Intro:
I had to create a second account because my normal account is known to a few people at my school. People know my screen name due to the fact that I only write things on the internet that I could say in real life. For some reason there is a huge taboo about discussing any grades or exam scores at our school, especially if you did really well.
I decided to create this post for the more classic M.D. AMG. A lot of people contribute to this thread, but it seems like the majority of the in depth posts from people describing their experience are written by FMG/IMG. I ran into the issue of trying to find posts similar to my situation when I was getting ready for the exam. I hope this helps all of the incoming M1’s and those beginning M2 who are studying for the USMLE. I have no delusion about it decreasing the number of threads titled, “what can I do to best prepare for step 1?” but maybe some of it will sink in.
I think it is best that I only mention this once because I do not think this is the most appropriate place for me to advertise for Phloston. Most people on this forum know that name. I started using his tutoring services in early April, almost two months before my exam. If someone wants to know more about my experience with Phloston, private message me. He definitely helped me to say the least.
Keep in mind that this entire post is n=1. I started preparing from day one of medical school, not specifically dedicated USMLE studying but rather learning everything I could. I did not know at the time that I was studying for the USMLE. There were questions I encountered on NBME’s, question banks, and even the real deal that I answered strictly because of the first two years of medical school. I actually answered a physiology question on the real deal because of an undergraduate course.
I say that because I see a lot of people asking things such as, “what source can I use for the hard questions?” or, “can you post the hard questions you remember?” That is why they are hard questions. There is no one source. If they were all in a known source, they would not be considered difficult by most students.
Highest yield things you can do:
1.) Work and time- there is absolutely no substitute for sitting one spot with an open book or a computer and actually studying. Not looking at Facebook, talking with friends in the library, or any other possible way to waste time while allowing yourself to pretend you are working.
2.) Questions- I will write more about this later, but I want to say one thing. It does not matter if you have memorized Big Robbins. If you cannot answer a multiple choice question about the information you have learned, memorizing every medical text in the world does zero good. The USMLE is not an oral exam nor is it an essay based exam. You sit down and answer 322 questions. I did almost 11,000 questions. The NBME did not care why my answer was correct or why my answer was incorrect. They only cared about whether my answer WAS correct or incorrect. Did you click the correct circle? Kinda sad but in the end, that is all that matters.
Background:
I attend a US academic MD school. We have a mediocre curriculum in terms of preparing a student to sit for step 1.
First year neuro, biochemistry, and anatomy are pretty good. Our physiology course is probably below average. Histology is average.
Second year micro is pretty good except for certain parts. Our pathology department does a good job with lecture, but the exam questions are not even remotely close to board style questions. Pharmacology is the most hit or miss course of second year. We cover every drug ever created and every drug that might ever be created. That is not to say that everything is taught well, presented in USMLE format, or tested well. It is exactly the opposite in a lot of cases. Our psych/stats/ethics is probably the worst taught course in medical schools in the entire world. It is literally that bad. I am dumber for having to wade through that material.
Prep:
NBME 5: 233 (early January)
NBME 12: 233 (early January)
NBME 6: 245 (mid February)
I did the offline forms of NBME 1-4. Depending on a few of the answer choices and which score correlation is used, my scores ranged from 230-260. I did these is early April. My percent correct was 88.5-94.5.
I had 4 weeks of dedicated study starting in May.
NBME 15: 260 (5/1/14); missed 14 for 93% correct
Free 138: (5/14/14) missed 7 for 95% correct
NBME 7: 260 (5/20/14); missed 10 for 95% correct
UWSA 1: 265 (5/21/14)
UWSA 2: 265 (5/22/14)
NBME 16: 260 (5/22/14); missed 15 for 92.5% correct
NBME 11: 264 (5/24/14); missed 10 for 95% correct
NBME 13: 273 (5/25/14); missed 5 for 97.5 % correct
Took the real deal on May 29th.
USMLERx Question bank: 78%
Kaplan Question Bank: 78%
UWORLD Question Bank: 82%
I also did both of the Kaplan simulated exams (78% and 82%) and the Kaplan self-assessment exam (74%). I do not remember the dates of these.
I had done about 700 questions from Rx, 200 from Kaplan, and 200 from UW by the end of March.
I am going to differ from most people and say that Pathoma did not help me as much on the real deal as it did most people. Pathoma is still incredibly high yield nonetheless.
I probably read less First Aid and less Pathoma than any other medical student I know. I never had a straight read through of either text. I knew some portions of First Aid well, but I did not know some sections well at all.
Exam:
It was tough, no doubt. I think I got near or slightly above the 260 mark. I never set a goal of 240, 250, 260 etc… It is what it is. I do not think I got to my high of 273. I actually think that score was an enigma to begin with. I have looked up about 100 questions so far from my exam. I know I have missed 13 of those 100, with the possibility of missing 21 of those 100. This does not take into account the other 222 questions.
I missed 3 incredibly simple recall questions, one of which occurred to me on the drive home. I missed medium and hard questions obviously also.
I do not think that the often quoted idea of experimental questions is as true as believed. I think most students rely on this in an attempt to make themselves feel better. “Man, that question was so hard it must have been experimental.” If true experimental questions actually exist, the number absolutely has to be very small. You can think about statistics required to stratify scores and easily see why this is the case. I am not going to discuss this entire concept in this post, but how else can the NBME spread out scores across such a wide range. 200 questions on a practice NBME is not enough questions to even be able to hit every single digit near the exam mean. I have seen a screen pic of a 283 posted online. I have seen every number in the 260’s. If those numbers are possible, just about every question counts.
The second thing that allows the NBME to better stratify students is that the real exam is more difficult. This allows a slightly more lenient curve. I use the word “curve” leniently. The exam is not graded on a curve per se. Every student who sits the exam on any given day can mathematically make a 260.
Last thing and I will leave this topic. Why do you think they have delayed score reporting from early May to late June? That is when questions are introduced obviously. More students take the exam during that period than any other. They use this period to judge the difficulty of the new questions. The large number of students sitting for the exam during this period allows the n number to be large enough. On my exam, I saw zero typos. I saw zero grammatical errors. For every question that I was able to look up, each and every one has a clear and obvious answer. I may not have known it at the time, but with the info given in the stem and the possible answer choices, there was one and only one correct answer. Most students leave the exam feeling like they did worse for a reason. They actually missed a higher percentage of questions on the real thing than they did on practice exams, but that does not mean their score will be lower. At the high end and very low end of the score range, one or two questions does matter a good deal for the score.
Micro: I had four tough micro questions. Two were awful. On three of my NBME’s, I had a star with no bar on the score report. I did not expect to be caught off-guard with micro. I had a couple low-yield pics, but I knew those from class. If you have not seen them before, no sense in trying to chase them down. They are not in FA, UW, or Pathoma. I did not have a lot of micro either.
Immuno: very straight forward other than one question. I think I got it correct from elimination. Not a lot of immuno on my exam.
Pharm: I know I missed three questions and two of my missed simple recalls were in this subject. This was not a difficult subject on my exam other than one question. I think all but three drugs were in FA. You did need to know more info about the drugs though than what was in FA.
Anatomy: I had a fair amount of anatomy, some specific, some really easy. I had a few images, with only one of them being difficult. I think people blow CT’s, MRI’s, and XRAY’s way out of proportion. They are only asking simple anatomy questions. Just do not freak out and the answer is usually very easy.
Next Step in Management: second area that is blown way out of proportion by students. I had a few won my exam. They are still asking a basic science question. We are second year medical students. Most of the time only one answer was even remotely correct.
Heart Sounds: I had 4 on my exam. All were doable other than one in my opinion. The best resource in my opinion for these questions is the Kaplan Question Bank. The heart sounds, breath sounds, and abdominal sounds are far and away superiors to UW and Rx. There are also plenty of internet sites with the same sounds.
Embryo: my third simple recall missed question was in this area. That is actually the only hard question I remember from this subject. Fair amount, but nothing too difficult. Though I did have one in utero birth defect from maternal exposure that I still do not know the answer.
Biochemistry/Genetics: more genetics than biochemistry, but vitamins were huge on my exam. I had one tough genetics question that was presented in the form of a patient vignette, but the patient vignette mattered zero. They named a very rare disease that it is not most textbooks. I had never heard of the disease, but after careful reading, you did not have to know the disease to answer the question. I finally found the answer in Rubin’s Pathology.
Stats: couple simple calculations, but the conceptual questions were more difficult than I expected. There were not as many questions from this subject as I expected. Only one calculation question stands out as hard.
Behavioral/Psych/Ethics: I had two ethics questions that were impossible. I also had two behavioral questions that were difficult and one psych that was tough. You were not getting those correct from FA or UW. The rest were not bad. I had some questions on Medicare/Medicaid/Insurance. The info for these is not in FA or UW. You absolutely have to know child development. I had a fair amount of questions from this subject, but not a ton.
Pathology: general pathology was the bulk of my exam. I was shocked to be honest. Most of it is in FA, UW, or Pathoma. There were a lot of systemic pathology vignettes that asked a question about general pathology. More difficult that I expected but still doable. I missed a general pathology question that is not in UW, FA, or Pathoma. I had to look in Robbin’s, Rubin’s, and RR to put the answer together.
There are some autoimmune associations with GI pathology that most medical students know by heart, but on the real deal I had to choose which autoimmune syndrome was more associated with a specific GI pathology. I think I missed the question. I was able to find some papers on PubMed, but even then I had to read between the lines to get the answer.
Systemic Pathology: no one area stands out as over or under represented. I had a dermatology pic that looked like two infectious diseases mated with two autoimmune syndromes and they made this awful never before seen rash and they asked about the epidemiology and risk factors for the rash. The patient had every exposure and familial risk factor imaginable. In the end I got the question correct because I was sitting there and said, “this looks and feels like XXXXXX.” I was able to put it together only because I had encountered that disease and similar presentations in so many practice questions.
Neuro: small amount on my exam, and I don't think any of it was overly difficult. Two pic questions were tough, but neuro was one of my stronger points. After our first year neuro course, I never reviewed neuro other than what I encountered in question banks.
Physiology: one of my stronger subjects, but I did miss two questions from this area that I should not have missed. I had a lot of arrow questions, but the ones I missed were classic multiple choice questions, neither of which was in FA. I answered one question from this subject from info I learned in undergrad. Not a huge area in my exam though.
Repeats: I had zero repeat questions.
Final Thoughts: the highest yield resources are UW, FA, NBME’s, and Pathoma. In that order I think, but sometimes my opinion on that order slightly changes. I think all NBME’s should be done. I think both Kaplan and Rx should be done, but I would NOT annotate much if any info from those question banks. It is more important to see 2600 questions from Rx than to complete and annotate 500 questions from Rx if the time frame is similar. If I clear 260, it will be because of Phloston and questions. You are welcome to ask questions. I will do my best to answer. This may sound contradictory to my advice about questions, but pharm, micro, embryo, and biochemistry should be memorized. Every word in FA should be memorized for these subjects. Reasoning is overrated for these subjects.
Wish me luck.
@Phloston
