How hard is it?

the material is the same, but the complexity/difficulty of the questions tends to be a little different. doing well in pre-clinical courses is an indicator that you have mastered the material on first-run, and that you should reach your potential faster than, say, somebody who blew off the first 2 years.

now, regarding what that potential correlates to in terms of score depends on several other factors (some of which are within your control [such as ability to correlate material from different subjects and your capacity to memorize large amount of information] and some of which are not [test-taking skills etc]), and the only way to get a sense is to take practice tests (mainly the NBMEs) which can give you an idea of the ball park of the score that you would get if you took Step 1 at that particular stage of your prep.

 

Honestly, the biggest variable is how smart you are. Number 2 is probably how well you did 2nd year. You seem to have the latter down. Once you buckle down and start studying after about 3 or so weeks IMO people will tend to have sorted themselves out into potential score ranges. Your diagnostic scores will continue to improve but as you forget things you will begin to have diminishing returns.

To some extent you can overcome this by studying twice as hard or twice as long as other people. I know there are a lot of success stories with those crazy 5-6 month study plans.

But really I think after about 3 weeks (a good once-through) of hardcore studying you'll see just about where your potential ceiling is. You can probably improve on that by 10-20 points through hard work.

 

Yea there's a good chance you will forget a lot of board relevant material if you study for it without a strategy. You need to develop reflexes that will help you answer concepts that won't be easy to recall by just memorization and this is only possible through practice. I am yet to come across someone that ended up with a good score by basically studying every day of their life and haven't put that effort in doing questions. I agree with above posters in terms of trying to review everything you learned in a short amount of time so it stays in your system and can be accessed on exam day. I take the same quizzes i already took in the past and one thing i noticed that my thought process is severely compromised in trying to boil down the answer however the familiarity is still there and i somehow more than not end up putting down the right answer..still it hurts your confidence when you can't explain an answer you are picking.