excitalopram and Clonazepam were added. The efficacy was inconsistent with a fluctuating level of sedation. When I couldn’t fall asleep that night, I panicked, called my psychiatrist and took an extra 2.5 mg Clonazepam and fortunately passed out shortly after. My sleep was short-lived with my anxiety waking me up at 4:15 AM. I struggled but was unable to fall back asleep till 5, when I gave up altogether. I quickly showered, got dressed and reviewed the last of the material that I couldn’t get through the day before, while listening to some heavy metal to pump me up. I ate my usual breakfast and my dad’s chauffeur dropped me off at the test centre.
I got there a whole hour and 20 minutes before my appointment time. I was reviewing some of my UW notes on the way over and continued the same while I was waiting to get in. My test centre proctors were unaware I was allowed earplugs so it took them some time to check until I pointed it out on my confirmation email. While I was reading my notes, I realised I was no longer processing any of the information I was reading, so I had a few sips of water, a can of redbull and went to the restroom before heading inside. I got fingerprinted and photographed like a common criminal just like my practise run. The security check process was very familiar at this point and I was dressed for speed; track pants upto mid calf with only 2 pockets and a light zippered cardigan without pockets.
The test format was very similar to UWorld but after all the practise, the real deal is far more challenging. I would say 50-60% are easy questions that are either straight recall or require a little bit of thought. 20-30% aren’t difficult but there will be at least 2 options that could fit, which can drive you mad. A curse upon whoever came up the single best answer format! 5-10% will be the weird questions. These include questions with very obscure information that you have to magically connect, minutiae that you may have accidentally picked up during med school and certain things you would have never come across until you see it in that particular question. I had only 2 questions that needed headphones for heart sounds and no videos. Sometimes the question is basically identifying an image you’ve never seen before with little to no clinical context. I had about 3 of those despite looking up every image I could think of during my preparation. It was an agonising experience in the beginning, but by the 4th block I realised this was the nature of the beast and I had to accept the test the way it was, much like an annoying sibling. During practise I would usually have enough time to do all the questions, review my marked questions and quickly review the unmarked questions to make sure I clicked the right option. Double checking the question said increased instead of decreased and making sure the option didn’t have some invalidating information. It’s a horrible feeling to get a question wrong despite knowing the answer, one I wanted to avoid. On step 1 however I had only about 10 minutes or less to review my marked questions and so I could only check about half of the unmarked before time ran out. I found it strange that they would repeat almost the exact same question on the same form. I had 2 repetitive questions and 3 with slight variations, which made me think one was experimental. If you get the the same question with a slightly modified stem or answer choice on one of your weaker areas, it wouldn’t be fair but that’s clearly not the game the NBME is playing.
I took two breaks of about twelve minutes after my second and fourth blocks to eat a roll, drink a little water, a can of red bull and go to the restroom. I would always stretch a little and pump my fists into the air on my breaks. I did this after the first and third blocks at my station without checking out as well to keep confidence up with biofeedback and it probably confused the proctors a little. I took another two breaks of about eight minutes after the fifth and sixth block just to drink some water, red bull and go to the restroom. Even though I had simulated the exam 10 times, I still felt a little more tired during the actual test. I had done simulations with the same amount of sleep too.
The end was very anticlimactic and the questions began to haunt me on the ride back home. I couldn’t believe that it was over and I had absolutely no idea how well it went. It was unlike any other test I’d ever taken before and it’s the first time I had post-test anxiety. I managed to remember 181 questions for which I looked up the answers, but there were 37 questions for which answers were not readily available. I believe it helped me to look up the answers just to stop the traumatic flashbacks and waves of doubt, but I still had absolutely no estimation of my score. I’m still feeling dazed and confused two days later, struggling to switch back to normal mode. I’ve thrown the javelin and have to watch it move in slow motion, hoping it lands far enough for me to make the cut.
My sister was in town for a couple weeks so we hit hit up all our favourite restaurants, getting fat and keeping my mind off my anxiety. My friend came to visit for a couple of days after that and she was a welcome distraction. I spent some of this time looking up STEP 2 CK resources and building a study plan and looking into what was needed for an IMG to match into Plastic or Neurosurgery. The day after my friend left, I rejoined my gym, started boxing again and sluggishly started my STEP 2 CK preparation. This was 19 days after STEP 1 and a day before my score was released. There was some delay for people who had taken the test in mid-December but when I saw my scheduling permit disappear from IWA, I was hoping that my wait was at an end. The next day, while watching a video, I received the awaited email. Initially, I thought I would finish my studying for the day before opening it but in the next five minutes my heart began to race, reverberating throughout my body and I couldn’t focus on what was in front of me. There were feelings of fear and exhilaration in equal measure. I opened the email and read it slowly, the link took me to OASIS and I opened the PDF containing my score. I hung on every single word dreading a catastrophe and slowly scrolling so as to delay any bad news. Under the table indicating I had passed was my score - 265. At first I was a little disappointed because I had begun aspiring to cross 270, but at the same time I was anticipating something in the 250s. This score is a point less than my NBME average and 6 points less than my best NBME but I can’t complain. Despite the poor sleep the night before and that unrelenting mother of a test, I was content with the outcome. I just hope it’ll be enough…
USMLE Official 2017 Step 1 Experiences and Scores Thread
score tracking.numbers
tl
dr (skip to the bottom if you're just after my stats on qbanks)Eight and a half months ago I cracked open First Aid and got a taste of what lay ahead. It had been four and a half years since I finished my second year of medicine, so everything seemed a little new. I had never really studied very hard in med school because there was not much payoff in my system. You never really had to understand anything. If you knew a little bit of everything you’d be fine so I focused my learning on what I found interesting; mainly diagnosis and the clinical aspect of medicine. So a lot of what I now had to learn was new or information I had glossed over during my foundation years because it was of no utility to me. I never saw the point in knowing BRAF and RET are associated with PCT or the multitude of different CD markers.
Initially I had planned to invest very little money into my preparations as bootlegged resources are very easy to come by. I only bought a set of Kaplan Lecture Notes and First Aid, what I believed was essential according to sources researched years ago. It probably wasn’t the smartest idea not to research the new trends and resources available. I hear anki is all the rage now, but technology seems to be leaving me behind in general.
I started out slowly doing a couple of hours of Kaplan videos a day and reading through the corresponding text the next day. During med school I discovered the only way to learn anything was repetition and so the method I developed was to read through the text three times on the first pass. Once to let the information seep into your brain, once to sort out what seems useful and highlight it for later and a final read to underline the key points for rapid review later. I then had to reread my highlights the day after the first reading and a also a week after that, attempting to recall it from memory before checking the page. This way the information starts getting familiar. Bear in mind I despise studying and hate repeating anything more than once, so it requires a little discipline but studying without retention of the material is pointless.
Going through the Biochemistry lectures, I started doing a little more every day, building momentum. I really enjoyed watching those recorded live lectures and thought it would be useful and more enjoyable to have a more interactive form of learning. It just so happened that Kaplan was starting Summer course at a time slot that didn’t need me to be a vampire. It was an accidental find but a stroke of good luck at exactly the right time. According to their schedule I would get through their material in four months - three months less than at the pace I was going at. I signed up without any hesitation.
They provide a medical advisor who is useful when you’re starting out and have no idea where you stand but the advice is a little generic at times. Still, it was useful for me to bounce my ideas off of someone who knew the upcoming battle better than I did. The reassurance also helped my crippling anxiety until I could touch my goal score.
The live classes started out with Biochemistry again, which I had managed to finish before enrolling. Since I didn’t need to read my material as intensely I decided to read ahead and use the live classes as revision and a chance to clear my doubts. I used the extra time to watch recorded video lectures of the next subject to be covered and read the lecture notes, while taking the live online classes in the evening and reviewing the corresponding notes the next morning. This added another couple of layers of repetition; painful but efficient. I aimed to complete the subjects about three weeks before the live classes so that the fourth pass would be almost a month after the 1st. I did an extra pass for Micro and Path because of all the nitty gritty details.
I was studying about 10 hours a day. We were advised to do 10-15 bank questions a day, which I was initially getting done before my morning boxing session, but later I prioritised getting through the material so that my spaced repetition was adequately spaced. I highly recommend not touching the bank until you’ve finished a pass of all the subjects because certain categories are covered in a different subject and the explanations are not the easiest to understand without a base. I do recommend doing the on demand quizzes as you go along and the subject tests when one is complete.
By the end of august I had finished the live online, about 500 of the Kaplan bank and about 300 pages of First Aid. I had also started sketchy micro around the beginning of August. It seemed terrible at first but I found that those bizarre picture associations seemed to stick, so it got incorporated into my plan. I did the Kaplan mid term and final, definitely not even close to USMLE quality. My advisor was very impressed with my performance, but I was starting to burn out.
My sister was in town for a few weeks, which did’t help my diminishing motivation. I had my med school graduation at the beginning of September too. My sister, dad and I took two days out for that. After all this time and preparation I still hadn’t even applied for the STEP. Initially it kept me calm knowing it was a far off date that hadn’t been set yet, giving me plenty of time. I was planning on an early December date but DEC-FEB permits only become available mid september so I had to wait.
The day after returning from my med school, I was able to apply for my permit. This meant another trip back to my med school 300km away and days waiting for the slowest clerks on earth get a document signed and shipped. Without follow up, they tend to forget, so I had to stay five days. Five days without a single USMLE question or any form of studying, just a trip to the office in the morning, then drinks with old friends later in the day. It was probably the best cure for my burnout. I got tired of doing nothing and left for home leaving a close friend responsible for following up.
Back home I had to compensate for my three simmering weeks since the start of September where I only managed to about a block of day. I had planned to be finished with Pathoma by this point but I suppose the break may have allowed me to press harder in this next phase of preparation. That’s probably just my optimistic side talking, which I usually tend to ignore. My advisor had told me to take the Kaplan simulated exam and an NBME a week ago so I bit the bullet and did the SIM exam. I got 244/280 and realised I had no idea how the USMLE is scored. Looking into it won’t be of much help because the NMBE guards their secrets herbs and spices a lot more closely than your favourite fast food restaurant. Going by people’s past experiences can help gauge where you’re at but you’ll never be certain, not until you see your score in your inbox. My advisor was impressed with this score too and I was beginning to feel most other test takers have a harder time with this. He told me the best predictor was to do an NBME. So After I finished my first pass of FA, using the same spaced repetition method of course, I took my first NBME (15) the beginning of October.
My stomach was full of goat soup and I took it pretty lightly, taking a few breaks and not really caring too much about it. I just wanted to get it out of the way so my advisor could tell me what to do next. What I truly needed was more intrinsic drive and new material. My advisor was once again impressed with my 248, but this was well below my goal of 260. He was afraid I wouldn’t be able to retain the information, whereas I felt I had very superficial level of knowledge of most topics. This gave me the kick I needed and I was able to pick up a pace, doing my last few block of kaplan and watching Pathoma, while reviewing it and the rest of my path the next day and a week after. Going through question banks, I realised the vast majority of this test is probably Pathology so a extra read can only help.
Around the first week of October I started UWorld and fell in love. What a delight it was to read such well written explanations. With the Kaplan questions, I would take screenshots and review the every day until I could recall the information before looking. Now without screenshots, I turned to writing notes. I did them in a flash card format so as be more active. Halfway though I realised I was writing the same note again and since the system clearly wasn’t working, started writing notes directly into FA and made a spreadsheet with page numbers and a keyword or two for recall. This method was much better and I recommend that all notes should e written in First Aid, otherwise there’s a high chance of repetitive note taking. Scattered notes are difficult to go through at the last minute as well. Hindsight 20/20. The spreadsheet entries would only get checked when I was satisfied I could recall all the associated information. This revision was also painful but there were a lot of new concepts I gained through UWorld and wanted to have them readily accessible in the back of my head to be brandished at will.
At the very end of October I took my second NBME (16) and got 263. It’s usually reassuring to cross your goal score, but my self doubt won’t let me believe that it wasn’t a fluke or a miscalculation. Do I need to mention my advisor’s reaction at this point anymore? He still felt retention would be difficult since I was so far from test day. I however planned a last round of revision was there to solidify any information that was still loosely held.
After getting through Pathoma, I revisited my Kaplan notes for what was probably going to be my final round before D-day. This time I would read the material once and repeat it the next week making notes of things still not firmly ingrained. These post it notes were stuck and read until all points could be recalled from memory and then repeated a week after that. The same way I did the final Pathology review combined with Pathoma. This was also the time I started panicking that my time left was getting shorter and I was not in a comfortable enough position. I decided to become a shut in after I couldn’t enjoy Kingsmen 2 (It was pretty bad) because all I could think about was how much time I was wasting not studying. I quit boxing and weight training shortly thereafter to maximise studying. I also started showering only twice a week now that I was barely breaking a sweat, not the most hygienic confession but that was the level of my anxiety. Detangling my mane was a luxury I gave up in exchange for an extra 2 hours a week.
The load was piling up and my hours had to match for me to be able to finish at least half of what I had planned on. I started doing about 12-13 hour days to accommodate a UW block everyday reviewing all the questions, previous UW reviews and some Kaplan Lecture Note review from the last week and some fresh Kaplan review for the day. I squeezed in some Sketchy Micro during breakfast and lunch. My only downtime was dinner with Dad, my morning bowel movement, 15 minutes of conversation with the aforementioned friend of mine and bathroom breaks. Sometimes I would crack and read through some past experiences on SDN and other forums or buy stuff for my desk from amazon. Once a week I would do seven blocks at a stretch to stimulate the real deal and build some stamina. That seventh block was a challenge initially. It also helped me figure out my food and water consumption and how to time them with the bathroom breaks because STEP 1 is so generous with their break time allocation (I hope the sarcasm is obvious). The thing I missed most during this intense phase was my morning play time with my puppies.
Mid-November I took another NBME - 265. An upward trend is good and this reaffirms that this is my range and not just a happenstance score. At the end of November, after finishing my first pass of UW, I was deciding which bank I should do next. I had just enough time for one more and Rx seemed to be more highly recommended than Becker or Medbullets, which were the only other options I was aware of. I later found out about Pastest (free this year) and loxolab but it was too late by that time. First I wanted to get through all the retired NBMEs (1-12). I found not having to review UWorld a welcome break. It’s a lot less taxing just to look up answers on different forums and I was just taking notes that I planned on reviewing only once; just before test day.
Early December I started Rx and while reviewing the answers, found them to be fairly cursory for the most part. A few were well explained but I already knew most of these concepts so decided to read through only my marked and wrong questions and questions where there were unfamiliar options. I would highlight anything unfamiliar (mostly minutiae), download the notes (an incredible feature I feel all other question banks should adopt), read them the next day and reread anything that still seemed unfamiliar. I was trying to grind for that low yield that could show up while reinforcing the neural pathways of the higher yield material I already knew. I did the questions as fast as I could to build speed and save time, so there were a few careless errors. My Practise exam at the Prometric centre was pretty cold and noisy, so I also had to readjust my home A/C to 19C to adapt and I ordered some earplugs - finding a pair that would fit into my small ear canals and block out the distractions took a couple of weeks. I prefer colder temperatures, but it takes me about 20 minutes of shivering for my body to adjust and I couldn’t have that affect my performance each time I took a break. I was able to bring down my water intake to 2.5L from my usual 7L to avoid needing the restroom.
My Kaplan review was going fairly slow at this point. I had half of Anatomy, Immunology, Micro and Pharm left. Another round of First Aid was also a minimum goal. After anatomy I would only read the text once and make notes which I would read till everything was familiar. No more weekly repetitions. There were 24 days to go, I didn’t have the time to be thorough and just hoped everything would stick till test day. I got done with this last round of Kaplan Notes by mid December and had to race through FA. Initially I used the same post it method but it was too slow for me to finish in time so I started marking things that seemed slightly unfamiliar and read it the next day. Whatever was still unfamiliar went on a post it note but no more active recall, just a single read through. I was banking on these superficial connections to suffice rather than be blindsided completely by a question on some unrevised topic. Mid December I also hurried through my Kaplan qbank incorrect questions because my subscription was expiring and I was afraid time would not allow me a review of my screenshots. Their tech support is the absolute worst! There were 12 questions that I was never able to access. When I brought this to their attention, they first assured me there was no problem when there was and after pestering them got a month free while “their developers got back to them”. A month passed and when I emailed them again, all I got was stony silence. I don’t want to encourage piracy but I make an exception for Kaplan. Their content is good for the most part but the most of the faculty only replied to 1 or 2 of my emails before ignoring me.
17 days out NBME 17 - 269
10 days out NBME 19 - 271
Confidence was sky high after 19, especially because everybody says it’s a tough test and under predicts your score. I finished FA 3 days out, but still had my initial UW notes to go through and the notes I made doing the retired NBMEs. I had also started doing my UW incorrect about 10 days out and unfamiliar facts or concepts went on a post it to be read the morning of the test.
2 days out NBME 18 - 263. It was disappointing especially after 17 and 19. I was advised to take 18 after 19 for my confidence, but clearly I’m an exception to that rule. The rest of the day was spent looking at all my incorrect NBME answers and all of the NBME pictures and graphs in case they decided to reuse one on my test.
My last day I finished the pictures and read a few post it notes of formulas, Inheritance patterns and other topics that I found be volatile over the course of the last few months.
Despite 10mg Zolpidem, 10mg Escitalopram and 2.5mg Clonazepam, I couldn’t get any sleep the night before. I should explain that my psychiatrist prescribed these when I started developing insomnia because of my anxiety. About 6 weeks out, I was started on Zolpidem and after 2 weeks Excitalopram and Clonazepam were added. The efficacy was inconsistent with a fluctuating level of sedation. When I couldn’t fall asleep that night, I panicked, called my psychiatrist and took an extra 2.5 mg Clonazepam and fortunately passed out shortly after. My sleep was short-lived with my anxiety waking me up at 4:15 AM. I struggled but was unable to fall back asleep till 5, when I gave up altogether. I quickly showered, got dressed and reviewed the last of the material that I couldn’t get through the day before, while listening to some heavy metal to pump me up. I ate my usual breakfast and my dad’s chauffeur dropped me off at the test centre.
I got there a whole hour and 20 minutes before my appointment time. I was reviewing some of my UW notes on the way over and continued the same while I was waiting to get in. My test centre proctors were unaware I was allowed earplugs so it took them some time to check until I pointed it out on my confirmation email. While I was reading my notes, I realised I was no longer processing any of the information I was reading, so I had a few sips of water, a can of redbull and went to the restroom before heading inside. I got fingerprinted and photographed like a common criminal just like my practise run. The security check process was very familiar at this point and I was dressed for speed; track pants upto mid calf with only 2 pockets and a light zippered cardigan without pockets.
The test format was very similar to UWorld but after all the practise, the real deal is far more challenging. I would say 50-60% are easy questions that are either straight recall or require a little bit of thought. 20-30% aren’t difficult but there will be at least 2 options that could fit, which can drive you mad. A curse upon whoever came up the single best answer format! 5-10% will be the weird questions. These include questions with very obscure information that you have to magically connect, minutiae that you may have accidentally picked up during med school and certain things you would have never come across until you see it in that particular question. I had only 2 questions that needed headphones for heart sounds and no videos. Sometimes the question is basically identifying an image you’ve never seen before with little to no clinical context. I had about 3 of those despite looking up every image I could think of during my preparation. It was an agonising experience in the beginning, but by the 4th block I realised this was the nature of the beast and I had to accept the test the way it was, much like an annoying sibling. During practise I would usually have enough time to do all the questions, review my marked questions and quickly review the unmarked questions to make sure I clicked the right option. Double checking the question said increased instead of decreased and making sure the option didn’t have some invalidating information. It’s a horrible feeling to get a question wrong despite knowing the answer, one I wanted to avoid. On step 1 however I had only about 10 minutes or less to review my marked questions and so I could only check about half of the unmarked before time ran out. I found it strange that they would repeat almost the exact same question on the same form. I had 2 repetitive questions and 3 with slight variations, which made me think one was experimental. If you get the the same question with a slightly modified stem or answer choice on one of your weaker areas, it wouldn’t be fair but that’s clearly not the game the NBME is playing.
I took two breaks of about twelve minutes after my second and fourth blocks to eat a roll, drink a little water, a can of red bull and go to the restroom. I would always stretch a little and pump my fists into the air on my breaks. I did this after the first and third blocks at my station without checking out as well to keep confidence up with biofeedback and it probably confused the proctors a little. I took another two breaks of about eight minutes after the fifth and sixth block just to drink some water, red bull and go to the restroom. Even though I had simulated the exam 10 times, I still felt a little more tired during the actual test. I had done simulations with the same amount of sleep too.
The end was very anticlimactic and the questions began to haunt me on the ride back home. I couldn’t believe that it was over and I had absolutely no idea how well it went. It was unlike any other test I’d ever taken before and it’s the first time I had post-test anxiety. I managed to remember 181 questions for which I looked up the answers, but there were 37 questions for which answers were not readily available. I believe it helped me to look up the answers just to stop the traumatic flashbacks and waves of doubt, but I still had absolutely no estimation of my score. I’m still feeling dazed and confused two days later, struggling to switch back to normal mode. I’ve thrown the javelin and have to watch it move in slow motion, hoping it lands far enough for me to make the cut.
My sister was in town for a couple weeks so we hit hit up all our favourite restaurants, getting fat and keeping my mind off my anxiety. My friend came to visit for a couple of days after that and she was a welcome distraction. I spent some of this time looking up STEP 2 CK resources and building a study plan and looking into what was needed for an IMG to match into Plastic or Neurosurgery. The day after my friend left, I rejoined my gym, started boxing again and sluggishly started my STEP 2 CK preparation. This was 19 days after STEP 1 and a day before my score was released. There was some delay for people who had taken the test in mid-December but when I saw my scheduling permit disappear from IWA, I was hoping that my wait was at an end. The next day, while watching a video, I received the awaited email. Initially, I thought I would finish my studying for the day before opening it but in the next five minutes my heart began to race, reverberating throughout my body and I couldn’t focus on what was in front of me. There were feelings of fear and exhilaration in equal measure. I opened the email and read it slowly, the link took me to OASIS and I opened the PDF containing my score. I hung on every single word dreading a catastrophe and slowly scrolling so as to delay any bad news. Under the table indicating I had passed was my score - 265. At first I was a little disappointed because I had begun aspiring to cross 270, but at the same time I was anticipating something in the 250s. This score is a point less than my NBME average and 6 points less than my best NBME but I can’t complain. Despite the poor sleep the night before and that unrelenting mother of a test, I was content with the outcome. I just hope it’ll be enough…
USMLE Official 2017 Step 1 Experiences and Scores Thread
score tracking.numbers
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