Congrats to everyone whos survived Step!
Im not that active a poster on SDN but Ive done a lot of lurking. I hope sharing my experience can help some people or is at least interesting 😛
Background: Im an American allopathic student. My school makes us take NBME 6 in March with a voucher. This is in the middle of psych block and before derm/statistics. I made a 241, which I was very happy with at the time! I didnt really start studying for step until about halfway through my last block(late April), and I started by doing only UWorld(I really hated reading FA at first). I did up to 6 blocks of questions per day and took notes on their explanations. When I did start FA I took all my old notes and added them to FA.
My school has grades and I made honors for every test except cardio, but Ive never made top of the class. I also did well first year, but pretty much forgot everything. I study a lot; not gonna lie. I bought a year subscription for Firecracker/GT in the summer before and planned to use for block tests/keep up throughout the year, but I pretty much stopped in October(it was too much hassle/annoyance to keep up with every day, and I tried to pick it up again during committed step studying but I felt like the question algorithm kept me from studying subjects I knew I wanted to cover.
I did do GT micro over Christmas break, and that actually helped a lot for block tests and since it stayed relevant a lot of knowledge lasted until the summer.
I also bought a six month uworld account with the same hopes as for GT, but I didn't start doing questions until dedicated study time. It did allow me to reset my account and do the questions again however.
A note about my schedule: Id say I studied around 12 hours a day on average, waking up at ten and studying til like midnight, with food, breaks, and exercise mixed in. I exercised every day, either lifting or playing some sports. There were many days where I took half days or a few hours to hang out with my girlfriend and friends. I would study at my school library four days out of the week but I would also go to coffee shops. Overall I found my study pace relaxed compared to some of my friends(but maybe theyre a bunch of gunners too
)
Before I started studying, I set goals for each day(one/two blocks of FA, a set number of uworld blocks, etc) and made sure I did that for the day. If I finished early for that day I either read ahead or just quit for the day. I spaced NBMEs after finishing benchmarks(a pass through FA, finishing Goljian, etc). I never fell behind my original schedule.
Timeline(I kept a more detailed diary as I studied to keep myself accountable, and these are highlights)
Test: June 17th
Mid-April: began doing Uworld blocks, but most focus on finishing school(end of April).
5/10/13: finished uworld. 79% correct. Done in review mode.
FA 1st pass starting with biochem. I had also started Goljian audio before this point; I never really made allocated time to do it but I would listen to him in the car and during workouts.
Began doing 3 Uworld blocks per day after resetting my account
5/12/13: NBME 13 610/247. I was actually disappointed that I didn't improve more after during UWorld first pass.
5/17/13 FA first pass done!
5/18/13 Finished all of Goljian! Took NBME 12, made a 650/257. Very happy with the improvement, though I thought the form was pretty hard; I think I marked like 40 questions.
5/20/13 Started Pathoma. 2-2.5x speed usually, at least 10 lectures a day.
Started 2nd pass FA going through biochem again. This pass took at least as much time as the first as I was really trying to get the details down.
5/31/13: Finished FA 2nd pass and Pathoma
6/1/13: Back to back practice tests to simulate the real exam. Took NBME 11 first. Made a 710/271! I was glad to see that all the studying appeared to be paying off. Then I took the UWorld Self-Assessment 1. I made 93% on 1 section and 87% in the other 3. My accumlated score was 800(the max) which equates to a 265+ for their system. I was also very happy with this.
6/4/13: Finished Uworld 2nd pass. 96%. Done in timed mode.
In this period I did a lot of practice tests. I got them from upperclassmen and timed myself. They may have been, uh, things that you can't find online anymore except from sites like ifileit. All I have to say about that >_>
6/8/13: NBME 15: 690/266. Missed 9. Made about 3 avoidable mistakes, 2 forgotten points, and 4 new concepts learned. Kinda discouraging. Needed to go through each question more thoroughly to make sure I'm not missing any of the question stem. Also Uworld self assessment 2. 91, 87, 91, 93%, 800/265.
6/9/13: NBME 7: 710/271.Missed 5. I felt like I was plateauing here but at a level I was very happy with. I also hadn't actually studied for a while at this point; I had been doing practice tests/question only for the past few days.
6/18/13: Spent the last week going through first aid 100 pages at a time. Also did Goljian another time. Two days before my test I went though uworld quickly, going through 35 blocks of questions one day and then 10 the next(with answers already filled in). Also went back through my uworld self assessments. I also looked at micro powerpoints someone in my class put up(by Phloston?): This was a mistake, it had a lot of stuff(that ultimately wasnt on my test) I had no idea about and it made me freak. Finally, went through my missed questions on previous NBMEs.
The aftermath: I slept really poorly the night before, partly due to nerves I guess. I fell asleep around 4 and woke up at 7 to get ready for my 8:30 test. Definitely not optimal. I tried to rapid fire review drugs when I couldn't sleep but I don't think I saw much of it the next day.
The test felt a lot harder than I expected. There was a lot more thinking and piecing through vignettes than represented on the NBMEs. It was most similar in style to the Uworld self assessments. It required a lot more thinking rather than recognizing a stereotypical clinical situation. There were also a lot of WTF questions in my opinion.
Things I recall(with much bias):
General concepts/ethics: This was very frustrating. I was asked a lot of questions where the clinical situation seemed very vague. I think all you can do is go by the basic principles in First Aid.
Biochemistry: Probably the highest yield topic for the test. I got a lot of glycogen storage diseases. Some vitamin deficiencies, and plenty of biochemical pathways.
Micro: Lots of easier questions(here's water house-friedrichson syndrome, what is the organism) , but there's a noticeable amount of more obscure information as well. Many clinical vignettes about the viral exanthems in children.
Pathology: I don't really remember much about general path questions. I think there was one about types of necrosis.
Pharmacology: I think I had one question that was a straight calculation for half-life, and a michaelis-menton question came up near the end of my test.
Cardio: The questions here were pretty straightforward. Recognizing where murmurs were, diastolic failure, etc. There was a question about coxsackie virus.
Endo: Also straightforward, knowing relationships up and down and feedback.
GI: I actually had a lot of trouble here. People kept having vague abdominal pain and I found it hard to make definitive diagnoses rather than educated guesses. I also know I missed one about a HepA biopsy and I'm kicking myself for that.
Neuro: There were a LOT of tricky questions here. I got no questions about subdural hematomas and epidural hematomas etc. I got a lot of localizing the lesion after a stroke. There were more brainstem slices than I expected as well.
Pyschiatry: pretty straightforward, recognizing timeframes and depression etc
Renal: Lots of prerenal azotemia. Fanconi's syndrome came up. No path images of glomeruli.
Repro: I actually don't remember any branchial derivates being asked. Some questions about fibroids and sex cord tumors and breast fibroadenomas.
Respiratory: Mostly straightforward, but they try to trick you with pulmonary issues versus left heart failure with orthopnea. I had some questions that were supposed to be really tricky. One was a pet store owner who spelunked in old coal mines and had just started a vegetarian diet. Interestingly, none of the patients who had sarcoidosis were noted to be black.
Heme/onc: had a lot of trouble here distinguishing granulomatous pathologies in the lymph nodes.
Skin/MSK: Lots of serum sickness, viral exanthems, pictures of rashes.
Overall felt that I'd be fortunate to get a 250+.
Results out: Wednesday July 10th 2013 @ 11:00 am Eastern time
Score: 273!!!!
For my score report, I was * in all subjects except pulmonary.
Very exciting! Definitely jumped up and down a bit.
I guess sleep isn't important before the night of the exam...
Definitely satisfied with my score and happy that all that work paid off. Like I said my confidence was really shaky coming out of the exam.
Here's my prioritized advice to all people with Step in their future:
1. Do well in second year. No joke. During the organ blocks do the best you can, and then you'll remember the essential information when you start hitting FA. There's no need to hit FA or other step resources for block exams; they're probably not detailed enough to help you for the blocks. You will forget a lot of everything, but your job 2nd year should be to get a firm grasp of physiology and pathology of organ systems so that you can fill in the details for step later.
Like I mentioned in my exam experience, there were a lot of WTF questions that weren't in any of the resources I covered for Step. Many of these may have been experimental questions, but I'm sure some of them counted and I think I got most of them right from educated guesses using principles taught during actual medical school.
6 weeks to study is more than enough if you have a solid background already. Like I mentioned before, I got honors for most blocks, but I dont think thats essential. I think remembering what was important got me a 241 in March without much dedicated step studying, but I know Im kind of a gunner(not in a malignant way[at least I hope] but I do dedicate a lot of time to school).
2. Read FA. A lot. I'd say it covers 70% of the tested material. Everyone studies different ways, but I'd suggest attempting to make FA your comprehensive resource as you continue in your studies. My FA is littered with notes in multiple colors with material from Goljian, UWorld, Pathoma, and internet searches. FA requires very active reading and filling in the blanks as you go will help you immeasurably.
I'd suggest 3x through including your annotations. Some people choose to use DIT for their first pass to motivate them through it; I say #$!@ it. You've known how to read for 20+ years and you've known how to study for a large part of that. It doesn't provide much new info and it'll slow you down for that first pass.
3. Goljian audio. Definitely the most high yield resource per time and concentration commitment. I don't know how old the recordings are but things he mentions are still essentially paraphrased in Step questions. I listened to him twice.
I looked through the pictures in the book but didn't read the text. In the end it wasn't very helpful. The path pictures on the exam are fairly classical/obvious, so FA covers it well.
4. UWorld. You gotta do it. I don't think there were any questions that were mirrored on the exam, but each question teaches you a concept and the explanations are great(if a bit too detailed at times). I did it 3x through, which is probably a bit much. 2x is fine, and I think 1x would've been adequate
FA, Goljian, and UWorld are the holy trinity in my opinion. If you have a good mastery of these three resources and you know fundamentals from block exams, I think you can get a 250+.
To reliably get above a 250 however I think you need to consider more resources.
5. Pathoma. Again, I only watched the lectures and didn't read the book. Pathoma would be good for block lectures too as it starts with basics and expands to more specifics. It's not nearly as high yield as Goljian but a few facts he mentioned that weren't elsewhere did appear on my exam.
6. NBME tests. I only saw one question that was repeated from old NBMEs, and I wouldve probably missed it if I hadnt seen it before. I was surprised that so few questions were in circulation still, but I guess that means you cant succeed by just giving the NBME all your money 😛. The tests are also very different in question style and length, but you can still learn a lot by going through the questions you miss and in the end the score predictions from NBMEs were most accurate for my real deal.
7. UWSAs. I think the questions are harder and more annoying than the real deal ones, but the question length and test format is spot on to the real thing.
8. Brainstem slices/cranial nerve locations. These WILL show up on your test and FA does NOT cover them. Some people get books, but there are a lot of great review websites that I found sufficient.
For most of my study period I had a partner and we would text questions/pimp each other. This helped me a lot in remembering things I had trouble with. He ended up taking the test a few weeks before me and scored very high as well.
If I had to redo it, I wouldve tried to add more question banks into my studying like Kaplan and USMLERx. I also would have thrown in GT/Firecracker in more since it has testable information thats not seen in FA, but its a HUGE time commitment and I didnt like it. My test had a lot of obscure facts that werent covered in FA or UWorld and the only way I can see how to tackle that is to have a huge knowledge base. Of course, youre not supposed to get everything right on the test, and I know I made a few mistakes on mine. I also would not have done UWorld as the first thing I did; its a great review tool and though I learned a lot I didnt make much improvement after doing it as my sole resource first.
I definitely spent a lot of extra money buying NBMEs, GT, and UWorld and I think I couldve been more economical, but I dont regret it too much.
Of course, theres nothing about my plan that makes it better than anyone elses. Everyone knows how to learn their own way. I think the key is making a goal and a systematic plan to reach it.
Thanks for reading. Good luck to everyone.
Cheers to 2013 
