Didnt pass Step 1 again, need advice please

[oceanic815]

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Hi everyone, first time poster, long time lurker. Need some advice/info please. I am a Carib med student, successfully completed first two years of basic sciences without failing any classes or repeating any semesters. Had a good GPA and LOR's, etc.

I took the Step last November 2009, and got a 184/74. Took the Step again on May 20th, just got my score and got a 182/72.

First time around I mainly used Kaplan Vids/Review books, supplemented by FA, RR Golijan and audio (one time through) and did Kaplan Q Bank but didnt finish it. Scored 52-55 percent, dont remember the actual percentage. Also did one NBME at the beginning of my studying, scored 340. Second time around, I used the same materials and added UW, but didnt finish it either, got through about 1000 q's with a 68 or 69 percent. Did two NBME's, first one scored 340 which was taken in mid-March when I began my studying, and second one scored 450, which I took a week before my exam.

As cliche as it sounds, I was devastated with my score yesterday. Simply put, in utter shock. I just shut down, and didn't know what to do anymore. I know I have pretty much screwed myself for match, assuming that I take and pass Step 1 again, not to mention having to rock Step 2 and probably a multitude of other factors. I sincerely believed that I had done better this time around. Felt much more prepared going into it the second time, felt better coming out of the exam the second time, compared to the first, where I felt like it was a hard exam, and had thought that I didn't do as well as I had hoped. I think the length between exams also hurt me big time, as well as probably not finishing UW or doing more NBME's.

My question is what to do next, how much time to realistically take, and how to prepare effectively. I am thinking about taking the Kaplan live retreat program (6weeks) to get my butt into gear, thinking that maybe something structured and intense would help, but dont know how effective it would be because I used the vids/books already, so trying to figure out if its worth it or not, then doing self-study afterwards (FA, DIT maybe). Second option is just doing FA, RR, and actually finish UW, plus doing DIT with all of that, and using the Kaplan books/vids as a supplement. I dont really know what to do at this point! Any advice/info would be appreciated, as I am really bummed right now, and just need to find something to spark that fire in me again. I know I put myself in a difficult situation, but I am determined to pull myself out, which is why I am asking for some help/advice.

Sorry for the long post, and I thank everyone who responds in advance.

 

[SuperSlacker]

Finish the UWorld and understand the explanations, know your path and physio well enough that so when you listen to goljan, u can answer the questions he poses...

a lot of ppl like to annotate other references (e.g. UWorld eplanations, RR) into first aid. don't go overboard on this but do this with topics u arent familiar with when u do the qbanks or when u think FA has a glaring hole. the act of writing things down also helps for remembering things (esp. biochem pathways, anatomy things like the brachial plexus...i'd take scrap paper and be able to draw it out from memory on my 2nd pass through the material)

lastly, make sure u prepare for the endurance factor of the exam...i usually took at least 4 blocks of uworld a day

best of luck to ya...though admittedly i'm not step1 GOD those were the things i found helpful. glad to hear u r still motivated to get through this!

 

[oceanic815]

Finish the UWorld and understand the explanations, know your path and physio well enough that so when you listen to goljan, u can answer the questions he poses...

a lot of ppl like to annotate other references (e.g. UWorld eplanations, RR) into first aid. don't go overboard on this but do this with topics u arent familiar with when u do the qbanks or when u think FA has a glaring hole. the act of writing things down also helps for remembering things (esp. biochem pathways, anatomy things like the brachial plexus...i'd take scrap paper and be able to draw it out from memory on my 2nd pass through the material)

lastly, make sure u prepare for the endurance factor of the exam...i usually took at least 4 blocks of uworld a day

best of luck to ya...though admittedly i'm not step1 GOD those were the things i found helpful. glad to hear u r still motivated to get through this!

Thanks for the post and info my friend. I appreciate your response. I definitely added a lot of info to FA the second time around. First time I barely had any notes in it, but second time around I went through the Kaplan books/RR/UW and added notes to FA so I had all the info that I thought was important in one place. I am definitely going to do more q's this time around, and more q's per day.

 

[Aphtalyfe]

I would definitely look into taking a course. It seems self studying is not sufficient.

 

[PokerDoc]

try the free lesson on doctorsintraining. It may not be the course thats for you but at least it will be able to tell you whether you would benefit from course style instruction.

 

[tideleonheart]

If you were to take a course, I wouldn't take DIT. DIT guy himself says that his course is NOT for people in your shoes. I would take a course that focuses on students who have failed (like boards boot camp).

If you don't do a course, I would focus solely on First Aid and a qbank. Get USMLE Rx if you are finished with UW. Get a person who is also studying for the exam, and quiz with them. Read 5 pages, quiz on the 5 pages until you know them. Move on to the next 5.

First Aid alone and unannotated is honestly THE highest yield resource for people trying to raise their score from failing to passing. Some may disagree, but I think the ones that disagree are already scoring in the 230s and are trying to get higher. For the 180-200 range and the goal of simply passing, First Aid is the only thing you need to be studying.

Also, focus on pharm. Make sure that every day you're doing pharm and you know the simple factual questions of side effects and mechanisms. If you simply know these and a few other basic things, you should be well on your way to passing. Pharm is just one of those subjects that you either know or you don't. Questions seldom trick you with pharm. A patient has seizures, imipinem/cilastatin is a choice, you pick it. Etc. Hope this helps.

Many people have been in your shoes and have gone on to be great physicians. Don't give up. Give yourself a reset. Focus on the fact that it is just a stupid standardized test that you need to beat. Step 2 is completely different, and has a lot less useless information on it. There IS a light at the end of the tunnel, and you will get there.

 

[PokerDoc]

If you were to take a course, I wouldn't take DIT. DIT guy himself says that his course is NOT for people in your shoes. I would take a course that focuses on students who have failed (like boards boot camp).

If you don't do a course, I would focus solely on First Aid and a qbank. Get USMLE Rx if you are finished with UW. Get a person who is also studying for the exam, and quiz with them. Read 5 pages, quiz on the 5 pages until you know them. Move on to the next 5.

First Aid alone and unannotated is honestly THE highest yield resource for people trying to raise their score from failing to passing. Some may disagree, but I think the ones that disagree are already scoring in the 230s and are trying to get higher. For the 180-200 range and the goal of simply passing, First Aid is the only thing you need to be studying.

Also, focus on pharm. Make sure that every day you're doing pharm and you know the simple factual questions of side effects and mechanisms. If you simply know these and a few other basic things, you should be well on your way to passing. Pharm is just one of those subjects that you either know or you don't. Questions seldom trick you with pharm. A patient has seizures, imipinem/cilastatin is a choice, you pick it. Etc. Hope this helps.

Many people have been in your shoes and have gone on to be great physicians. Don't give up. Give yourself a reset. Focus on the fact that it is just a stupid standardized test that you need to beat. Step 2 is completely different, and has a lot less useless information on it. There IS a light at the end of the tunnel, and you will get there.

i didnt suggest he sign up for DIT, i said to try the free lesson to see if a lecture based course is something he feels he can learn from. And how can you say just focus on pharm? How does that help? My test had like 6 pharm questions the entire way through, focusing on one thing too hard isnt the right way to go about it.

 

[tideleonheart]

i didnt suggest he sign up for DIT, i said to try the free lesson to see if a lecture based course is something he feels he can learn from. And how can you say just focus on pharm? How does that help? My test had like 6 pharm questions the entire way through, focusing on one thing too hard isnt the right way to go about it.

Whoa sorry buddy, didn't mean to make you think I was attacking you... just offering a different opinion, and making sure the OP knows what Jenkins himself says about his course.

I didn't say to "just study pharm," I said to "study pharm." It's one of those things you have to do a little bit of every day to keep it fresh... People who just read straight through topics all the way before they go back for their second pass tend to forget drugs easily after not seeing it again for a few weeks. But if you study it a little bit every day and review every day, it makes pharm a LOT more manageable. Pharm has been considered by many to be one of the more high yield subjects. (the 3 P's: path, pharm, phys)... While your test had 6, many other people have had many more than that. Anyway, my reasoning was this: a lot of questions in pathology and physiology you can generally rule out a few answer choices if you don't know the correct one. With pharm though, if you don't know the drug, it's much harder to rule things out.

 

[ThePursuit]

1. Write down/analyze how you have been studying for step I and the first 2 years of med school.
2. Don't study that way anymore, find something different.

I would make sure I know my learning type (kinesthetic, auditory, visual etc.) and then make sure I use that to my advantage. I would put my head down, give up my social life (to an extent) and go back and learn the things I previously skipped over. Kaplan definitely has everything you need to pass the test. So does DIT. It should also be evident by now that you've been exposed to everything you need to pass. My guess is you just need a little help on figuring out how to apply that material a little better to start getting some more questions right.

 

[oceanic815]

Thanks for the replies everyone. I appreciate the advice. I guess I do need to find a different method of studying and apply the material better. Still trying to figure out if I need to do a live course with Kaplan or use DIT to complement my studying. Again, thanks for the advice.

 

[knuckles]

Not to be a dick, but have you thought about why you aren't doing well on these tests? Are you just not a good test taker? Do you have a knowledge gap?

It seems you weren't doing very well on your NBMEs , yet you still went ahead and took the real thing, rather than delay it and prepare longer. You should definitely finish the Test banks you've started. If you've gone through every explanation and know why you got wrong, what you got wrong, and thoroughly read the explanations for each of the alternate answer choices, you will no doubt have a comprehensive knowledge base of 90%+ of what will be on the real test.

 

[NotMeNow]

Thanks for the replies everyone. I appreciate the advice. I guess I do need to find a different method of studying and apply the material better. Still trying to figure out if I need to do a live course with Kaplan or use DIT to complement my studying. Again, thanks for the advice.

I'm sorry to here that you didn't do well after feeling so much better this time around.

Like someone else mentioned: Do you know why you don't do well? Are you in general a poor test taker? Are you really weak in a few areas? Is it the "thinking" questions that through you off?

If it is a knowledge gap, then a live course would help. However if you are a bad test taker or bad at "thinking" question (which I guess are related) I would recommend doing 10,000 questions (no joke) before you take it.

I would do ALL of usmle world TWICE and know the explanations COLD. Do the 2 uwsa self-assessment exams. I would do ALL of kaplan Qbank. I would do ALL the brs physio questions.

Doing 200 questions a day, it would only take 50 days to do 200 questions. 200 questions will take you about 6-8 hours to do properly.

Obviously some first aid is important, other than that I'm not sure if adding sources is best for you at this point.

Best of luck my friend.

 

[oceanic815]

Not to be a dick, but have you thought about why you aren't doing well on these tests? Are you just not a good test taker? Do you have a knowledge gap?

It seems you weren't doing very well on your NBMEs , yet you still went ahead and took the real thing, rather than delay it and prepare longer. You should definitely finish the Test banks you've started. If you've gone through every explanation and know why you got wrong, what you got wrong, and thoroughly read the explanations for each of the alternate answer choices, you will no doubt have a comprehensive knowledge base of 90%+ of what will be on the real test.

Yeah i think my mistake was not completing the qbanks, and not reading through the explanations for every q. i only read the explanations on questions i got wrong, and the ones i got right i skipped over. And on the ones i got wrong, i only read the wrong explanation, not the other answer chances.

And yeah, I have asked myself what am i doing wrong. Am I stupid? not capable? Lazy? I am close to passing, but i ask myself why cant i score higher. I think that the problem is that i am so worried about passing that i am only doing the bare minimum to just pass and get it over with, which has now come to bite me in the butt. I also think that I am just getting burned out because I have had to review material twice, and combined with the time involved between my two tests, it is just getting harder to retain material and stay motivated.

Anyways, thanks for the response and honesty, I appreciate it.

 

[oceanic815]

I'm sorry to here that you didn't do well after feeling so much better this time around.

Like someone else mentioned: Do you know why you don't do well? Are you in general a poor test taker? Are you really weak in a few areas? Is it the "thinking" questions that through you off?

If it is a knowledge gap, then a live course would help. However if you are a bad test taker or bad at "thinking" question (which I guess are related) I would recommend doing 10,000 questions (no joke) before you take it.

I would do ALL of usmle world TWICE and know the explanations COLD. Do the 2 uwsa self-assessment exams. I would do ALL of kaplan Qbank. I would do ALL the brs physio questions.

Doing 200 questions a day, it would only take 50 days to do 200 questions. 200 questions will take you about 6-8 hours to do properly.

Obviously some first aid is important, other than that I'm not sure if adding sources is best for you at this point.

Best of luck my friend.

I don't think its a knowledge gap, but more of a maybe I forgot some basics because of how long it is taking to study. And even though I have heard it so many times, I think I just need to do thousands and thousands of q's. I only did q's toward the end of my study periods, never throughout. So i think just being exposed to more would help me, but again I can convince myself of anything I guess.

Thanks for the encouragement, I appreciate that.

 

[knuckles]

For me, personally, I learn best through application, which is why I love question banks. I learned much more from questions than from reading standalone notes, going to lectures, etc. The step is testing your ability to apply the knowledge you know, so you could know all the information, but they can ask you to apply it in myriad ways that you may not have ever even considered, which is why it's absolutely essential to practice, practice, practice. Like notmenow said, if you do 10,000 questions (maybe a bit of an exaggeration, I'd say do around 5,000) and understand each one, you will EASILY pass, and be on your way to a 230+. The people on this forum who get 240s and above have all done USMLEWorld, which is 2000+ questions.

I think you should start by learning First Aid, alongside the USMLERx question bank. That should take you a month if you do 100 questions a day. Then do USMLEWorld, and that should take you about 20 days if you keep up the 100 question a day pace. Then for your last 10 days, take a practice NBME (6 or 7), review weaknesses in First Aid and do some questions you got incorrect.

Anyway, that's just an idea for a 2 month preparation. If you don't have the time, I'd skip the Rx part. You can pass in 1 month with USMLEWorld and First Aid. If you really want a stellar score, I think you would need 2 months.

 

[oceanic815]

For me, personally, I learn best through application, which is why I love question banks. I learned much more from questions than from reading standalone notes, going to lectures, etc. The step is testing your ability to apply the knowledge you know, so you could know all the information, but they can ask you to apply it in myriad ways that you may not have ever even considered, which is why it's absolutely essential to practice, practice, practice. Like notmenow said, if you do 10,000 questions (maybe a bit of an exaggeration, I'd say do around 5,000) and understand each one, you will EASILY pass, and be on your way to a 230+. The people on this forum who get 240s and above have all done USMLEWorld, which is 2000+ questions.

I think you should start by learning First Aid, alongside the USMLERx question bank. That should take you a month if you do 100 questions a day. Then do USMLEWorld, and that should take you about 20 days if you keep up the 100 question a day pace. Then for your last 10 days, take a practice NBME (6 or 7), review weaknesses in First Aid and do some questions you got incorrect.

Anyway, that's just an idea for a 2 month preparation. If you don't have the time, I'd skip the Rx part. You can pass in 1 month with USMLEWorld and First Aid. If you really want a stellar score, I think you would need 2 months.

Thanks for this advice, I think its great, and I don't know why I didn't realize it earlier. I guess it is just common sense, the more q's you do, the more material that is exposed to you, etc. I dont think I need to hear/learn the majority of the material again, which is why I do not know if I should do the Kaplan retreat again, espeicially since i have gone through the videos and books already. But then again maybe i do because of how long it is taking me to get past the Step. I dont know.

I think repetition with questions, and doing thousands of questions and understanding the explanations would definitely be something that I will do this time around. Figuring out how to start is my next step.

 

[PokerDoc]

Yeah i think my mistake was not completing the qbanks, and not reading through the explanations for every q. i only read the explanations on questions i got wrong, and the ones i got right i skipped over. And on the ones i got wrong, i only read the wrong explanation, not the other answer chances.

And yeah, I have asked myself what am i doing wrong. Am I stupid? not capable? Lazy? I am close to passing, but i ask myself why cant i score higher. I think that the problem is that i am so worried about passing that i am only doing the bare minimum to just pass and get it over with, which has now come to bite me in the butt. I also think that I am just getting burned out because I have had to review material twice, and combined with the time involved between my two tests, it is just getting harder to retain material and stay motivated.

Anyways, thanks for the response and honesty, I appreciate it.

Why dont you study with the mindset that you need a 205 to pass. If you are just trying to pass, set the bar higher than you need. Thats what I did, I pretended my target score was what I needed to pass and made sure that I had a very good shot at doing that. Who knows though, I'm still waiting, it could have been a bad plan.

 

[knuckles]

I think Kaplan is a bad idea. You'll be wasting 8 hours a day learning extraneous details. I don't think it's humanly possible to retain all that and still have the energy to do questions on top of that every day for 6 weeks. It's not very high yield. Question banks are high yield. As soon as you finish an entire question bank, take an NBME. You will have a passing score, guaranteed. If not, then well...maybe it's time to cut your losses and move on.

 

[InTheMaking]

3rd times the charm?

Take a review course in the US. Try PASS program. Sounds like you need a good concept base.

 

[ThePursuit]

Hey Ocean, just keep a couple things in perspective. There's NO WAY doing 10,000 questions will help you. You need to realize that every question you get correct is a waste of your time. All you did was confirm that you already know that factoid. So, if you're getting 50%, 60%, 70% (whatever) of the questions right, that time is essentially wasted because you're not exposing yourself to new material you're not wasting. Second, I seriously question that there are 10,000 questions of quality for the USMLE UWorld and Kaplan are by far the best and together are only 4k. Some people repeat them, but again, how much of that time is wasted on stuff you already know?

As far as a live course: I would take one if you are an auditory learner (I am not, I get nothing from listening to someone blab), or if you need the structure (which I really did, and this is the reason I took DIT).

You also need to consider burn out and sleep. 8hrs of sleep really does wonderous things to your intellect and problem solving abilities. I know that if I had spent 2 months and done 10k questions I would have burned out, lost motivation and forgot everything from the first month.

Lastly, each student has a maximum potential. Some people could have probably passed step I before they even finished second year. Others need to be at their peak just to have a shot at passing.

Sit down and identify your weaknesses and strengths, then use your strengths to address your weaknesses. I agree that Kaplan has more than what you need, but people also learn better when complexity and meaning is added to the subject. You can simplify to an irreducible minimum, but then you strip away the meaning and retain so much less of the data over time that you may not actually be doing yourself any favors.

I would chose one question bank (Uworld was mine, otherwise Kaplan), finish it once noting the topics you got wrong and your stupid mistakes (and figure out how to best eliminate both). Don't rush on to the next question until you have made the first question a meaninful use of your time by learning from it. Then I would go back only through the questions you initially missed (that way you're not wasting as much time).

Longer than intended, but I really hope you pass and hang in there! Maybe a little more hard work will finally get you that extra step to where you need to be.

 

[oceanic815]

Hey Ocean, just keep a couple things in perspective. There's NO WAY doing 10,000 questions will help you. You need to realize that every question you get correct is a waste of your time. All you did was confirm that you already know that factoid. So, if you're getting 50%, 60%, 70% (whatever) of the questions right, that time is essentially wasted because you're not exposing yourself to new material you're not wasting. Second, I seriously question that there are 10,000 questions of quality for the USMLE UWorld and Kaplan are by far the best and together are only 4k. Some people repeat them, but again, how much of that time is wasted on stuff you already know?

As far as a live course: I would take one if you are an auditory learner (I am not, I get nothing from listening to someone blab), or if you need the structure (which I really did, and this is the reason I took DIT).

You also need to consider burn out and sleep. 8hrs of sleep really does wonderous things to your intellect and problem solving abilities. I know that if I had spent 2 months and done 10k questions I would have burned out, lost motivation and forgot everything from the first month.

Lastly, each student has a maximum potential. Some people could have probably passed step I before they even finished second year. Others need to be at their peak just to have a shot at passing.

Sit down and identify your weaknesses and strengths, then use your strengths to address your weaknesses. I agree that Kaplan has more than what you need, but people also learn better when complexity and meaning is added to the subject. You can simplify to an irreducible minimum, but then you strip away the meaning and retain so much less of the data over time that you may not actually be doing yourself any favors.

I would chose one question bank (Uworld was mine, otherwise Kaplan), finish it once noting the topics you got wrong and your stupid mistakes (and figure out how to best eliminate both). Don't rush on to the next question until you have made the first question a meaninful use of your time by learning from it. Then I would go back only through the questions you initially missed (that way you're not wasting as much time).

Longer than intended, but I really hope you pass and hang in there! Maybe a little more hard work will finally get you that extra step to where you need to be.

I know that I need structure, thats for sure. The problem is I don't know if i need 8 hrs of lecture a day for 6 weeks as my structure, or using something like DIT to supplement my self-study. Thanks for the kind words and advice as well, its always been an uphill battle, but I just need to reinvigorate myself and get motivated again and decide what is the best study plan going forward, what are my strengths, and build on that. What I know for sure is that I am definitely using UW again and will finish it this time, as well as read all explanations and go through them thoroughly.