An excessively exhaustive guide to Step 1 preparation from a 268 scorer

FindersFee5

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Introduction:

About me: M.D. student at top 20 school. Around top 1/3 of class, though definitely not a tip top student. My MCAT was decent but not remarkable.

Scores:
Rx – 84%
Kaplan – 89%
UWorld 1stpass – 91%
NBME 15 – 257, 9 weeks out
NBME 18 – 255, 6 weeks out
NBME 20 – 252, 5 weeks out
UWSA1 – 275, 4 weeks out
NBME 22 – 259, 3 weeks out
NBME 13 – ~265, offline, 2 weeks out
NBME 16 – ~263, offline, 2 weeks out
NBME 17 – ~265, offline, 2 weeks out
NBME 21 – 265, 1 week out
UWSA 2 – 271, 4 days out
Free 120 – 95% correct, 2 days out
Actual step 1: 268

Principle of learning

Medical school is overwhelming. The amount of information we need to learn is truly remarkable. There will be times throughout the process, even very close to the test, that it feels like an impossible task. How can you keep track of everything you need to know, the interactions between all these things, and still maintain the ability to work through completely novel questions from basic principles?

Your conscious mind can’t. But you’re still going to be able to do it.

If you’re not into metaphors, skip this next part. Personally, I love metaphors because they’re models that your brain can use to make sense of very complicated situations.

Think of your brain as a closet, and everything you need to learn as the things you fill that closet with. When you learn a new piece of information, this is like throwing a new piece of clothing or a pair of shoes or something into your closet. But when you first learn it, you’re just throwing it in there. You’re not thinking about where it fits in, how it connects to other items in your wardrobe, or anything else about it. You’ve just stuffed that new piece of knowledge into the closet.

If you threw a pair of socks into your closet and then didn’t think about them, do you think you could find them 6 months later when you needed them? Maybe, but probably not. This is where spaced repetition comes in – spaced repetition is continuously reminding yourself where you put things.

Now, if the amount you needed to learn was actually similar to the number of items you put in your closet, this would be all you need. But it’s not. By my estimation, there are about 35,000 discrete facts that make up a preclinical medical school curriculum. You need to remember, understand, and be able to apply most of these facts.

This is where organization comes in. If you had 35 THOUSAND items of clothing, there is no way you could find the single pair of socks you were looking for when you needed it. The facts that you used frequently would get placed on the top and you could find them, but everything else would get lost in the mess. Even with spaced repetition, you’re going to be losing the war to mental entropy. Facts are going to keep disappearing if they’re all disjointed, even with daily effort.

Question banks allow you to test, think about, and draw connections. Eventually, they can turn your pile of facts into a more cohesive whole. When you first learn about a type of malignancy, for instance, you might learn what age people most commonly get it, the clinical signs, the treatment, the histology, imaging findings and random facts about genetic rearrangements or other cancer markers. That’s like getting a blue striped button-down shirt with pockets. Which of these is most important – IE, how should you categorize this cancer or shirt? With a piece of clothing, we have pretty good intuition about what’s most important – usually, the style. I’d put that blue striped button-down shirt with my other button-down shirts, not with my other blue shirts, or my other striped shirts, or my other shirts with pockets. This is harder to do with new clinical knowledge, but question banks will intuitively teach you about how new information should be organized and what facets of it are most important to remember (although any of the facts about it can be tested on, potentially).

Question banks are also merciless in not allowing you to skip information. You can tell yourself that it’s unimportant to know what exact translocation causes APML, but the third time you get a t(15;17) question wrong, you’re going to learn it. Similarly, I frequently felt that I understood something, but the understanding was brittle: I could answer a question when it was asked in one specific way, but not when it was approached from another angle. If you get a question wrong that you think you should have known, this is really valuable – it means you need to go back to the basic principles related to that question and relearn it until you can answer any question about it, no matter how it’s asked.

Eventually, you will have a well stocked and well organized closet. You will know where all your information is, or at least where to find it. This is the ultimate goal. I knew this wouldn’t be possible to accomplish in the cramped 6 weeks of a study block, so I began early and worked slowly and steadily. In the next sections, I’ll elaborate on the nuts and bolts of this process.

Mindset

First, though, I want to talk a little bit about my mindset throughout this process. If you look at the preclinical years as a chore, you’re never going to get through them. It’s a tough time. It’s a tough time even if you enjoy it. Try to frame your mindset such that you appreciate the privilege of learning and think about how wild it is that you get to learn these things!

Related to this is the idea of learning vs memorizing. Memorizing is not fun. I got through my initial anatomy class with basically just rote learning. I hated it, and almost burned out in the 10 weeks I spent in anatomy. If I had continued that trajectory throughout med school, I think I would have dropped out.

I had an amazing physiology course though, taught by professors who truly educated us. They instilled an appreciation for learning and a desire to question thoroughly and understand deeply. I found this so much more rewarding it wasn’t even in the same realm. Moving forwards, I tried to apply the same techniques to everything I learned in the future. I found that I actually enjoyed relearning anatomy for step prep because I was focusing on functional anatomy and pathology. There is certainly memorizing, but memorizing should be a means of fitting pieces into the larger puzzle.

Class vs. test prep

There have been a ton of threads about people trying to do well in class vs. preparing for Step. This is really silly – preparing for Step IS preparing for class. There are certain things that you’ll get out of class that you won’t get out of Step prep and vice versa, but by and large, you’ll learn the same things. I think what people mean when they say “just focus on doing well in class” is actually just telling people not to spend the first two years just memorizing facts. This isn’t what Step prep should focus on though. Learning everything in a strong, flexible way will serve you well both in class and on Step, and I assume throughout your future. If going to class is the best way for you to do this, do that. If question banks and video resources help you more, then do that.

The one caveat I’d add to this is that you should take clinical opportunities whenever they present themselves. Whenever you have a chance to examine real patients, write notes, or create differentials, take it. These are really important and they aren’t easy. Question banks and anki also will not help you much here – it doesn’t matter how much knowledge you have, this is a new skill that comes only from practice. It also always motivated my learning when I was able to see how my knowledge was being applied. Fully engage with any clinical opportunities your school offers.

Pre-dedicated preparation

Entering medical school, I knew I had some strengths and some weaknesses compared to the average medical student. I was always interested in a few competitive specialties so I knew I needed to play to my strengths and compensate for my weaknesses. I learn things relatively quickly, but I have a poor memory compared to my classmates. My biggest strength, though, has always been my ability to break large tasks into manageable chunks and work through them over long periods of time. My preparation style reflects this.

Matching studying to curriculum and general schedule

I went to a school with a classical curriculum, so my study method reflects this. However, I believe it might actually work even better with a systems based curriculum, and should be easily adaptable to this type of school. For people with a 1.5 year preclinical who take step 1 after 3rdyear, it may be less applicable.

How do you match studying from board prep resources with class curriculum? There are a lot of different ways, but here’s what I did.

There are a few principles I applied here, but a main one was that I learned better from outside resources and used classes/group labs as my second pass. For other people, classes may be a better first pass. In that case, flip this.

First year after anatomy, I focused on Zanki and learning concepts through textbooks. I don’t think this was the ideal way to learn, but it worked alright. I didn’t use any question banks because they often required too many leaps involving simple facts I had not learned yet, so they weren’t super useful. I did do about 200 Rx questions after I finished microbiology and physiology just to see how boards style questions felt – this isn’t essential, but I thought it was helpful for shaping my learning going forwards.

Summer after first year, I kept up with all my old Zanki cards and went through sketchy pharm while completing the anki decks that went along with them. I thought this was super helpful, especially because it meant I only had to watch a couple videos a day and it meant I started the year ahead of the curve.

For my second year, I would learn the initial content through pathoma or sketchy and complete all zanki cards. This sometimes involved me doing work at the end of breaks or while I was in another unit, but you have to learn this stuff sooner or later, and classes worked a lot better for polishing my knowledge than instilling it. During each unit, I would watch boards and beyond videos for class topics for the current day and go through the class slides, adding cards to my deck for any facts that I didn’t know. I did Rx practice questions at the end of each organ system, and would complete all practice questions for a specific system before I my test for that system. I started doing about 20 – 40 Kaplan practice questions per day in December, drawing from all previous units as a sort of review. The day before a test, I would do all the practice questions provided by TAs as well as going through their reviews, but other than that I didn’t do any test specific prep prior to class tests. Constant spaced repetition and questions kept me sharp even if I had been learning something else more recently.

My time breakdown per day: I probably spent about 90 minutes on reviewing old anki cards (for all previous units) and 60 minutes on new/learning ones (adding new cards and going through reviews for the current unit). I spent about 2 hours in active learning discussion labs with classmates. Around 1.5 hour on questions, and around 1.5 hours on video resources. This meant that I was doing about 7.5 hours of work a day. Weekend schedules were similar, except I substituted the discussion labs for an extra hour of videos or questions (so I studied about 6.5 hours each weekend day). I know some people on the internet who talk about studying 10-12 hours every day, but I averaged only around 7 hours a day.

I would recommend reading The Talent Code, which emphasized for me the importance of deep learning and immediate feedback. Active learning frequently felt difficult for me, and I initially thought that meant I was doing it wrong – especially because passively reading textbooks felt easier, like I immediately understood everything that was happening. With my study schedule, especially second year, every day included moments of struggle. But what The Talent Code explained is that moments of struggle, difficult moments, are the moments before you actually learn something. If all your learning feels too easy than you aren’t testing yourself enough – it’s too passive. Try to figure out a way to make it more active and difficult. I think it’s impossible to spend all your time deep learning though, and review outside of this is helpful as well. Versus total time spent studying, I probably spent only 1-3 hours a day in that deep learning state.
 
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FindersFee5

FindersFee5

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Thoughts on specific resources

Anki/Zanki:
I love Zanki. It’s a remarkable tool. It’s not the only tool you need, but for me it was my most important study aid and the thing I spent the most time on. Midway through first year, I set the goal to have Zanki entirely matured by the time dedicated started. To accomplish that, I would need to learn about 80 cards/day, every day. I was able to basically do this, though I started at 100/day, did about 60/day over the summer after M1, and went back up to 100/day at the start of second year. I missed only one day from December of M1 up to the day before my test.
I did cards on Christmas, my birthday, at music festivals, at the gym, while traveling with friends. Because I did all my cards every day, Zanki never took up all that much time – I rarely spent more than 4 hours on it and most days before 2ndyear it was less than an hour. No matter what else you’re doing, you can almost always find a free 60 minutes spread through your day. Having anki on your phone is a must too – think about how many times through your day you open your phone and mindlessly scroll through Instagram or snapchat or whatever. Replace those with getting 5-10 cards done, and you’ll pretty quickly find it doable. I firmly believe that Zanki is not something you can do in spurts, it needs to be a constant effort. But your effort will be well rewarded.

I used Zanki. I know a lot of people have success with organizing cards through tags, but I primarily used decks. I created one large deck called “Reviewing” that I would move decks for past units into. However, studying from this would go through all the cards sub-deck by sub-deck, so I created a filtered deck to randomize this. To do this, go to Tools -> create filtered deck. In the window that pops up, under Search use the search criteria is:{d}ue deck:{Deckname}. So for the randomized review deck, my Search criteria was is:{d}ue deck:Reviewing.
Set the limit to 10000, and cards selected by Random. At the start of every day, select that deck and click Rebuild at the bottom of the screen. This will build a deck from all the due cards in the larger subheading of the Reviewing deck. It will also arrange all the cards randomly so you’ll be seeing cards from all the sub-decks in a shuffled order.

I created a second filtered deck called “Current reviews” that I would use to draw cards from the decks applicable to my current unit. This allowed me to learn my new cards for every day separately from my reviews, which I found helpful.

For my anki schedule, I would go through my Current reviews filtered deck first, because these were the most recent things I was learning and the most important thing for me to be fresh for. Then I would learn whatever new material I needed (usually set as whatever material was covered in what the next 100 cards). For learning new cards, I set all decks to “Show new cards in order added.” For the most part, Zanki follows the order of review resources so you can start by watching a Pathoma video and then go through all the cards for that video quickly. An example day while learning cardiology: I would watch the first Pathoma video in the cardiology section. Then I would go through the Zanki cards for cardio pathology until I reached cards I didn’t recognize from that video. I would watch the next video then and repeat until I reached my daily limit of 100 new cards.

For my reviews of more distant subjects, I would scatter these throughout my day and could usually do enough so that at night I only had 100-200 cards I needed to sit down and get through, which was super doable. I did all my reviews every single night.

At the end of each Zanki section are some of his cards that he created from UWorld stuff he didn’t know or other things that he just wasn’t sure about. I think these cards are less helpful because they aren’t in a greater context like the rest of the deck, and I ended up suspending a lot of them. Your call on how helpful you feel they are though.

Pathoma:
Pathoma is amazing. It doesn’t include all the details you need, but Dr. Sattar teaches you to think about pathology in the right ways. Use Pathoma. Just do it. 90% of my initial learning for pathology came from Pathoma.

Boards and beyond:
B&B is pretty good, especially for things not covered in pathoma. The biochem and stats sections in particular were pretty good. The whole cardiology section is amazing too. However, this one does feel more like a review source. I wouldn’t use B&B as my primary learning tool. Good for filling in gaps and reviewing stuff you’ve already learned though.

Costanzo physiology:
Zanki physiology decks are primarily based off Costanzo physiology, so I would read the corresponding sections first before doing the cards. I think this was a really good book and I’d definitely recommend using it. The BRS physiology review book that goes along with it is pretty good too, and I think it could be a good resource for people who felt weak on physiology during dedicated. I know some people used Zanki by itself for physiology, but for me it was helpful to read through a section so I could get an overview before I started filling in the nitty gritty details.

Sketchy micro/pharm:
I’m going to go against the common grain here and say that I actually liked sketchy pharm more than sketchy micro. Pharm videos are longer and have more involved, but they also review relevant physiology, and pharmacology is just straight up more complicated. I attribute most of my pharm knowledge to my leisurely use of sketchy pharm through the M1 – M2 summer. Both are great resources though, would definitely recommend.
Proof that sketchy pharm is all you need:

First aid:
I didn’t use first aid nearly as much as most people, I think primarily because I took most of my notes in Anki. I did make one full pass through it during dedicated just to pick up on any low-yield facts I had missed, which maybe got me 1-2 questions on the real thing. It’s a good resource to make sure you don’t have any large knowledge gaps but I wouldn’t recommend spending much time just reading it. Taking notes in it is okay, but I know that I probably wouldn’t have gone through those notes again, whereas taking notes with Anki flashcards forces you to review those things again and again.

Robbins pathology:
I didn’t read all the way through big Robbins, but it is a pretty helpful book for deeper review of a topic you consistently struggle with. The diagrams are great as well. I think it’s scary for some people, but it is the big daddy of pathology.

Goljan:
I listened to the Goljan audio recordings on runs. I got through the whole thing about once. Information wise, it’s probably a 7/10 resource. The fact that you can’t see the slides makes it less helpful. Some of his information is out of date now as well. However, he does present things in an interesting and fun way. He also draws connections between different fields that you wouldn’t necessarily think of, and models how you should be thinking about new information as you learn it.

Practice questions:
Question banks are key. All added up, I completed around 11000 unique questions. Other than Zanki, I attribute most of my success to doing this. When you see enough questions, you’re going to be able to recognize presentations unconsciously. This unconscious processing is key for the real thing: the questions are complicated enough that you need to be able to diagnose the condition without effort so that you can immediately move onto figuring out what they’re actually asking.

-Kaplan: I actually really liked Kaplan. Sure, there are some nitpicky questions, but the physiology questions really teach you to think. If I had to choose only one Qbank other than Uworld, I would choose Kaplan.

-Rx: Was okay for initial assessment and solidification of learning. However, questions were frequently miscategorized, which means that even with selecting subjects you’ve learned you’ll see some things that you haven’t learned yet. Still a pretty good resource and teaches you to read First Aid carefully.

-Amboss: Got some free amboss passes so I did about 1300 questions for kicks. Amboss has a few good questions that really make you think, and a larger number of unnecessarily tricky questions or super easy questions. If you REALLY want more questions, it’s worth your time. You can definitely pass on it though and it won’t hurt you.

-UWorld: The best. Great questions, clear explanations, wonderful figures. I saved UWorld for dedicated because I wanted to keep seeing new questions throughout dedicated. Personally, I did the entire thing on timed random, although in certain situations I can see how system and tutor mode would be better. I also read every single word of every explanation and added cards for any facts that I didn’t know, even if they seemed low yield (not necessary unless you’re aiming for really high scores, but did get me 1 question on test day!). When reviewing questions with answer choices that aren’t immediately apparent (IE, nephrotic syndrome question where all the answers are descriptions of histology), make sure you know what every wrong answer choice means, and think about what parts of the question would have to be different for each wrong answer to be the right answer.

I went through UWorld once + my incorrects once. I’m not sure how much I would have gotten out of doing UWorld in its entirety a second time, though if you were less zealous about making cards for unknown facts it might have been more useful.

-NBMEs: I wish I had done fewer NBMEs. Didn’t do 23 or 24, but from all the NBMEs I did, they weren’t very useful. I had a hard time believing this at the time, but UWorld really does do a better job of simulating the test than the NBMEs do. If I had to say what the real test was most similar too, I would say it was like UWorld questions with NBME answer choices. I think doing 2-3 NBMEs would be plenty.

***Per @Diphyllobothrium latum, on advising NBME 23 as a good one to take: "I felt it was very demanding and concept-heavy exam. It is probably the most difficult NBME around (I remember marking around 60Qs in total). The Q style does not approach the real deal or UWorld in terms of length as the stems are shorter but very much does so in terms of how they actually want you to apply knowledge rather than simply recall it. It really helps building your test taking abilities imo.***

For reviewing the NBMEs, I would go through every question and read it again. For questions I marked or got wrong, I wrote down in a notebook why I got it wrong or why I was uncertain about it, then figured out exactly what facts I was missing. If it was a knowledge problem, I would add cards to my anki deck so that I could learn from it.
 
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FindersFee5

FindersFee5

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Understanding incorrect answers

Meta-cognition and understanding why you get questions wrong is a really important part of this process. Whenever you get a question wrong or mark a question, ask yourself “What piece of information was I missing? What would have helped me get this right?” I was able to place almost all my mistakes into one of 6 buckets: diagnosis errors (IE, question about ulcerative colitis that I thought was a patient with Crohns), knowledge gaps (IE, correctly diagnosed patient with ulcerative colitis but didn’t know that UC was associated with primary sclerosing cholangitis), memory failure (knew all of the above but just forgot it), connection problems (knew the facts you needed but perhaps had never thought of them in this context), overthinking (initially wanted to choose the correct answer but argued yourself into choosing another answer because of some small detail), or careless errors/misreading. Each of these problems will have a different solution.
  • Diagnostic errors: Learn general presenting characteristics of classes of disease. Then figure out what specific physical findings or lab findings will help you separate similar disorders. For instance, I think a lot of people struggle with the leukemias because they have very similar presentations, but once you realize that test makers use only a few traits to distinguish between them, the diagnosis becomes really easy. You can read the question and answer choices, think “some kind of leukemia,” and then immediately scan the stem for one of those trigger words or images.
  • Knowledge gaps: This is where First Aid shines. If you’re lacking knowledge about some condition, go back to FA, read the section for that condition, and figure out any other parts of it that you didn’t know about or understand. Then make flash cards for those facts so you don’t forget them in the future. If you still don’t get it, go back to big Robbins. These are actually the easiest errors to fix.
  • Memory failure: You learned the facts, but for whatever reason they didn’t stick. Teach the topic to yourself again and add flashcards for the facts that you forgot. If you have multiple anki cards about a single subject, that’s okay, especially if it’s a fact you have a difficult time remembering.
  • Connection errors: The solution to these is mostly proactive. While you’re studying, make sure you’re constantly making connections. If you learn something in one context, make sure you think of different ways it could be tested. When I learned an interesting new fact I liked to write practice questions in my head and try to predict all the different ways a test maker could approach that fact. I actually got a question on Step 1 that was almost identical to a question I had thought about but had never seen in any review resource. Doing lots of practice problems will help with this. Goljan is also helpful for teaching how to think in an integrative way.
  • Overthinking: This became more of a problem for me as dedicated went on. Knowing more facts is not always good. It’s important to be aware of when you’re overthinking vs. when you’re approaching the question in a new way. There’s a very specific feeling I had when I was arguing with myself, and I learned to recognize that. In these cases, mark the question, move on, and come back to it later. Here are a few other principles I used when I felt myself overthinking: Don’t choose an answer you’ve never heard of unless you can confidently eliminate other answers. Don’t choose an answer with a weaker justification, even if it would be the best answer were that justification correct (IE, I remember a Crohn’s disease question that asked about which portion of intestine was affected, but the affected portion had to be retroperitoneal. I was torn between the descending colon and the ileum – I couldn’t remember if the ileum was retroperitoneal or not, though I knew crohn’s frequently affected this area. I was sure, though, that the descending colon WAS retroperitoneal so I choose that.) If you’re really not sure on a question, go with your first answer. Don’t change an answer unless you’ve found some new piece of information in the question stem or remembered some new fact. Don’t change it just because you have some feeling about a different answer.
  • Careless errors/misreading: People have different methods to deal with these. I knew some classmates who would go through the entire test twice – that didn’t work for me because I’d find myself skimming and rarely catch errors. Instead I did two checks after I chose my answer. First, I’d read through all the other choices and quickly explain why they were wrong. Then, I’d quickly read the last line of the question again and compare it to the answer I chose. This helped me prevent my most gratuitous errors, the kind of things that I felt the dumbest about when I reviewed them later.
Going over questions carefully in this way will also teach you where your knowledge deficits lie. Instead of using NBMEs to target some broad category of weakness, use every question you do to help you. If you feel kind of confused on a question even after reviewing it, go back to primary sources and read all about it, write out diagrams, figure out where it fits in with everything else, and make Anki cards so you don’t forget it.

Another good thing to do when reviewing questions is to figure out why UWorld chose all the wrong answer choices they did – frequently, at least 3 of them are closely related. These are usually conditions that might closely mimic each other in some way. It’s worthwhile to be able to describe to yourself the slightly differing presentations that would make you think of one condition vs. the other. Especially useful with nephritic/nephrotic syndromes, basically all cancers, developmental cardiac and GI defects, skin conditions, and psych conditions.
 
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FindersFee5

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Method for approaching questions

I had a very strict routine that I practiced with every single new question I saw (I was never able to make myself stick to it with questions I had seen before, which is partly why I think new questions are so much more valuable). When you have a set routine, panic won’t affect you as much. I remember how anxious I was sitting in the chair at the testing center as I clicked through the tutorial, but as soon as I opened my first set and saw the first question, my brain instinctively entered question-answering mode. A routine is key to prevent panic. Here was mine:

1. Read the last 2 sentences of the stem, the question that it’s actually asking you. This will help prime your mind for what you should be focusing on during the question. Also, sometimes the last 2 sentences will give you enough information that you don’t even need to read the rest of the question (this is especially common on really long questions for some reason).

2. Skim the answer choices. This will further help prime you during your first read through. For instance, maybe you see that one of the answer choices is “Linear IF on kidney biopsy” and so any suggestions in the stem that this is Goodpastures syndrome will stand out to you more.

3. Re-state to yourself what the question is, in your own words. Something like “This is a question about an MI, and I need to figure out which coronary artery was blocked,” or “This is a question asking about what bug is causing this infection.” Restating the question in your own words helps you remember what you’re looking for as you go back and read the stem, and gives you a more active role in the learning process. This helped prevent me from those instances where you read the question, read through the stem, and then realize that you remember neither of them and just wasted 45 seconds.

4. Read the stem. You should already have a list of differential diagnoses in your head as you begin, simply from reading the last line and the answer choices. If there’s anything that you’re particularly confused about, skip over it and find out if it’s actually necessary to answer the question.

5. If you feel good about an answer, choose it. Then read through all the other answers too and make sure that none of them is a better answer choice. This is my main consistency check to prevent careless errors – I don’t do a complete recheck at the end, I only look at marked questions again.
NOTE: It’s good practice during practice questions to see if you can describe in a few words to yourself why all of the other answers are wrong, and what would need to be changed in the stem to make them correct. This technique was not as useful on the real thing because I often wasn’t able to figure out why the wrongs were wrong, just knew that I felt better about the right answer – don’t panic in this case, just choose the answer you feel is right. This intuition was built by study habits throughout dedicated.

6. If you still aren’t sure, read through the question again and jot down anything that stands out to you. I actually used paper extensively for this, much more than most of my friends – I went through 8 sheets of paper on test day! Often, UWorld and Step 1 will use synonyms to describe something that make no sense, but when you put them in your own words you realize it’s a pretty classic case presentation. Remembering all the parts takes up a lot of your working memory though, which is where writing it down comes in. Who knew that writing stuff down made it easier to hold multiple parts of a complex problem in your head? I think this was one of the biggest things I did to close the gap on people who were naturally better at complex tasks.
NOTE: As First Aid said, “Sometimes the questions are difficult and the answers are easy.” Many of the questions that other people claimed were WTF are actually quite easy when you don’t panic and start breaking it down. I went over a few practice tests with friends who would just give up and choose an answer when they weren’t able to figure it out in 90 seconds. Don’t do this!

7. If you still aren’t sure, do the same thing for all the answer choices. A lot of the time, you kind of know what most of the answer choices are, but force yourself to go over them again and say, “this histology definition fits this condition,” or “this set of up/down arrows would be seen in SIADH, but the prompt is describing diabetes insipidus, so it is incorrect.” By breaking the problem down into its simplest components, I frequently found that problems that initially seemed really difficult were actually quite simple. Cross out answers you’re sure are wrong to help you see that maybe the question you initially felt was a total guess actually becomes a 50/50 choice!

At first, this might feel clunky or unnatural, but the more you approach questions in this strict manner, the more natural it will become. The structure allows you to approach questions even when they seem really unfamiliar, and it can have a calming effect during high stress situations. But it requires practice!

There are some types of questions that I modified this formula for, but it’s probably not worth writing up all these different methods. If you are wondering about how I’d tackle a specific question, feel free to message me!
 
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Mental preparation

I think mental preparation is a somewhat underrated aspect of this process. Doing practice problems is like working on a skill in a sport, but mental prep is like general fitness. I meditated at least 15 minutes a day during dedicated, usually doing bodywork such as the 10 Points Practice or GAP Practice. This was immensely helpful at the end of every day but especially days that I felt upset with my performance. Bodywork is a great way to view your performance in a non-judgemental manner. As an aside, I’m actually against positive self-talk – I think it can be nearly as damaging as negative self-talk. The best way to prepare is to look at what you’re doing with equanimity, almost as if it were somebody else’s work you were critiquing. This will also help you on test day, as feeling either overconfident (pretty rare) or panicked (much more common) can seriously alter your performance. If you want your best self to be taking the test, I think meditation is a must.

The other thing this non-judgemental mindset will do for you is allow you to be comfortable with uncertainty. Many of us have been excellent test takers our entire lives, so we’re used to reading a multiple choice question and immediately knowing the answer. Board style questions are not like this! For me at least, I rarely read a question and immediately know what the answer is (probably less than 20% of the time on UWorld). When I started doing Rx questions, that initial uncertainty was originally a very frightening and unfamiliar experience for me, and I would frequently pick and answer just to move on and get past it. However, when I learned how to sit with that uncertainty comfortably, my percentage steadily climbed almost 15% with little improvement in knowledge. This goes back again to the wealth of information that we need to know – it’s not always going to be consciously available right away. If you let your subconscious work on it in a calm state, though, you’ll frequently discover that you actually dohave the answers.

My final comment is on sleep and learning. Sleep is incredibly important. I knew this before, but Anki showed me how important it was on a visceral level. There were frequently days that I would be struggling through my new cards, feeling hopeless, like I would never be able to learn those long biochem terms or how to tell these cancers apart or whatever. I would finish the cards, go to sleep, and then do my reviews the next day. This was often 12 hours later, so I should be doing worse, right? Nope! I would fly through them. Sleep has been shown in research time and time again to be key for memory consolidation, emotional regulation, and priming for complex learning (If you’re interested, I would read Why We Sleep by Matthew Walker). If you’re sleeping less than 7.5 hours per night, you are sabotaging your ability to learn in the long term, and probably also your performance in the short term. Unless you have kids in medical school, there is no reason you shouldn’t be able to get at least 7.5 hours of sleep almost every night. Through dedicated, when my time was all my own, I slept 9 hours per night. Just as sleep is the third pillar of exercise, sleep is the third pillar of learning as well.

Some thoughts on dedicated

My dedicated schedule was pretty standard – I would do 2 blocks/day, do all my anki reviews, read some first aid, and do content review on whatever I was missing. Practice test every weekend. I don’t think there was anything in my day to day schedule that other people haven’t discussed.

The one thing that I’d like to talk about is peaking at the correct time. I see a lot of people going through dedicated who finish UWorld a few weeks or even months before they take the test, and then they spend the rest of their time going through UWorld a second time. I don’t think this is the right way to do it. As I discussed earlier, I think your brain reacts uniquely to novel questions and it’s really important to continue seeing new questions throughout your prep. If you’re primarily seeing repeated questions over your last few weeks, it’s going to feel like a shock when you see all the new questions on Step 1. I’m convinced that this is why a lot of people feel like **** coming out of the test itself: they don’t really remember how uncertain new questions can make you feel so they think they failed the test. This might be a minor detail, but I think peaking at the right time can help you squeeze the last 5 points or so out of your prep.

About the test

The test itself is long but pretty fair. I’m not the first to say this, but I would say that the questions felt most like UWorld, although the answer choices were usually a little more straightforward (more questions where the answer choices were literally just the diagnosis). It was similar in feel to the free 120 although there were a few more difficult questions. Less than 5% of the test was truly WTF, one line questions that had nothing to figure out and you either knew it or you didn’t. An additional 10% of it included questions that could be WTF or felt WTF initially, but when I started breaking them down, were actually relatively simple or at least doable. Finally, one thing to prepare for is that at least 4 questions per block were significantly longer than any UWorld question – however, almost all of these could be answered by the last two lines and the answer choices, maybe skimming through the passage to confirm your answer. If you were reading them carefully beginning from the first line though, I could see these being a major timesink, resulting in shorter time for other questions and potentially panicking you. The remainder of the test was quite fair and well written, with very little similarity to the NBMEs at all. The one thing that I think was similar was how poor some of the images were – I felt like UWorld included mostly beautiful textbook images, while some of the Step 1 images were similar to what the NBMEs looked like. Ascultations were crisp and clear. Both of my EKG questions were not bad, which I think is actually generally true – EKGs require years and years of reading to be good at, so basically all they can test us on are the basic 10-12 rhythms.

A few final thoughts: this process is difficult, but it is not impossible. Because I worked consistently but not at a furious pace, there were very few times throughout this process that I actually felt like I had to give anything up. It takes dedication and work every day, but it’s doable. A positive mindset and enjoyment of what you’re learning is key. There will be moments of uncertainty and moments where you have no idea how you’ll ever learn it all, but it will be okay. I firmly believe that a 245+ is within reach of everybody who has been able to get into medical school – in this way the test is actually really good because it is a wonderful measuring stick for effort. Work hard, work smart, and everything will turn out fine.
 
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This should be a must read for all entering M1s. Prob the highest quality write up I’ve ever seen for step1. I work with students on Step and I usually recommend this type of approach for students who want to murder the exam. What an amazing, thoughtful post
 

Diphyllobothrium latum

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This should be a sticky, it's exceptionally well-written and organized. It covers pretty much all aspects of the preparation for this test thoroughly with a systematic approach.

A lot of times, people intuitively discover small bits of wisdom mentioned in this guide as their prep goes forward, but fail to put them together into a well thought out and structured approach as is done here.

You see UFAP being thrown around all the time or people asking for particular resources. People make the assumption that it's the resources that make great scores. Yes, not all resources are created equal. But really who takes Step 1 these days without doing Uworld or FA? Sure there are exceptions, yet they represent a small minority. On the other hand, you can find people who used UFAP and scored in the 200s as well as the 260s.

So the recipe of success is actually what @FindersFee5 took the time to extensively present here : Consistent work from early on (versus cramming during dedicated), emphasis on concepts and active learning (versus pure memorization), constant practice and test taking skills refinement through novel questions all the way till test day.

My only (partial) disagreement is about NBMEs. I do find them unreasonably expensive and of poor quality in general but the way answer choices are presented is more similar to the real deal as it is correctly pointed out. Crossing out choices in UWorld is easier because each answer choice represents a learning concept that makes up for high-yield learning topic. NBMEs on the other hand are more random and often include answer choices you 've never heard of or that do not correspond to an actual disease process. If you do what is said on the how to approach Qs chapter, you shouldn't fall for the traps most of the times, but still getting some exposure to this style of Qs might be necessary in my humble opinion.

From my personal experience, I'd say certainly advise that everyone does 18 and 23, and from there they can choose a couple of others (preferrably from the newly released ones). NBME scores are also somewhat useful to see where you stand - the caveat here is that this is true for the averages and the trends of all scores rather than an individual score. Qbank scores are not that much predictive (though your 1st pass percentage of Uworld especially if timed and random might be an exception to this) since people solve Qbanks in a very diverse way, with all the different available options and often do 2nd or 3rd passes. You might also see repeats from NBMEs in the real deal, but these are literally a drop in the ocean and shouldn't be your main incentive to solve NBMEs.

Again, thanks for taking the time to put this together and congratulations on your well-deserved score!
 
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FindersFee5

FindersFee5

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This should be a sticky, it's exceptionally well-written and organized. It covers pretty much all aspects of the preparation for this test thoroughly with a systematic approach.

A lot of times, people intuitively discover small bits of wisdom mentioned in this guide as their prep goes forward, but fail to put them together into a well thought out and structured approach as is done here.

You see UFAP being thrown around all the time or people asking for particular resources. People make the assumption that it's the resources that make great scores. Yes, not all resources are created equal. But really who takes Step 1 these days without doing Uworld or FA? Sure there are exceptions, yet they represent a small minority. On the other hand, you can find people who used UFAP and scored in the 200s as well as the 260s.

So the recipe of success is actually what @FindersFee5 took the time to extensively present here : Consistent work from early on (versus cramming during dedicated), emphasis on concepts and active learning (versus pure memorization), constant practice and test taking skills refinement through novel questions all the way till test day.

My only (partial) disagreement is about NBMEs. I do find them unreasonably expensive and of poor quality in general but the way answer choices are presented is more similar to the real deal as it is correctly pointed out. Crossing out choices in UWorld is easier because each answer choice represents a learning concept that makes up for high-yield learning topic. NBMEs on the other hand are more random and often include answer choices you 've never heard of or that do not correspond to an actual disease process. If you do what is said on the how to approach Qs chapter, you shouldn't fall for the traps most of the times, but still getting some exposure to this style of Qs might be necessary in my humble opinion.

From my personal experience, I'd say certainly advise that everyone does 18 and 23, and from there they can choose a couple of others (preferrably from the newly released ones). NBME scores are also somewhat useful to see where you stand - the caveat here is that this is true for the averages and the trends of all scores rather than an individual score. Qbank scores are not that much predictive (though your 1st pass percentage of Uworld especially if timed and random might be an exception to this) since people solve Qbanks in a very diverse way, with all the different available options and often do 2nd or 3rd passes. You might also see repeats from NBMEs in the real deal, but these are literally a drop in the ocean and shouldn't be your main incentive to solve NBMEs.

Again, thanks for taking the time to put this together and congratulations on your well-deserved score!
How many NBMEs do you think is the sweet spot? 1/week, as has been recommended in general? I also did not take 23, what did you like about it more than the others?

Another potential option would be to take 18 and 23 online, to get scores on those, and then try to find offline copies of the other NBMEs (I know there are a good number of comprehensive NBME files floating around somewhere, and I used one extensively for the older NBMEs). How would you feel about that?
 

Diphyllobothrium latum

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How many NBMEs do you think is the sweet spot? 1/week, as has been recommended in general? I also did not take 23, what did you like about it more than the others?

Another potential option would be to take 18 and 23 online, to get scores on those, and then try to find offline copies of the other NBMEs (I know there are a good number of comprehensive NBME files floating around somewhere, and I used one extensively for the older NBMEs). How would you feel about that?
I did go overboard with NBMEs myself too, I solved 7 but I felt quite comfortable with them after having done 4. I think 4 NBMEs coupled with the 2 UWSAs throughout the last 6 weeks of one's prep, doing 1/week as you suggest is reasonable, with Free 120 left intentionally for couple of days out of the exam.

Regarding NBME 23, I felt it was very demanding and concept-heavy exam. It is probably the most difficult NBME around (I remember marking around 60Qs in total). The Q style does not approach the real deal or UWorld in terms of length as the stems are shorter but very much does so in terms of how they actually want you to apply knowledge rather than simply recall it. It really helps building your test taking abilities imo.
 
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FindersFee5

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I did go overboard with NBMEs myself too, I solved 7 but I felt quite comfortable with them after having done 4. I think 4 NBMEs coupled with the 2 UWSAs throughout the last 6 weeks of one's prep, doing 1/week as you suggest is reasonable, with Free 120 left intentionally for couple of days out of the exam.

Regarding NBME 23, I felt it was very demanding and concept-heavy exam. It is probably the most difficult NBME around (I remember marking around 60Qs in total). The Q style does not approach the real deal or UWorld in terms of length as the stems are shorter but very much does so in terms of how they actually want you to apply knowledge rather than simply recall it. It really helps building your test taking abilities imo.
Thanks for the feedback! Have edited to include your words on 23.
 
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Vladimir7

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Alright I wanted to try a few things advised here and advised elsewhere for my first midterm before asking any pre-dedicated related questions. We are now post-Midterm 1.. Considering i spent 1 week not studying (basically at all ) and 2 weeks before midterm basically playing catch up and cramming daily..scoring average is decent so I think I will continue with my current plan using some advice from above and adjust when need be. Just stay caught up going forward.

A little background on my school. We have a modern, system-based curriculum. We have a foundational first block, then our subsequent blocks will go through each organ system with respect to the anatomy, physiology, and pathology of each. (obviously micro, pharm etc too..). We are tested on a faculty and NBME based level (supposedly to prep us for STEP but these are old NBME questions and as you say NBME does not simulate step as well as UWorld does. I definitely prefer this though because faculty based exams are worse than NBME when it comes to relevant material. NBME is First Aid based. HOWEVER, we don't even take STEP 1 AFTER our basic clerkship rotations. So 1.5 years pre clerk, 1 yr mandated clerks, then step one after 2.5 years.

So this leads me to my first question:

However, I believe it might actually work even better with a systems based curriculum, and should be easily adaptable to this type of school. For people with a 1.5 year preclinical who take step 1 after 3rdyear, it may be less applicable.
How do you think your pre-dedicated period would change with this in mind? So far I'm not sure if it would make much of a difference.. I still need to get through all 25,000-35,000 discreet facts (basically complete Anki deck) within the next 18 months, and I still need to retain this information by the time I get to STEP. So my plan right now is to slowly keep unlocking cards while reviewing old cards, and maintain my reviews (if i can) while being on rotations.

Side note, I don't plan on using UWorld prior to 3 months before dedicated, but since UWorld is good for shelf/ clerkships..i guess i will have to use it before step 1 dedicated? I just hope that theres a separate STEP question set and clerkship set. Idk, I haven't even glanced at UW yet.

There are a few principles I applied here, but a main one was that I learned better from outside resources and used classes/group labs as my second pass.
I kinda want to do this too, but how do you know whats relevant for your lectures/professors. Don't you risk listening to an outside resource and learning 50% more than what was in your lecture? I have found this happening a few times with BnB, and I know this because I listen to the lecture beforehand. However, I guess you can circumvent this by just looking at lecture slides / main lecture objectives, then using the external resource to learn.

On that note, my current study method is this: Watch Lecture, Watch BnB for review, Do BnB questions, Unlock Anki cards based on the BnB videos at the end of my study (this is known as the Infinity and Beyond method because its the lightyear deck + Boards and Beyond). Zanki is currently being updated (AnkingOverhaul) to incorporate a BnB tag, if it's mostly complete for a module I will use it instead of Lightyear. At the end of each week/towards exams, I will use USMLE-Rx as my First Aid based question bank. I don't want to get too many resources.. so Kaplan and AMBOSS are currently not considered. I will use Sketchy for Micro/Pharm, and Pathoma for pathology though. My hope is that BnB + Lecture + FA is good enough for physiology, if not I will use Constanzo or Physeo. I'm saving Goljan, and Uworld for STEP. How does this sound?

I probably spent about 90 minutes on reviewing old anki cards (for all previous units) and 60 minutes on new/learning ones (adding new cards and going through reviews for the current unit).
I know a lot of people have success with organizing cards through tags, but I primarily used decks. I created one large deck called “Reviewing” that I would move decks for past units into.
Alright so I want to do this too, is there a way of doing it in a tags based way? Especially since not every card in a deck is relevant; is there a way to only move unsuspended cards to a new "Old material"-style deck?. I'd love to be able to learn new/current cards, but maintain knowledge of my past blocks. Also about how many cards were you reviewing per day? I currently have 60 reviews which I know will increase greatly once I unlock more cards, but doing cards for 3-4 hours per day sounds overwhelming during pre-dedicated. I spend less than 30 mins currently. 2 hours tops will be optimal..
 
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How do you think your pre-dedicated period would change with this in mind? So far I'm not sure if it would make much of a difference.. I still need to get through all 25,000-35,000 discreet facts (basically complete Anki deck) within the next 18 months, and I still need to retain this information by the time I get to STEP. So my plan right now is to slowly keep unlocking cards while reviewing old cards, and maintain my reviews (if i can) while being on rotations.
I'm in third year now, and I honestly don't know if I would have been able to keep up with my step 1 reviews while still learning everything I needed to for my clerkships. It's also not worth sacrificing clinical learning to try to hold on to preclinical minutiae. I would say try to get through Zanki and keep reviewing in that first 18 months (actually a little longer than the time frame I did it in), but then stop reviewing it during your clerkships. Clerkship stuff has a lot of overlap, and you should trust that to keep the big points reviewed. Then during your dedicated period, go back and hit the little basic science tidbits hard.

Side note, I don't plan on using UWorld prior to 3 months before dedicated, but since UWorld is good for shelf/ clerkships..i guess i will have to use it before step 1 dedicated? I just hope that theres a separate STEP question set and clerkship set. Idk, I haven't even glanced at UW yet.
Definitely use UWorld for studying for shelfs and clerkships. UWorld has a step 1 and a step 2 qbank - you'll be using the step 2 qbank during your clinical time. You can still save all the UWorld step 1 questions for your dedicated period

I kinda want to do this too, but how do you know whats relevant for your lectures/professors. Don't you risk listening to an outside resource and learning 50% more than what was in your lecture? I have found this happening a few times with BnB, and I know this because I listen to the lecture beforehand. However, I guess you can circumvent this by just looking at lecture slides / main lecture objectives, then using the external resource to learn.
If BnB or pathoma teaches you more than your lecture, 99% of the time it's material that you need to know at some point. You might as well learn it now because you'll need to learn it eventually. My favorite example of this from my school was anti-arrhythmics: we literally never learned anything about them in our cardiac pathology or pharmacology units. But I still learned them because they were in sketchy pharm. Come dedicated time, many of my classmates spent a long time trying to cram them and never really had that good an understanding.

For class stuff that's not in BnB or pathoma or FA, maybe 20% of it ever comes up again in a useful way.

Alright so I want to do this too, is there a way of doing it in a tags based way? Especially since not every card in a deck is relevant; is there a way to only move unsuspended cards to a new "Old material"-style deck?. I'd love to be able to learn new/current cards, but maintain knowledge of my past blocks. Also about how many cards were you reviewing per day? I currently have 60 reviews which I know will increase greatly once I unlock more cards, but doing cards for 3-4 hours per day sounds overwhelming during pre-dedicated. I spend less than 30 mins currently. 2 hours tops will be optimal..
Again, I'm not the best person to ask about this because I barely used tags. You could move all unsuspended cards because they get automatically sorted to the top when you go to the card browser.

I was reviewing between 300 - 500 cards/day for most of second year.
 
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iforget2

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I'm well aware there are no guarantees, and practice problems are a necessity to do well on step. However, what would you say is the floor of someone who matured all of zanki without doing any practice problems before their exam?
 
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I'm well aware there are no guarantees, and practice problems are a necessity to do well on step. However, what would you say is the floor of someone who matured all of zanki without doing any practice problems before their exam?
Without any practice problems before step? Floor would be failing.

Board style problems are a shock the first time you see them, especially for people who are used to cruising through MCQ knowing the answer basically as soon as they read it. These questions are longer and 2nd, 3rd, 4th order - they take figuring out, and you need to get used to the fact that you aren't necessarily going to flash to the answer immediately.
 
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As an example, my first few blocks on Rx I was averaging about 50 - 60%. It took me a while before I realized there was a pretty large space in between "no idea what the answer is" and "definitely know what the answer is as soon as I read it." When I figured that out and started working through questions systematically, my percentages shot up 15% or so.
 

fldoctorgirl

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You mentioned doing about ~11,000 questions on top of Zanki, which sounds awesome. When did you start? I know you mentioned saving UWorld for dedicated, which is what I would like to do despite hearing some people suggest otherwise. When did you start Rx and Kaplan?
 

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Is this relevant for incoming M1s?
Just got accepted and I want to start looking into how to study and what materials are needed.
Thanks for this - Bookmarked.
 
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You mentioned doing about ~11,000 questions on top of Zanki, which sounds awesome. When did you start? I know you mentioned saving UWorld for dedicated, which is what I would like to do despite hearing some people suggest otherwise. When did you start Rx and Kaplan?
I started Rx spring M1 and then did a few over the summer, maybe around 300 - 500 or so? Then after I completed sketchy pharm over the summer I did all the pharm questions.

Other than that, I would just do the Kaplan and Rx questions for the sections I was on. I finished Rx around february and that's when I added about 30 - 40 casual emboss questions along with finishing kaplan. Started UWorld 40/day around March to ramp up to my dedicated schedule. Doing all of Rx + kaplan in a thorough fashion is super doable pre-dedicated M2. It just takes daily dedication and consistency.

Is this relevant for incoming M1s?
Just got accepted and I want to start looking into how to study and what materials are needed.
Thanks for this - Bookmarked.
I would say it is relevant to M1s, but not M0s. Don't worry about this stuff now, you'll need to figure out your school's curriculum before you can start to make a longitudinal study plan.
 
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I started Rx spring M1 and then did a few over the summer, maybe around 300 - 500 or so? Then after I completed sketchy pharm over the summer I did all the pharm questions.

Other than that, I would just do the Kaplan and Rx questions for the sections I was on. I finished Rx around february and that's when I added about 30 - 40 casual emboss questions along with finishing kaplan. Started UWorld 40/day around March to ramp up to my dedicated schedule. Doing all of Rx + kaplan in a thorough fashion is super doable pre-dedicated M2. It just takes daily dedication and consistency.



I would say it is relevant to M1s, but not M0s. Don't worry about this stuff now, you'll need to figure out your school's curriculum before you can start to make a longitudinal study plan.
@FindersFee5 How did you manage to finish Rx by february? Were you ahead of your classes? and how many questions were you doing daily between Rx and Kaplan ? Thanks and congrats
 
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@FindersFee5 How did you manage to finish Rx by february? Were you ahead of your classes? and how many questions were you doing daily between Rx and Kaplan ? Thanks and congrats
I did all the pharm Rx questions while going through our pharm class. Then I did applicable Rx practice questions at the end of each unit, prior to our test, probably ~80/day for the last couple days of each unit. I did study over winter break which let me finish our last unit about 3 weeks early, so I finished up Rx at that time and started adding a few amboss questions.
 
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I'm roughly 4 months out from test day at this point. I've done about 1/3 of Rx and 1/4 of Kaplan. What are your thoughts on working through these vs getting onto Uworld? I'm trying to decide if I'm better served knocking out as much of them as I can before Uworld or using them as additional questions after Uworld
 
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I'm roughly 4 months out from test day at this point. I've done about 1/3 of Rx and 1/4 of Kaplan. What are your thoughts on working through these vs getting onto Uworld? I'm trying to decide if I'm better served knocking out as much of them as I can before Uworld or using them as additional questions after Uworld
I would say it's more valuable to do as much as you can before UWorld, with the caveat that you want to make sure you still leave yourself enough time to delve into UWorld deeply. It'll probably take at least 1.25 times as long to get through UWorld as you think it will.

How long is your dedicated?
 
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8 week dedicated, have to take by end of June. Really would like to take by end of May. I have done zanki since day 1 and kept up, I'll finish all news by early March at latest. Started doing Uworld this week but added up the practice test numbers and that and didn't think it was enough total questions
 
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FindersFee5

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8 week dedicated, have to take by end of June. Really would like to take by end of May. I have done zanki since day 1 and kept up, I'll finish all news by early March at latest. Started doing Uworld this week but added up the practice test numbers and that and didn't think it was enough total questions
Definitely get through kaplan and Rx now then. Hold off on UWorld until about 8 weeks out. It's worthwhile to get the big picture stuff from other qbanks so when I think you go through UWorld, you're able to pick out the finer details instead of being overwhelmed by information. Going through other qbanks after UWorld is less worthwhile because they have a lot more chaff to sift through. UWorld also provides new ways of understanding concepts, but you have to understand those concepts first to get the full benefit of that.
 

ak427

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I'm an M1 who has been following this plan for a few months and doing really well lately, but today's news about P/F Step 1 potentially retroactively replacing my future score is very demoralizing.
 
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Hey, thanks for your post.

I have some extra time and am considering doing some Amboss. I won't be able to do it all, so I'm considering going through only the intermediate and hard (3 & 4 bars) questions only. Thats around 30 blocks, which I can fit into my schedule. Do you think this is a good idea, or will I be missing out by excluding the easy and very easy questions?

Also, any advice on the supplementary amboss qbank? The intermediate + hard on those are around 10 blocks, but I've heard those questions arent very good.
 
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I don't know anything about the supplementary bank.

Amboss questions are worth it if you have time after you've finished UWorld, Rx, and Kaplan, but otherwise I'd say they're less worth it - they definitely have the highest degree of chaff questions that are poorly written with poor explanations, or are way overly specific.
 
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