How to learn from disappointing Step 1 score

[rule out normal]

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I just got my step 1 score back: 226/82. Three weeks before it, I made a 217 (NBME 6); two weeks before I made 221 (NBME 13); ten days before I made 238 (UWSA 1); and four days before I made 247 (UWSA 2).
After each test, I worked on the lowest sections by reading FA, Pathoma, and some RR Path. I listened to the corresponding Goljan audio. During all of this, each day stared with 2-3 timed random UWorld sections; I thoroughly read the explanations to the incorrect ones, as well as the questions on which I took more than 100 seconds to answer (right or wrong). For the last three days before the test, I re-read the biochem, micro, and pharm FA sections. I also went over my "drug list", a hand-written list of all drugs I encountered in UWorld questions (name and brief description). The day before the test, I spent about 7 hours reading UWorld notes from the "notes feature", and went over some micro and pharm again.
The last ten random UWorld blocks, I averaged 72%, with a range of 65-80%.
The night before, I took Benadryl (which I had done night before each practice test) at 9:30 PM, and probably fell asleep around 10:30 PM. I woke up at 5:50 AM, did my usual morning routine, usual meal, etc. I felt reasonably rested and ready to take the test.
During the actual test, I finished each section about like I did for the qbank: the last two or three questions I felt somewhat rushed, but always had time to read the question and answer choices. I got up and walked around for 5-10 minutes after every block, just like in practice. I ate snacks as I felt necessary.

If you skimmed all that, at least contribute your thoughts on why I only got a 226. While I was fully aware of the score inflation of the UWSA tests, I thought a 230 was a reasonable expectation. Thanks in advance; any advice will be considered as I try to improve when I take Step 2 next year.

 

[FSU2013]

A few thoughts...
1. You did just about everything right and were a little unlucky
2. You were still within the margin of error from most of the practice tests.
3. Benadryl the night before probably isn't a great idea.
4. Take the day before the test off (for step 2).
5. Don't just eat when you feel like you need to.
6. 226 isn't a bad score. It's just a bad score on the upside-down world of SDN. You'll be fine.

 

[rule out normal]

After some research, I really regret taking the Benadryl. I thought I would be okay by taking it at 9:30 PM, which gave me about 10-10.5 hours until the start of the test. I took 50 mg, the recommended dose. I hate that I ruined such an important day because I thought I was helping myself. Very down about this...

 

[SlaveOfTCMC]

Don't feel so bad. You may not be able to do Plastics or Derm anymore (though you can do anynthing you want provided you ahve the proper resources) but there is still a whole world of opportunity out there for you.

A lot of research can still be done. You can still make a great difference in people's lives.




And yes of course you can still make a lot of money by doing something procedural... yes this is the big pink elephant in the room every physician thinks about but never says out loud for fear of being labelled a greedy pig.

But please no demagoguery... my motivation is not to make money (the government will not allow it anyway) but to make a difference. However, I do always think about maintaining a pretty good living commensurate with the amount of input I put into my craft.



Back to the OP:

Just do the best you can for Step 2. It might not make a world of difference but it can't hurt you either.

 

[Vertices]

Good questions...I also recently got my step 1 scores back and am wondering how to best tackle step 2. There were a few excellent resources for really learning step 1 material (ex. Pathoma), but I'm not sure what's out there to continue with. So far it seems like just UWorld and whatever texts for the clerkships...FA step 2 CK seems too superficial to really learn from. I know there's Kaplan step 2 videos, but those are crazy $$$ and I don't know if they're worth it. Anybody have some input?

Don't mean to jack OP's thread, but I think my questions are on point with what OP was looking for...

 

[Valadi]

OP, first off, your score is good and nothing to feel bad about!

My breakdown as to what happened:
-Yea, you were unlucky and got a test that didn't cater to your strengths.
-You said your range was 65-80. Was this including from starting in the beginning, or your last 10 blocks? If you were fluctuating from 65-80 late in the game it means you were deficient in certain areas. The longer step exam exploited these.
-You may have benefitted from some more depth than just FA and Pathoma. I generally look at it like FA+UWorld+Pathbook(RR or Pathoma) is what most students use, and most people get a 220+/-20. The threads I see with people scoring 240+ they used multiple other sources in addition to these (not saying everyone has to, but it's a common theme I see).

That being said, I know plenty of people who scored 220s on Step 1 and broke 250 on step 2. Read like a madman during third year and kill your shelves, this is the best prep for step 2. Then see OverActiveBrain's advice on how to get a killer step 2 score. Personally, I had great experiences with DIT and think it helps to maximize your potential. Their added info is clutch.

 

[RestoreSight]

To be clear, 226 is not a bad score. It shows you learned the material from the first two years of medical school well and you are ready to move into the wards. For residency purposes, it is not a kiss of death either. Highly compeitive fields like derm, rad onc and ophtho will screen candidates using STEP 1, but there are other factors you have to consider including the prestige of your medical school, 3rd year clerkship grades, STEP 2, and your personal ability to interview well. Do you know what field you plan to apply in?

 

[rule out normal]

Was interested in ophtho, rad of any type, path, anesthesiology, and certain IM specialties like cardio and GI. The advisors at my school said diagnostic rads was still a possibility, but I've read that Step 2 isn't even seen by radiology programs before you apply to them.

 

[Valadi]

Was interested in ophtho, rad of any type, path, anesthesiology, and certain IM specialties like cardio and GI. The advisors at my school said diagnostic rads was still a possibility, but I've read that Step 2 isn't even seen by radiology programs before you apply to them.

Aim to take step 2 early (may-july) and crush it so all programs see it.

 

[rule out normal]

Thanks to everyone for their input here. One additional detail I have also thought about: at the beginning of my 6-week dedicated study period, I started doing UWorld timed/random blocks for most of the day, then First Aid about 3 hours per day. This is how I studied the first three weeks, for the most part. As I did the questions. I spent lots of time reading the whole explanation to almost every question. I was annotating things from UW into FA. Sometimes, doing this with one 46-question block took up to 8 hours, as I would go ahead and read that particular First Aid page i had just annotated.
With about 3 weeks remaining, I saw I wasn't doing the Qbank fast enough, so I decreased the annotations, and spent less time on the questions I easily got right (without guessing, etc). I also allotted more daily time to sitting down and reading First Aid and Pathoma, as I didn't want to leave any sections unread, especially in First Aid. However, I only made it though about 6 chapters of Pathoma...I selected these chapters based on weaknesses in my Qbank and the two NBMEs I took a couple of weeks before the real exam.

Any comments on this stuff?