MD Is UFAPs a scam?

[jhenj529]

Hi!

So I'm an M1 and I've been doing a lot of thinking. During my first year, I've been doing a lot of Zanki and pathoma/Bnbs. I currently have about 10,000 board related cards at the moment. Nearly everyone online talks about how important preping for boards is. People have been saying to focus more on board prep rather than classwork. Hence, Ive been pretty much getting close to honors in all my classes, but occasionally do get some misses here and there. A few days ago, I came to wonder, what evidence is there that this stuff works? I've been thinking more and more that this whole board studying craze has been a ploy to prevent students from getting AOA. If you look, many of the top specialties love AOA, some saying that it matters more than step. Thoughts?

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[wontonsoup]

Very sneaky trying to bring down the STEP1 average like this

 

[jhenj529]

Very sneaky trying to bring down the STEP1 average like this

Definetly not my goal. I don't know, you get told all of this stuff and I never really questioned it till now. I just wanted to see if anyone else had thought of this before

 

[Melchizedek]

It's a bit like asking "whats more important for med school admissions, GPA or MCAT?"
Yes a high GPA (AOA) is awesome, but a terrible MCAT isn't going to do you any favors, and vice versa.
GPA/AOA is going to test how well you can run the marathon and consistently do well.
MCAT/Step is going to test how well you can handle immediate pressure when it comes down to the wire.

Doing well in your undergrad classes is going to lead to a good MCAT score (provided they are chem/bio/biochem etc classes.), but not as good of a score as if you ignored your classes and only studied for the MCAT for 4 years. Does that mean you'd fail your classes? No, you're still learning the material, you might not get amazing grades, but you'll learn enough to pass the class.

Now replace the above MCAT and undergrad classes with Step and pre-clinical grades. Its the same concept.

That being said, I don't think a residency would prefer a 230 Step 1 w/ AOA over a 250 Step 1 w/o AOA

 

[sella.turcica]

Hi!

So I'm an M1 and I've been doing a lot of thinking. During my first year, I've been doing a lot of Zanki and pathoma/Bnbs. I currently have about 10,000 board related cards at the moment. Nearly everyone online talks about how important preping for boards is. People have been saying to focus more on board prep rather than classwork. Hence, Ive been pretty much getting close to honors in all my classes, but occasionally do get some misses here and there. A few days ago, I came to wonder, what evidence is there that this stuff works? I've been thinking more and more that this whole board studying craze has been a ploy to prevent students from getting AOA. If you look, many of the top specialties love AOA, some saying that it matters more than step. Thoughts?

Who cares? You should aim for the highest possible Step 1 score and UFAP is simply the best way of getting all the important information in your brain. Many students before you have succeeded this way, so questioning a very established method without any substantiated thought is a quite bold move. If you don't like it use a different approach. But don't be whining when you receive your 200s score and have FM in butt**** Tennessee as your only option.

 

[Jesus1]

Keep doing whatever you're doing but prioritize getting the highest scores possible on your class exams. Doing this usually will ensure that you are truly understanding the material.
UFAP is not a scam but understanding the stuff in UFAP is what matters. Just knowing the facts alone won't get you anywhere.

 

[Treebeard]

UFAP +/- S is the best set of materials to prepare for boards.

It is NOT the only thing you should ever be looking at throughout all of M1 and M2. For classes, study however works for your best and learn all of the material that your school holds you responsible for. When it is time to study for Step 1, UFAP it up.

 

[whoknows2012]

It’s diminishing returns with more time invested and more resoruces. You can just as easily kill 1-2nd yr, have a life, and then when it comes time to devoted studying go nuts with FA uworld and nbme practice tests (do they still have these??!!) and get >250

 

[7331poas]

Keep doing whatever you're doing but prioritize getting the highest scores possible on your class exams. Doing this usually will ensure that you are truly understanding the material.

Possibly the dumbest thing I have read on this website.

Your priority should be P=MD. The only thing that matters is step 1. No one is going to give a **** whether you got a shiny A- on your cardio block because you got a few questions right regarding the professor's lab research interests.

 

[Prehealth1011]

Keep doing whatever you're doing but prioritize getting the highest scores possible on your class exams. Doing this usually will ensure that you are truly understanding the material.
UFAP is not a scam but understanding the stuff in UFAP is what matters. Just knowing the facts alone won't get you anywhere.

lol

 

[Jesus1]

Possibly the dumbest thing I have read on this website.

Your priority should be P=MD. The only thing that matters is step 1. No one is going to give a **** whether you got a shiny A- on your cardio block because you got a few questions right regarding the professor's lab research interests.

Sounds good. I would encourage you to look through USMLE "experience" threads from many years prior (start from 2012 if you can). Don't go with simple anecdotes. Actually take the time and fact check. The strongest predictor of USMLE Step 1 performance is pre-clinical performance. This is something that has been proven time and time again. It is quite unfortunate when you hear stories of people that said they would just ignore class and do the minimum needed to pass. They somehow manage to not crush these exams as hard as they thought. There are exceptions to this rule (I have seen them myself), but this advice of P = MD and going hard on Step 1 primarily has burned many more people than helped them. The people that crush these preclinical exams are invariably the ones that do the same on the USMLEs. There are also exceptions to this, but they are extremely rare. Your preclinical course work builds a foundation.
And tbh, not my job to get into an inflammatory convo on a public forum. Take my advice with a grain of salt. Just giving my 2c having been through and observed tons of people go through said process. Wishing you all in the best in the future.

 

[aldol16]

I think a lot of people tend to approach boards studying in a backwards way. The boards test you on material that you should be taught during your pre-clinical years. At least most of the boards material is taught, anyway. And if you learn the material well the first time, boards review will be exactly what it sounds like - review. Then you do UWorld and NBMEs to get into the habit of answering questions in the way the exam likes to present them. This two-pronged method is necessary because while you may have the underlying knowledge, the boards require you to apply that knowledge in a variety of ways that you may not have seen before and so getting that practice up front will help you. Spaced repetition software like Anki should help you in this process, not replace it. In other words, your flashcards should be triggering memories of concepts and pathophysiology rather than just random facts.

The other way you can do it is focus on boards prep instead of learning the material well the first time. If you do this, you might memorize a lot of associations, buzzwords, etc. and that will also help you do well on the boards but in the long run, you're going to forget all the associations (unless you continue with your Anki decks post-boards which I haven't personally heard of anyone doing). But if you learn the material well the first time around and then review for boards as dedicated approaches, you can be confident that you'll enter clerkships knowing the material well and have that knowledge in your head for the future. Both of these methods can lead to doing very well on the boards - the difference lies in the depth of knowledge.

The exception, of course, is if your school for some reason substantially deviates from the boards curriculum. If your classes are all on your professor's research interests and have nothing to do with what you need to know for the boards, then obviously you should be looking at other sources instead to learn what you need to know.

 

[FourniersGreenGang]

I know this sounds like a cliché but studying for classes is studying for boards. I scored >260 on step one and the best thing I did was build a very strong foundation in class. UFAPS is essential to perform well, and the more you look at it the better, but there were quite a few things on test day that I got simply from class, not from board prep. If you put it in long-term understanding and memory you'll kill boards.

 

[Merely]

Hi!

So I'm an M1 and I've been doing a lot of thinking. During my first year, I've been doing a lot of Zanki and pathoma/Bnbs. I currently have about 10,000 board related cards at the moment. Nearly everyone online talks about how important preping for boards is. People have been saying to focus more on board prep rather than classwork. Hence, Ive been pretty much getting close to honors in all my classes, but occasionally do get some misses here and there. A few days ago, I came to wonder, what evidence is there that this stuff works? I've been thinking more and more that this whole board studying craze has been a ploy to prevent students from getting AOA. If you look, many of the top specialties love AOA, some saying that it matters more than step. Thoughts?

You’re right bro it’s just a ploy. Don’t use UFAP it’s a total scam. Only use your lectures from school then go take step1 and let us know how it goes

 

[watermelon master]

Is this not a troll post?

 

[Foot Fetish]

You’re right bro it’s just a ploy. Don’t use UFAP it’s a total scam. Only use your lectures from school then go take step1 and let us know how it goes

This. Use only school powerpoints. The ones with yellow comic sans font over a blue background are especially high yield.

 

[DrMcLovin]

My recommendation is do well in class then use UFAPS for studying to tie everything together and refresh your memory on topics you forgot. It comes back fast when you learned it well the first time. I focused on keeping honors in all preclinical classes, then used pathoma videos along system based classes, sketchy medical for micro, and started hammering Uworld spring of 2nd yr. Got ~260 on both step1/2. Im a DO so I didnt take step 3 but got 99 percentile on comlex3 without much studying since I had a solid base of knowledge. Now I’m in the process of forgeting medicine so I can practice ortho correctly.

I had classmates who focused on just passing class and just studied for USMLE so they could “crush boards” and they all got around 230. They likely had a better lifestyle the first 2 yrs though.

 

[Med Ed]

A few days ago, I came to wonder, what evidence is there that this stuff works?

Experimental evidence? None whatsoever. But given that the admissions process selects for students who are intelligent, motivated, and good at taking tests, it has long been recognized that we could drop you all off on a deserted island with a crate of old, yellowed, dog-eared textbooks and you would learn the material well enough to pass. So whatever the herd is using nowadays will look like it works.

 

[jhenj529]

Sounds good. I would encourage you to look through USMLE "experience" threads from many years prior (start from 2012 if you can). Don't go with simple anecdotes. Actually take the time and fact check. The strongest predictor of USMLE Step 1 performance is pre-clinical performance. This is something that has been proven time and time again. It is quite unfortunate when you hear stories of people that said they would just ignore class and do the minimum needed to pass. They somehow manage to not crush these exams as hard as they thought. There are exceptions to this rule (I have seen them myself), but this advice of P = MD and going hard on Step 1 primarily has burned many more people than helped them. The people that crush these preclinical exams are invariably the ones that do the same on the USMLEs. There are also exceptions to this, but they are extremely rare. Your preclinical course work builds a foundation.
And tbh, not my job to get into an inflammatory convo on a public forum. Take my advice with a grain of salt. Just giving my 2c having been through and observed tons of people go through said process. Wishing you all in the best in the future.

I guess the issue I've always had with this is that are they actually going hard with Step 1 prep during class, or are they just blowing everything off all together.

This. Use only school powerpoints. The ones with yellow comic sans font over a blue background are especially high yield.

Not saying this either. All I was asking is if step 1 one prep was overblown as a deterrant to getting AOA. I go to a school in the Southeast, and everyone always talks about how our school isn't the best at prepping us for step 1. Hence, I was asking people were just hyping this up to prevent people from getting AOA. Our AOA doesn't take into account step 1 at all. I'm pretty sure schools and programs would want someome with a 240 + AOA rather then 270 with no AOA

 

[libertyyne]

The evidence that does exist is limited and speaks to the largest correlations between step 1 score being class performance and MCAT scores. The problem with UFAP is that people think if they ufap from day one in medical school they will get 270, which is not the best strategy considering in such a long timeline you are going to forget stuff, and if you never understood the material you are going to do even worse retention-wise. Most people that do end up getting stellar scores with UFAP during dedicated have been doing well in class are generally good test takers at baseline.

 

[sovereign0]

Agree with the people saying that doing well in pre-clinicals helps for Step. Scored >>250, did zero board-specific prep before dedicated. My curriculum was true P/F. Building a strong foundation is the best thing you can do for yourself during M1-M2, and studying board materials isn't giving you that.

I'm not sure I totally believe in UFAPS because it doesn't weigh things accurately. UW is the single most valuable resource for Step 1, hands down no exceptions. First Aid is ****ty reference material. Pathoma doesn't even hit enough of the specifics to be a critical resource (though it still has it's place).

IMO the answer to Step 1 is learn pre-clinical curriculum really well, Spring of MS2 plow through Pathoma, SketchyPharm/Micro. Reinforce old topics with B&B. When dedicated time comes, grind out a pass of UW + incorrects and take every single practice NBME and UWSA available to you.

Also, the whole Step 1 vs. AOA thing is ridiculous. Step 1 trumps all. Entire specialties and programs will be closed to you if you don't score at a certain threshold. Having AOA will not open those doors for you. Not to mention, many schools don't have AOA and the difference in nomination criteria and grade inflation is vast from school to school.

 

[sovereign0]

\I'm pretty sure schools and programs would want someome with a 240 + AOA rather then 270 with no AOA

What evidence, personal experience, or anecdote could an MS1 possibly have to support this claim? I'm assuming none, because it's wrong.

 

[CyrusHabs7695]

Our school lectures are so bad its unbelievable. I feel like you can trust your school material if you notice all the major points are being hit in first aid and pathoma. After realizing giant chunks were being missed throughout first year, I decided to switch to focusing on bb/pathoma/zanki/lightyear and my q bank % has gone way up. I guess what Im trying to say is that telling people to 'focus on school lectures because they build your foundation' is generalized and not true at some schools.

 

[jhenj529]

Our school lectures are so bad its unbelievable. I feel like you can trust your school material if you notice all the major points are being hit in first aid and pathoma. After realizing giant chunks were being missed throughout first year, I decided to switch to focusing on bb/pathoma/zanki/lightyear and my q bank % has gone way up. I guess what Im trying to say is that telling people to 'focus on school lectures because they build your foundation' is generalized and not true at some schools.

In what ways are your school lectures bad? Is it just because it seems like they miss something here and there? Couldn't they end up covering those topics later on? Also, what question bank are you referring to? A lot of people say if you memorize first aid/zanki, your question back performance is biased. How have you been doing on class exams ever since you switched?

 

[jhenj529]

What evidence, personal experience, or anecdote could an MS1 possibly have to support this claim? I'm assuming none, because it's wrong.

There was someone that said in general surgery, the top programs only interview AOA. Also, if you look at the radiology thread, the Adcom there says AOA gets automatic interviews.

 

[7331poas]

Sounds good. I would encourage you to look through USMLE "experience" threads from many years prior (start from 2012 if you can). Don't go with simple anecdotes. Actually take the time and fact check. The strongest predictor of USMLE Step 1 performance is pre-clinical performance. This is something that has been proven time and time again. It is quite unfortunate when you hear stories of people that said they would just ignore class and do the minimum needed to pass. They somehow manage to not crush these exams as hard as they thought. There are exceptions to this rule (I have seen them myself), but this advice of P = MD and going hard on Step 1 primarily has burned many more people than helped them. The people that crush these preclinical exams are invariably the ones that do the same on the USMLEs. There are also exceptions to this, but they are extremely rare. Your preclinical course work builds a foundation.
And tbh, not my job to get into an inflammatory convo on a public forum. Take my advice with a grain of salt. Just giving my 2c having been through and observed tons of people go through said process. Wishing you all in the best in the future.

No one is doing the "bare minimum" during preclinical. What I am saying is to ignore the useless BS that professors *think* is important for step 1. There is zero chance you can convince me that memorizing the professor's research articles that they posted for pre-reading will help me for step 1. It simply will not.

Studying for Step 1 during preclinical is hard. You should not get distracted by professors and what medical schools think is important.

 

[libertyyne]

There was someone that said in general surgery, the top programs only interview AOA. Also, if you look at the radiology thread, the Adcom there says AOA gets automatic interviews.

Top programs want it all. It is like saying All students need 518 mcat because WashUs average is 518.

There is a almost linear relationship between step score and matching into any specialty. It is the most important aspect of being screened. For the most part top performers are going to have 245+ AND AOA AND research AND great Clerkship grades.

Excelling in any other aspect of an application is not going to open all doors for a person, but step 1 score is the closest thing to the one thing that will make or break an application.

 

[Goro]

Hi!

So I'm an M1 and I've been doing a lot of thinking. During my first year, I've been doing a lot of Zanki and pathoma/Bnbs. I currently have about 10,000 board related cards at the moment. Nearly everyone online talks about how important preping for boards is. People have been saying to focus more on board prep rather than classwork. Hence, Ive been pretty much getting close to honors in all my classes, but occasionally do get some misses here and there. A few days ago, I came to wonder, what evidence is there that this stuff works? I've been thinking more and more that this whole board studying craze has been a ploy to prevent students from getting AOA. If you look, many of the top specialties love AOA, some saying that it matters more than step. Thoughts?

That trio is pretty much what my students use, but they also swear by Sketchy (much to the bemusement of my Micro colleagues). I'm impressed by BNB.

The best students use a variety of resources, and what works best for one, doesn't necessarily mean that it will work for you.

I'm personally also a fan of doing as many practice questions as possible.

 

[Vulfman]

I don't understand the idea that focusing on step resources means that you aren't learning the material well. I used UFAPS, B&B, and anki as my primary resources and was able to score in the top 10% of my class, do well on step, and create a solid knowledge base to succeed in third year. My only real use of lectures was cramming random details right before the test. Obviously, what works for each person will be different and there are many ways to learn, but the implication that using step resources is somehow a lesser form of learning is a little ridiculous.

 

[Oh_Gee]

My recommendation is do well in class then use UFAPS for studying to tie everything together and refresh your memory on topics you forgot. It comes back fast when you learned it well the first time. I focused on keeping honors in all preclinical classes, then used pathoma videos along system based classes, sketchy medical for micro, and started hammering Uworld spring of 2nd yr. Got ~260 on both step1/2. Im a DO so I didnt take step 3 but got 99 percentile on comlex3 without much studying since I had a solid base of knowledge. Now I’m in the process of forgeting medicine so I can practice ortho correctly.

I had classmates who focused on just passing class and just studied for USMLE so they could “crush boards” and they all got around 230. They likely had a better lifestyle the first 2 yrs though.

 

[Treebeard]

I don't understand the idea that focusing on step resources means that you aren't learning the material well. I used UFAPS, B&B, and anki as my primary resources and was able to score in the top 10% of my class, do well on step, and create a solid knowledge base to succeed in third year. My only real use of lectures was cramming random details right before the test. Obviously, what works for each person will be different and there are many ways to learn, but the implication that using step resources is somehow a lesser form of learning is a little ridiculous.

B+B is very thorough. That's different than just using FA and Pathoma.

 

[Pool]

I don't understand the idea that focusing on step resources means that you aren't learning the material well.

Didn't you hear? Using Zanki and FA means you're only memorizing facts without understanding them! School lectures build a F O U N D A T I O N of knowledge,
and I N T E G R A T E the facts together !!!

/s

 

[libertyyne]

Didn't you hear? Using Zanki and FA means you're only memorizing facts without understanding them! School lectures build a F O U N D A T I O N of knowledge,
and I N T E G R A T E the facts together !!!

/s

are you even learning anything if you arent writing with a stick on an earthen tablet, or using papyrus?

 

[Matthew9Thirtyfive]

are you even learning anything if you arent writing with a stick on an earthen tablet, or using papyrus?

Chisel and stone tablet or gtfo.

 

[Melchizedek]

Chisel and stone tablet or gtfo.

Cave paintings using berries and mud for ink.
C’mon M9 get it together.

 

[Matthew9Thirtyfive]

Cave paintings using berries and mud for ink.
C’mon M9 get it together.

That’s for DO schools.

Jk.

 

[TheIllusionist]

don't feed the troll. OP just did this for the #triggers

 

[FindersFee5]

I don't understand the idea that focusing on step resources means that you aren't learning the material well. I used UFAPS, B&B, and anki as my primary resources and was able to score in the top 10% of my class, do well on step, and create a solid knowledge base to succeed in third year. My only real use of lectures was cramming random details right before the test. Obviously, what works for each person will be different and there are many ways to learn, but the implication that using step resources is somehow a lesser form of learning is a little ridiculous.

I definitely agree with this. I think a lot of the people who say things like "Studying for Step only won't prepare you as well as lectures," or "Studying for step won't prepare you for third year," are parroting professors who really don't understand how good a lot of the new review resources are. I have never had a class exam that is nearly as well written as a kaplan block (generally regarded as the worst qbank). The people who write Step 1 are professionals at what they do. They write better questions than your professors do - which makes sense, because it's their job.

Here's my take on it: through the second half of M2, I didn't look at class slides once. I learned everything with pathoma and Zanki, reviewed it with B+B, solidified it with qbanks, and practiced it in discussion groups. I scored above average (~75th percentile) on every test. I wasn't in the top 10% because I didn't memorize details (also I think at least 20% of the people in my class are just straight up brighter than me and are going to beat me out regardless of what I do). But I'm in dedicated now, and I'm happy that I prepared the way I did.

 

[ed*26]

So you're getting honors in all your classes by using UFAPS, and are coming here to speculate over whether UFAPS is a scam?

I'm not understanding your question. Getting AOA and using UFAPS/board prepping is not mutually exclusive. Even looking at the most competitive specialties, less than half of those who matched were AOA. People say board scores matter because there's unequivocal evidence that they do:

 

[Gurby]

kaplan block (generally regarded as the worst qbank).

...This is news to me?

I thought the consensus was that generally, UW >>> Kaplan = Amboss > Rx... something like that.

I've been using Kaplan alongside class - found Rx to be too easy since I did Zanki. Would you recommend doing Amboss instead of Kaplan, if I only have time for 1 QBank other than UW?

 

[libertyyne]

...This is news to me?

I thought the consensus was that generally, UW >>> Kaplan = Amboss > Rx... something like that.

I've been using Kaplan alongside class - found Rx to be too easy since I did Zanki. Would you recommend doing Amboss instead of Kaplan, if I only have time for 1 QBank other than UW?

RX is the third level of hell, Kaplan IMHO is much better.

 

[jhenj529]

So you're getting honors in all your classes by using UFAPS, and are coming here to speculate over whether UFAPS is a scam?

I'm not understanding your question. Getting AOA and using UFAPS/board prepping is not mutually exclusive. Even looking at the most competitive specialties, less than half of those who matched were AOA. People say board scores matter because there's unequivocal evidence that they do:

View attachment 255096

Not a troll. My school is a little bit inflated. For our last block, the average grade out of 200 students was honors. The other two blocks before that the average grade was HP and Honors. Hence, that's why I'm asking. And you could also look it the other way around. Over half of the students that matched did have AOA

 

[jhenj529]

RX is the third level of hell, Kaplan IMHO is much better.

I thought RX was pretty good, no? I thought everyone said Kaplan was worse.

 

[libertyyne]

I thought RX was pretty good, no? I thought everyone said Kaplan was worse.

RX consistently wants you to answer based on a single buzzword in FA. Kaplan on the other hand will make you flex your POE and second order thinking. Plus it will throw in a WTF question from left field that you have never seen before in any other resource.

 

[Med Ed]

I thought RX was pretty good, no? I thought everyone said Kaplan was worse.

Just like FA is student-authored, so is RX. It's a brilliant business model to have your consumers write the materials for themselves.

 

[7331poas]

Just like FA is student-authored, so is RX. It's a brilliant business model to have your consumers write the materials for themselves.

Kaplan is also partially written by students.

 

[FindersFee5]

...This is news to me?

I thought the consensus was that generally, UW >>> Kaplan = Amboss > Rx... something like that.

I've been using Kaplan alongside class - found Rx to be too easy since I did Zanki. Would you recommend doing Amboss instead of Kaplan, if I only have time for 1 QBank other than UW?

Personally I agree! I would probably put it at UW> Kaplan>> Rx>/= Amboss. I just thought general consensus was that Rx was better than kaplan.

Kaplan physio has honestly helped me more on weird NBME questions than any other single source.

 

[Mad Jack]

...This is news to me?

I thought the consensus was that generally, UW >>> Kaplan = Amboss > Rx... something like that.

I've been using Kaplan alongside class - found Rx to be too easy since I did Zanki. Would you recommend doing Amboss instead of Kaplan, if I only have time for 1 QBank other than UW?

If you're just using Kaplan to supplement the stuff from class it is fine, but you really only need one qbank, and that is uworld. UW twice>>>>>UW once plus Kaplan

 

[libertyyne]

If you're just using Kaplan to supplement the stuff from class it is fine, but you really only need one qbank, and that is uworld. UW twice>>>>>UW once plus Kaplan

There isn't a lot of good data on this question. But the studies that do exist indicate unique questions improves scores more compared to repition of u world. The Reddit correlations which admittedly are not pristine also point towards the same result that 2x u world does not improve scores .

 

[Gurby]

There isn't a lot of good data on this question. But the studies that do exist indicate unique questions improves scores more compared to repition of u world. The Reddit correlations which admittedly are not pristine also point towards the same result that 2x u world does not improve scores .

The Reddit "study" seems to show that UW is unquestionably the best QBank. In fact, I think the formulas used here to determine lines of best fit are shady - UW first pass is a linear equation, and the others are polynomials but still not even close to as good.... This means UW is maybe even better than it looks here based on R^2 values.

Nonetheless, people who did UW 2x didn't seem to score higher than those who did it once through.

I'm thinking a reasonable strategy might be to do UW -> Kaplan -> UW incorrects/flagged. I think there is value in seeing unique questions, but also UW is the bible and enough people have scored >260 based on UW alone so...

old.reddit.com/r/step1/comments/an01lt/results_of_2018_usmle_step_1_comlex_level_1/