A different problem with Step 1

[sadperson]

Hi everyone.

I posted here a year ago about depression affecting my focus and cognition, thus affecting my performance in exams. Last year I posted that I had to repeat the last exam. This year, I had to repeat two more because, despite seeing multiple healthcare providers, my mental health has not improved. Throughout the year, I did not really feel like I was learning. The exams that I didn't have to repeat, I basically passed by very little. Now my performance in practice exams pretty accurately reflects my pre-clinical years: failing.

I had always planned to take the year between 2nd and 3rd off to basically tend to my wounds, so I scheduled my exam for a later than usual date to try to make up for the lost study time during second year. Of course, it's not really possible to do in 2mo what most people do over the course of the year. I expected below average scores, but I did not expect failing ones. I entered medical school with the average MCAT score of all admitted medical students (without any study courses or anything). If MCAT scores correlate with Step 1 scores and if everything in medical school had gone normally for me, I would be getting a 230.

In early June, I took my first UWorld Self Assessment. I thought "I don't know" with 80% of the questions and got a 147. I have been using the UWorld Qbank while referencing FA, watched some DIT videos (some I've found to be helpful, and many are not so much), made flashcards (hoping that the process of making them helped because I don't really look at them often), Sketchy, Pathoma... Even Pathoma has not been working out for me, in the sense that it's hard to be engaged and actively learning. Clearly, I am not myself. It had never been difficult for me to learn before, but every time I do UWORLD blocks and see that I'm still scoring in the 30s and 40s, a heaviness falls upon me and it takes me a long time to recover and get back on track.

I got a 170 on an NBME I took Friday of last week. I started using Kaplan videos the day after and found them to be better at teaching me. I've been using them more this week and scored 180 on the next NBME I took, exactly a week after the first. At this point, I just want to pass, so if I get to a 210 on an NBME, I'll take the exam. The problem is that it's in 3 weeks. August is the last month of my 3mo block. Obviously, I would have to pay the full $700 or so for a later date if I don't think I'll pass in August, but I'm trying to study as if I am taking the exam in the end of August. If I fix my mindset, I really should be able to do well.

The reason I'm writing this post is because I'm wondering if there's any advice that you guys have for me about what resources are best for each organ system, how to improve test taking skills (which were pretty good before medical school but now either I don't know or I'm anxious), or how to improve my mindset to be able to study at my best potential (I'm referring to the moping I do every time I finish a UWORLD block).

Any help or advice is appreciated. Thank you.

P.S. Please don't respond with "I don't think you can take the exam in 3 weeks" and leave it at that. I'm realistic. I already don't believe I can do it, but I'd still like to make the best use of the time I have and study as if I could take the exam in 3 weeks.

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[12glaucoma34]

Hi everyone.

I posted here a year ago about depression affecting my focus and cognition, thus affecting my performance in exams. Last year I posted that I had to repeat the last exam. This year, I had to repeat two more because, despite seeing multiple healthcare providers, my mental health has not improved. Throughout the year, I did not really feel like I was learning. The exams that I didn't have to repeat, I basically passed by very little. Now my performance in practice exams pretty accurately reflects my pre-clinical years: failing.

I had always planned to take the year between 2nd and 3rd off to basically tend to my wounds, so I scheduled my exam for a later than usual date to try to make up for the lost study time during second year. Of course, it's not really possible to do in 2mo what most people do over the course of the year. I expected below average scores, but I did not expect failing ones. I entered medical school with the average MCAT score of all admitted medical students (without any study courses or anything). If MCAT scores correlate with Step 1 scores and if everything in medical school had gone normally for me, I would be getting a 230.

In early June, I took my first UWorld Self Assessment. I thought "I don't know" with 80% of the questions and got a 147. I have been using the UWorld Qbank while referencing FA, watched some DIT videos (some I've found to be helpful, and many are not so much), made flashcards (hoping that the process of making them helped because I don't really look at them often), Sketchy, Pathoma... Even Pathoma has not been working out for me, in the sense that it's hard to be engaged and actively learning. Clearly, I am not myself. It had never been difficult for me to learn before, but every time I do UWORLD blocks and see that I'm still scoring in the 30s and 40s, a heaviness falls upon me and it takes me a long time to recover and get back on track.

I got a 170 on an NBME I took Friday of last week. I started using Kaplan videos the day after and found them to be better at teaching me. I've been using them more this week and scored 180 on the next NBME I took, exactly a week after the first. At this point, I just want to pass, so if I get to a 210 on an NBME, I'll take the exam. The problem is that it's in 3 weeks. August is the last month of my 3mo block. Obviously, I would have to pay the full $700 or so for a later date if I don't think I'll pass in August, but I'm trying to study as if I am taking the exam in the end of August. If I fix my mindset, I really should be able to do well.

The reason I'm writing this post is because I'm wondering if there's any advice that you guys have for me about what resources are best for each organ system, how to improve test taking skills (which were pretty good before medical school but now either I don't know or I'm anxious), or how to improve my mindset to be able to study at my best potential (I'm referring to the moping I do every time I finish a UWORLD block).

Any help or advice is appreciated. Thank you.

P.S. Please don't respond with "I don't think you can take the exam in 3 weeks" and leave it at that. I'm realistic. I already don't believe I can do it, but I'd still like to make the best use of the time I have and study as if I could take the exam in 3 weeks.

Don't take the exam unless you are certain you will pass. Do you exercise? Have you considered any alternative options for treating depression? Speak with your healthcare provider.

 

[sadperson]

Don't take the exam unless you are certain you will pass. Do you exercise? Have you considered any alternative options for treating depression? Speak with your healthcare provider.

I go to the gym two mornings a week and have been doing 1-2hr dance lessons once a week. I flew home to study for Step 1 (it's easier to get out of bed here), so I haven't been able to see my healthcare provider. I should e-mail her, though.

 

[12glaucoma34]

I go to the gym two mornings a week and have been doing 1-2hr dance lessons once a week. I flew home to study for Step 1 (it's easier to get out of bed here), so I haven't been able to see my healthcare provider. I should e-mail her, though.

Given your background and likely academic situation, prioritize so that you don't fail Step 1. You need to see a healthcare provider, maybe a second opinion would be helpful. Get an evaluation from a ketamine clinic to see if you may benefit.

 

[Crayola227]

Reposting a lot of my self care tips here

First, I think you might benefit from seeing your PCP. If *they* recommend psychotherapy & medication, seriously consider following through on their recommendation

Second, if there are any responsibilities in your life draining you right now that you can afford to say no to, then feel free to say no to them.

Keep in mind if you are depressed/burnt out some people still need things outside them as responsibilities to help them keep moving/feeling connected.

WELLNESS
This is basic lifestyle advice I don't think violates TOS
How Should I Proceed?
you have to scroll up one for my post on self care
I'm going to rewrite my advice here, all of this it would be best to cover with your personal medical providers

I just read something by Dr, Pamela Wible on KevinMD to a med student experiencing burn out
she makes a point that with burn out, "feeling numb", getting back into your body is important
she recommends weekly massage for getting back in touch with your body / relax
Make a point of getting a hug a day.

I recommend psycheducation.org Dr. Phelps' website, it is aimed at bipolar but he talks about blue light's effect on sleep which I find valuable, and most of my lifestyle advice for sleep & blue light is based off his site, he cites lots of research

1) routine, especially sleep
-I don't know if you sleep with a partner, but I would recommend taking whatever steps to ensure your sleep hygiene is good, even if that means you two sleep separate (studies show people physically have worse sleep quality with a partner, but subjective rating of quality is higher, so it's up to you what will be best for how you are doing). Remember, you don't have to sleep together to sleep together.
-same wake time, same sleep time, *even on weekends,* allot enough hours. if you can avoid fighting your natural rhythm (morning lark vs night owl) that would be good
-cool, dark room free of pets (I have to have an electronic scat shock mat to keep my cats from scratching at the door at night)
-if needed, invest in darkening shades perhaps, that will block out the light that might wake you in the am, but you could invest in a sunrise simulator (you can even just plug a lamp into a cheap timer) with a daylight spectrum bulb, if this conflicts with partner, consider a facemask
-cut out electronics or tone down the blue light with apps like f.lux after the sun goes down
2) don't skip a good breakfast
3) don't go hungry, eat healthy
4) no caffeine within 8 hours of sleep, or after 2-4 pm,
-some people find they get a midday "slump" from caffeine and feel better cutting it out entirely.
-If you drink regularly and are going to try to cut it out, anticipate possible headache and have a plan with your provider possibly including an OTC med like tylenol or ibuprofen
5) with consultation of a physician consider melatonin if needed
-less is more with dosage, main side effect can be freaky nightmares which often levels out, risk is that it *can* worsen depression in some but that's rare, it can have a paradoxical effect at high doses (meaning opposite to intended effect) so always start low go slow
-don't use herbs or other OTC items for mental health/medical purposes without talking to your primary care provider.
6) drink more water, this is easier to do *with* food, but just carrying some around with you can help encourage intake.
-To encourage myself to drink water (I'm picky) I invested in a Brita filter, make ice using that water, and drink out of a large glass mason jar with lid so my cat can't knock it over (she loves to!).
-You can also do herbal unsweetened tea.
-There is no magic number but I aim for 2L a day.
-Most of us, especially caffeine/soda drinkers, walk around chronically dehydrated, eventually the feedback loop regulating this will turn off your thirst drive, so initially you may have to "force" yourself to drink water, you will adjust
7) cut out all alcohol for now.
-if you go out with friends, there are plenty of things you can ask to have "virgin."
-if your friends ask and you don't want to explain, just say you're on a "cleanse" or some hippy thing.
-I buy non-caffeinated root beer in glass bottles so I still get the "treat" / psychosocial aspect of drinking without the alcohol at home. Soda isn't ideal but it's a better choice to substitute for a weekend beer on your porch if you are struggling with mental health
8) no marijuana. Really, no marijuana.
-If giving up these things bums you out, just remember it's temporary.
-In my opinion, booze & MJ don't help feelings of burn out. A single stressful day? Maybe, but burnout, no.
-goes without saying, none of the other street drugs either. Really.
9) I personally see benefit to a multivitamin although I can't say the studies are dramatically behind me.
-Data is mixed but particularly look into vitamin D (90% of us tested above a certain parallel in the US test deficient per the FDA RDA, and there is controversy over whether that amt is enough for optimal health, don't just rely on the summer to replenish you),
-consider fish oil too, Costco enteric coated from Amazon is cheap, keep in freezer to avoid fish burps, the most common side effect.
-Talk about iron with your doctor and be sure to include good dietary sources.
10) Exercise but I know that can be hard,
-even just getting 10 minutes of walking a day more than what you're doing now, a brisk walk.
-Stretching/yoga!! Netflix has some programs so you can do it from home, or YouTube videos, even just pictures online.
-Stretching by Bob Anderson is my fave resource for home stretching. http://www.amazon.com/s/?ie=UTF8&keywords=stretching,+bob+anderson&tag=googhydr-20&index=aps&hvadid=28618117647&hvpos=1t1&hvexid=&hvnetw=g&hvrand=491951793333905093&hvpone=&hvptwo=&hvqmt=e&hvdev=c&ref=pd_sl_79e40b5ucp_e
-A foam roller does amazing things for my neck, back, IT band. There are large ones and travel sized ones.
-A TheraCane is a nice way to make love to yourself.
11) If you can sit by a window with a view, maybe with a little plant or beta fish to keep you company, sunlight, having plants/pets life that depends on you helps. Gardening, even just a few potted plants.
12) Time with nature, maybe go to the zoo or aquarium.
Sometimes just looking at the animals at Petsmart cheers me up
13) I suggest looking into Adult Children of Alcoholics/Dysfunctional families, you can google them and see if that fits you or might be helpful, even if you don't think it reading my post at least check out the website
14) Look into meditation, mindfulness techniques, guided meditation, relaxing music, biofeedback programs
15) Daily rituals like hot tub, warm bath, candles, incense, herbal tea, aromatherapy
16) Read some comics everyday, something to make you laugh. xkcd is one online example.
17) More ambitious: swimming, camping, hiking, beach, river, bike riding, even just day trips, scenic drives
18) Google Thich Nhat Han. I've found a lot of his writings very inspirational.

When I get really depressed/burnt out, I start at the top of this list, and try to slowly work down it as I can. Doing it all at once can be too much. But as you add each step of wellness and feel better, it gets easier to add another

In my opinion, the best thing for burn out is to basically stop doing/worrying about as much as I can, and start over with self care. Maslow's hierarchy, start with the biological like sleep & food, and work up to pleasurable low stress activities

- the key thing is that our bodies are not made for sitting for long periods, or standing still for long periods. We are made for walking and movement. So you need to introduce more movement.

you should be taking 5-10 min breaks every hour to walk and do some stretches.
Trust me, it's time invested in your productivity.

look up desk work health
definitely look up spine health and be doing stretches/exercises aimed at undoing the "chair bound" body issues

also, you can learn "chair stretches" seriously, look it up
Bob Anderson has some great picture books on stretching with entire routines - google images! Amazon has some of his books, One is designed for the workplace and cubicle life.

look up ergonomics - be sure you have your chair, desk, keyboard, etc all properly placed

you can also swap in a large exercise ball to sit on, they're harder to sit on, but I still found value in swapping it in and out with a regular chair

I would try to mix up positions - for example, one hour of FA reading on a couch. 2 hours UWorld on a laptop on the carpet so I could move about on the floor. Grass, blanket, FA for an hour outside. Back inside 2 hours Uworld at a desk. Etc ideas

I did an hour of yoga a day during my step study period so that I was getting some bloodflow, stretching, and strengthening altogether, quite efficient. You can watch a Youtube video and there were some programs on Netflix. I also was biking about a 1/2 mile to/fro my study site

I don't recommend much lifting because that can leave you sore, and if you're not getting enough stretching/moving (hard to do with step study period) I find it makes me feel worse/more stiff, unless it's just gentle calisthenics that are part of spine/chair health

Be sure to be having enough snacks too. Now is not the time to worry about weight, so eat as much as you need to, to feel good, but you also don't want to eat so much/carb crash that you're sluggish. I like a nice carby & fibery but not too fatty breakfast (eggs or bacon, oatmeal), and a very protein and veggie heavy lunch (leafy salad with hardboiled eggs, tuna, chicken, etc), formal snack breaks for like granola bars and peeling hardboiled eggs, a yogurt,
At my desk for anytime gnoshing, carrots, nuts, raisins. There's a little bit of pleasure grazing that helps pep me up.

I have a lot of aches, pains, horrific posture and neck/back pain, and the above is how I studied with a minimum of discomfort!

you can alternate APAP and ibuprofen during the day with the blessing of your physician, but the goal is to do the above to prevent/treat the source of pain, rather than needed to rely on meds to cover up symptoms

TLDR:
5-10 min breaks/hr
stretching, walking
change position often
ergonomic workspace
spine health
yoga
snacks

Tips and Tricks to stay alert on Test Day?

1) You cannot fail this test.
I recommend you get with your school to discuss all of this and to come up with a plan.
That might mean painful schedule changes, but even delaying a year or even 2 for graduation will not be the red flag that a Step 1 failure is, and often Step 1 failures lead to further schedule changes, so taking the test on time and then failing it usually doesn't save you the bother.
You need help from your mentors.

2) You need to get your self care under control.
Ditto seeking help from a provider, and I provided some general tips for general wellness.
Self care, mental health, and seeking help from medical providers, are all related to doing well.
You need help from friends and family.

2) Dedicated tips for wellness for dedicated study period I provided above. My main tips under that are:

-Consistent sleep/wake.
For general wellness, I tell people not to fight their natural morning lark/night owl tendencies if they can help it. For times when you have to perform outside your comfort zone, then consistency to entrain yourself to the rhythm you are expected to perform at, is what I think best. I say it takes about a month to fully adjust to any major sleep/wake time changes. It was a toss up for me what to do since I'm an extreme night owl. I ended up keeping the sort of hours I would need to have test day for the whole of my study period to get my brain used to functioning when it doesn't function best. The trade off was that a lot of the hours I was studying weren't as efficient. But half my particular battle wasn't just studying, but switching my body rhythm.

-Know thyself
You need to use SDN, Meyers-Briggs, voodoo, Student Study Center, any resources to help you figure out your learning style. I find that learning strategies vary by topic, ie what helped me learn biochemistry pathways was not what helped me learn neuroanatomy. Elsewhere recently I posted about learning strats, I mean, learning down to "I learn by writing on paper but not on whiteboard" is the level of detail that can actually help you. Confidence that what you are doing is what works for you, can help a lot.

-Plan
Based on how you learn, what your topic weaknesses are, it should actually be fairly simple to use SDN to figure out a daily study plan. My plan was quite simply to study X number of pages of FA a day, and do Y number of UW questions. I read all explanations and would have saved ones I did wrong for a second pass had I the time. I used a few books to supplement FA where I felt I needed it. I had a pattern of sleep, wake, breakfast, reading, questions, lunch, questions, reading, etc from 9 am to 7 pm M-F with a light Saturday and Sunday totally off, that worked for me.
Point is, to have a plan, a pattern, stick to it, reassess, and be able to make some course corrections. But consistency with a realistic sustainable plan over time is key.

-Go easy on yourself
The makers of UW outright say the the average student will start out at 60% on the Qbank. You have mental health challenges, maybe didn't maximize your learning during the didactic years, and you're outright anxious and at the start of your period. So no surprise you're coming in below average at 40%. Just as the 60% student can expect to bridge the gap to passing, you can too. You don't have that far to go.

You need to keep perspective on the difficulty of the test questions (they aim to be a tad harder than the real thing), where you are in your studying, and that the bank is designed so you get a lot wrong, because they figure you learn more from ones you get wrong (an indication that you've just covered something new, and are expanding your knowledge base for the test). They want the average student's knowledge base coming in cold to only account for 60% of the questions they ask. The gimmes.

In the vein of go easy on yourself, you need to be sure you're not scheduling those NBMEs or diagnostics too early or you'll just hurt your confidence. Conversely, yes, you need to take them and do well enough on them to avert disaster by taking the test too early and unprepared.

CONCLUSION
The only thing you can control here, is how hard you self care, how much help you seek, how hard you work, and how hard you beat back those fears. Plans and knowing thyself can do a lot for anxiety in my experience. You need to control everything you can. You actually have more control here than you think. You also need to let go of what you can't control. You can't control everything that's already happened, where you are starting from, what calendar date it is. You don't need to, to move forward successfully.

The reality is what you described here. If you can get your mental health better through working with providers, self care, get help from friends, family, mentors, other med students, SDN, come up with a good plan that plays to your strengths (once your brain is working better - medicated, therapized maybe, rested, fed, etc), with enough time, reading, and practice questions, you can get a passing score on Step 1.

 

[Redpancreas]

Hi everyone.

I posted here a year ago about depression affecting my focus and cognition, thus affecting my performance in exams. Last year I posted that I had to repeat the last exam. This year, I had to repeat two more because, despite seeing multiple healthcare providers, my mental health has not improved. Throughout the year, I did not really feel like I was learning. The exams that I didn't have to repeat, I basically passed by very little. Now my performance in practice exams pretty accurately reflects my pre-clinical years: failing.

I had always planned to take the year between 2nd and 3rd off to basically tend to my wounds, so I scheduled my exam for a later than usual date to try to make up for the lost study time during second year. Of course, it's not really possible to do in 2mo what most people do over the course of the year. I expected below average scores, but I did not expect failing ones. I entered medical school with the average MCAT score of all admitted medical students (without any study courses or anything). If MCAT scores correlate with Step 1 scores and if everything in medical school had gone normally for me, I would be getting a 230.

In early June, I took my first UWorld Self Assessment. I thought "I don't know" with 80% of the questions and got a 147. I have been using the UWorld Qbank while referencing FA, watched some DIT videos (some I've found to be helpful, and many are not so much), made flashcards (hoping that the process of making them helped because I don't really look at them often), Sketchy, Pathoma... Even Pathoma has not been working out for me, in the sense that it's hard to be engaged and actively learning. Clearly, I am not myself. It had never been difficult for me to learn before, but every time I do UWORLD blocks and see that I'm still scoring in the 30s and 40s, a heaviness falls upon me and it takes me a long time to recover and get back on track.

I got a 170 on an NBME I took Friday of last week. I started using Kaplan videos the day after and found them to be better at teaching me. I've been using them more this week and scored 180 on the next NBME I took, exactly a week after the first. At this point, I just want to pass, so if I get to a 210 on an NBME, I'll take the exam. The problem is that it's in 3 weeks. August is the last month of my 3mo block. Obviously, I would have to pay the full $700 or so for a later date if I don't think I'll pass in August, but I'm trying to study as if I am taking the exam in the end of August. If I fix my mindset, I really should be able to do well.

The reason I'm writing this post is because I'm wondering if there's any advice that you guys have for me about what resources are best for each organ system, how to improve test taking skills (which were pretty good before medical school but now either I don't know or I'm anxious), or how to improve my mindset to be able to study at my best potential (I'm referring to the moping I do every time I finish a UWORLD block).

Any help or advice is appreciated. Thank you.

P.S. Please don't respond with "I don't think you can take the exam in 3 weeks" and leave it at that. I'm realistic. I already don't believe I can do it, but I'd still like to make the best use of the time I have and study as if I could take the exam in 3 weeks.

Yeah this sounds very much like a depressive episode. You need to change your environment completely where you're getting more support. Go home, have your mom make you home-cooked meals, etc, and schedule your exam close to home.

Flash cards that you don't review are pointless. Either create a gigantic set of every factoid and put them in a box and cycle through them until you fall asleep and keep them on the side of your bed or just don't waste your time because you're never gonna set aside time to review them.

You're not ready to take the exam in 3 weeks. Delay. All the resources are fine and that's not the issue; things aren't sticking for one reason or the other. Also, you took to much time off and I suspect we're very unproductive with your year off.

 

[sadperson]

Yeah this sounds very much like a depressive episode. You need to change your environment completely where you're getting more support. Go home, have your mom make you home-cooked meals, etc, and schedule your exam close to home.

Flash cards that you don't review are pointless. Either create a gigantic set of every factoid and put them in a box and cycle through them until you fall asleep and keep them on the side of your bed or just don't waste your time because you're never gonna set aside time to review them.

You're not ready to take the exam in 3 weeks. Delay. All the resources are fine and that's not the issue; things aren't sticking for one reason or the other. Also, you took to much time off and I suspect we're very unproductive with your year off.

I never took time off. I just finished second year and will be doing an enrichment year between 2nd and 3rd year.

I did go home for support and scheduled my exam near home. I also try to get some exercise in (3x weekly). I chose an environment and habits that were healthier for me and am doing better in my hometown than I do when I'm not.

I agree about the flashcards and the "fact notebook." I do like 20 incorrect UWORLD questions a day to review things I missed, though I will soon finish the deck and be able to review all the questions again. I tried to make a fact notebook from UWORLD questions, though I don't know if it's a "fact notebook" or just a notebook. I stopped reviewing it some time ago, and should revisit them, either right before bed like you say or first thing in the morning. Thank you.

 

[sadperson]

Tips and Tricks to stay alert on Test Day?

1) You cannot fail this test.
I recommend you get with your school to discuss all of this and to come up with a plan.
That might mean painful schedule changes, but even delaying a year or even 2 for graduation will not be the red flag that a Step 1 failure is, and often Step 1 failures lead to further schedule changes, so taking the test on time and then failing it usually doesn't save you the bother.
You need help from your mentors.

2) You need to get your self care under control.
Ditto seeking help from a provider, and I provided some general tips for general wellness.
Self care, mental health, and seeking help from medical providers, are all related to doing well.
You need help from friends and family.

2) Dedicated tips for wellness for dedicated study period I provided above. My main tips under that are:

-Consistent sleep/wake.
For general wellness, I tell people not to fight their natural morning lark/night owl tendencies if they can help it. For times when you have to perform outside your comfort zone, then consistency to entrain yourself to the rhythm you are expected to perform at, is what I think best. I say it takes about a month to fully adjust to any major sleep/wake time changes. It was a toss up for me what to do since I'm an extreme night owl. I ended up keeping the sort of hours I would need to have test day for the whole of my study period to get my brain used to functioning when it doesn't function best. The trade off was that a lot of the hours I was studying weren't as efficient. But half my particular battle wasn't just studying, but switching my body rhythm.

-Know thyself
You need to use SDN, Meyers-Briggs, voodoo, Student Study Center, any resources to help you figure out your learning style. I find that learning strategies vary by topic, ie what helped me learn biochemistry pathways was not what helped me learn neuroanatomy. Elsewhere recently I posted about learning strats, I mean, learning down to "I learn by writing on paper but not on whiteboard" is the level of detail that can actually help you. Confidence that what you are doing is what works for you, can help a lot.

-Plan
Based on how you learn, what your topic weaknesses are, it should actually be fairly simple to use SDN to figure out a daily study plan. My plan was quite simply to study X number of pages of FA a day, and do Y number of UW questions. I read all explanations and would have saved ones I did wrong for a second pass had I the time. I used a few books to supplement FA where I felt I needed it. I had a pattern of sleep, wake, breakfast, reading, questions, lunch, questions, reading, etc from 9 am to 7 pm M-F with a light Saturday and Sunday totally off, that worked for me.
Point is, to have a plan, a pattern, stick to it, reassess, and be able to make some course corrections. But consistency with a realistic sustainable plan over time is key.

-Go easy on yourself
The makers of UW outright say the the average student will start out at 60% on the Qbank. You have mental health challenges, maybe didn't maximize your learning during the didactic years, and you're outright anxious and at the start of your period. So no surprise you're coming in below average at 40%. Just as the 60% student can expect to bridge the gap to passing, you can too. You don't have that far to go.

You need to keep perspective on the difficulty of the test questions (they aim to be a tad harder than the real thing), where you are in your studying, and that the bank is designed so you get a lot wrong, because they figure you learn more from ones you get wrong (an indication that you've just covered something new, and are expanding your knowledge base for the test). They want the average student's knowledge base coming in cold to only account for 60% of the questions they ask. The gimmes.

In the vein of go easy on yourself, you need to be sure you're not scheduling those NBMEs or diagnostics too early or you'll just hurt your confidence. Conversely, yes, you need to take them and do well enough on them to avert disaster by taking the test too early and unprepared.

CONCLUSION
The only thing you can control here, is how hard you self care, how much help you seek, how hard you work, and how hard you beat back those fears. Plans and knowing thyself can do a lot for anxiety in my experience. You need to control everything you can. You actually have more control here than you think. You also need to let go of what you can't control. You can't control everything that's already happened, where you are starting from, what calendar date it is. You don't need to, to move forward successfully.

The reality is what you described here. If you can get your mental health better through working with providers, self care, get help from friends, family, mentors, other med students, SDN, come up with a good plan that plays to your strengths (once your brain is working better - medicated, therapized maybe, rested, fed, etc), with enough time, reading, and practice questions, you can get a passing score on Step 1.

Thank you for your response. I do try to take care of myself, get enough sleep and exercise, etc. I also have been doing light Saturdays and taking Sundays off. Now I'll be doing light Sundays (also because my exam is a Friday now instead of a Monday, and the lighter day should be the weekday before).

Finding what works for me is the hard part. DIT worked for a couple of topics, and for others it feels like I don't get much out of them. Kaplan worked for genetics and I'm liking it for pathology and other sections, but those sections are longer so I have yet to see how much I retain once I'm done. I'll keep using Kaplan for now because I do feel like I learn things rather than listen to someone say something and hope I remember.

I like your point about starting to study around the time you'd have to get up to take the exam when the day comes. I'll start doing that.

Thanks again!