Longtime lurker, used this thread heavily to help guide my studying and now looking to help others. I'm a pretty average medical student (full disclosure: my undergrad was in engineering at a "decent" school in the northeast). I had mostly Bs, an A and 2 Cs first year (biochem as our first class owned me for 8 weeks….). Second year mostly Bs and As because I worked my butt off. Step 1 really is like training for a marathon (I've done both) and you really get out of it what you put into it. This is way different from the MCAT. My goal was to break 240, as that seems to be the cutoff for most things and I just wanted to keep my options open (look at my username and you can prob guess what I'm going to go for).
Here are my practice exams and then I'll detail my method:
NBME 7 (12 wks out) – 205
NBME 13 (7 wks out) – 221
NBME 15 (school-administered, 4 wks out) – 235
UWSA 1 (2 wks out) – 248
UWSA 2 (1 wk out) – 257
Real Deal: 245 (and wicked stoked)
Method:
Pathoma - buy it, this is non-optional. Go through it 2nd year and know this book. It easily increased my score 10-15 points.
Goljan – mostly optional, but he does have a few gems where he makes connections and you go, "ohhh. So that's why that does that!" I also run/exercise a lot to stay sane and Goljan was my friend during these times so I could feel useful and not psych myself out for taking an hour "break". I remember 3 or 4 questions from my test that as I was reading them I heard Dr. Goljan saying the answer. Also, Goljanoids (what he calls his grandkids) is now a term I still use.
THE MOST IMPORTANT RESOURCE FOR STEP 1: First Aid, First Aid, First Aid, First Aid (one for each time I read it cover-to-cover). I ended up having a Kinko's cut the binding off of mine and spiral binding it. This made it great for folding in half, being able to writing deep into the margins, and overall was an awesome thing to do in hindsight. I highly recommend it.
I read somewhere on orthogate or SDN that if you know First Aid, you will do well on this test, and I am a good example of that. Know it like the back of your hand; you don't have to memorize it, and for me it took until the 3rd pass to start really having information sink in to the point where I could tell you on which pages diseases and concepts are discussed (I'm a visual learner). I annotated my first aid every pass through, and if I found myself wanting to write something down that was already written down, I'd write it down again anyways so it would stick.
Note: I worked my tail off first and second year; took me a while to learn how to learn in medical school. This test really is 90% "second year material" with some anatomy and phys thrown in as pathology-based questions. For those just starting second year: work. your. tail. off. I'd say don't start studying for boards until within at least 6 months. Go ahead and read the section of first aid for the current block you are doing, but be mindful the edition will get updated in ~ january.
I laid out sections of First Aid into 18-26 page blocks using an excel spreadsheet, that let me get through the whole book in 26 days reading just 1-1.5 hrs per day, on top of normal class studying. I am un-medicated and have a bit of ADD, so being able to see the end of my reading helped me focus for an hour and get it done.
-February-
1st Pass through FA, then NBME 7 at the beginning of March for a baseline and to help me identify things I needed to do better on (which at this point was everything). IMHO, the extended feedback is a waste of time because you don't get a lot for the extra $10 bucks (that's two beers!) and have to sort through loads of posts on USMLE forums with bad English to maybe get an answer that is possibly correct. Instead, what I did for the second two was write down 4-5 words on the topic of a question I wasn't totally sure about DURING the exam. For each 200 question NBME (Form 13 and 15) this was around 60-70 topics. I then would reference these lists while I was reading through FA or Pathoma or UWorld or Pharm and review them.
A lot of this test is about identifying tidbits of information you are unsure of, and hammering them home during multiple review sessions and readings through of first aid.
NBME 7  205 (hmmm… well at least I haven't started really studying yet).
-March-
2nd pass through FA, while starting to do blocks of Kaplan questions in the evening. I bought a three-month subscription to UWorld and ended up stopping after four blocks because I realized it was a better learning tool if used closer to the exam thanks to some posts on Orthogate and SDN (my first four scores were 62, 50, 54, and 64, for those interested). Our spring break was last week in march, and TBH I had planned to read first aid fully in one week. This did not happen and I ended up taking the whole week off (after finishing my second pass through FA) and taking an NBME at the end of spring break. This was form 13, I scored a 221, and starting to realize that something was working. I was about 50% through Kaplan at this point. It is important to use Math as your friend. If you have 1200 questions in a Qbank left, figure out how long it will take you to finish it doing X questions a day and use that to help you plan. Proper planning is so immensely important to help lay out study schedules. If you are not organized, get organized; or PM me and I can send you my schedule. It is basically one giant Excel spreadsheet.
Also, I bought a two month subscription to Rx because I wanted more questions than just Kaplan. Rx is awesome if you are hammering First Aid because, as hundreds of other people have already stated, it really does just act like flashcards for FA. After all was said and done I ended up doing around 1000 questions from Rx (blocks of 10-25 add up real fast if you do 1-2 of each/day for two months). Kaplan is nice, but some of their questions are super-duper nitpicky.
Form 13  221 (holy crap I think I might be able to hit this crazy 240 score everyone is talking about….)
-April-
I took Form 13 on a Saturday at the end of March, so took that afternoon and Sunday completely off before our last block of 2nd year. Mentally prepare yourself for no long breaks for the next two months (longer than an afternoon after taking a practice test or final), and don't let yourself get jealous of friends on vacation, family members, etc. Turn off facebook if you have to (I did, and it helped a lot). April for us was only "three weeks long" because we had two weeks of final exams the last week in April/First week in May. I used a compressed FA schedule (in 21 days) so was reading around 26-28 pages/day but as I said earlier, your third pass through you start picking things up really well and being able to read a bit faster. Reminder for those like me and who don't like reviewing things you are comfortable with, DO NOT SKIM OVER A PAGE and call it "reading". Read every single word and if you are distracted, then just look at the pictures. Let your curiosity get the better of you if a pretty picture is somewhere on the page. I read about half the book "backwards" where I'd see the picture, read the accompanying text and end up getting drawn into the page. Yeah it's kinda weird, but it worked for me.
If you have finals (ours were NBME shelf exams in Micro/Immuno, Path, Pharm, and a hand-wavy approach to clinical diagnosis final), dedicate yourself to those subjects for four days.
Micro: I went through the FA Micro/Immuno sections twice, half the first day, half the second day, repeat that 3rd and 4th days, and also did the entire Rapid Review Micro/Immuno (Goljan series) qbank in those four days (it's around 125-150 q's/day but doable). Yes you will be working 14 hour days, but after that I didn't miss more than a handful of micro questions in all of UWorld and rocked the micro section of Step.
Path: this is where pathoma comes in handy. I went through all of pathoma in 4 days, and it was kind of painful and didn't really feel like it helped with the Pathology shelf, but it definitely helped me kick butt in Uworld. Sattar does an awesome job at integrating things, making seemingly complicated groups of cancers (i.e. breast, germ cell, etc.) differentiable, and so on.
Pharm: I used the Kaplan/Lionel Raymond Pharmacology videos, had a C in pharmacology before the shelf, and aced the shelf using these videos. I swear by them and they made me love Pharmacology. I wish I had been using them all year. I also rocked the pharm section of step because of them. If you can get your hands on his Pharm videos they are gold (comparable or better to Goljan path). Also, he is absolutely hilarious, and makes jokes about "snow in Miami" and certain controlled substances…..
Phys – no final but it's part of the big 3; I took a computational physiology course in grad school, and this plus med school made my phys kung fu strong. I didn't use BRS phys and First Aid was plenty good. I will say:
- Practice drawing the Pulmonary function test diagram. Draw one of these on your sheet before you start your test.
- Know all your renal equations (ERPF, RPF, RBF, GFR, etc.). Write them down on your sheet before you start your test. It will help lighten the mental load.
- Know the Hb dissociation curve cold
- For most everything else, study for understanding, NOT for memorization.
Side note – I am way better at problem solving and am mediocre at rote memorization; most of the resources I used/liked aside from First Aid stressed conceptual/abstract understanding of things rather than just listing facts. This is what Step 1 is all about; there are a few obligate straight recall questions, but a majority of the test is questions requiring you to think through a diagnosis. These are the 2-3 step questions everyone talks about.
After finals, we had several days to study for a school-administered NBME, which was the latest one released (form 15) this year. I basically ignored studying for it and started studying for step 1 with DIT (huge waste of time and $$$; see below). I started doing one block of UWorld every other day mid-way through our final exam period, and after finals were over did 1 block of UWorld every day.
-May- (Last month)
I spent the first week of dedicated board studying doing DIT, reading first aid, and doing UWorld before our school-administered NBME. My daily schedule was something like: wake up at 6-7, eat breakfast, and start doing DIT by 8. I'd do 5-6 lectures between 8 and lunch, then try to be back to doing DIT by 1-2. I'd then do another 6 lectures and stop DIT for the day around 5. Read my 26 pages of FA (not the same ones they covered in DIT that day) and then do a block of UWorld and review the questions, then bed by 10. The NBME CBSSA our school bought was the 8th day after my first week of studying, and that afternoon I came home and did two blocks of UWorld, then reviewed them. This was 3 weeks out:
Three weeks out:
Form 15  235 (almost there….)
Two blocks of UWorld after Form 15  74% and 68%. After the 68% I decided I wasn't going to do three, went for a run and then watched a movie with my wife.
The next three weeks consisted of the same daily schedule as above, with no breaks except for an hour each day when I would run (some days) and eat lunch. The days I took a break was after a self-assessment. I guess it's kind of sad if I said I finished two seasons of family guy while studying for step, but it kept me sane. I took UWSA 1 two weeks out, following by two UWorld blocks. This took me the rest of the day to review:
UWSA 1 – 248 (84%, 62%, 76%, 76%) (break between 2, 3, and 4th)
Two blocks of UWorld – 78% and 74%. (no break)
This was really important for me because I got a 62% on the second block of Uworld and was like, "dafuq?" I realized that I needed to be conscious of this fact the next time I took a self-assessment, so made sure to be more awake for the second one. This is the power of doing practice tests. If you track your percentage on each block you can identify when/where it would be most advantageous for your exam. I ended up taking a break between blocks 1 and 2 on UWSA 2 and did much better on the second block.
Continued doing DIT + FA + UWorld, reading 26-30 pages of First Aid now and plogging through DIT. I was about 70% done with UWorld 2 weeks out from my test, and finished DIT with 6 days to go. A week before my exam I took UWSA2 and got a 257, followed by two blocks of UWorld.
UWSA 2 – 257 (86%, 76%, 74%, 76%)
UW 2 blocks – 78%, 76%
Taking a break after every block definitely made it easier, and even if I didn't feel like taking one I ended up feeling better after a snack and some air squats.
Last week – kind of just treat water and keep sane. I flipped through sections of First Aid, and did 3-5 blocks of Uworld every day. This really helped me because I started freaking out about little things I didn't know. This will happen and it does to everyone and you will be fine. Read that again: you will freak out about little things, but it happens to everyone and YOU WILL BE FINE. I had about 600 questions in UWorld left 4 days before my exam and just did blocks of 46 all day until the end of those 4 days. The last day I went through the last 17 pages of Uworld with the super-dense summaries of word associations, and then put the book down and stopped studying at 5 PM on a Sunday. My wife and I went to dinner, watched a movie and then went to bed.
The day before, I did nothing until we got to our hotel (she was also taking it). I broke down and fast-read the biochem section because I wanted those diseases to be fresh. I ended up not having a single biochem question on anything I read that evening (-_-). We went to a Texas Road House and drank a Sam Adams over a full rack of ribs and realized that this adventure was finally over. For those of you who do long-distance races, it felt kind of like the night before a marathon.
Test day – breakfast at Panera/Starbucks. I took a break after every section save between blocks 4-5. I'd eat a granola bar, drink some water, and go back in. Don't hang out and talk to other test-takers, just eat your glucose and jump back in the ring. I used the bathroom between blocks 1-2, 3-4, and 6-7. Do it even if you don't feel like you have to. Remember kids, you have voluntary control over your external urethral sphincter! Block 3 I almost pissed myself and that probably hurt my score.
For my last block I knew from my practice tests that I had been in "screw this I want to be done" mode, so I mentally prepped myself during block 6 to focus on the next one until the end. This was a great strategy in hindsight and just for fun I took the whole time on the last block reviewing final questions and making sure I was happy with it.
Walking out of the test center I couldn't recall hardly anything in the long-term, but I can tell you at that point I felt like just passing or getting 200+ would be fine with me. This fluctuated and mostly I spent the next 35 days waiting for my score probably slightly bipolar with regards to step 1. I think we call this defense mechanism splitting ;-).
Predictions - The UWSAs over-predicted my score, but my UWorld percentage was spot on.
Practice test averages – 221 + 235 + 248 + 257 = 240
UWorld %-age – 70% (90% of this was blocks of 46, the other 10% were shorter blocks of 25 I'd do just to do some questions and were easier/quicker to review). 70*2.3 + 84 = 245.
Step 1 – 245.
PM me with questions and I hope this helps the next round of students. It is possible to rock step 1 (by all standards) with average grades if you study hard, study smart, and keep an even keel. I also owe a big thank you to everyone else on this thread because lurking on here and reading your guys' discussions helped me to excel.
Cheers to 2013 
