So I took the beast yesterday in Houston, TX. Just to give people some realistic context (i.e. I'm not cooler on SDN than in real life), I'm your
average med student by all means, mostly B's in school, couple C's, and A's here and there. MCAT= 28Q. I have never struggled, but I'm not at the top of my class.
Anyway, I took step 1 a little early because I'm starting an internship on June 1 and didn't have time to take it after that begins.
Review:
Began about 3 weeks before my school classes ended.
While I was still in classes:
I did 50
kaplan qbank questions in the morning and 50 at night every day. Also, I had read through
Goljan RR Path and listened to his lectures throughout the year, but I read through the areas in RR we were covering in class at the time.
FA 2007 because I saw no point in paying for 2008... I wrote extra things into FA that I thought might be important. I put my FA in a binder and added in my own notes here and there.
Lange Micro Cards: I took these by section and tried to cover a section per weekend.
Pharm Cards (green box): same, picked a section and tried to cover during the weekends.
After Classes Ended
I had 18 days between the end of classes and Step 1.
Basically my schedule was: wake up at a decent hour, i.e. 10-12am (my test was scheduled for noon- perfect time), take my dog for a run, make leaded coffee, begin with 50 kaplan qbank questions/morning (all unused, timed). Then read through a section of first aid with a supplement book. Then I did 150 or so subject review questions in
USMLE World per night (unused, incorrect, timed).
I used these ancillary sources:
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CMMRS (I had read this during the school year and just reviewed the things that helped previously;
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HY Neuroanatomy: I didn't read all of this, but the major sections.
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HY Biostatistics: (I had read through this during the school year but again reviewed the good parts).
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Kaplan Pharm notes: (I reviewed this for the Pharm Shelf, but again looked it over)
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HY Physiology: Fantastic! I got through this book in less than a day. Its a down and dirty phys review
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Goljan RR: I referenced things from FA to this book, but I also tried to cover as much of it as I could.
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Goljan Audio: I had listened to this throughout the year, but I listened to it while running with my dog and when my eyes stopped working at night.
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Kaplan pharm for palm: This is the FREE version from the qbank website. I used this while I was waiting in lines, etc to review drugs.
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Goljan High Yield facts (some pdf floating around)- I used this during the day leading up to the test, also looked over it the morning of the test.
Qbanks
Kaplan qbank: 35% completed, 62% correct (all unused, timed)
USMLE World: 33% completed, 65% correct (subjects, unused, incorrect, timed)
NBME 4 5 days before Step 1: score of 500 = 220?
(average)
Day of the Exam
I actually slept great the night before- I ran an extra 3 mi the afternoon prior to calm myself down (self-medicated ADHD I think). Woke up the morning of, drank some coffee and ate some oatmeal, fruit, and eggs. I had to go to the university to take Step 1 so I left early and arrived about 1hr prior to my start time. The test center people are cool, the guy even let me start early so my breaks would be staggered from other test takers. Put my stuff in a locker, took my picture, and took my dry erase boards, pens, locker id, and drivers license to my workstation.
I finished the tutorial in less than 5 minutes, but I'm glad I did it because my headphones didn't initially work and there is a "headphone test." It was worth the extra 5 min to figure that out early.
My first block was rough. I had a ton of weird path on there that I know was nowhere in Goljan or FA. But then I had the usual: goodpastures, wegeners, caisson disease, pretty much everything that goljan said in lecture was on there. I was amazed.
Micro/immuno is my best subject, as I did immuno research before med school so I didn't review this too heavily and I relied on my previous knowledge. The micro/immuno questions were really fair: Know major cytokines, IL1,2,4,5,6,8,10,12, TNFa, TGFb, IFNa, IFNg, IFNb, GCSF, GMCSF, major CDs:1,3,4, 28, 9+10 (b cell ALL). Also I had 1 question on which cells are myeloid lineage... All pretty basic. As far as bugs, I didn't have any crazy ones: Naegeria fowleri was about as exotic as they get (i.e. kid dives into a lake then dies of a headache...). Several TB questions, specifically know the aspergillus co-infection, the dissemination syndromes (potts, etc), and the side effects of the major TB drugs. There were maybe 5 questions on ABX but all very straight forward.
I got several biostats q's. Know how to calculate PPV, NPV, what a p score means, very basic stuff.
As far as anatomy I had a couple brachial plexus q's, couple cardiac (enlargement of left atrium causing dysphagia) and a ton of GI anatomy q's... especially regarding mesenteric artery infarction, i.e. would this structure be affected, where would a bullet hit if shot through the 9th IC space laterally... blah blah
Neuro: I had 2 spinal cord sections: 1 asked me to identify where pain is conducted for a patient with chronic pain. The other a pic of parkinsons. I had 2 brain gross pictures- meningioma, vertebral artery dissection. A couple MRIs, mostly cerebral hemorrhage (predisposing factor? HTN), subarachnoid versus subdural or epidural hematoma, and a child abuse skull fracture.
Behavioral science was ******ed... I don't know where they come up with those but I guess just answer them with the attitude: if they're gonna die, and can't tell you that they want a surgery- do it anyway. Keep everything confidential. Validate concerns. Don't use big medical words with patients, blah blah blah.
Pharm was straight-forward: hr/bp graphs of epinephrine administered alone vs. with a beta blocker. Major drugs for major side effects: aplastic anemia, drug induced SLE, gentamicin and ototoxicity, nephrotoxicity.
1 audio/video: Which was a lot like the set up in DxR clinican: Put your stethoscope places and listen... but the question string gave a history that was sufficient to answer the question without even looking at the video (pt. with marfans and mvp... whats he at risk for? berry aneurysm). The video was just of the mitral valve murmur.
I took little over 5 minutes for each break and trucked through the thing. I brought a banana, a frappuccino, and a bag of granola. This worked well cause I'd come out, drink some frappuccino, down handfuls of granola, take a piss and get back to it. I never finished any sections early and I always had time to go back over the ones I had marked.
I walked out of there very much in the same state as after my first wake-up of boot camp: tired, hungry, and disoriented. I think my GCS at this point was around an 11. So I cured it with some margaritas and excedrin (physician heal thyself) and forgot about it.
Overall, I was worried I was not adequately prepared, but after taking it I feel like I could have studied another month and still would not have covered all those "out of left field" questions. Out of curiosity I was looking some of them up after the test, and the answers aren't in goljan, FA, or even harrison's (i.e. what is the prototype drug name for AZT? blow me...).
My goal was a solid score, but not stellar (I'm military so I'm going to the sandbox no matter what). My best advice is just take the damn thing when you've gotten the score you want on NBME, you're over it, and you've put up a good fight. Thats about where I was at. Time will tell if I was ready.
Score TBA
You are just mad you can't see whether your prediction turned out right 
