Did anybody take the STEP 1 on/after 15th MAY?

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I have not seen a single post about the new step 1 experience...hasn't anybody taken it yet? The changed were to be made from the 15th of May. Its well a week over that.

just wondering. let me know please
 
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Do you guys ever answer questions just after reading the last line? Seems like they sometimes will ask, "what is the mech of action of this drug?" Then just skim and see the word vincristine and select the answer with "microtubles" in it. They spend a crap ton time explaining some situition that you reall do not need to even read. Or the last line will say "what is the effect if intravenous bolus of saline" and you see all the answer choices are in the Cardiac output/end diastolic curve graph form. There is no point in reading about the dramatic scenario about the paitent with hemmorhage.

I find myself doing this more and more on uworld and finishing with way more time. I did this on several questions on the new free 150 and the school administered nbme cbse. Sometimes I would get scared that I might have missed some extra info that would change the answer so I skim it after answering. 95% of the time it adds nothing.
 
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badasshairday said:
Do you guys ever answer questions just after reading the last line? Seems like they sometimes will ask, "what is the mech of action of this drug?" Then just skim and see the word vincristine and select the answer with "microtubles" in it. They spend a crap ton time explaining some situition that you reall do not need to even read. Or the last line will say "what is the effect if intravenous bolus of saline" and you see all the answer choices are in the Cardiac output/end diastolic curve graph form. There is no point in reading about the dramatic scenario about the paitent with hemmorhage.

I find myself doing this more and more on uworld and finishing with way more time. I did this on several questions on the new free 150 and the school administered nbme cbse. Sometimes I would get scared that I might have missed some extra info that would change the answer so I skim it after answering. 95% of the time it adds nothing.
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Yep, I do that frequently. Any time a passage looks like it's going to take some effort to get through, always read the question first.
 
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metalrex said:
Man, now when I look back I think those latest free 143 did have few questions with long vignettes.Should have seen this coming.
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so they have updated the free 150 to reflect these changes?
 
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BC848 said:
so they have updated the free 150 to reflect these changes?
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I assume so yes.

The latest free 150 was released during last week of April and was in conjunction with NBME's release saying they will include media plus fewer test items and lesser number of questions on clinical vignette format.

This new free "150" had 46 questions in 3 blocks with an additional 4th block comprising 5 media qs.So, yeah I assume this should be the latest one they were harping about.
 
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I'm thinking about calling my testing center to see if they are going to have the new changes for when I test. I wonder if they will give that information out? I'll report back as soon as I know.
 
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lildave2586 said:
I'm thinking about calling my testing center to see if they are going to have the new changes for when I test. I wonder if they will give that information out? I'll report back as soon as I know.
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The testing center wouldnt know. I called up atleast 2-3 testing centers asking them if there was going to be a change and they said they have no way to find out.


Damn I hope they don't try to mess us up with the longer scenarios. I always thought even thou they r increasing the length, its going to be helpful with more hints. lets see! Hope first aid is still useful for this test with the changes.
 
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I took the new version with 46q/block.

I want to put some people at ease here because this new change is not that dramatic. Yes there are more questions that have long stems, but there are still plenty of very short questions (3-4 lines). So it balances out.

Also, don't assume that just because the stem is long that the qeustion will be difficult. If you pace yourself at 1min/question you will be fine because now you have only 46Qs, and will have 14 minutes left to review if you want.
 
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Igor4sugry said:
I took the new version with 46q/block.

I want to put some people at ease here because this new change is not that dramatic. Yes there are more questions that have long stems, but there are still plenty of very short questions (3-4 lines). So it balances out.

Also, don't assume that just because the stem is long that the qeustion will be difficult. If you pace yourself at 1min/question you will be fine because now you have only 46Qs, and will have 14 minutes left to review if you want.
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thats somewhat comforting, did you or anyone else who has taken the 46q version take the new free 143?
 
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Thats good to know.

From what I make of these experiences, is that the only thing challenging with the new step is the timing. If you can take care of that then the rest of test itself isn't hard. I mean the long passages will give you hints and clues.

Is first aid still good enough for the changes? Or are they looking for details and random facts?
 
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plus I would want to know which one of the practice tests out there: closest NBME form vs.UWSA's suit this 'new' format best.
 
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I only had 2 media questions on my exam, both of which were easy. Also there were only 2 biochem q's on my exam! I had more immuno q's than biochem. Don't spend any more time on this subject. The majority of my exam was basic pathology, though many were 3rd order questions. Timing was never an issue for me, but I'm a fast test-taker in general. Good luck!
 
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papillon2 said:
I only had 2 media questions on my exam, both of which were easy. Also there were only 2 biochem q's on my exam! I had more immuno q's than biochem. Don't spend any more time on this subject. The majority of my exam was basic pathology, though many were 3rd order questions. Timing was never an issue for me, but I'm a fast test-taker in general. Good luck!
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Everybodys exams is different. They might have more bio then immuno, so you have to give enough/equal time to both the classes.

Did u take the new format exam?
 
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Can anyone who's taken the new form confirm if the question stems are about the same length as the Free 144 questions on the website? I took that today, and I gotta say, the questions seemed pretty long to me--don't know if they could lengthen em much more than that.
 
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Can you please link me to the free 144 NBME for step 1 that you guys are talking about. I want to take it.
 
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To those who already took the test, would you recommend doing the practice session onsite? I've heard its good as it'll help reduce anxiety the day of the actual exam, but I dont know if its worth spending 3-4 hours and 52 bucks....
 
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Just finished it, and got the 46 question exam so I will be waiting 2 months for my score. I can't say I felt good about it, I really just felt like I was doing 7 UWorld blocks in a row. The changes really weren't that dramatic, and if anything I thought the slightly longer blocks helped since there were more questions where they would give you multiple symptoms to help you figure out the disease, rather than just one. To go against what the guy above said, I actually got a big chunk of biochem, including 4 questions from that page on lysosomal storage diseases alone. Also, I got asked to identify the hippocampus on an MRI not once but twice, which considering I had no idea where the hippocampus is seemed pretty unfair.

All in all getting the new USMLE felt lot like getting a new cellmate. It might have looked a little different, but at the end of the day it's still going to make you its b*tch. Now good luck to everyone and I'm going to go spend two months trying not to think that I failed.
 
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Can any of yall tell me how much of GI physio did you guys have? I think out of all the sections in first aid, this will get the least of my attention...am I doing the right thing?
 
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Hey Perrotfish, did you feel like the biochem you got on the exam was evenly representative of FA's coverage of the material or was it heavily weighted towards a single area? (like disproportionate amounts of molecular bio, metabolism, etc?)
 
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meerak said:
Can any of yall tell me how much of GI physio did you guys have? I think out of all the sections in first aid, this will get the least of my attention...am I doing the right thing?
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Probably fine. GI physio is different from other systems because it seems mostly like just straight memorization.
 
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coldweatherblue said:
Hey Perrotfish, did you feel like the biochem you got on the exam was evenly representative of FA's coverage of the material or was it heavily weighted towards a single area? (like disproportionate amounts of molecular bio, metabolism, etc?)
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What I got was several lysosomal storage diseases, a glycogen storage disease, a SCID, an albanism, multiple 'what kind of receptor goes is acted on by this hormone' questions (I had multiple questions about Insulin acting on a tyrosine kinase receptor), and I think a few others but I can't recally them specifially. Honestly it's all fair game, though I would make your last priority the parts of pathways that aren't associated with known diseases. For example memorize just the enzymes related to porphyria and sideroblastic anemia in the heme pathway, and ignore the other enzymes and intermediates that aren't associated with named diseases unless you have time later.
 
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On my re-run through FA, when it comes to Biochem I'll probably just focus on the pages that have actual diseases, and then refer to any pathways as necessary to clarify. And pray that some of that pathway junk stuck with me anyway.
 
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I have a friend who had 2-3 questions asking him to identify the step in which the "enzyme X" was located. There were like choices from A-E through out the pathway. So I guess it all fair game, esp since its already in first aid (and the answer to those 3 is in first aid also).
 
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i can't compare the new test to the old, having only taken the new one, but i felt it was whack. On U world i was easily finishing with > 10 minutes to spare and I felt i had plenty of time to evaluate any questions involving a long stem. On the actual test (the new 46q) I was speed reading vignettes and making best choices on first impression or after maybe 10-15 seconds of rereading. I finished all the sections but i had less than 60 seconds left on average at the end of each.

felt confident about 60% at best. The rest of my answers i was only moderately comfortable with but had to move on. What is the point of testing us in this fashion?

edit: for the people asking about biochem -- i dont want to alarm you but that was my major and for half of the questions i had, i think i only got them right because of my background. For example, a lysosomal storage disease question i had seemed like it would throw people who didn't know the exact chemical building blocks of sphingomyelin and how they change in metabolism.

i just remembered another one: the actual specific chemical reaction that occurs in the first cytochrome complex in mitochondria. people who never studied the iron sulfur and flavin electron handoffs might have been thrown by not recognizing it as part of the ETC.
 
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VoiceofReason said:
-- i dont want to alarm you but that was my major and for half of the questions i had, i think i only got them right because of my background. For example, a lysosomal storage disease question i had seemed like it would throw people who didn't know the exact chemical building blocks of sphingomyelin and how they change in metabolism.

i just remembered another one: the actual specific chemical reaction that occurs in the first cytochrome complex in mitochondria. people who never studied the iron sulfur and flavin electron handoffs might have been thrown.
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😱 Biochem is one ****** sub for me, all I can do good with it is learn up all that FA has to offer by brute memorization. What do you recommend we do/read to tame biochem?

With more and more people emphasizing the time crunch they faced, I think those 8 hours will go by in a blur- I just hope we are able to make well -thought of-answer choices with that seriously disabling 'crunch mode' thinking.:xf:
 
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VoiceofReason said:
i can't compare the new test to the old, having only taken the new one, but i felt it was whack. On U world i was easily finishing with > 10 minutes to spare and I felt i had plenty of time to evaluate any questions involving a long stem. On the actual test (the new 46q) I was speed reading vignettes and making best choices on first impression or after maybe 10-15 seconds of rereading. I finished all the sections but i had less than 60 seconds left on average at the end of each.

felt confident about 60% at best. The rest of my answers i was only moderately comfortable with but had to move on. What is the point of testing us in this fashion?

edit: for the people asking about biochem -- i dont want to alarm you but that was my major and for half of the questions i had, i think i only got them right because of my background. For example, a lysosomal storage disease question i had seemed like it would throw people who didn't know the exact chemical building blocks of sphingomyelin and how they change in metabolism.

i just remembered another one: the actual specific chemical reaction that occurs in the first cytochrome complex in mitochondria. people who never studied the iron sulfur and flavin electron handoffs might have been thrown by not recognizing it as part of the ETC.
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I wonder if this sort of "nit-pick" question is characteristic of a handful of questions regardless of whether you take the new or the old test? Cuz I don't think it was their intention to make questions harder per se, right? Just put certain non-stem questions into longer clinical vignettes?

As for the time thing - do you think the gravity of the situation caused you to dwell on questions you weren't sure of a little longer than you might have on practice blocks? I know, for example, I too finish most UW blocks with 10-15 mins to spare, but when I did my UWSA, I tended to go until the last 2-3 minutes and I will probably take the same approach on the real thing...
 
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Folks struggling with biochem should really consider kaplan biochem, its solid and has a lot of big picture diagrams and summaries
 
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meerak said:
How about FA+UW for biochem?
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Those should be fine for most of it. I feel like FA's handling of sugar metabolism is fine. But their fat and protein stuff might be a little lacking. Maybe because it is not as high yield as the glucose story. But the gaps in FA might be covered by specific UW questions covering those topics.

I've formed this opinion after having done both UW+FA and Kaplan biochem, btw.
 
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How was FA in general for the exam? did you also do the goljan audio transcripts?how do they rate?
 
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jmcappleby said:
I wonder if this sort of "nit-pick" question is characteristic of a handful of questions regardless of whether you take the new or the old test? Cuz I don't think it was their intention to make questions harder per se, right? Just put certain non-stem questions into longer clinical vignettes?

As for the time thing - do you think the gravity of the situation caused you to dwell on questions you weren't sure of a little longer than you might have on practice blocks? I know, for example, I too finish most UW blocks with 10-15 mins to spare, but when I did my UWSA, I tended to go until the last 2-3 minutes and I will probably take the same approach on the real thing...
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i got the sense after the first block that i was spending more time per problem, but i really don't think it was because this was the real thing and U world wasn't. i think instead it was because there was simply a lot more information to parse on every question, and in addition many questions i would finish reading and have no really strong diagnosis. Its like there was a deliberate dearth of strong clues.
 
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VoiceofReason said:
i got the sense after the first block that i was spending more time per problem, but i really don't think it was because this was the real thing and U world wasn't. i think instead it was because there was simply a lot more information to parse on every question, and in addition many questions i would finish reading and have no really strong diagnosis. Its like there was a deliberate dearth of strong clues.
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ARRGH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 😱

Damn the NBME! Trying to screw with slow readers like ME!
 
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im trying really hard to analyze whether or not im just making excuses but this is how i honestly feel. It just seemed difficult overall, there were also long ass setups and explanations accompanying most of the graphs that they love for physiology or hypothetical experiments. i almost regretted U world in the end also because it trained me to think really carefully about possible tricks and at points during the test i was feeling bogged down looking for places i might have been tricked
 
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One thing that is vital on these long-step Qs is to memorize the normals for lab values (the back of FA has them).

This saved me a TON of time and the lab values are usually the key piece of evidence needed to make a diagnosis.
 
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metalrex said:
😱 Biochem is one ****** sub for me, all I can do good with it is learn up all that FA has to offer by brute memorization. What do you recommend we do/read to tame biochem?

With more and more people emphasizing the time crunch they faced, I think those 8 hours will go by in a blur- I just hope we are able to make well -thought of-answer choices with that seriously disabling 'crunch mode' thinking.:xf:
Click to expand...

i don't know what to tell you man. in my previous post the example about the ETC was a question regarding methemeglobinemia, and they wanted to know which reaction isn't working. You had to know that NADH:flavin reductase is part of the first complex so it isn't running in the absence of oxygen. They were also nice enough to include the b5 reductase enzyme that counters methemoglobinemia in the answer choices, but it just gets overwhelmed in this scenario, it doesn't stop running in fact it would probably be induced (if that even happens i dont know)

to me, that seems needlessly difficult since med students don't look at chemical structures we mostly learn that the ETC consists of several complexes that accept and transfer electrons and maybe you also know that flavin is part of the structure of one of them but thats probably the extent of it, its just tough if you aren't a guy with a biochemical background i would think
 
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VoiceofReason said:
i don't know what to tell you man. in my previous post the example about the ETC was a question regarding methemeglobinemia, and they wanted to know which reaction isn't working. You had to know that NADH:flavin reductase is part of the first complex so it isn't running in the absence of oxygen. They were also nice enough to include the b5 reductase enzyme that counters methemoglobinemia in the answer choices, but it just gets overwhelmed in this scenario, it doesn't stop running in fact it would probably be induced (if that even happens i dont know)

to me, that seems needlessly difficult since med students don't look at chemical structures we mostly learn that the ETC consists of several complexes that accept and transfer electrons and maybe you also know that flavin is part of the structure of one of them but thats probably the extent of it, its just tough if you aren't a guy with a biochemical background i would think
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Maybe it was an "experimental" question? 🙂
 
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VoiceofReason said:
i don't know what to tell you man. in my previous post the example about the ETC was a question regarding methemeglobinemia, and they wanted to know which reaction isn't working. You had to know that NADH:flavin reductase is part of the first complex so it isn't running in the absence of oxygen. They were also nice enough to include the b5 reductase enzyme that counters methemoglobinemia in the answer choices, but it just gets overwhelmed in this scenario, it doesn't stop running in fact it would probably be induced (if that even happens i dont know)

to me, that seems needlessly difficult since med students don't look at chemical structures we mostly learn that the ETC consists of several complexes that accept and transfer electrons and maybe you also know that flavin is part of the structure of one of them but thats probably the extent of it, its just tough if you aren't a guy with a biochemical background i would think
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I swear I am not trying to be an ass. But, just wondering... I mean, in methhemoglobinemia, you have a lack of 02 delivery to tissues.... the only complex, that is dependent on oxygen is Complex IV (cytochrome oxidase) as an electron acceptor.

How would a lack of oxygen affect Complex I? (when anaerobic glycolysis can continue to provide NADH (albeit less) for oxidative phosphorylation?)
 
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This makes me think I should just scrap doing the uworld self assessments and go straight to nbme 6 and 7, so I can get use to nbme style. I don't want to over think uworld style on test day. Seems like nbme is more 2nd and 3rd order questions while uworld is 3rd 4th and sometimes 5th order.
 
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badasshairday said:
This makes me think I should just scrap doing the uworld self assessments and go straight to nbme 6 and 7, so I can get use to nbme style. I don't want to over think uworld style on test day. Seems like nbme is more 2nd and 3rd order questions while uworld is 3rd 4th and sometimes 5th order.
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The UWSAs are actually a bit easier than UW Qbank, I would say. Might be that they seem to pick some of the easier/more representative questions because this is supposed to be used as a diagnostic and not necessarily as a pure learning tool (which of course it can still be used as). I saw many questions in my UWSA, for example, that had been gotten right by 80-90+% of test takers - which is generally a rarity in the UW Qbank. Granted, it could just be that the people taking UWSA are more prepared than the people taking UWQbank, but still, it felt easier.
 
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FutureDoc4 said:
I swear I am not trying to be an ass. But, just wondering... I mean, in methhemoglobinemia, you have a lack of 02 delivery to tissues.... the only complex, that is dependent on oxygen is Complex IV (cytochrome oxidase) as an electron acceptor.

How would a lack of oxygen affect Complex I? (when anaerobic glycolysis can continue to provide NADH (albeit less) for oxidative phosphorylation?)
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unless im really ******ed the whole metabolic pathway stalls in the absence of oxygen, because without an acceptor at the end all the redox states at every step going back to the beginning will be wrong

edit: or not 'wrong' but you can think of the ETC as one big complicated chemical reaction that is missing a cofactor/substrate
 
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No, your right. Everything will be backed up and "reduced" if you have a blockage at complex IV (you can't keep passing electrons). But, I thought you said the question asked which part of the ETC would be stopped in methhemoglobinemia (which is essentially which part will be blocked in the absence of oxygen). Well, they all would be "backed up". But, the block actually occurs at Complex IV, no?

I guess I assume its the same thing as asking, what happens with cyanide poisoning. Well, you can't keep passing electrons along at the first complex because of a "block" in the chain. But, Cyanide actually does its damange at cytochrome oxidase
 
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FutureDoc4 said:
No, your right. Everything will be backed up and "reduced" if you have a blockage at complex IV (you can't keep passing electrons). But, I thought you said the question asked which part of the ETC would be stopped in methhemoglobinemia (which is essentially which part will be blocked in the absence of oxygen). Well, they all would be "backed up". But, the block actually occurs at Complex IV, no?

I guess I assume its the same thing as asking, what happens with cyanide poisoning. Well, you can't keep passing electrons along at the first complex because of a "block" in the chain. But, Cyanide actually does its damange at cytochrome oxidase
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oh i see, well my recollection (which is already hazy) was that they wanted you to choose the process that isn't running and I only recognized two processes that were even relevant (perhaps in my haste). the one i chose (part of the first complex) and the b5 reductase which helps clear methemoglobin that is produced physiologically or otherwise.
 
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jmcappleby said:
The UWSAs are actually a bit easier than UW Qbank, I would say. Might be that they seem to pick some of the easier/more representative questions because this is supposed to be used as a diagnostic and not necessarily as a pure learning tool (which of course it can still be used as). I saw many questions in my UWSA, for example, that had been gotten right by 80-90+% of test takers - which is generally a rarity in the UW Qbank. Granted, it could just be that the people taking UWSA are more prepared than the people taking UWQbank, but still, it felt easier.
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Sheesh..I am back to square one with my 'which test to take-2 weeks out' dilemma again.

So what do you reckon will be the best and most accurate bet: NBME 7 or UWSA??
 
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metalrex said:
Sheesh..I am back to square one with my 'which test to take-2 weeks out' dilemma again.

So what do you reckon will be the best and most accurate bet: NBME 7 or UWSA??
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I actually did not (and don't have time to) take the NBME 7. I took NBME 6 2 weeks ago and UWSA2 a couple days ago and I got a very satisfying prediction on the latter so I decided to leave it at that.

However, it seems to be that if you've done a lot of UW questions, and you are good at them, that UWSA's can over-predict your score. NBMEs are probably a bit more "fair" although my own opinion after taking NBME 6 (maybe one of the harder ones?) was that some of the questions were kinda bad... maybe I just didn't know how to answer them.

I would probably do UWSA2 2 weeks out and NBME 7 1 week out... that may be your best bet.

In my case, my guess would be I am somewhere between my NBME 6 and UWSA2 prediction with a slight leaning toward the latter because I took it more recently. At least I hope so. 😀
 
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