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May 26, 2014
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Hey guys recently took my step 1 and thought I would share my experience while it is still fresh in my head.


CBSE January 2017:188
CBSE April 2017: 243
NBME 17:238(curve is ridiculous)
NBME 18: 256
NBME 19:250(curve yet again ridiculous but I got better at step I guess)

Ill try my best not to break any NBME laws but if I do please let me know so the NBME lords don't come to my doorstep and seize everything I own.

I feel like while I was taking the exam I was having so many epiphanies that I feel like you can only have if you've taken the exam but by then its too late. No amount of SDN, reddit reading can help you fully capture the exam experience but I will try to give you some lessons I learned while taking the exam.

1. Having good exam day mentality is so important. I never took strictly test setting practices, full lengths, paused my tests alot, looked up answers before finishing a block, and was very lazy with this overall. Well during the exam I was running low on time on almost every block and the uncertainty of not knowing the answers was killing me. You have to be prepared for the exam day itself as a part of your studying. I.E getting good sleep, food, not getting worn out, not getting thrown of by distractions(for example someone taking an exam other than STEP which requires a lot of typing and ANNOYING LOUD KEYBOARD BANGING THAT THREW ME OFF FOR THE FIRST TWO BLOCKS). ughhh Time plays a big factor in making you feel unsure. You dont always have time to check all your answers other then maybe marked questions and I think thats why people feel awful.
As important as this test is dont try to change how you answer questions. I remember in the beginning I would make sure to read every little detail in the question and make sure I wasnt missing a single thing and was very slow at answering. I ended up going back to my old approach of answering questions midway through and had a better experience from there on it.

2. The material is all in in UFAPS. I was so afraid of SDN people talking about questions outside of these resources, questions that are completely left field. I barely had any of these types of questions. I did notice alot of questions that could LOOK left field but ultimately they were testing a basic first aid concept so know these cold and do UWORLD. People also say that the exam is more clinical rather than buzzword heavy. Maybe theres not as many buzzwords but I still could recognize the description of buzzwords. I feel like having the mentality that STEP 1, as convuluted as it may be, is testing a basic concept helped me answer questions and navigate through the crap.

3. The test is very similar to UWORLD but even UWORLD doesn't capture the higher ordered nature and trickiness of step. The trickyness of step isn't necessarily that they are deliberately trying to make you choose the wrong answer like MCAT or sometimes UWORLD. Its more that they just make you uncomfortable picking answers that you know are probably right but there are other answers that could be right too. I felt like I was making so many educated guesses but at the same time I felt like I was still choosing the best answer. You need to get used to this feeling by doing a lot of practice test and UWORLD.

4. Process of elimination is important. There were a lot of questions that sometimes felt like there could be 3 or even 4 answers that are correct but then I would go back to the passage and be like "hmm that cant be right, this doesnt make sense within this context" Until I get to the answer.
This plays into the higher orderedness of the questions. One question can have information about a disease and ask you a detail on that disease, and then they include bits of information on other diseases that you have to eliminate because they dont make sense within the context. Mix that in with physio/pharm/ anatomy tie ins and youve got one gigantic monster question that requires you to know the full presentation of 4-5 different diseases and some knowledge on other Non organ system topics to get one question right. Oh and you have about a minute and a half to move through your brain access all the info you need, make the best decision and move on without any assurance of whether you got the question right or not. So when you are learning first aid keep this mentality of mind. Take disease, know their full presentation ask yourself how changing certain factors can make you choose another similar disease. There were so many questions where I felt like I knew 90% of the information in the questions and answers but could not make that last link to the answer which really frustrated me.

5. Topics are skewed, thankfully they favored my strengths but they may not so know everything well, show no weakness!!
There were also a good chunk of straight forward questions so don't neglect memorization from first aid, sketchy, pathoma. There are people who are UWORLD fanatics and go over the top about how great it is and how it is all you really need. Thats somewhat true but you still need to memorize the dumb details which I found to be lacking in UWORLD.

6. Anatomy is pretty low yield. wasted so much time freaking out about CTs,MRIs, gross path, and overstudied for it. Most high yield is probably Neuroanatomy, GI, and I guess cardiopulm but that anatomy is simple so need to worry.

7. The main difference between UWORLD and Step 1 is that step 1 questions don't try to trick you as much as UWORLD. UWORLD goes overboard with this. I also feel like STEP 1, questions tend to be more muddy and exclude a lot of information(like NBMEs) that could give you more confidence with your answers. STEP 1 also had questions even higher ordered than UWORLD.
Essentially, a good chunk of STEP 1 questions felt like NBME and UWORLD questions did a FUSION Ha and then took it to the next level and went super saiyan three.

8. Do your NBMES. Noticed some similar appearing questions. One question that I obsessed over for the NBMEs because I could not find an explanation for it actually came up on my test.

Overall, I would say what makes the step 1 hard is the actual test experience itself, knowing information so well that you can apply it to difficult, uncomfortable questions, memorizing the dumb details for the gimme questions, and overall maintaining composure, being confident and efficient.

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Great post.

How would you say the CBSEs compared to both Uworld and the step?

What was your UW schedule (questions per day, etc.)?

Thoughts on starting UWorld earlier than the dedicated period?
Hmm I wouldnt start is sooo much earlier, maybe like a couple of weeks earlier than dedicated time when everyone starts slowly focusing more on step. I started it kinda late and only had 6 weeks to do it. I wasnt very disciplined so I felt like I was really missing out on UWORLD learning towards the end and rushing to finish while also finishing my other resources.

I started doing 1-2 blocks a day which I felt was letting me get the most out of learning. Towards the last two weeks I was doing 3-3.5 and I felt like I was just rushing and not learning.

So I would calculate it to where I can comfortably do 1-2 blocks a day and go through it maybe twice a week before the exam. That last week was crucial to memorize stuff for me.

CBSE was much easier than either UWORLD or step. Though I dont remember it much, it felt like even the gimme questions in step were harder than a lot of cbse questions
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awesome write up, thanks! any advice for someone three weeks out from test day? maybe tips on where time would be best spent (perhaps for those memorization questions)?
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Do you think everything we need to know is in uworld? Would it be a good idea to just run through uworld 3 times throughout 2nd year ?
Thanks for this!!

I have seen a few people write about neuroanatomy coming up on their exam.

What would you recommend as good sources to master that.. right now I have just been focused on what is in FA and uworld do you think that is enough?