Got my result today.
243.
Heres how my experience went down. As an international medical student, our curriculum is heavily focused on clinical science, and basic science is only cursory. As a result, my starting knowledge in biochemistry, microbiology, genetics and immunology was nonexistent. Pharmacology was weak. Pathology, anatomy, physiology, behavioural science were good.
Study Timeline
Started with two weeks of FA biochemistry, fleshing out things with Kaplan LNs where applicable. This was a mistake to do so early, since I had to revise it heavily towards the end of my prep, having forgotten a lot of the metabolic pathways. Then began Pathoma (and wished I had started it earlier), took about 2 weeks to watch all the videos and more or less memorise the book by transcribing most of the points into Anki flashcards. Excellent resource, I actively enjoyed learning from Sattars teaching.
Moved onto microbiology, using MicroCards, and transcribed their contents into Anki. This was a shock to the system, since it was so detail heavy, but Anki helped make things stick. Also added any facts that were additionally present in FA Micro. This took around 7-9 days. Immunology and pharmacology followed, and again, my only source was FA, transcribing every fact into Anki cards. These two took probably around 10 days. The same process I repeated for Physiology and Anatomy from First Aid over the following 2 weeks. My physiology turned out not to be as strong as I thought, so this took a little longer than expected. Tried BRS physio but did not like it.
My full-time study was from the start of December to mid Feb, with the intention of sitting the exam at the end of this period. Unfortunately plans changed, and the date was pushed 3 weeks forwards into a very busy clinical surgical rotation, where I had minimal time for study during the week.
UWorld I began in early/mid Jan, and did around 1-2 blocks per night for 30 days. Usually, I would do the topic I had been studying during the day in the first block (subject, timed), and the second block would be a block of all the topics studied up until that point. This meant at the start I was just doing two blocks of pathology, but towards the end of my study period, my second block was effectively timed random. I found this was an effective way to combine the utility of timed subject and timed random as I was learning from the Qbank. Any incorrect questions or correctly answered questions with important explanations I would make into Anki flash cards as well. I did some USMLERx (~800q) early in my prep, before starting UWorld, but abandoned it when I started the latter.
My prep was effectively complete towards the middle of Feb, but as mentioned I had to spend the next 3 weeks mitigating the damage of facts leaking out of my head, before finally sitting the exam. Some of you may have noticed my reliance on Anki, and Ive developed a love-hate relationship with the program. My daily review cards escalated very quickly, and so towards the middle of January, about 3-4 hours of study each day were dedicated to just card review. In terms of time efficiency this was not ideal, but it did help to solidify the facts. It also meant that I only went through FA once, and did no annotations as most of the book was in flashcards, and so were all the things I would have added from UWorld. Throughout these 2-3 months, I listened to Goljan in the car. This made my busy days on rotation towards the end of my study period a little more guilt free.
NBME11 235 (3 weeks out)
NBME13 245 (2 weeks out)
NBME 12 226 (10 days out)
NBME7 235 (1 week out)
UWSA1 245 (3 days out, back to back with UWSA2)
UWSA2 247
Free150 86% (2 days out)
UWorld cumulative 70%
The exam
As far as difficulty goes, I thought the real thing was easily on par with the NBMEs. The UWSAs I thought were easier.
In decreasing difficulty UW > Step 1 = NBME > UWSA > Free150
The exam itself is a bit of a blur to be honest. The first 4 blocks I finished with about 15 mins spare to go over the questions. The final 2 blocks were much more difficult and I was pressed for time, and flagged a large number of questions. Large number of theoretical investigation type questions (which I am no good at). Generally speaking, the questions were very straightforward. Almost no three-step reasoning questions, with plenty of straightforward fact recall.
- Anatomy Brachial plexus, lymph nodes, pelvic anatomy. Lots of neuroanatomy.
- Microbiology Not many questions, fairly straightforward, only one or two questions on worms, the rest were classic bugs. MicroCards were overkill for this, for certain.
- Immunology FA was easily enough for this
- Embryology I think I was lucky here. The questions were straightforward and few in number. I decided to not study this topic, and it did not affect my score.
- Behavioral Science Again, I did little study for this. Biostats were straighforward incidence, prevalence and sensitivity type questions. Psych and patient-doctor scenario questions generally had an obvious answer.
- Biochemistry Was fairly clinical, and the questions that were not, were facts from FA. Biochemistry was a subject I was afraid would slam me, but FA was sufficient.
- Physiology A number of difficult questions came from here, and I am uncertain whether my reasoning was always correct.
- Pathology On the whole, Pathoma and FA were enough for this. Had a few questions that were decidedly difficult, but I wouldnt have gone through all of Goljan for the chance of being able to answer them.
- Pharmacology I knew this section very well, and was disappointed with the number of questions. Most were single step name the side effect/mechanism/resistance mechanism questions.
So all in all, I think I was lucky with a good question set that generally played to my strengths. I made quite a few careless errors which really played on my mind in the 3 weeks following the exam, but thats the nature of exam taking. I hope that this allays the fears of some people planning to take the exam. FA, UWorld, Pathoma (and Microcards) were what I primarily used, and these were enough for someone with no background in half the subjects of the USMLE (see first paragraph). In retrospect, I had only about ?5/6 questions which I feel I could have answered if I hadnt pushed my exam date. So dont get too bent out of shape if you need to take the exam without having a dedicated cram period immediately before. Also take heart that your most recent NBME may not be as accurate as your most recent UWSA in score prediction.
Things I did not study
- Embryology, Medical ethics, Psychiatry
Things I would do differently
- Do Biochemistry later in the study period, as its very detail heavy
- Start with Pathoma
- Probably not bother with MicroCards. But ambivalent about this one, as I still value the additional knowledge that came from these cards.
- Make more time to review NBME incorrects. I had questions in the real thing that came from these, not sure if I got them all
- Write up my flashcards before my dedicated study period. This would have saved an immense amount of time.
- Focus some more on the theoretical investigation questions. Probably via Kaplan.
This forum, whilst excellent at promoting an inferiority complex, was also a very useful source of information for me. So I hope this helps.
Cheers to 2013 
