I got a 262 on Step 1, ask me anything

[lucky01]

hey thanks for taking the time out to reply to us! I have a question: 2 of my seniors told me not to worry about memorizing the details on FA. Just know the bigger picture of everything that's going on. Is that true? For example i'm studying grave's disease atm, and it says on FA that it's associated with HLA-B8. To me that seems like a small detail, is it true that i can get away with just knowing what grave's disease is in general and be okay for step 1?

any insight would help! thanks!

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[Treebeard]

hey thanks for taking the time out to reply to us! I have a question: 2 of my seniors told me not to worry about memorizing the details on FA. Just know the bigger picture of everything that's going on. Is that true? For example i'm studying grave's disease atm, and it says on FA that it's associated with HLA-B8. To me that seems like a small detail, is it true that i can get away with just knowing what grave's disease is in general
and be okay for step 1?

any insight would help! thanks!

No.

Do some practice Qs from UWorld or the NBME self-assessments to get an understanding of the level of depth.

Whoever told you this test isn't about detailed knowledge is either a fool, or they are smarter than they realize and they actually do know the 'little details' and don't realize it.

 

[USMLE_Pro]

hey thanks for taking the time out to reply to us! I have a question: 2 of my seniors told me not to worry about memorizing the details on FA. Just know the bigger picture of everything that's going on. Is that true? For example i'm studying grave's disease atm, and it says on FA that it's associated with HLA-B8. To me that seems like a small detail, is it true that i can get away with just knowing what grave's disease is in general and be okay for step 1?

any insight would help! thanks!

So the spirit of what your seniors said has some truth to it, but overall the impression you got from it is incorrect, as the poster above me mentions. You need to know MANY small details to do well on Step 1. My general view is that test-taking skill is underemphasized and that this is very important to excel (particularly to get a very high score) to either have great test taking skills or work to improve them. You can't just "know what grave's disease is in general". That being said, the HLA-B8 association is very low yield, and there are many, many low yield facts in FA. My method was to focus on questions (UWorld and NBME only) and us FA as a cross-reference as I made my own Anki cards to memorize the minute details that were leading me to get q's wrong. The better your test-taking skills, the less minutiae you have to memorize, but there is still a fair amount of memorization little details. Reading first aid is a terrible way to do this, however, which is why I recommend flash cards. You will forget 90% of what you just read in less than 2 weeks. So you have lots to memorize, but there are some much more efficient (and thus less frustrating) ways to do it.

 

[Treebeard]

The other thing about knowing the 'little details' is that while many of them are unlikely to directly tested, MANY of them will either be given to you in the vignettes or given as incorrect answer choices. So if you do happen to know some of them, you can confidently throw away answer choices or very quickly narrow down the diagnosis.

 

[USMLE_Pro]

The other thing about knowing the 'little details' is that while many of them are unlikely to directly tested, MANY of them will either be given to you in the vignettes or given as incorrect answer choices. So if you do happen to know some of them, you can confidently throw away answer choices or very quickly narrow down the diagnosis.

The caveat to this is that you don't HAVE to memorize as many little details if you are using test-taking skills very effectively. You definitely have to memorize a fair amount of details, but I think the general tendency is to try to memorize too much using relatively ineffective techniques. In my experience being more selective about what you memorize and using efficient methods (like spaced repetition) is significantly helpful for many students.

 

[MedicineMan1994]

Thank you so much for replying! Just have a few clarify some points you made. I’m a pretty average student ( last block exam I was literally the average and median ). I picked up Zanki a little bit late around November 2018, didn’t do any during winter break for about a month! and recently picked up on it again. Zanki has been the best study tool I’ve used and it reflects on the subject content question scores. Do you recommend doing decks like Zanki from now on until dedicated, or all throughout dedicated until test date. I’m just worried they’re random facts and won’t be able to integrate into questions come test day.

As for making anki cards on UWorld incorrects, I’ve been using u world as a learning tool but haven’t made any incorrect anki cards. Should I start making cards with my current incorrects or should I do incorrects when I complete my second pass? ( ~50% done with first pass ) with about 14 weeks left until step and about 6 weeks of dedicated. Thank you!

 

[Raccoon]

Hello! I was reading your replies and deeply inspired by your methods and advices.

I’m a month ahead the test, and I just wanted to ask how you think about 2nd or more cycles of UWorld instead of doing another qbanks.

I’m doing 2nd round of UW and 1st pass on the usmleRx at the same time. But I think I can’t finish either of them if I stick to this way.

So anyway what I really want to be convinced is Does 2nd pass helpful? I would like to know whether you did more than 1st pass, and how was your progress in %?

Really thanks to your kind replies. Really helped a lot.

 

[USMLE_Pro]

Thank you so much for replying! Just have a few clarify some points you made. I’m a pretty average student ( last block exam I was literally the average and median ). I picked up Zanki a little bit late around November 2018, didn’t do any during winter break for about a month! and recently picked up on it again. Zanki has been the best study tool I’ve used and it reflects on the subject content question scores. Do you recommend doing decks like Zanki from now on until dedicated, or all throughout dedicated until test date. I’m just worried they’re random facts and won’t be able to integrate into questions come test day.

As for making anki cards on UWorld incorrects, I’ve been using u world as a learning tool but haven’t made any incorrect anki cards. Should I start making cards with my current incorrects or should I do incorrects when I complete my second pass? ( ~50% done with first pass ) with about 14 weeks left until step and about 6 weeks of dedicated. Thank you!

You're welcome! This is a great question. I personally tend not to recommend Zanki or any of the other currently available pre-made decks as I feel it forces you to memorize more facts than you need to, even to score 260+. However, some people swear by Zanki and I don't want to discourage people from using it if it works for them (it can be advantageous to over-memorize if you don't have any means of improving your test-taking skills).

I think the discrepancy comes from the fact that making your own cards is more of an art than a science. It is easy to spend far too much time making cards, make ineffective cards, or make overly detailed cards (this can be corrected relatively easy, but usually not without some kind of external guidance). Most of the students I see are getting help to learn how to make effective cards efficiently, so that's my bias (i.e., making your own cards works better, but only if you're making good cards). If you struggle to make cards, Zanki may be a better option.

If you are comfortable making your own cards, I recommend making them on a first pass. The real reason people do a second pass is that they have not retained the majority of info from their first pass. One way to address this is repetition (do a second or even third pass) or to use a method that greatly improves retention (making and reviewing cards with spaced repetition). A second pass may not be necessary if you use this card method (I only had to do one pass).

 

[USMLE_Pro]

Hello! I was reading your replies and deeply inspired by your methods and advices.

I’m a month ahead the test, and I just wanted to ask how you think about 2nd or more cycles of UWorld instead of doing another qbanks.

I’m doing 2nd round of UW and 1st pass on the usmleRx at the same time. But I think I can’t finish either of them if I stick to this way.

So anyway what I really want to be convinced is Does 2nd pass helpful? I would like to know whether you did more than 1st pass, and how was your progress in %?

Really thanks to your kind replies. Really helped a lot.

I really appreciate the kind words! I prefer multiple rounds of UWorld to other QBanks. USMLE Rx, in particular, I do not recommend (it is helping you memorize FA, but not helping you actually do better on NBME-type questions).

I did one pass of UW, but I made Anki flashcards based off of my incorrects. I find this to be more effective than doing multiple passes (reading UW explanations leads to much poorer retention and recall than spaced repetition). I started the beginning of my 6.5 week dedicated period doing random, timed blocks of UW (this was after my 3rd year clerkships since that is wen we take Step 1, but without any true pre-dedicated studying). My % correct started in the 40s and increased to high 80s towards the end. I learned from UWorld, rather than trying to memorize FA and then doing questions (I cross-referenced FA as I made my cards). I caution people to not worry too much about the UW%. NBME questions are a bit different (often require better test-taking skills and less detailed memorization of obscure facts) than UW questions, and what you really need to do well on are NBME questions. I use UW mostly as a learning tool (the UWSAs are a different story, however). Hope this helps!

 

[Panteleimon2]

Hello,

good on you for remaining active on this thread. I was wondering if you have any advice for a student just starting their dedicated. I took my CBSSA form 19 exam on Monday to establish a baseline. I scored a 225. A good portion of the material I got wrong was because I simply lacked the knowledge. I have finished my first pass of UWorld Heme/Onc with an average of 84%. Through the block, I didn't notice my scores in UWorld improve. I was wondering how I can break this plateau. If It's not me making stupid mistakes, it's me just not knowing a very particular piece of minutia. Do you have any advice on how I can get over this plateau? I've redid my incorrects, and made flashcards of my incorrects (as well as those I felt ambiguous about). I've also used Pathoma and Sketchy. Today I downloaded Anki to bang through 300 flashcards with the hopes of picking up minutiae (most of it seems like being able to recall pathoma faster though).

Thanks,
-P

 

[USMLE_Pro]

Hello,

good on you for remaining active on this thread. I was wondering if you have any advice for a student just starting their dedicated. I took my CBSSA form 19 exam on Monday to establish a baseline. I scored a 225. A good portion of the material I got wrong was because I simply lacked the knowledge. I have finished my first pass of UWorld Heme/Onc with an average of 84%. Through the block, I didn't notice my scores in UWorld improve. I was wondering how I can break this plateau. If It's not me making stupid mistakes, it's me just not knowing a very particular piece of minutia. Do you have any advice on how I can get over this plateau? I've redid my incorrects, and made flashcards of my incorrects (as well as those I felt ambiguous about). I've also used Pathoma and Sketchy. Today I downloaded Anki to bang through 300 flashcards with the hopes of picking up minutiae (most of it seems like being able to recall pathoma faster though).

Thanks,
-P

Thanks for the kind words! I suggest making your own Anki flashcards to learn from your UW incorrects (this is the method I used). This method specifically targets retaining the minutiae that you don't know (that's causing you to get questions wrong). I also suggest doing UW in random, timed mode rather than by subject, as you're training yourself to rely on context clues that won't be there on test day. I hope this helps!

 

[Panteleimon2]

Thanks for the kind words! I suggest making your own Anki flashcards to learn from your UW incorrects (this is the method I used). This method specifically targets retaining the minutiae that you don't know (that's causing you to get questions wrong). I also suggest doing UW in random, timed mode rather than by subject, as you're training yourself to rely on context clues that won't be there on test day. I hope this helps!

Thanks for the input! I was off SDN for a couple of weeks and am only seeing this now. I've basically just marked and make flashcards for questions I got wrong and wasn't sure about.

 

[kenken]

Hey guys, I've been giving a lot of advice to people on the Reddit thread R/Step1, and SDN has been really helpful to me in the past so I figured I'd post here as well.

Feel free to ask me anything!

Hey!
Thank you for offering to help and all the feedback and advice you have given everyone else on this thread so far. I have my test coming up on April 10th and had a couple questions about these last couple weeks of studying.

Just to preface my questions: My NBME and UWSA1 scores so far are not even close to my target range (>240). I have a 225 on NBME 16 so far and a 219 on NBME 17 (around 165/200 on both), and a 237 on UWSA1 however I have read that it overpredicts quite a lot. I have been going through the score reports and targeting subjects that I didn't do so well on, however I am finding that in studying for those, I am doing worse on disciplines that I was doing well on previously. I used Anki pretty religiously at the beginning of dedicated, but have kind of stopped using it in the last 5 weeks as I don't think its helping me retain very much. I have gone through Uworld once with a 60% correct score and am in the process of going through my incorrect Qs. I have also been filling gaps in my knowledge with sketchy pharm and micro to some extent, and reading pathoma to reinforce concepts as needed.

1. Is there a specific way to study in the last couple weeks before test day that you would recommend? I feel slightly lost, because I still plan on taking NBMEs 18,19,20,21,22 and UWSA2 before test day but I'm not sure how to space them out or how else to go through/review concepts to push my scores into my target range. As it is, the scores I have gotten so far are pretty demoralizing. I feel like as much as I would like to, I don't have enough time to go through everything again to reinforce concepts, but I'm not sure what else will help bring my scores up by almost 20 points in 2 and a half weeks.
2. Do you think doing questions for most of the day is the way to go now or do I still have time to shore up my knowledge in these last 16 days?

Thanks.

 

[USMLE_Pro]

Thanks for the input! I was off SDN for a couple of weeks and am only seeing this now. I've basically just marked and make flashcards for questions I got wrong and wasn't sure about.

You're welcome!

 

[USMLE_Pro]

Hey!
Thank you for offering to help and all the feedback and advice you have given everyone else on this thread so far. I have my test coming up on April 10th and had a couple questions about these last couple weeks of studying.

Just to preface my questions: My NBME and UWSA1 scores so far are not even close to my target range (>240). I have a 225 on NBME 16 so far and a 219 on NBME 17 (around 165/200 on both), and a 237 on UWSA1 however I have read that it overpredicts quite a lot. I have been going through the score reports and targeting subjects that I didn't do so well on, however I am finding that in studying for those, I am doing worse on disciplines that I was doing well on previously. I used Anki pretty religiously at the beginning of dedicated, but have kind of stopped using it in the last 5 weeks as I don't think its helping me retain very much. I have gone through Uworld once with a 60% correct score and am in the process of going through my incorrect Qs. I have also been filling gaps in my knowledge with sketchy pharm and micro to some extent, and reading pathoma to reinforce concepts as needed.

1. Is there a specific way to study in the last couple weeks before test day that you would recommend? I feel slightly lost, because I still plan on taking NBMEs 18,19,20,21,22 and UWSA2 before test day but I'm not sure how to space them out or how else to go through/review concepts to push my scores into my target range. As it is, the scores I have gotten so far are pretty demoralizing. I feel like as much as I would like to, I don't have enough time to go through everything again to reinforce concepts, but I'm not sure what else will help bring my scores up by almost 20 points in 2 and a half weeks.
2. Do you think doing questions for most of the day is the way to go now or do I still have time to shore up my knowledge in these last 16 days?

Thanks.

Apologies for my delayed response, just returned from traveling out of the country post Match Day! In case you don't see this in time, I hope your exam goes well!

Agree that UWSA1 can overpredict significantly, currently with those practice tests you were sitting in the 220s.

1. For your last few days, you should focus on reviewing the NBMEs very thoroughly. Your kind of plateau often has to do with test-taking skills.
2. Yes, questions are the best way to review.

Hope your scores improved, if not feel free to reach out and we can discuss if it may be appropriate to delay your test and rethink your approach.

 

[subdural_hematoma]

Hi!

What do you think about doing UW first pass systems? I want to learn as much as I can from UW and felt that I wasn't able to concentrate on the details I was missing in each question to tie in the bigger picture unless I did it by systems. I am trying to do it completely as a learning tool pre dedicated (which I have 3 weeks left of) then begin do random timed once dedicated starts. I have so far done around 1300 questions.

I have been keeping a Word doc of my incorrects that I plan on writing into Anki cards and then re-doing UW a second time. Do you think this would be a good idea moving forward? Or should I try to incorporate another Q bank?

Thank you for your help, I have read your posts throughout my prep and found them very motivating!

 

[USMLE_Pro]

Sometimes, it is appropriate to do a pass by system first, but usually what you really need is to make Anki cards based on your incorrects. You'll retain the information much better that way. I don't see any reason to do a word doc and then do Anki cards. I've had students just do a single pass with Anki cards, it's not always necessary to do two. I did just one pass, for example. I don't typically recommend using other Qbanks--it's usually preferable to do two UW passes vs. a different, lower quality qbank.

Thank you for the kind words and good luck on Step 1!

 

[many5724]

Hi!
Coming from a low rank USMD school, I'm worried about my schools step one preparation because only a few upperclassmen manage to score 250+ every year. I'm staring MS2 this fall, and I was wondering what can I do to make up for my schools bad step prep? Like I already established that I retain the most by doing questions and flashcard if that helps.

Also, I sent you a PM as I am highly considering your tutoring services.

 

[USMLE_Pro]

Hi!
Coming from a low rank USMD school, I'm worried about my schools step one preparation because only a few upperclassmen manage to score 250+ every year. I'm staring MS2 this fall, and I was wondering what can I do to make up for my schools bad step prep? Like I already established that I retain the most by doing questions and flashcard if that helps.

Also, I sent you a PM as I am highly considering your tutoring services.

Hi, thank you for reaching out! It's great that you're being proactive about this. I'll need some more info about you to make specific recommendations and will reply to your PM. Apologies for my delay, have been traveling post match!

 

[subdural_hematoma]

Sometimes, it is appropriate to do a pass by system first, but usually what you really need is to make Anki cards based on your incorrects. You'll retain the information much better that way. I don't see any reason to do a word doc and then do Anki cards. I've had students just do a single pass with Anki cards, it's not always necessary to do two. I did just one pass, for example. I don't typically recommend using other Qbanks--it's usually preferable to do two UW passes vs. a different, lower quality qbank.

Thank you for the kind words and good luck on Step 1!

Hi again!

So I am 4 weeks into dedicated. I have the following NBME scores NBME 21: 225 NBME 23: 223 UWSA1: 249. Plan is to take 22, 18 and UW2 in the coming weeks

I have already been through UW once and have followed your advice by making anki cards for all my incorrects. I am working my way through a second pass and have about 2.5 weeks left before my exam. What do you think I can do to push my scores to a 240+? Would you recommend continuing UW questions or trying to cram in 1/2 more NBMEs and review those? I am worried my plateau in the NBMEs may be due to test taking skills and reviewing those tests may help identify where I am going wrong.

I hope you enjoyed your trip post match! Thanks so much for all your advice so far.

 

[USMLE_Pro]

Hi again!

So I am 4 weeks into dedicated. I have the following NBME scores NBME 21: 225 NBME 23: 223 UWSA1: 249. Plan is to take 22, 18 and UW2 in the coming weeks

I have already been through UW once and have followed your advice by making anki cards for all my incorrects. I am working my way through a second pass and have about 2.5 weeks left before my exam. What do you think I can do to push my scores to a 240+? Would you recommend continuing UW questions or trying to cram in 1/2 more NBMEs and review those? I am worried my plateau in the NBMEs may be due to test taking skills and reviewing those tests may help identify where I am going wrong.

I hope you enjoyed your trip post match! Thanks so much for all your advice so far.

You're welcome! Appreciate the kind words. Are you studying with anyone else? The ideal would be a friend or classmate who is an excellent test-taker who can walk you through their approach to questions. Assuming you are making effective cards (it's a bit of an art and science), the issue is likely primarily test-taking (a common cause of a plateau at these scores). Another thing you can try is categorizing each of your errors and seeing if you can detect the systematic patterns of cognitive errors, but that's definitely tricky to do by yourself. Do make sure you understand each NBME question in depth--that's the highest-yield thing you can do!

 

[USMLE_Pro]

Thanks for sharing your thoughts. I can see that you have many valid points regarding focusing on high-yield resources tailored to the exam and active learning methods for retention.

I am in a position to take step 1 just to pass for board requirement (Canadian resident). Also, our MD curriculum was much more clinically based and did not cover much basic sciences to begin with - and it was a few years ago anyways. I am wondering if you have any specific advice for me? My goal is to pass comfortably but also use the least amount of time as needed.

Also, because Anki is a key component of your methods, I am wondering if you mind sharing some thoughts about the ideal time each day to make cards and the total number of cards for the exam.

Thank you!

If you're a few years out from basic science work, you may want to consider starting with a video series like boards and beyond, and/or reading Crush Step 1 to get an overview of the material, before jumping into Anki cards. I have a blog post detailing my method for Anki cards, just PM me if you'd like me to share it with you. Good luck!

 

[pandnana]

Felt like I got a bunch of the gimmes wrong. How will that affect my score? Ik this is a hard question to answer

 

[foreverhopeful95]

As an incoming first year, what do you recommend I do to make dedicated for Step 1 easier? I know some have recommended supplementing blocks with first aid but is there anything else I should be doing?

 

[USMLE_Pro]

Felt like I got a bunch of the gimmes wrong. How will that affect my score? Ik this is a hard question to answer

Apologies for the delayed response, hope you were happy with your score! To everyone else, please try to avoid counting your incorrects after your test, it's super tempting but can drive you crazy!

 

[USMLE_Pro]

As an incoming first year, what do you recommend I do to make dedicated for Step 1 easier? I know some have recommended supplementing blocks with first aid but is there anything else I should be doing?

First year I would focus on doing well on your classes (if you have a standard 2-year preclinical curriculum). You can consider reading through the relevant portions of Crush Step 1 with your courses. Good luck!

 

[USMLE_Pro]

Hi!

What do you think about doing UW first pass systems? I want to learn as much as I can from UW and felt that I wasn't able to concentrate on the details I was missing in each question to tie in the bigger picture unless I did it by systems. I am trying to do it completely as a learning tool pre dedicated (which I have 3 weeks left of) then begin do random timed once dedicated starts. I have so far done around 1300 questions.

I have been keeping a Word doc of my incorrects that I plan on writing into Anki cards and then re-doing UW a second time. Do you think this would be a good idea moving forward? Or should I try to incorporate another Q bank?

Thank you for your help, I have read your posts throughout my prep and found them very motivating!

Oops, didn't reply to this one directly. Original response:

"
Sometimes, it is appropriate to do a pass by system first, but usually what you really need is to make Anki cards based on your incorrects. You'll retain the information much better that way. I don't see any reason to do a word doc and then do Anki cards. I've had students just do a single pass with Anki cards, it's not always necessary to do two. I did just one pass, for example. I don't typically recommend using other Qbanks--it's usually preferable to do two UW passes vs. a different, lower quality qbank.

Thank you for the kind words and good luck on Step 1!"

I will add, for others, that sometimes I will have students use an excel file to track the types of errors they are making. This is more from the perspective of tracking systematic test-taking errors than particular content, in order to recognize patterns and cognitive biases.

 

[canada667]

do you think an older img can do it even tho you did in the 3rd year?

 

[USMLE_Pro]

do you think an older img can do it even tho you did in the 3rd year?

Are you asking if you can excel on Step 1 as an older IMG? Absolutely! It's generally more difficult, but we've certainly worked with IMGs able to achieve really great scores.

 

[slaveofthehealer]

How do you recommend reviewing the NBME exams?

 

[slaveofthehealer]

@USMLE_Pro

 

[USMLE_Pro]

Awesome question! You definitely want to review every single NBME practice question in detail. In my experience, it is only necessary to do the exams currently available on the NBME website, and I see going back and doing retired exams as overkill (I.e., people get 260+ scores without this)

In terms of how to actually review them, consider making an Anki card for each question you get wrong, and at least laying eyes on every single question, even those you get right. Pay particular attention to the images (make sure you can identify all the labeled anatomical regions in the brain, for example, if that comes up in a question). Given that there are no answer explanations currently available, unless you're reviewing the exams with someone, I recommend using Google and First Aid to look up the information needed to understand why the right answer is right. This can often take A LOT of time, but it's really worth it. If you're stumped, consider reaching out to a friend or classmate who has already done well on the exam. The review process can be arduous when approached this way, but it's very active learning and will lead to much better long-term content retention.

Do not spend your time searching explanations online, or using "explanation" documents circulated among students. I've seen really, really terrible errors in both these sources, which can lead to the kind of misunderstanding that can cause you to get questions wrong in the future. Good luck!

 

[slaveofthehealer]

Awesome question! You definitely want to review every single NBME practice question in detail. In my experience, it is only necessary to do the exams currently available on the NBME website, and I see going back and doing retired exams as overkill (I.e., people get 260+ scores without this)

In terms of how to actually review them, consider making an Anki card for each question you get wrong, and at least laying eyes on every single question, even those you get right. Pay particular attention to the images (make sure you can identify all the labeled anatomical regions in the brain, for example, if that comes up in a question). Given that there are no answer explanations currently available, unless you're reviewing the exams with someone, I recommend using Google and First Aid to look up the information needed to understand why the right answer is right. This can often take A LOT of time, but it's really worth it. If you're stumped, consider reaching out to a friend or classmate who has already done well on the exam. The review process can be arduous when approached this way, but it's very active learning and will lead to much better long-term content retention.

Do not spend your time searching explanations online, or using "explanation" documents circulated among students. I've seen really, really terrible errors in both these sources, which can lead to the kind of misunderstanding that can cause you to get questions wrong in the future. Good luck!

Thanks for your reply. If I have an average foundation (score around the mean on exams at a DO school) and I want to score 240+ and I have 4 months until the exam, (2 months until dedicated) how would you recommend studying?

 

[USMLE_Pro]

Take a practice test now! That will help me target my recommendations. I know it feels really far away, but it's super important information. I would take the lowest numbered NBME (Comprehensive Basic Science Self Assessment, CBSSA) currently available on their website (I believe 18).