It's been a while since a post was added to this thread but I thought since i'm one day post-exam I would share my experience, generally echoing the sentiments expressed above.
One thing I thought coming out of the exam, talking with a few friends of mine, was that if someone asked me how to prepare for this exam I would be at a loss for explanation. Hard work? Not cramming? So here I'll just let my fingers go with a stream of consciousness, if it helps fantastic if not then scroll on by...
1. The seven blocks on my exam hit every topic, I think it was a fair and challenging assesment of the work I've put in so far in medical school.
2. FA: I could only count 10-15 questions that were not mentioned in first aid soemwhere. A lot of people have expressed that "nothing in my exam was in First Aid", I contend that those people didn't know FA absolutely cold. First Aid is an absolute gold mine and I would highly highly recommend buying it the first day of medical school and knowing it cold before beginning the step one study. In retrospect, the morning of the exam I flipped through first aid and there were still a few topics I was not familiar with, they unfortunately came up in my exam and I couldn't help thinking that if I had started reviewing with FA under my belt I would have whooped the exam. Of course, to be efficient FA does require background knowledge to draw the lines in between the points...that's the reality of a review book right?
4. There were a few WTF questions, but not too many. There were a lot more of the simple questions you thought you knew but they took the concept that extra step past assumed knowledge. One area I found that took the most concentration on the exam was the molecular biology section, and after taking the exam I feel that one could know absolutely nothing about MolBio to get through the questions, they don't require posteriori knowledge but require time and concentration...when the clock is ticking and you have to code out an mRNA strand or sort through a 15 lane RFLP analysis that's connected to a 6 generation pedigree a small bead of sweat develops on the brow. If you don't speak the mol bio language and haven't yet heard of DNA or are confused on the difference between a southern and northern or southwestern blot then it may be a good idea to spend an afternoon with HY Cell and Molecular Biology...but if you have a degree in the sciences you're probably better off spending the time in another subject.
5. The questions on the exam were most similar to the NBME exams (obviously); and in addition I thought the Pre-Test clinical vignettes book (orange) and USMLERx question bank were briliiant. So this leads me to...
My prep:
Reviewed for about 6 weeks over the summer, two light weeks in the begining to purchase books and listen to goljan and four heavy weeks averaging about 10h per day. In general my biggest recommendation for tearing through the exam is to work hard throughout the first two years so that the review books work as review books and not substantive text. There's little point in reading BRS Pathology, which is basically a book a statements if you haven't worked through your pathology course and understood the concepts. Another thing I thought worked well in my prep was setting a background goal that had nothing to do with step 1, what worked for me was the gym. It's easy to get into a rut when studying for this exam, if you underachieve on a series of Qbank blocks or an NBME exam the stress can add up. For me it was nice to have the daily fitness outlet, something to look forward to before or (sometimes and) after a full day of studying.
When I was 4 weeks out I made a schedule to stick to throughout the prep...I just sat down with FA started marking off chapters, adding them to my calendar until I had four days left in the end which I left blank for "intense" review. My basic day was a morning of 150-200 questions and review of quesionts from various sources (Kaplan Qbank, USMLE Rx, Pretest Clinical Vignettes, Boardbusters USMLE Step 1, Robbin's Review of Pathology, etc). After I would spend the day reviewing the subject from first aid and after I could write the chapter out from memory I would move to build on high yield concepts in review books (mostly from the high yield series). In the evenings I would try to devote an hour to reading Goljan 100pp or listen to a lecture (Windows MP is great because you can listen to him at 2x speed).
Resources:
1. Goljan - Listened to his audio over the last year, not consistently but if I was on a long bus ride or walk...and barring his tangents I thought it was a brilliant review of pathology for the exam. He definitely clued me in early to the importance of knowing why instead of what, know why and you'll kill the exam because it takes time to know why, knowing what is much easier. The other Goljan resource I thought helped was his 100pp notes that i received from a friend...I would say these notes covered 75-80% of my step 1 exam, no joke.
2. Kaplan Qbank - Finished Qbank in the spring, middle of june. Thought this was a great resource for annotating First Aid, not a great resource to use right before the exam. After working through the some odd 2000+ questions on Qbank with full annotation of my FA I was ready to begin studying...the questions themselves covered the basic concepts and some really small print stuff (like the Haverhill and Soduko types of rat bite fever, I mean come on!) This made it great for addiing to the well of knowledge but I could imagine that if I was being bludgened with such material before my exam I could lose confidence.
3. USMLERx - Absolutely brilliant for use the month of the exam. I found the questions in here to be written quite similar to the real exam questions and to be of similar difficulty. Since most everything (85%) is already in first aid, you don't do much annotating but you get to see whether you know FA well or not. I found my averages to be higher (low to mid 80's on random 50s) for USMLERx than Kaplan (mid to upper 70s), however that could be because I used USMLERx later in my study.
4. Useful books -
HY series (Neuroanatomy (a must), Microbiology (concise, need to know info), Immunology (per above), Embryology (if you have time it helps pull concepts together and is great for pregnancy milestones, development etc though my exam did not express >3-5 embryo questions), Histology (a lot of people slag this book but I thought it was great to read in a day...it pulls the concepts together and has a slew of common pictures (Gap junctions, Desmosomes, etc) that come up in the exam).
Questions Robbins Review of Path excellent to use during your medical school course, great for learning how to quickly read through clinical cases and to get familiar with abnormal lab studies (PT, PTT, Calcium, Hb, etc)...i think it was this resource that enabled me not to have to use the lab resource on the real exam and saved time...plus the explanations are excellent. Pretest Clinical Vignettes - this book has 1 full length exam in it and I got the idea from Long Dong after he posted his score I thought it would be good to do it as a correlation...I thought the questions in this book were similar in difficulty, language, and concept depth as the Step 1. NMS Question Book - useless, too detailed. Boardbusters - a nice book for more questions, organized by systems with a pharmacology chapter and a full length exam something like 1400 questions in all...good for the money!
5. NBME exams...excellent, awesome, a must. Not only as a series of checkpoints, these exams represent the real exam format identically...from the layout to the style and difficulty this is the best $180 you can spend (plus the $30 for FA0 in preparing for the exam. I did all four, one per week until one week before the exam and completed them in the 1 - 4 - 3 - 2 order...I would say 3 is the most conceptually difficult and 2 has the most "damn I forgot that" questions. These tests are nice, however one thing I didn't like was the "artificial" confidence at getting a "predicted score", somehow I think this took away from the fire of preparation. When you're two or three weeks out and you have a 240+ it's tough to sit inside and study on sunny days...I always came back to the fact that if I failed step 1 the residency director at MGH isn't going to care if I bring in my four 240+ NBME forms.
Last point - listen to some great music on the way to the exam, have a good breakfast and pack some snacks! This was extremely long winded and it's probable that my rambling is unintelligible or that I made many typos but hey...post step-1 withdrawal
